Saturday, August 8, 2009

Caregiver Assistance and Resource Enhancement Act passes U.S. House

H.R. 3155, the Caregiver Assistance and Resource Enhancement Act, was introduced by Representative Michael H. Michaud of Maine, Chairman of the Subcommittee on Health of the Committee on Veterans' Affairs, on July 9, 2009. H.R. 3155, as amended, would create a new caregiver program to help family and non-family members who provide care for disabled, ill, or injured veterans enrolled in the U.S. Department of Veterans Affairs (VA) health care system.

The VA would also be required to conduct a survey on caregivers in order to better understand this population. Key components of the new caregiver program would include support services such as educational sessions, access to a comprehensive one-stop resource directory, counseling and mental health services, and respite care. In addition, this legislation would provide a monthly financial stipend, health care through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), and lodging and subsistence to eligible caregivers of certain veterans.


Today, more servicemembers are surviving the wounds of war than those injured in previous conflicts. For example, the ratio of wounded to killed averaged approximately 1.7 wounded for every fatality for the first two World Wars. In Korea and Vietnam, the ratio improved to three wounded per fatality, largely due to air medical evacuation. In Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF), improved body armor and superior battlefield medicine techniques have resulted in seven wounded per fatality. The increasing number of wounded OEF/OIF servicemembers surviving the war brings to the forefront the question of who will provide continuing care for these injured men and women once they transition to veteran status.

It is estimated that for any given year there are more than 50 million people who provide informal caregiving for a chronically ill, disabled, or aged family member or friend. These caregivers serve as the foundation of the country's long-term care system. It is estimated that about 80 percent of adults living in the community and in need of long-term care depend on a family member or a friend, thereby avoiding costly institutional nursing home care. The majority of these caregivers are women. Caregiving exacts both a financial and physical toll on these individuals. For example, women caregivers are more than twice as likely to live in poverty and are five times more likely to receive Supplemental Security Income (SSI) than their non-caregiver counterparts. Also, individuals serving as caregivers for a family or friend report having a chronic health condition at twice the rate of non-caregivers and those who provide 36 or more hours of weekly care are more likely to experience symptoms of depression and anxiety than non-caregivers.

Because the VA does not collect data on this population, the number of family members and friends who provide care for veterans is unknown. However, the July 2007 report of the President's Commission on Care for America's Returning Wounded Warriors (Dole-Shalala Commission) found that of the 1,730 injured OEF/OIF veterans surveyed, about 21 percent of active duty, 15 percent of the reserve, and 24 percent of retired or separated servicemembers had friends or family who gave up a job to be a caregiver. In order to better understand the caregiver population providing care to veterans, H.R. 3155 would require the VA to conduct a caregivers survey at least once every three years to individuals caring for veterans enrolled in the VA health care system. It would also require a report to Congress providing the findings of the survey no later than 180 days after the date on which the survey is completed. The Committee believes that this study would be an essential component in meeting the needs of caregivers in the future.

H.R. 3155 would establish a new caregiver program in order to provide coordinated support services to caregivers. Caregivers often have a poor understanding of the services they are eligible for, thereby resulting in an underutilization of caregiver support services available through the VA. H.R. 3155 would require the VA to train existing case managers to also provide information about support services and benefits available to the caregivers of such veterans. This legislation would also require the VA to provide information and conduct outreach using all mediums of communication to spread the message about caregiver support services available through the VA, including new services made available through this Act.

Although VA offers support services to caregivers of veterans, additional services are needed for those who forego their employment, education, or make other major life changes in order to care for their wounded veteran family member. The well-being of the caregiver is important as it affects the quality of care that the wounded veteran receives. Ensuring the best care for our veterans means equipping family caregivers with the right tools and support services.

H.R. 3155 would provide a range of support services to help both family and non-family caregivers of veterans of all eras. This includes educational sessions for caregivers, a one-stop caregiver resource directory, and respite care which is age-appropriate and meets the needs of the veteran. This legislation would also provide counseling and mental health services, and include peer support groups to help caregivers cope with the daily stress of caregiving.

H.R. 3155 would also provide key benefits of lodging and subsistence, a financial stipend, and health care for a select group of caregivers of certain eligible veterans who were deployed in support of OEF/OIF, are determined by the Secretary of VA to have a severe service-connected injury or illness, are unable to carry out activities of daily living (including instrumental activities), and are in need of caregiver services such that without them the veteran would require hospitalization, nursing home care, or other residential institutional care. This legislation would authorize the VA to reimburse caregivers for lodging and subsistence when they accompany certain eligible veterans on medical visits. Such caregivers must meet the definition of an attendant under the current statute. This would help to address the plight of some family caregivers who depend on the travel, meals, and lodging allowance provided by the Department of Defense (DoD), which is suddenly discontinued when the wounded warrior transitions to veteran status. This provision would be a step forward in establishing some parity and continuity in caregiver benefits provided by DoD and VA. This legislation would also provide a monthly financial stipend to primary family caregivers of certain eligible veterans through October 1, 2012. To be eligible, the caregiver may not be employed by a home health care agency to provide caregiver services to a family member veteran, or otherwise receive payment for such services. Finally, H.R. 3155 would provide health care through the CHAMPVA program through October 1, 2012, to primary family caregivers of certain eligible veterans if they are without health insurance or are not eligible for other public health insurance options.


On June 4, 2009, the Subcommittee on Health held an oversight on `Meeting the Needs of Family Caregivers of Veterans.' The following witnesses testified: Anna Frese, Caregiver, Wounded Warrior Project; Commander Rene A. Campos, U.S. Navy (Ret.), Deputy Director, Government Relations, Military Officers Association of America; Barbara Cohoon, Ph.D., RN, Government Relations Deputy Director, National Military Family Association; Jill Kagan, MPH, Chair, ARCH National Respite Coalition; Suzanne G. Mintz, President and Co-Founder, National Family Caregivers Association; Mark S. Heaney, President and Chief Executive Officer, Addus Healthcare, Inc., Home Care Aide Section Representative Officer, National Association for Home and Hospice Care; Madhulika Agarwal, M.D., MPH, Chief Patient Care Services Officer, Veterans Health Administration, U.S. Department of Veterans Affairs accompanied by Lucille Beck, Ph.D., Chief Consultant, Rehabilitation Services, Veterans Health Administration, U.S. Department of Veterans Affairs; Thomas E. Edes, MS, Director of Home and Community-Based Care, Office of Geriatrics and Extended Care, Veterans Health Administration, U.S. Department of Veterans Affairs; Thomas J. Kniffen, Chief, Regulations Staff, Compensation and Pension Service, Veterans Benefits Administration, U.S. Department of Veterans Affairs; Edwin L. Walker, Acting Assistant Secretary for Aging, Administration on Aging, U.S. Department of Health and Human Services; and, Noel Koch, Deputy Under Secretary, Office of Transition Policy and Care Coordination, U.S. Department of Defense. Adrian Atizado, Assistant National Legislative Director, Disabled American Veterans submitted a statement for the record.

On July 9, 2009, the Subcommittee on Health met in open markup session and ordered favorably forwarded to the full Committee H.R. 3155 by voice vote.

On July 15, 2009, the full Committee met in an open markup session, a quorum being present, and ordered H.R. 3155, as amended, reported favorably to the House of Representatives, by voice vote. During consideration of the bill, An amendment in the nature of a substitute by Mr. Michaud of Maine to establish a new caregiver program and to provide for a monthly stipend was agreed to by voice vote.


On July 27, 2009, H.R. 3155 as amended was passed by the U.S. House of Representatives by a voice vote.

The bill has been referred to the Senate Committee on Veterans' Affairs, where it now awaits further action.


Letters and emails expressing support for the Caregiver Assistance and Resource Enhancement Act should be addressed to:

Rep. Bob Filner, Chair and Rep. Steve Buyer, Ranking Member, U.S. House of Representatives Committee on Veterans' Affairs, 335 Cannon House Office Building, Washington, D.C. 20515

Senator Daniel Akaka, Chair and Senator Richard Burr, Ranking Member, U.S. Senate Committee on Veterans' Affairs, 412 Russell Senate Office Building, Washington, D.C. 20510

Courtesy copies of the original letters or emails should be sent to the Senator and Representative who represent the state and Congressional district where you live. A nationwide database providing complete contact information on local Congressional representation is available at

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