How to Get Approved for The VA Caregiver Program
Veterans who were injured or experienced illness as a result of military service may require the help of a caregiver for activities of daily living. This is also true for veterans experiencing mental disorders like PTSD.
Caregivers of veterans are often family members who assist with home care, transportation to health care appointments, and other daily tasks. They often take on the role of a home health aide but lack the financial support.
To help support these family caregivers, the U.S. Department of Veterans Affairs offers the Program of Comprehensive Assistance for Family Caregivers. This program provides VA health care benefits, monthly stipends, coverage of travel expenses, and other types of financial support to the caregivers of eligible veterans.
Those who are eligible for this program can receive a number of caregiver benefits. Here’s what disabled veterans and their family members should know about this caregiver support program.
What Is The VA Caregiver Program and How Do You Get Approved?
Program of Comprehensive Assistance for Family Caregivers (PCAFC) is open to veterans who were injured or experienced an aggravated injury in the line of duty after September 11, 2001. If a veteran qualifies for the program, their caregiver can receive a number of benefits, including:
- Caregiver stipends
- Health insurance
- Mental health services
- Beneficiary travel benefits
- Respite care
- Support resources
- Other caregiver services
Caregivers may be eligible for health care benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). These types of services can help a veteran’s loved ones provide home care and support the well being of the veteran.
According to the VA, a family caregiver is a son, daughter, spouse, parent, stepfamily member, extended family member, or any person who lives with the veteran fill time or is willing to do so if designated as a caregiver. So, veterans need to consider who their primary family caregiver is when applying for the program.
To apply for the caregiver program, veterans need to fill out VA Form 10-10CG. This is the first step in the application process.
You can read more about the caregiver program and eligibility requirements in our previous blog post.
How Does The VA Determine Eligibility?
For a veteran to be eligible for the caregiver program, they must meet several initial criteria:
- The veteran must have sustained a serious injury including traumatic brain injury, psychological trauma, or other mental disorder incurred or aggravated in the line of duty on or after September 11, 2001.
- The veteran must have a need for personal care services because of an inability to perform one or more activities of daily living and/or need supervision or protection based on symptoms or residuals of neurological impairment or injury.
- The veteran must be enrolled in the VA health care system.
When an injured veteran applies for the Caregiver Program, he/she will be scheduled for a C&P exam to determine if the veteran is eligible for the program and what kind of care the veteran requires.
The first part of the exam goes over the seven eligibility criteria, which were outlined in a previous blog post. The exam will then rate the veteran’s ability to perform various Actions of Daily Living (ADLs), as well as the degree to which the veteran must be supervised and/or protected to due mental conditions.
High Dependence: 28-21
Moderate Dependence: 20-13
Low Dependence: 12-1
4 = TOTAL ASSISTANCE (Veteran completes < 25% of task/activity or is unable to do task task/activity without assistance)
3 = MAXIMAL ASSISTANCE (Veteran completes 25-49% of task/activity with supervision/ coaching assistance)
2 = MODERATE ASSISTANCE (Veteran completes 50-75% of activity with some hands on help)
1= MINIMAL ASSISTANCE (Veteran completes 75% or more of task/activity with some hands-on help)
0 = COMPLETE INDEPENDENCE (Veteran completes task/activity without help)
Category 1 – ADLS
The VA examiner will rate the veteran’s competency in or use of:
- Assistive devices
Category 2 – Assistance/Supervision
The VA examiner will also rate the degree to which the veteran has difficulty in, or needs assistance/supervision with various areas:
- Requires supervision/assistance as a result of seizures (blackouts or lapses in mental awareness, etc.):
- Difficulty with planning and organizing (adhering to medication regimen, managing financial and other household affairs):
- Safety risks (significant risk of falling, wandering outside the home, leaving stove/oven on, crossing street, using electrical appliances, suicidal ideation):
- Difficulty with sleep regulation:
- Requires assistance/supervision as a result of delusions/hallucinations:
- Difficulty with recent memory (forgets what day it is, what happened yesterday, etc.):
- Self-regulation (being able to moderate moods, agitation/aggression):
The examiner will combine the scores of both categories, and the total will determine the tier to which the veteran belongs. This score also determines how many hours a week the veteran will need care or assistance, which will be the basis of the primary caregiver’s stipend.
High Tier (Tier 3) – A Veteran who scores 21 or higher will be presumed to need a full-time caregiver, one who provides 40 hours of personal care services per week.
Medium Tier (Tier 2) – A Veteran who scores 13-20 in all categories will be presumed to require 25 hours per week of caregiver assistance.
Low Tier (Tier 1) – A Veteran who scores 1-12 will be presumed to need 10 hours per week of caregiver assistance.
Keep in mind that while the application process may be complicated, a local caregiver support coordinator (CSC) is available at your local VA Medical Center to help. If the VA accepts you application and you enroll in the program, a VA clinician will schedule a home visit to ensure that your caregiver has the resources they need for home care.
Have Questions About Getting Approved for the VA Caregiver Program?
If the VA denied your application for VA caregiver support, there are resources available! Caregivers to disabled veterans can also reach the National Caregiver Support Line at 1-855-260-3274. More information about caregiver support resources is available on caregiver.va.gov. You can learn more about veterans’ health care through the Veterans Health Administration (VHA).