My spouse and I have recently undergone the process for the VA Caregiver Program. Please go to the website,
https://www.gpo.gov/fdsys/search/pa...8-vol2-part71&packageId=CFR-2012-title38-vol2, to read about the program so that you are well informed of the protocols and requirements.
The Caregiver Program,
www.caregiver.va.gov, to find a handout about appeals. Your VA Patient Advocate can help with the process. If your Primary Care Team wasn't consulted about your participation or any decisions about your care and what personal care services you need, then read the 38 CFR 71 and my comments below. If they haven't then you need to address this with your Primary Care Team and Patient Advocate.
We just learned due to issues with our Caregiver Program and researching for the regulations on the program that our Caregiver Program at our VA aren't following the regs.
(Excerpt) According to 38 CFR 71, 71.15....Primary care team means a group of medical professionals who care for a patient and who are selected based on the clinical needs of the patient. The team must include a primary care provider who coordinates the care, and may include clinical specialists (e.g., a neurologist, psychiatrist, etc.), resident physicians, nurses, physicians’ assistants, nurse practitioners, occupational or rehabilitation therapists, social workers, etc., as indicated by the needs of the particular veteran.
Your Primary Care Team at your VA is required to do the majority of your request for a caregiver processes. So, Your Primary Care Team not a review board or c&p or the caregiver program employees or your caregiver coordinator is/are responsible for making the necessary 'personal care or safety/protection' determinations, interviewing your designated primary or secondary caregiver to find out if they are willing and able to perform the 'personal care services' and to provide training to them if they are selected to be your caregiver (s). Your Primary Care Team is also responsible for determining the number of required personal care services that your primary caregiver will be paid. The Caregiver Program and Coordinator are there for your caregiver (s) assistance, to assist you and your caregiver in finding programs/services and assisting with get assistance from these programs/services, etc...not to make care (a veteran's treatment care plan)determinations requiring assistance of a caregiver to perform personal care services in your home.
(Excerpt) Home Assessment per the regulation, 38 CFR 71,section 71.25, states.....
(e) Initial home-care assessment. No later than 10 businessdays after completion of Caregiver education and training, or should aneligible veteran
be hospitalized during this process, no later than 10 daysfrom the date the eligible veteran returns home,
a VAclinician or a clinical team will visit the eligible veteran’s home and assess the Caregiver’s completion of training and competence to provide personal care services at the eligible veteran’s home, to measure the eligible veteran’s well being.
38 CFR 71, 71.25 Approval and designation of Primary and Secondary Family Caregivers.
(a) Application requirement.
(1) Individuals who wish to be considered for designation by VA as Primary or Secondary Family Caregivers must complete and sign a joint application, along with the veteran or servicemember. Individuals interested in serving as Family Caregivers must be identified as such on the joint application, and no more than three individuals may serve as Family Caregivers at one time for an eligible veteran, with no more than one serving as the Primary Family Caregiver.
(2) Upon receiving such application, VA will perform the
clinical evaluations required by this section; determine whether the application should be granted; and, if so, whether each applicant should be designated as identified in the application.
(3) An application may be put on hold for no more than 90days, from the date the application was received, for a veteran or servicemember seeking to qualify through a GAF test score of 30 or less but who does not have a ‘‘continuous’’ GAF score available.
(b) Eligibility to serve as Primary or Secondary Family Caregiver. In order to serve as a Primary or Secondary Family Caregiver, the applicant must meet all of the following requirements:
(1) Be at least 18 years of age.
(2) Be either:
(i) The eligible veteran’s spouse, son, daughter, parent,step-family member, or extended family member; or
(ii) Someone who lives with the eligible veteran full-timeor will do so if designated as a Family Caregiver.
(3) There must be no determination by VA of abuse or neglect of the eligible veteran by the applicant.
(4) Meet the requirements of paragraph (c) of this section,and any other applicable requirements of this part.
(c) Assessment, education, and training of applicants. Before VA approves an applicant to serve as a Primary or Secondary
Family Caregiver, the applicant must:
(1) Be initially assessed by a VA
primary care team as being able to complete
caregiver education and training. Such assessment will consider any relevant information specific to the needs of the eligible veteran, as well as:
(i) Whether the applicant can communicate and understand details of the treatment plan and any specific instructions related to the care of the eligible veteran (accommodation for language or hearing impairment will be made as appropriate); and
(ii) Whether the applicant will be capable of following without supervision a
treatment plan listing the specific care needs of the eligible veteran.
(2)
Complete caregiver training and
demonstrate the ability to carry out the specific personal care services, core competencies, and other additional care requirements prescribed by the eligible veteran’s primary care team.
(d) Caregiver education and training. For the purposes of this section, caregiver training is a program of education and training designed by and provided through VA that consists of issues that are generally applicable to Family Caregivers, as well as issues specific to the needs of the eligible veteran. During this program of education and training, family members are eligible for beneficiary travel under 38 CFR part 70. Respite care will be provided during the period of initial caregiver instruction, preparation, and training if the participation would interfere with the provision of personal care services to the eligible veteran. Caregiver training will cover, at a minimum, education and training concerning the following core competencies:
(1) Medication management;
(2) Vital signs and pain control;
(3) Infection control;
(4) Nutrition;
(5) Functional activities;
(6) Activities of daily living;
(7) Communication and cognition skills;
(8) Behavior management skills;
(9) Skin care; and
(10) Caregiver self-care.
(e)
Initial home-care assessment. No later than 10 business days after completion of Caregiver education and training, or should an eligible veteran be hospitalized during this process, no later than10 days from the date the eligible veteran returns home,
a VA clinician or a clinical team will visit the eligible veteran’s home and assess the Caregiver’s completion of training and competence to provide personal care services at the eligible veteran’s home, to measure the eligible veteran’s well being.
(f) Approval and designation. If the eligible veteran and at least one applicant meet the requirements of this part, VA will approve the application and designate Primary and/or Secondary Family Caregivers, as appropriate. This approval and designation
will be a clinical determination authorized by the eligible veteran’s primary care team. Approval and designation is conditioned on the eligible veteran and designated Family Caregivers remaining eligible for caregiver benefits under this part. (Authority: 38 U.S.C. 501, 1720G)
38 CFR 71, 71.30 Caregiver Benefits states...
(2)
The primary care team will maintain the eligible veteran's treatment plan and collaborate with clinical staff making home visits to monitor the eligible veteran’s well-being, adequacy of care and supervision being provided. This monitoring
will occur no less often than every 90 days, unless otherwise clinically indicated, and will include an evaluation of the overall health and well-being of the eligible veteran.
Our Caregiver Coordinator and Caregiver Nurse showed up to 'inspect' every room in my house. We were told that they have been to veteran's houses that were infested with cock roaches and bed bugs. The Caregiver Supervisor told us that they can do 'environmental' checks. Read the 38 CFR 71and tell me if it says anything about 'inspection of every room' or 'environmental inspections'. It doesn't, as I posted everything on what there is in the regulation about home assessments/visits.
Our Caregiver Program at my VA, Mountain Home VA, Johnson City, TN accessed my medical and mental health records to include my psychotherapy notes (without my written permission) read them then made all the determinations. The Caregiver Supervisor told us that they are authorized to access our records, she doesn't include my Primary Care Team because the doctor's wouldn't get any work done and that they (social workers) are fully capable of reading veteran's records and making care decisions. Yes, they don't need to talk to our doctors. Second, they don't have a medical need to know as they aren't authorized to perform these tasks.
According to the regulations, they don't mention any duties or responsibilities of a Caregiver Coordinator, Caregiver Supervisor, or Caregiver Nurse or Caregiver Social Worker in any aspect concerning the veteran. Yes, no regulatory requirements for them to be involved in any aspect of our Primary Care Team or the process. Also, there isn't any mention in any of the regulations that mention the words 'Caregiver Coordinator, Caregiver Supervisor, Caregiver Nurse, Caregiver Social Worker, etc" ; and there is no mention in any of the regulations the words "medical records or mental health records or psychotherapy notes or records". No mention of the "Caregiver Program has authorization to access, read, review, monitor, edit, etc" in any of the regulations. So, why are they accessing our records and/or allowed to access our records? What is their 'medical' need to know as they aren't medical professionals nor our providers (doctors, physician assistants, etc)? The Caregiver Program does not provide any medical or mental health care to a veteran!
I was so horrified to find out that these social workers are reading my personal conversations with my mental health counselor without my written permission or a medical need to know. Also, my VA Caregiver Program holds a monthly board with the caregiver employees only to discuss veteran's records, approve/disapprove applications, make personal care decisions and rate them, decide what tier your caregiver is paid and deny reevaluations.
We appealed our request for a reevaluation and at the time we didn't know that my Primary Care Team wasn't consulted or that they were responsible to be involved. My Primary Care Team told us that no one from the Caregiver Program has contacted them on anything regarding me and the program. The Caregiver Program denied our request. They didn't even consult with my Primary Care Team. How can they make determinations on my medical and mental health care when they aren't my doctors treating me? My VA Caregiver Program is broke. I informed the medical director and the appeals board in my appeals letter that this happened and they sided with the Caregiver Supervisor. (I wasn't allowed to attend, only provide a written statement)
The Caregiver Program should have no medical need to access our records much less read them. Our Primary Care Team is responsible for assessing our eligibility, determining what personal care services we require, rating them accordingly to his/her medical opinion, interviewing the primary/secondary caregiver and providing training and a clinician or clinical team is required to do the home assessment (which isn't an inspection of every room in your house, don't let them fool you with "it's for safety reasons" and determining tier increases. The appeal process should be our Primary Care Team and the appeals process.
We also found out that our VA allows full access to all the veteran's medical/mental health records to include psychotherapy notes to all the VA employees working there. Yes, they all have full access without any oversight. Veterans can request a SPAR report through your local VA facility which will tell you who accessed, what they accessed and when it was accessed.
The 2 regulations governing the program are US Code 38,1720G and 38 CFR 71.
You can file HIPPA violations to the Health and Human Services (HHS) online or by mail. Privacy violations thru your VA Privacy Officer. You can contact your local vet organizations (VFW, DAV, AMVETS, etc), your congressman, etc to assist you to.
I wanted to share what we have experienced and went through with our local Caregiver Program.
I hope this has shed some light on the program and provided you with the information you need in obtaining caregiver benefits.
The 38 CFR 71 is only a few pages and well worth the 10 minutes to read it so you are informed and prepared when you need VA Caregiver Benefits or if you are having issues with the program.
