Lawmakers at a hearing of the House Veterans’ Affairs Committee on Wednesday, Sept. 25, 2024, urged support for the Sen. Elizabeth Dole Act, which would increase funding for at-home and community services to help disabled and elderly veterans continue to live at home and stay out of institutional care. (Stars and Stripes)

WASHINGTON — House lawmakers on Wednesday urged the swift passage of legislation to better support family caregivers and home health aides who help veterans with serious disabilities continue to live at home and stay out of institutional care.

Rep. Mike Bost, R-Ill., who is chairman of the House Veterans’ Affairs Committee, said he soon plans to bring to the floor the Sen. Elizabeth Dole Act, which would increase funding for the Department of Veterans Affairs for noninstitutional alternatives to nursing home care.

The legislation also would address the needs of family members serving as full-time caretakers, including providing them with mental health care services, respite care, home health aide and other assistance. It was introduced by Rep. Julia Brownley, D-Calif., in 2023, and would authorize agreements with non-VA medical and social service agencies to offer community and at-home services that are comparable to what veterans receive in nursing homes.

Expenditures for at-home care cannot exceed 65% of what the cost would be if the veteran lived in a nursing home. The change would increase the amount to 100% under the Sen. Elizabeth Dole Home Care Act.

The program provides elderly and disabled veterans — or their designated family caregiver — with a small monthly budget to pay for help with daily living activities, such as bathing, dressing and meal preparation, so they can continue to live at home.

Some veterans and their advocacy groups said there is a lack of sufficient services to support caretakers in the community.

“My husband requires supervision at all times, and I manage every aspect of his life. Our lives are full of medical appointments, countless hospital stays and the never-ending medication management,” said Vanessa Chism, caretaker for her husband, Cody, an Army veteran medically retired in 2011 after serving in Iraq.

“Cody is here physically, but I have lost my husband to traumatic brain injuries,” she said. Her husband suffers from seizures, chronic pain and cognitive impairment.

But Chism said she has struggled to gain and keep access to VA-sponsored programs and services that enable her husband to live at home with her and their three children.

Bost cited new findings from the nonprofit Rand Corporation on challenges and hardships of families that are caring for veterans with serious disabilities.

The Rand study found there are more than 14 million caregivers of veterans and service members, representing 5.5% of the U.S. adult population. Most caregivers surveyed by Rand spend up to 30 hours per week providing care for veterans with illnesses and injuries from military service. Caregivers are often isolated and experience high level of stress and burnout, Bost said.

“Veterans caregivers play an unseen role in supporting loved ones. Many face emotional, financial and physical hardships,” he said.

Bost said he is hearing from constituents that they cannot find respite care after they qualify for it.

Provisions of the Elizabeth Dole Act would require the VA to award grants to improve the mental health assistance for caregivers, who might be forced to reduce work hours or end careers, he said.

Some financial help from the VA is already available through stipends, but it often falls short, Bost said.

Colleen Richardson, executive director of the VA’s caregiver support program, said the VA is prioritizing respite for caregivers and has seen program use increase by more than 270% since fiscal 2022.

She said the VA funds a program called comprehensive assistance for family caregivers. The program pays a monthly stipend to family caregivers with seriously disabled veterans and provides access to health insurance through the VA’s civilian health and medical program, also known as CHAMPVA.

Recipients also can receive travel reimbursement to veteran’s health care appointments and qualify for 30 days of respite care per year, when it is available.

Richardson said there is assistance for veterans to hire home health aides and other caregivers who are not family members.

The VA also has started a virtual program for providing online therapy sessions for family caregivers and will complete more than 14,000 appointments this year, she said.

The Congressional Budget Office issued a report in 2023 on the costs of providing “all-inclusive” non-VA care for seriously disabled and elderly veterans to continue living at home and in their communities. Expanding in-home assistance, caretaker support and other community-based services could grow spending as much as $119 million through 2033, according to the report.

How the VA manages its budget has come under closer scrutiny by lawmakers.

Congress just passed an emergency spending measure to close a $3 billion shortfall at the VA for fiscal 2024, which ends Sept. 30.

But lawmakers also criticized the VA for not anticipating greater spending needs after passage of Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act. Also known as the PACT Act, the law provides benefits to veterans who developed illnesses from burn pits, radiation and other toxic exposures during military service.

A $12 billion shortfall is projected for 2025, as the VA has enrolled thousands of additional veterans in VA health care since 2022 and provided compensation for their illnesses and disabilities connected to military duty.

More veterans who are seeking care drives a need to hire 5,000 additional workers to cover rising demand for services. The VA also anticipates higher costs for popular prescription drugs, especially for treating diabetes and obesity.

Rep. Mark Takano, D-Calif., said he supports Congress providing the assistance veterans need to remain at home. He described the Elizabeth Dole Home Care Act as transformative for veterans and their families.

He said caregivers are an indispensable component of the complex system of support and health care that disabled veterans need.

“I too want to see this legislation enacted as soon as possible,” he said.

Takano said he also supports awarding Social Security credits to family members who are full-time caretakers for disabled relatives, which is not addressed in the bill.

Credits are based on a person’s earnings and work history over a lifetime, and are used to determine retirement benefits, Medicare coverage and other services. But they do not consider individuals who leave jobs and careers to work as full-time caretakers for disabled family members.

Takano said the VA also must be provided funding to build capacity, modernize infrastructure and meet veterans’ health care needs at its facilities.

He urged a balance of money for VA care at hospitals and clinics and non-VA care delivered at home and in the community.