their home is unearned, if their veteran was injured and medically retired, they may receive 100% from the total v.a. pay and social security disability as well as the p.c.a. caregiver stipend. all that is unearned and caregivers cannot contribute to social security or any type of retirement account. that leaves those caregivers in a very precarious financial state for when their care giving years end and they reach retirement. the act, the reeducation, reimplement and retirement act that you and senator sinema introduced would study whether or not caregivers would be allowed to contribute to social security and their retirement accounts where there would be a mechanism that could be created for that to take place. it also would allow caregivers

to have to leave care giving either because their veteran passed or they became unable to care give or their veteran recovered or their veteran had to go in a state home. it would give them $1,000 per caregiver to renew their employment certifications they lost due to care giving and it would also offer them returnships that already exist for older americans within the department of labor. if you watched "the intern" with robert de niro and ann hathaway, that's a returnship where robert de niro returns to the workplace and that's the returnship program we're looking at caregivers. basically, this bill creates a way to secure the financial security for caregivers in their later ages, because as of right

now, there is no mechanism for them to be financially secure. once their veteran passes away, they're looking at being financially destitute in their later years. >> thank you for highlighting those. you're a more effective advocate when i say those things and thank you for putting this in the record. please give my regards to senator dole. we have two senators that are considered kansans and both senator doles use their lives post senate career to make a difference in a lot of people's lives and particularly veterans. sen. moran: i'll be at the eisenhower presidential library tomorrow as we take a look at celebrating, recognizing the importance of d-day and those who served and certainly senator bob dole in his efforts to recognize world war ii veterans on the national mall and senator elizabeth dole in her role to

make sure veterans are cared for fully and appreciated in kansas and across the country. one of the things, there are times that occur in which i think how can this happen? how can somebody bringing me a problem from their veteran perspective and yet your reaction is this can't be true, what is going on here? and one of them is the dismissal of legacy participants in the caregiver program. it's on pause. we're all pleased about that but would you highlight, ms. beck, the position of being in no man's land, no person's land in which no answers come and we just keep waiting? 's ms. beck: senator, thank for you that question. i decided a long time ago the first time i stopped saying why is this happening is the first time i thought i shouldn't be doing this anymore. hannah's story probably explains it best of the emotional, financial uncertainty that's

gone along with this program for the legacy cohort of caregivers. there's currently 14,000 individuals who are considered as part of that legacy cohort and that number is dwindling every day due to, unfortunately, death and sometimes improvement and sometimes divorce. so that number is not extraordinarily high and going down. so the idea of offering grandfathering to that population of people would be to recognize they have undergone so many different regulation changes, as ms. sawyer pointed out, the program intent somehow shifted from seriously injured to severely injured and those legacy cohort that have been found eligible time and time again would be removed from the program when the new regulations are issued. so in recognition of that, and that is something congress has repeatedly said it was not intended, then the idea of grandfathering that population and moving forward and allowing

c.s.p. to focus on actually supporting this population rather than a divided conversation of eligibility that's gone on for years would be in their best interest. sen. chester: i want to talk about some time lines here to flesh out the way it used to be and the way it is now and why. i'm going to correct my questions to you, hannah. i understand that the challenge here or the problem from my perspective is that there were regulations published almost four years ago, july 31,2020 that went into effect october 1, 2020. you've been taking care of your husband nearly 20 years. can you tell me what it was like before those regulations went into effect? hannah: before the regulations went into effect, i felt supported and certainly felt like there was a mechanism

within the v.a. if i needed additional case management or support for kelly's needs, i knew who to call and who to ask, and i had assurances i would be able to navigate his care successfully. ms. nieskens: once those regulations passed and we were dismissed from the caregiver program, as senator moran expressed, we feel like we're in a purgatory situation here we just don't know what the next iteration of these regulations would look like. sen. tester: so for further explanation, a regulation was put into effect october 1, 2020, nothing changed with your husband, his needs remained the same and potentially even got greater because they're getting older. ms. nieskens: correct. sen. tester: and yet you were removed from the program because of a reassessment?

ms. nieskens: that's correct. sen. tester: and that regulation was required because of the new regulation? ms. nieskens. sen. tester: and you appealed? ms. nieskens: yes. we received a letter that said it was unnecessary to appeal because everything was on pause. the entire program was being put on pause. sen. tester: the pause wasn't preregulation but post regulation. ms. nieskens: correct. sen. tester: tell me what that impact had on your family, the impact of losing that certainty that the caregiver program gave you before october 1, 2020. what impact did that have on your family? what impact did that have on you and your husband and children. ms. nieskens: basically it

created a large fence of uncertainty, what does the future look like? because if this resource for all these caregivers, including myself, is going away, what replaces it? i don't know. i don't have those answers. and so it becomes increasingly difficult to fathom how to meet kelly's needs in the future. sen. tester: financially, what did it do to you? ms. nieskens: i would lose the caregiver stipend which means a significant portion of our income is simply going away. sen. tester: thank you for that. it's my understanding the new regulations are there and just haven't been released? that's correct. i see a hot nod. that's good enough. thank you. i want to go to you, meredith. i appreciate your comments. we've got some really good bills that actually get things done and get hung up because of politics of the day. you're spot on and quite

frankly, it ain't right. good policy is good policy regardless of political party and regardless who is carrying it and we ought to look at it from that standpoint. i want you to take a moment to summarize because you're intimately familiar with the elizabeth dole home care act. and i want you to summarize and particularly highlight why this bill is so important for our nation's caregivers. and if you could refer back to some of the challenges hannah just explained, that would be helpful. ms. sawyer: to be clear you prefer the elizabeth dole home care act and the package or just the dole act. the elizabeth dole home care act, as i mentioned has probably most importantly for the most severely injureds and most ill is the provision of the removal of the cap.

ms. beck: i have caregivers watching now waiting every single day to ensure they're able to get the services they need in the home to keep the veterans they care for in their home and will be individuals with long term a.l.s., m.s., severe or traumatic brain injuries. without the removal of that cap which everyone seems to agree, including the v.a., that they will potentially have to move to a nursing home because that cap prevents them getting the care and services inside their home. also included in the legislation is the requirement the veteran directed program be within every v.a. medical facility because that program in addition can actually help to support a lot of the caregivers who may not qualify for pcsc because you're allowed to pay your family caregiver under that program. that's significant for those who care for a individual who have cognitive or mental health

disabilities who at the moment may not qualify for ptsd and give them the quality and care of who they're hiring in the home because those veterans of those conditions don't want someone unfamiliar in their home and you're able to hire a friend or family to do that. the other provisions in the legislation include mandating that the other programs within the v.a. that provide those care services, home health aides, home based primary care are mandated to stay within the v.a. because while those are a little more widely available than veteran directed, as we've seen with patca, if not regulated can be taken away. sen. tester: thank you. sen. casey: we'll turn to senator rickets. sen. rickets: thank you. there are 16 million veterans living with m.s. including

111,000 brave women and men that made brave sacrifices for our country when they put on the uniform and i'm committed to make sure they've got quality benefits and care they've earned and why i introduced the tax cuts for veterans act. the bill would make military retirement pay tax free at the federal level like we did in nebraska were made tax free. furthermore, across the country there are 6.5 million veterans and military caregivers who provide $14 billion in unpaid labor for america's wounded warriors every year. family and others who provide care for veterans spend on average $11,500 of their personal income in out of pocket expenses related to the care giving of their veterans every year because roughly about 1.5 times higher than what other family caregivers spend. the u.s. department of veterans' affairs offers support and resources for caregivers of veterans enrolled in the v.a. health care to the v.a. caregiver support program. this program provides caregivers with the access to v.a. health

care benefits, caregiver education, financial aid, mental health services and 30 days respite care. only 34% of veterans have used their earned benefits at v.a. health care. ms. sawyer, over 33% of nebraskans veterans live in rural areas that can create unique problems. do the v.a. programs offer any resources that specifically help veterans and caregivers living in rural communities and if so, how do they provide support that addresses the unique challenges those veterans face? ms. sawyer: thank you for the question. so in rural areas, with we have caregivers in urban areas that can't get out of the home, there is -- or there are mental health

programs that are virtual programs that have been put in place by ptafc. if you're a member of comprehensive assistance for family caregivers, you now have access to therapy virtually through that ptsd program. you also have options for respite care in home or in facility if they can find a home health aide caregiver, that being the concern. what i was saying earlier, in rural areas where it's difficult to find home health care workers, there are provisions in place to raise the number and make it more attractive and possibly make health care workers more widely available in rural areas, because trying to

get someone to come across the continental divide for $13 an hour is rather daunting but in south dakota, they've managed to raise the reimbursement rate to $85 .05 an hour and in alabama it's $30.50 an hour. so if your v.a.'s are able to raise that reimbursement rate, you'd have better access to those home health care workers. also, it's difficult sometimes for caregivers and veterans to travel to v.a. facilities and certainly community care makes sense. the concern then is for the program of comprehensive assistance is that those records need to be able to get in to v.a. medical records, which is what we see is keeping people from being accepted into the program. it's not that there is a lack of

need of assistance of the veterans, there's a lack of evidence of the need of assistance and partly because those outside records never get into the v.a. or their practitioners aren't asked about the specific needs of the veteran. and ptafc in that evaluation process is not actually ever asked about during your yearly exam. your p.c.m. never evaluates you for a.d.l. or supervision and protection needs and are usually done by specialists and most of the time you see your specialist in your community rather than traveling 200 or 400 miles in the case of hannah and her husband in montana. so you have to have that mechanism to get those records in. at quality of life we issue a questionnaire to specialists that would actually document those needs and have that

submitted to the v.a. by the veteran and caregiver. so one of those things is really getting that documentation into the v.a. sen. : is that relying on the veteran asking that or make sure that's the way the information is captured when they see those specialists? ms. sawyer: there's a duty to assist that exists within v.b.a. and we've worked with dr. richardson and her team to really train her team on duty to assist through v.h.a. it would be helpful if congress come qualify duty to assist in the veterans health administration which would mean if a veteran and caregiver identify there are outside medical records that need to be obtained for the evaluation process, it is v.a.'s responsibility to get those records so that they may be considered in that process. so while dr. richardson has

trained her staff to do that, it's been sheer force of will and leadership power she gets her team to do that but that didn't really exist within v.h.a. itself. sen. casey: we'll turn now to senator contain. sen. contain: there's an unspoken view, implementation is as important as vision. we deal in laws up here, but the majority of what you've been talking about today has been implementation of the laws. we can pass great laws but if they're not adequately implemented it ain't going to work. one of the best examples, mr. sganga, you may know about this. 3 1/2 years ago we passed a law about domicile care at state veterans homes and still waiting for the regulations. 3 1/2 years later.

sen. king: and at the same time our veterans homes in maine are losing something like $3 million a year based upon the lack of having this back payment and the implementation. tomorrow is the anniversary of d-day. i'm waiting for people to tell me how long it's going to take. unions hour took 11 months. eisenhower took 11 months. we should not be waiting for the laws to pass here. i hope that can be a theme to this committee, not that the v.a., they're bad people or trying not to enforce the laws but somehow we have to break through the delays and the sort of sometimes nonsensical such as what you endured, hannah. implementation because one of

the other themes here is home care is a, preferred, and b, cheaper. we should be encouraging it p. mr. townsend, i presume you would rather be at home than in a hospital or nursing home. mr. townsend: that's absolutely correct. sen. king: and the care you're receiving, even at an adequate reimbursement rate is cheaper than what it would be in one of those institutions, isn't that correct? mr. townsend: that's correct. sen. king: my mother used penny-wise and foolish but in our case it would be pennywise and dollar foolish. but we're nickel and diming what is a much, much lower cost alternative. is that not correct, am i -- this is the big picture as i see. ms. nieskens: these are human beings, first of all.

as you said, the care in the home is causing in most cases better health outcomes or better quality of life. from the perspective of cost savings, the idea as has been pointed out previously, the pcafc program has higher standards to become a part of than the more expensive home health program. sen. king: i have to cut you off. another example is, mr. sganga, the recent rules about staffing ratios, hrsa indicates by next year we'll have a 78,000 nurse shortage in this country and yet c.m.s. is issuing rules for increasing staffing what there's nobody to hire. and i know in maine, we've lost -- we're losing four

nursing homes so far this year, one this week. we've lost 26 in the last 10 years, mostly because lack of staff. these well-meaning regulations, no one is against adequate staffing levels but well-meaning regulations will end up with less care if we lose nursing home beds, do you agree? mr. sganga: i agree, it's a problem and should look at nationwide. we think skilled nursing facilities alone we'll be lacking about 102,000 registered nurses and certified nursing assistance to meet that. sen. king: just because c.n.s. passes a regulation doesn't mean the nurses will spring into fruition. mr. sganga: well stated, i agree. sen. king: let the record reflect he said well stated.

and the reason the nurses are getting burned out is they're working so many hours. the question should be how do we surge people into this industry not requiring staffing levels that will not end up with lesser care but no care for veterans and elderly people throughout the country. mr. sganga: during the covid pandemic i lost 36 caregivers on a single day september 28, 2021 and that was due to the vaccine mandate. we have to think quick on our feet at the long island veterans home. we came up with a new provider caregiver title of unit assistant, people who are not certified nursing assistants but can do many of the tasks of the c.n.a.'s with the exception of toileting and bathing and was great and worked out well for us and made a little less than a certified nursing assistant and we found people to fill that role but the sad part for us is from a institution we dot no

benefits from c.m.s. and we didn't have caregivers to help feed the residents and help them get dressed and helping make their beds and transfer them around the facility. we were able as a state veterans home program to come up with the bodies to provide the care but sadly, c.m.s. did not recognize this kind of caregiver and when it came to the metrics of providing certain amount of providers per resident they were not counted. sen. king: we should move c.m.s. out of washington into poughkeepsie or bowsman, montana, so they know what's going on in the ground. thank you. sen. casey: we'll turn to senator haslem. >> thank you for this hearing and to all our witnesses. thank you for being here today. thank you for the extraordinary work you do and your advocacy. and not only for our country's

veterans but the people who take care of our country's veterans. it's important and critical work, obviously. mr. townsend, i just wanted to start with a question to you and i want to thank you for your service in the army, for your years at work for a physician's assistant and your advocacy. sen. has an: the law that was signed has a amendment that will change with changing stations in airport rest rooms and will provide those who experience disabilities and their caregivers with a safer and more dignified travel experience. i want to extend a special thank to you the paralyzed veterans of america and disabled veterans for their support of the provision and helped get it across the finish line. can you speak to the importance of making travel more accessible for individuals experiencing disabilities and how it helps them participate more fully? mr. townsend: with regard to

travel, what i faced since i've become a full time wheelchair user in the community is distance. since becoming a wheelchair user, i'm reluctant to consider flying. therefore i only travel by ground and heard the horror stories by many others what's happened to their wheelchairs during travel and i can't imagine the frustration of getting to your destination only to have your legs taken away from you. sen. hassan: i appreciate that and is another issue we're trying to address. i think a lot of people aren't aware the lack of access to universal changing rooms can be a real barrier for people with disabilities and their caregivers. ms. beck, i want to thank you for a lot of the work of the elizabeth dole foundation and thank you for the elizabeth dole home health care act i'm a co-sponsor and proud to work with you on.

in your testimony you touched on the financial strain experience by caregivers, especially families of veterans not associated with the v.a. or who have difficulty accessing v.a. programs. the credit for caring act which has bipartisan support would help relieve some of these strains by providing tax cuts to family caregivers who also hold down another job which is a pretty frequent situation. can you discuss some of the financial strains that caregivers might face and how these costs impact them and the people they care for? ms. beck: sure. thank you very much. essentially would be two populations probably involved in that question and would be those veterans associated with the v.a. and those who are not. for veterans associated with the v.a. there are any number of programs and services that can potentially reimburse or pay for needed supplies. however, as we discussed earlier, accessing information about that and knowing about that and having the time to do that is incredibly difficult.

so veterans and caregivers often pay out of pocket even if they are associated with the v.a. especially housing modifications or something as small acetyl -- as tylenol or gauze. and somebody not affiliated with the v.a. would be responsible for those out-of-pocket expenses. and so we are very much strong supporters of s.3702, the credit for caring act because of those out-of-pocket expenses they have to pay for. sen. hassan: there are caregivers that work part-time jobs instead of full time jobs and earning less as they're trying to take on these additional work and expenses. last question and it is for you again, ms. beck. it's really important that we obviously support people with disabilities in their homes and for being as independent as they can be. we talked a lot today about the

work force shortage here. we face a shortage of professionals who provide credittal services for individuals with disabilities including direct support professionals who can assist with communications, daily tasks, provide job support and respite to family caregivers. my colleagues and i have been working to make sure we have the information we need to support these professionals and work they do mainly getting d.o.l. to support a job category for support professionals to track how many we have. i want my colleagues to know how important these people are. i have an adult son with severe disabilities and have been blessed with a direct support professional who has been with him 36 years and has just been extraordinary. that's are people who are creative, hard-working and make a huge difference and can provide respite care and help people be independent. ms. beck, what else can congress do to strengthen support services for people with disabilities in the care giving work force?

ms. beck: one, thank for you that legislation because we've all talked about the shortage issues and can't do anything about it until we have data that shows where they are and what is necessary. increasing those reimbursement rates as i mentioned, a lot of these people will do this out of the goodness of their hearts but there are a lot of people -- most people will need to be employed and paid at an adequate rate in order to provide the services necessary. the reimbursement rate as mentioned earlier, especially within the department of veterans' affairs and the varying knowledge of the mechanisms by which you can increase those reimbursement rates. because certainly the elizabeth dole foundation is supporting family caregivers, they also rely on the direct support professionals in order to provide the services you mentioned. this work force is incredibly important to us as we're trying to make sure everyone has the services they need in order to stay in their homes. sen. hassan: thank for you your

indulgence. sen. kelly: >> my first question is no ms. sawyer. one of the sacred promises we make is to care for our service members when they return home. and i'm committed to making sure our country keeps their promises. sen. : and it's important he sen. kelly: and it's important they have the care they need to care for their loved ones. i heard from veterans families they were removed from the program of comprehensive assistance for family caregivers during the expansion rollout. and they had previously qualified in some cases for years for this program. so while i'm glad the v.a. has suspended the reassessments and discharges for legacy

participants. i'm troubled that some of the folks who are disqualified still do not have an expedited appeals process. this is an important issue that's impacting arizona's veterans and also their families. and i've continued to urge the v.a. to fix this. so ms. sawyer, could you please share your experience with the changes to this program, the program of comprehensive assistance for family caregivers ms. sawyer: thank you, senator. in the beginning when the program was first created, the only appeals that were available were clinical appeals and they were governed under v.a.'s regular clinical appeal guidance. when the new regulations were written for the mission act in 2020, those appeals, clinical appeals shifted to the centralized eligibility

assessment team that was created. with the bodett court decision, it opened up multiple more avenues for appeals. so the v.a. was -- the v.h.a. was forced to create supplemental claims, higher level review claims which all occur under v.h.a. and then there was an avenue opened up for board of veterans appeals claims. none of those had existed prior to the bodett case. also because decisions had been governed under regular clinical appeals, clinical appeals in the v.a. do not require justification. they simply can be listed as approved or denied. and so with the bodett decision, the v.a. did undertake --

sen. kelly: can you describe the bodett decision? ms. sawyer: sure. it's a court decision that basically said a veteran and spouse leave the v.a. and said we weren't eligible for the program but we don't really know why because the letter you sent us doesn't tell us why and we don't have a right to appeal that we would in other situations. so the bodett decision then created those extra avenues for appeals and it created the need for the eight-point letter. the eight-point letter is a letter the veteran gets that basically mirrors the process within the v.b.a. or the veterans benefits administration that explains exactly why a veteran is denied. so with the setting up of the

supplemental claims and higher level reviews, this is something unique to v.h.a. they had never done before. so that is kind of what has taken so long. originally v.a. had to completely set up a process. v.h.a. had to completely set up a process they'd never been involved in and then they had to write regulations, do the administrative the v.a. does and train a staff to do that. in the meantime they were already accepting those appeals but weren't able to act on them. they were accepting appeals between 12-18 months before they could actually act on them. they are actually acting on them now for supplemental claims and higher level reviews. and so we are starting to see some decisions come out of there. one of the things is quality of life foundation we do, though, is to say if you had supplemental information that

should have been available at the time of your original denial, while we'd urge you to go ahead and submit a supplemental claim, we also want you to, if you've been denied from the beginning, want you to go ahead and submit a new application using that evidence so we can go ahead and get you in the program with that extra information, while at the same time your supplemental claim runs which would then, if you are accepted under your new application, you would be back paid from your supplemental claim from the approval of your new application back to the date of your original application. however, there is a little bit of a narrow window that if that information that we consider supplemental should have been available at your first review, you can actually file it as a clinical appeal and have your

appeal acted on within 30 days and would actually get you back paid to your original application. and recently we've just at quality of life had that happen with a veteran. actually, he was an arizona veteran and we got him back paid all the way to his denial in 2021 because they had never contacted his specialist. sen. kelly: i'm way over but is this moving in the right direction? ms. sawyer: i feel it's moving in the right direction but slowly. sen. warnak: thank you, chair casey and thank you for holding this special hearing today. first lady rosalind carter of georgia used to say there are only four kinds of people in the world. she said there are those who have then caregivers, those who

are currently caregivers, those who will be caregivers, and those who will need caregivers. yet our care giving infrastructure is falling short for too many, including our veterans. the v.a. boasts generous care giving programs for veterans and their families, grateful for the work that happens there but two of our witnesses today confronted challenges with one federal program intended to financially support caregivers of injured veterans. the program of comprehensive assistance for family caregivers or the pcafc. ms. nieskens, i'm deeply sorry to hear about your husband's ruling and experiences with the pcafc reassessment process. you are a human face of the public policy issues we're trying to address and it's

important we send it on to the veterans. how can the v.a. approve the reassessment process so veterans won't have to experience the turmoil you and kelly faced? ms. nieskens: the regulatory changes which were implemented which required a.d.l. assistance each and every time and supervision, protection, and instruction assistance at a rate of continuous daily care were exclusionary and therefore needs such as my husband has for neurogenic bowel and seizure care and things like that. while those are very serious and require constant care, regular

care, they're episodic and therefore because of that, the nature of the disability itself, they were unable to meet the standard of each and every time and continuous daily care. and so that language is problematic and should be changed. sen. warnock: you're the human face of public policy, regulations often don't match where people live. so we have to be very intentional about getting it right. mr. townsend, thank you for your service and for being here today as a witness. like ms. nieskens, you and your wife encountered barriers to receiving care giving support. can you talk about your experience getting connected to assistance after the v.a. denied your application for p -- pcafc? mr. townsend: after we were denied access to the comprehensive program,

fortunately we were still able to access most of the benefits. lisa has since been enrolled in the general program of caregiver assistance and we're able to participate in benefits such as respite care. we really haven't had -- put it this way, the main benefit of the comprehensive program is the benefit, at least for me, is the availability of the medical insurance coverage through champ v.a. the other benefit is the financial support through the stipend. we can live without the stipend but what made it possible for my wife to retire early and become my full-time caregiver was that availability of champ v.a. and in our case, since we were denied access through the comprehensive program, fortunately for us because of the 100% permanent and total nature of my disability rating we were able to access that

benefit through other means, not through the caregiver program itself. sen. warnock: you weren't automatically connected with the care program? mr. townsend: it's interesting as we went through the application of the comprehensive program, in our meetings, for example, with the social worker at the hospital, she explained if we were denied access.com hencive program we could access the benefits through the general program. we assumed that transition from the comprehensive program to the general program would be almost automatic if we were denied access.com hencive program but come to find out it was not the case. it was only later when i contacted the staff v.a. that i realized lisa was not formally enrolled in the basic or general caregiver program. she is now but it was not an automatic transition. so whatever the committees can do to work with the v.a. to ensure a more seamless transition between the comprehensive program and the

general caregiver program if you're denied access.com hencive program would be a tremendous benefit. sen. warnock: you paint a picture of a fractured system where the constituent parts do not talk seamlessly to one another. and so clearly, there's room for improvement in addressing the need for continuity of care, making sure veterans don't fall between the cracks. but thank you so very much for your witness and it helps us to see the work we got to do. thank you for your service. >> senator. >> i'm a physician. and senator warnock is a pastor, you know what i'm saying? [laughter] >> i am a physician and i noted you had said in your testimony

people have asked questions and i have been running around and i apologize for not hearing what the answers were, but you spoi with ineligibility for the program of comprehensive assistance for family caregivers because your didn't require assistance each time. i'm a physician. not a neurologist. but m.s. waxes and waynes. -- wa nmp es. how does that play? is that still an issue. what is the way to approach this? >> you are correct that medical conditions like m.s. is associated with symptoms that wax and wa nmp emp. that has been my experience with

the condition and i am confident that there are many other veterans out there with similar circumstances. the v.a.'s current requirement that the veteran require assistance with the performance of certain with daily living each time that is excluded not only myself but many other veterans like me from participation in this program. >> is there a solution to propose? >> and and remains each and every time. one of our requests that is codified that it needs to be regular assistance because it was in the regulation that was

regular assistance and so that's why we would like to ask -- why did they reinterpret it? >> v.a. realigned the program with other extended care programs. what they did was make this program harder to get into those other programs. there were -- there is this rampant rumor that there is a lot of fraud within this program. it has not been proven to be a lot of fraud. has there been some? sure. but it is not rampant like it was -- like has been suggested. the one way that i would be

curious to talk about that you can get around each and every time standard is that if a needs supervision, those can be considered under supervision protection and instruction. but in the beginning, a lot were not trained to look at it that way. so i would be curious to know if he ever appealed and had it looked at -- a lot happens in the interim and she has a son who has been mentally ill and 40 and diagnosed when he was 27.

and she said at some point she felt like giving up, like, i can't do it. we can feel that, right? and you mentioned here the issue of support for the supporter. so if you had to put your finger on the critical gaps in mental health services for the caregivers, where would your finger land? >> thank you for the question. it is a significant problem that we have seen quite a bit of and i think that one of the major things in our testimony is to it's been great that ptsd offered mental health services who were eligible for that program but a small minority of the population. we recommended it be extended in

the general program as well to take a larger bite of the apple. i think we haven't -- we can try to remove some of the burden felt by the caregivers and addressing issues that are rampant within the v.a. in almost every case that i have run into and years of doing this and years with the foundation, lack of care coordination has been at the root of the problem and the caregiver and the amount of time that the caregiver has to navigate and frustration of repeat and prove your issues and the needs is weighing heavily on caregivers and veterans. >> she said every year i have to go and re-establish that it's true that my son has been disabled from mental illness for

20 years. it's like, why. i get you recover from some things but some things you do not recover from. and can we make some distinctions. i have to apologize. i went over longer. but thank you all very much. >> senator cassidy. i just have one question before we wrap up and i appreciate the testimony of all of our witnesses. i wanted to go back to you, mr. townsend and you are a retired physician assistant and someone who is engaged with other veterans in your community to the paralyzed volunteering at the local v.a. medical center in wilkes-barre and and your veteran connections, you had to self-educate on the benefits.

multiple veterans said they received no outreach about the caregiver support program and vets have heard of the program from the veterans service organization not from the v.a. i'm concerned that this approach and that might be an understatement, this haphazard approach to outreach will leave too many families that are in the dark. veterans and caregivers deserve to know when there is a program that can provide them with the support. how did you find out about the caregiver support program? and number two, how do you think veterans who are not health care experts or as you are can find out about about these programs and how to navigate them? >> the haphazard approach has

been my personal experience. most of what i learned through a process of self-education by talking to fellow veterans and working with veteran service organizations and looking at online resources and some of them are produced by the v.a. and one of the things that is common sense to me because i agree that the v.a. medical system can be intimidating even with someone with health care experience. one of the things that i thought of that would occur, particularly when you are new in the system you have the opportunity to sit down with a social worker at the v.a. and explain to you the benefits you are eligible for and that wasn't in my experience. if i could make one recommendation, it would be for the v.a. to better educate the beneficiaries of all the

services that are available to them because that communication of information often doesn't occur at least not in the way that it should. >> that's a reasonable proposal. we need a few of those around here. i wanted to close with a statement and we'll wrap up and all of you have been very patient with your time and experience and your expertise and we appreciate you being here with us. as we heard today from our witnesses, the v.a.'s caregiver support program is a vital and life-changing benefit for so many families but too many veterans are not able to get the benefits that they have earned and they and their families deserve. our servicemembers and veterans put their lives on the lipe every day to ensure that america america is the land of the free and rely on their commitment and when they are wounded or when they are injured or ill, they

need our support. and they need our commitment. with 5 1/2 million caregivers in the united states, it is imperative we do everything we can to support the critical workers providing family and underpaid caregiving. as one family in pennsylvania near my hometown of scranton, shared in a statement for the record, quote, if our son t.j. who lost his eyes and one-third of his brain in service to our country, if he is disqualified and wondering who truly qualifies for these services, unquote. we must do more to provide support to veterans and caregivers so they can do their work and are supported fully in the process. we need to provide easier and clear access to information about the care giving and

long-term care and services and support that the v.a. offers as well as easier navigation and support in the application process. as we heard from mr. townsend, veterans shouldn't have to rely upon the word of mouth to find out about these life-changing benefits and make sure that the v.a. has the resources that it needs including a strong, stable work force. including caregiver support services. i look forward working with my colleagues to address the needs of our millions of veterans and their family members who are in need of long-term care. i know we'll have a number of statements for the record for this hearing, closing statements for the record for the hearing and we'll enter those into the record at the appropriate time.

i thank my witnesses for contributing their time and expertise today. i will be entering and i'm holding up a folder with -- containing five written statements from the record and from pennsylvania veterans who receive long-term care services and support from the v.a. or who are enrolled in the family care giving program. lastly, if any senators have additional questions for the record for witnesses or statements to be added to the record, the hearing record will be kept open for seven days until next wednesday, june 12. thank you for participating today. and this concludes our hearing. [captions copyright national cable satellite corp. 2024] captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit ncicap.org.

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