Assistance and Support Services for

Family Caregivers

Christy Knight, MSW, LCSW

Caregiver Support Coordinator

Durham VA Medical Center

919-286-0411 ext. 6068

christy.knight@va.gov

Learning Objectives

• Describe who the caregivers are for our Veteran’s• Understand the importance of caregivers and their

daily activities • Highlight facts and findings of caregiver challenges &

burdens from the National Alliance for Caregiving-Caregivers of Veterans Study.

• Review the Caregiver Support Coordinator role• Provide an overview of Public Law 111-163

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According to AARP, a CAREGIVER is someone who provides unpaid

assistance to someone else who is ill or disabled.

Caregivers of Veterans -Spouse, Partner, Adult

Children, Parent, Friend, Neighbor, Relative or Ill Person Themselves (Veteran).

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Snapshot of a Veteran Caregiver • The typical caregiver of a Veteran whose

illness, injury or condition is service-related is a woman who is taking care of her husband or partner. In fact, 96% of these caregivers of Veterans are women, and 70% provide care to their spouse or partner. This contrasts with the national picture of family caregivers where 65% are women and only 6% provide care to their spouse or partner. (National Alliance for Caregiving Veterans’ Study, Nov. 2010)

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Why Family Caregivers Matter National Alliance for Caregiving and Evercare Survey indicates that the value of services family caregivers provide “for free” when caring for older adults is estimated at $375.00 billion dollars. Without family care, many people could not live in community. Caregivers spend about 20.4 hours per week providing care. 31% of caregivers consider their caregiving situation to be highly emotionally stressful. Caregivers make significant contributions to the successful outcomes of Veterans healthcare.

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Top conditionsstated by caregivers of Veterans requiring

care:

80% report comorbidity 70% Mental Illness (depression, anxiety) 60% PTSD 29% Traumatic Brain Injury 28% Diabetes 20% Paralysis or Spinal Cord Injury(National Alliance for Caregiving Veterans’ Study)

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Caregiver Activities and Burden of Care

• The conditions for which Veterans need care differ greatly from the typical care recipient population.

• Caregivers of Veterans are in their caregiver role for a longer period, but their burden of care is also heavier-65% are in a high burden caregiving situation compared to 31% nationally.

• (National Alliance for Caregiving Veterans’ Study, Nov. 2010)

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Caregiver Activities

• Perform Personal Care-bathing, dressing, lifting a Veteran, transferring, feeding, toileting

• Make decisions on behalf of the Veteran• Complete household chores• Provide transportation• Help with medication management & financial

management• Prepare meals

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Caregiver Activities Continue…

• Keep Veterans safe at home• Try to balance work/family responsibilities• Provide support and companionship• Manage challenging behaviors• Provide symptom control or wound care• Manage health care-appointments, interact

with medical staff• Provide care over years…and years..and years

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Challenges of Caregiving• Not knowing what to expect medically with the Veteran’s condition• Not being aware of VA services that could help• Not knowing how to address PTSD or mental illness• Difficulties getting through the bureaucracies in order to obtain services• Not knowing where to obtain financial assistance• Not knowing where to turn to arrange a break from caregiving• Not knowing where to obtain specialized care

(National Alliance for Caregiving Veterans’ Study, Nov. 2010)

• Not knowing where to obtain specialized care

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Impact of Caregiving• Caregivers own healthy behaviors decline-

exercise, eating habits and going to ones own doctor/dental appointments on schedule

• High emotional stress (depression, anxiety, lack of sleep)

• High physical strain• Many stop working or take an early retirement• Marital strain• High financial hardship

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Rewards of Caregiving

• Many caregivers describe their role as meaningful• Many gain new skills-organization, assertiveness,

awareness of their strengths• Develop new support or friends through support

groups or community contacts• Find joy in small pleasures• Learn to take care of their own needs• Caregiving is a chance to give back to someone

important in life

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Caregivers of Veterans

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Caregiver Support Coordinators

• At all VA medical centers

• Clinical experts on caregiver issues including VA and non VA resources.

• VAMC subject matter experts on administrative procedures to process applications, coordinate required home visits, monitor training requirements, and coordinate between clinical teams, business office, and others as required.

• Maintains the Caregiver Application Tracker (CAT) web tool for the VAMC and reports to VISN lead.

• Assist with application for new benefits

• Organize caregiver focused activities and services

• Ensure caregiver sensitivity is integrated into all programs

VA Medical Center Caregiver Support Coordinators:

Asheville-Patricia Kitlasz Durham- Christy Knight

Fayetteville- Walter Hair (Acting CSC)

Salisbury-Deborah Volkmer

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Comprehensive Caregiver Support Services

• Allow Veterans to remain at home in the community• Address specific needs of family caregivers with a menu

of programs and services• Promote Veteran and caregiver health and well-being• Provide one location to obtain needed information • Provide training and information on common

conditions• Reduce isolation with professional and peer support• Provide respite care options to give caregivers a break• Sensitize health care providers to the caregivers role

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Current VA Services

In-Home CareHomemaker Home Health ServicesSkilled Home CareHome Based Primary CareVeteran Directed Home & Community Based CareSpinal Cord Injury/Disorders Bowel & Bladder Care

Respite Care In Home Adult Day Health Care Institutional Placement

Additional BenefitsEquipmentHome AdaptationAutomobile GrantTransportation AssistanceIncreased Veteran Pension and Compensation – Aid & Attendance

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Education, Training and SupportCaregiver Education and Training

Pre-Discharge Care InstructionSpinal Cord Injury/Disorders Polytrauma Rehabilitation Blind RehabilitationFamily Psycho-education Caregiver Information on VA Health WebsiteBrochures and written materials

Family Support ServicesSupport GroupsFamily CounselingSpiritual and Pastoral CareFamily Leisure and Recreation ActivitiesTemporary Lodging – Fisher Houses

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Eligibility for P.L. 111-163Sections 101-104

P.L. 111-163 Section 101 Veteran Eligibility Criteria:

• Veteran who suffered a serious injury incurred or aggravated in the line of duty on or after 9/11/01 including traumatic brain injury and psychological trauma or other mental disorder

and• Is in need of personal care services because of

• an inability to perform one or more activities of daily living; • a need for supervision or protection based on symptoms or

residuals of neurological or other impairment or injury; or• such other matters as the Secretary considers appropriate

• General Caregiver benefits include all era Veterans

Eligibility Criteria

• Administrative: Post 9-11/Serious Injury in the Line of Duty

• Clinical:

The injury renders the Veteran in need of a Family

Caregiver

Clear clinical criteria consistently applied

Based on functional limitations - need for assistance

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Eligibility Criteria

Focus on safety and need for supervision as well as assistance with personal care services

The Family Caregiver Program is in the best interest of the Veteran

The Veteran will receive ongoing care from a VA health care team to participate in the program

Personal care services provide to the Veteran by the Family Caregiver will not be provided regularly by another source or program

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Current vs. New Caregiver Benefits

Current Benefits

Available to Veterans of All Eras

World War IIKoreanVietnamGulf WarPost-9/11------------------------------------

Education and Training Family Support Services In-Home Care 30 Days of Respite Care Aid and Attendance Additional Benefits

Additional Benefits under P.L. 111-163Available to subset of post-9/11 Veterans

and ServicemembersPrimary Caregivers Receive: Stipend Health care (if not otherwise

available) Mental health services Family Caregiver Benefits

Family Caregivers Receive: Travel, lodging and per diem for

training Respite care during training Lodging and subsistence for Veteran’s

VA appointments Appropriate instruction and training Counseling

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All General Caregivers Receive:

•In person education•Interactive website •Telehealth training

•Teaching techniques, strategies, and skills for caring•Counseling and other services under § 1782

•Respite care under §1720B• Information on all available services

Family Caregivers Additionally Receive:Post 9-11 Only

•Appropriate instruction and training •Travel, lodging, and per diem for training

•Lodging and subsistence for appointments•Respite care during training•Ongoing technical support

•Counseling

Primary Family Caregiver Additionally

Receive:Post 9-11 Only

•Monthly caregiver stipend•Appropriate Mental health services

•Respite care not less than 30 days/yr•Health care coverage

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Application and Assessment

• Joint application for Veteran – family caregiver (10-10CG)

• Options for application – on-line/in-person/phone

• Assessment of Veteran and proposed caregiver

• Eligibility transfers from one facility to another

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Caregiver Education and Training

Standardized Core Curriculum • Easter Seals provides core training• In-person, web-based or workbook• Convenient and easily accessible

Specific Training to individual Veteran needs • In-home return demonstration• Additional training to ensure success

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On-Going Support to Veteran and Caregiver

• In-Home initial visit

• Well-being checks every 90 days • Home visits are supportive and instructive

• Evaluation of Veteran and caregiver’s physical and emotional state

• Recommendations for additional training, support, equipment, etc

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Primary Family Caregiver Benefits

• Stipend – Direct payment to primary family caregiver– Centrally funded and managed– Based on wages of a home health aide in the geographic area

where the Veteran resides – Tiered based on amount and degree of personal care services

provided• Health Insurance

– CHAMPVA• Travel and Lodging

– Integrate into existing programs • Mental Health Services

– Individual/Group psychotherapy and counseling– VA or by contract 28

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www.caregiver.va.gov

How Can You Help?

• Help educate Servicemembers/Veterans/Caregivers

• Spread the word about the 1010CG applications

• Share the Caregiver Support Line Number

• Share the Website Link

• Refer appropriate Veterans/caregivers to their local CSC

• Connect Veterans/Caregivers with their local caregiver

support coordinator

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VA Medical Center Caregiver Support Coordinators:

Asheville-Patricia Kitlasz Durham- Christy Knight

Fayetteville- Walter Hair (Acting CSC)

Salisbury-Deborah Volkmer

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•Questions??

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