Department of Veterans Affairs Caregiver Support Program Update Michael Kilmer, LCSW Chief Consultant , Care Management and Social Work Services Patient Care Services Department of Veterans Affairs June 24, 2014

Caregiver Support Program Mission Statement: To promote the health and well-being of family Caregivers who care for our nation’s Veterans, through education, resources, support, and 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 & Caregiver health and well-being Provide one location to obtain needed information Provide training & information on common conditions Reduce isolation with professional & peer support Provide options to give Caregivers respite Sensitize health care providers to the Caregivers’ role

Menu of VA Services to Support Family Caregivers In-Home Care Skilled Nursing Home Health Aide Home Based Primary Care Veteran Directed Home & Community Based Care Services to Address Mobility Issues Equipment Home Modification Automobile Modification Education and Training Core Curriculum Self-Care Courses Financial Support Aid and Attendance Caregiver Stipend (Post 9-11) Information and Referral Caregiver Web site: www.caregiver.va.gov Caregiver Support Line: 1-855-260-3274 Caregiver Support Support Groups Caregiver Support Coordinators Peer Support Mentoring Program Building Better CaregiversTM Respite Care

Caregiver Support Coordinators At all VA Medical Centers Clinical experts on Caregiver issues Knowledgeable about VA and non-VA resources Assist with application for new benefits Organize Caregiver focused activities and services Ensure Caregiver sensitivity is integrated into all programs Provide National Caregiver Support Line follow-up Establish programming for National Family Caregiver Month in November Caregiver Support Coordinators, located at each VA medical center, serve as the program champions, shepherding Veterans and Caregivers through the application process for the new services, and providing support and resources to Caregivers of Veterans of all eras. As of October 2013, there are a total of 225 CSC’s in the field 180 of these CSC are SW’s and the rest are RN’s. We do not have and Psychologists at this time.

Caregiver Education, Training, and Support Expanding Evidence-Based Interventions & Best Practices Resources to Enhance All Caregivers Health VA (REACH VA) Designed to provide education support, and teach problem-solving for Caregivers of Veterans with Alzheimer’s Disease/dementia Currently being expanded to Spinal Cord Injury /Disease, Multiple Sclerosis, and Mental Health Spouse /Caregiver Telephone Support Groups of Post 9/11 spouses meet with a VA clinician to learn problem solving skills, resiliency training, and to receive support Currently being expanding to broader audience Building Better CaregiversTM An interactive, web based workshop developed by Stanford University and provided in partnership with the National Council on Aging (NCoA) Peer Support Mentoring Program New Caregivers are matched to more experienced Caregivers These are programs available to Caregivers of Veterans from all eras REACH= Resources for Enhancing All Caregiver’s Health – staff trained at more than 125 VA facilities Spouse Telephone Support groups – staff trained in 100 VA facilities – currently being expanding to include content for other era Veterans Building Better Caregivers – more than 2,000 Caregivers have been referred and more than 200 caregivers are participating in an active on-line community Peer Support Mentoring – close to 150 Caregivers have participated – exploring new ways to provide peer support such as a one-time interaction and a speaker’s bureau of caregivers

www.caregiver.va.gov Caregiver Outreach Caregiver Support Line More than 130,000 calls received Averaging ~ 200 calls per day Caregiver Website List serve members = 38,000+ Average visits per day = 830 Pages viewed per visits = 3 www.caregiver.va.gov

Program of Comprehensive Assistance for Family Caregivers - Eligibility Criteria Overview Veteran or Servicemember undergoing medical discharge incurred or aggravated a serious injury in the line of duty on or after September 11, 2001 (includes Traumatic Brain Injury, psychological trauma or other mental disorders). and Veteran or Servicemember requires on-going assistance from a Caregiver for a minimum of 6 months to: Assist with the management of personal care functions required in everyday living; Significantly enhance the Veteran’s or Servicemember’s ability to live at home safely; and Support the Veteran or Servicemember’s potential progress in rehab.

Program of Comprehensive Assistance for Family Caregivers - Eligibility Criteria Overview (contd.) and The serious injury requires another person (a Caregiver) to assist the Veteran with the management of personal care functions required in everyday living because of one or both of the following: An inability to perform one or more Activities of Daily Living including dressing and undressing, personal hygiene, grooming, toileting, feeding oneself, mobility, or a frequent need of adjustment of a prosthetic or orthopedic appliance A need for supervision, protection, or assistance based on symptoms or other impairments or injury including seizures, difficulty with planning and organizing, safety risks, difficulty with sleep regulation, delusions or hallucinations, difficulty with recent memory, or difficulty with self-regulation **Note: there are additional criteria beyond what is listed here.

Primary Family Caregiver Supports and Services 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 Civilian Health and Medical Program VA (CHAMPVA) Travel and Lodging Integrate into existing programs Mental Health Services Individual/Group psychotherapy and counseling VA or by contract 9

Program of Comprehensive Assistance for Family Caregivers Update* Applications filed: 31,130 Approved Applications: 15,900 Tier 3 – 6,121 (national average $2,320 per month) Tier 2 – 6,078 (national average $1,470 per month) Tier 1 – 3,701 (national average $610 per month) New Healthcare Coverage enrollees: 4,115 Veteran Demographics: 26% are Service Connected for TBI 70% are Service Connected for PTSD *Data from May 9, 2011 to June 9, 2014

Program of Comprehensive Assistance for Family Caregivers Caregiver Education and Training Standardized Core Curriculum Developed in collaboration with Easter Seals In-person, workbook/DVD, or web-based Includes modules on: Caregiver Self-Care Home Safety Basic Caregiver Skills (vital signs, etc) Providing Personal Care Managing Challenging Behaviors Resources (legal, financial, VA, community, advocacy) Training Data Update: More than 20,000 Family Caregivers have completed training to date Future training will focus on web-based courses & workbook /DVD training.