Christine Schei with her son, Erik, during one of his therapy sessions. Army Spc. Erik Schei was shot in the head during a patrol in Iraq on Oct. 26, 2005. In a report published Thursday, Sept. 19, 2014, the Government Accountability Office said the Department of Veterans Affairs significantly underestimated demand for a caregiver program for Iraq and Afghanistan war veterans. (Stars and Stripes)
The Department of Veterans Affairs significantly underestimated demand for a caregiver program for Iraq and Afghanistan war veterans, overtaxing already stretched resources and limiting services to veterans and their loved ones, an independent federal watchdog has found.
As a result, some VA medical centers have had difficulty managing the workload, and caregivers have experienced long delays in getting their applications approved and receiving program benefits, according to a Government Accountability Office report published Thursday.
The Family Caregiver Program was established in May 2011 after Congress passed legislation requiring the VA to set up a program to help families with the rigors of caring for veterans.
Congress approved $1.5 billion through 2015 for the program. To be eligible, veterans must have suffered a serious injury in the line of duty after Sept. 11, 2011.
Services include a monthly stipend, training and counseling, and medical assessments and home visits by VA doctors and nurses. About 80 percent of caregivers in the program are spouses. Most are assisting veterans with mental health diagnoses or brain injuries, some with accompanying physical disabilities.
The VA’s initial estimate that about 4,000 caregivers would be approved for the program by the end of fiscal 2014 was way off the mark. By May 2014, almost 30,400 caregivers had applied and about 15,600 had been approved as caregivers, according to the GAO report.
In the face of such high demand, the VA’s staffing for the program is inadequate, the report says. Staff at many of the VA medical centers told government investigators that “delays exist at some or every step of the application process,” including “determining caregiver eligibility, administering medical assessments and conducting initial home visits,” the report says.
Families assigned to case coordinators range from six to 251 per caseworker, according to the report.
Some families have had to wait more than 90 days to find out whether their application was approved; VA guidelines call for no more than 45 days. At one VA medical center, follow-up home visits were occurring every six to nine months, instead of every 90 days, which is the established standard.
Some caregiver coordinators don’t return phone calls, GAO investigators were told. “One caregiver recounted that when she became desperate to learn how to manage a veteran with increasingly severe symptoms” from a traumatic brain injury, a caregiver coordinator told her that hers was one of many requests and that “the program could not provide counseling for caregivers,” the report says.
Officials at VA hospitals and medical centers say getting VA physicians and nurses to conduct medical assessments and home visits can be challenging, since their workloads are heavy and some hospital directors don’t consider the caregiver program a high priority.
The VA, in comments posted to the report, says it “generally agrees” with the GAO’s conclusions and says it is working on solutions.
The VA made efforts to improve staffing levels for the program. Some VA medical centers began offering nurses overtime pay to conduct home visits, while others have hired contractors. In August 2012, the VA began allowing medical centers to conduct home visits by telephone after one year of satisfactory home visits in cases without serious medical risk.
But the GAO says while these steps have benefited the program in some locations, more will have to be done to keep up with the program’s steady growth of about 500 approved caregivers per month.
One of the first orders of business is overhauling the program’s inadequate computer system, the GAO says. The system limits officials’ abilities to easily retrieve data and assess current workloads across all VA medical centers.
“If the program’s workload problems are not addressed, the quality and scope of caregivers services, and ultimately the services that veterans receive, will continue to be compromised,” GAO investigators concluded.
