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VA Sees Issues with Caregiver Program Ahead of MISSION Act Expansion

Issues with the enrollment and eligibility process for the VA Caregiver Program led to lapses in patient care access, OIG found.

va caregiver program

By Sara Heath

- The VA has failed to adequately monitor its Caregiver Assistance Program, leading to limitations on patient care access and insufficient program discharge processes, according to a recent analysis from the VA’s Office of Inspector General (OIG). VA must address these problems ahead of the program’s expansion as a part of the VA MISSION Act, stakeholders say.

The Caregiver Assistance Program, which is a part of VA’s Caregiver Support Program, provides a monthly stipend to the caregivers of qualifying veterans. This helps support caregiver efforts in supporting quality patient care.

Veterans have traditionally qualified for the program after experiencing a serious injury in the line of duty on or after September 11, 2001. Eligible veterans rely on “personal care services for supervision and protection or to help them with daily living activities,” OIG explained.

The Caregiver Assistance Program relies on caregiver support coordinators, or CSCs, who work across 140 VA medical facilities. CSCs are in charge of monitoring veterans’ well-being at least once every 90 days to ensure the veteran is getting adequate care. CSCs must also ensure caregivers are receiving adequate support.

These check-ins are also essential for the discharge process, OIG noted. CSCs can determine whether veterans are discharged because they no longer require caregiver services or because caregivers are not complying with program guidelines.

READ MORE: VA Choice Program Needs Reworking Ahead of MISSION Act Revamp

The OIG audit, which took place June 2017 to 2018, responded to Congressional and media reports that veterans were being inappropriately and unnecessarily discharged from the program. Reports alleged veterans were being discharged for unsatisfactory reasons and without proper notice.

The assessment found some truth in the reports. The audit compared veterans both enrolled in and discharged from the program and compared monitoring habits and enrollment or discharge processes.

The audit team also interviewed VA facility personnel, program personnel, and program enrollees.

OIG concluded that the Caregiver Assistance Program often resulted in insufficient patient care access or delays in care.

Specifically, CSCs did not determine veteran eligibility within an allotted 45-day window for about 65 percent of all veterans approved for the program.

READ MORE: President Signs VA Mission Act Into Law, Extends VA Choice Program

CSCs were also not always accurate in determining program eligibility. About 4 percent of all program discharges occurred because the veteran was not eligible for the program in the first place. These types of errors cost VA about $4.8 million.

“The OIG found that clinicians and CSCs either did not adequately document how much veterans’ health conditions changed, or failed to routinely monitor these veterans and their caregivers prior to the clinical reassessment that led to their program discharge,” OIG explained.

“Without consistently monitoring and documenting changes in these veterans’ health conditions, and seeking a timely clinical reassessment of eligibility based on those changes, VHA risked providing an inappropriate level of care or extending caregiver benefits to veterans who were no longer eligible.”

OIG did mention that there were no reported incidences when CSCs did not report the reason for veteran discharge in the veteran’s EHR. Additionally, CSCs always communicated the reason for discharge to the veteran and his or her caregiver.

Pitfalls in enrollment and discharge likely stem from limited governance and accountability in the program, OIG reported.

READ MORE: What Providers Should Know to Improve Patient Access to Healthcare

“As a result, medical facility directors operated the Family Caregiver Program without performance goals to evaluate application processing timeliness, the accuracy of initial program eligibility determinations, and the consistency of monitoring enrolled veterans and their caregivers,” OIG said. “Furthermore, there were no requirements that veterans’ program eligibility and need for care were reassessed as a result of the routine monitoring sessions that CSCs are required to perform four times a year.”

VHA also did not have the staffing levels necessary for CSCs and other staff members to adequately meet the demands of their jobs.

These findings have implications for future policies, the OIG report pointed out.

Earlier this year, Congress passed legislation expanding the family caregiver program as a part of the VA MISSION Act. Expansion will allow caregivers of all veterans, not just those serving after 9/11, access to caregiver support.

As such, it is important for VA to iron out its veteran eligibility process and monitoring system.

“The OIG recommended the VHA Executive in Charge establish policies and implement procedures to improve Family Caregiver Program operations,” OIG asserted.

Specifically, OIG suggested the VA Executive in Charge:

  • Establish a governance environment for the Family Caregiver Program
  • Ensure all veteran eligibility determinations are accurate
  • Update VHA Directive 1152, Caregiver Support Program
  • Establish need for care assessment guidelines
  • Designate program leads at the Veterans Integrated Service Network level with responsibility for Family Caregiver Program oversight
  • Assess current program staffing levels

Congressional leaders have expressed dismay at the OIG report findings. Jon Tester, ranking member of the Senate Veterans’ Affairs Committee and one of the politicians commissioning the report, called for immediate VA action.

“This report shows a troubling lack of diligence by the VA to monitor the wellbeing of our most injured veterans,”  Tester said in a statement. “The VA must immediately take steps to adequately staff and overhaul the way it manages the Caregiver Support Program, which provides a lifeline to so many caregivers. The VA has one year before our bipartisan VA MISSION Act expands the Caregiver Support Program to veterans of all eras. The VA knows what it must do before then: fix it.”

Senator Patty Murray, who joined Tester in requesting the OIG report, echoed those sentiments, calling caregivers the “hidden heroes” helping veterans after they have served overseas.

“As a nation we make a promise to have our veterans’ backs when they return home from war, and this report confirms that VA has not been holding up their end of the deal,” Murray stated. “Now, it is clear that it is beyond time for VA to begin implementing the report’s recommendations and running the Caregivers program as Congress intended to help meet the critical needs of our veterans—and we will be watching to make sure they do.”

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