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Feb. 19, 2023 - Stew Peters Show
57:52
The Richard Leonard Show: The VA Caregiver Program: Hinderance Or Help? I
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*music* Earlier this summer on this show, we spoke in length about the VA's Caregiver Program, as well as the Elizabeth Dole Foundation.
Today we're going to take a dive in, and folks, this is going to be a more than one show series because there's a lot of information and there is a whole lot of things to talk about.
So today we're going to have my good friend Robin, who you saw last summer.
She's going to join us to break it all down for us.
So stick with us.
Don't go away.
We start now.
Hey guys, and welcome here to the next episode of The Richard Leonard Show.
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Okay, so folks, I'm telling you that the next few weeks worth of the Richard Leonard Show is going to be very valuable to you as the audience.
We talked earlier last summer about this VA Family Caregiver Program.
How there was going to be a purge.
And through our efforts and also the efforts of Veterans Warriors, which is a nonprofit that advocates for vets and many others, there was...
A decision to halt the purge for a few years until Congress could come up with legislation to make this purge permanently go away.
The question now is, are they really doing that?
And so, my good friend Robin has agreed to come on the show for as long as it takes To ensure that all the information is out there.
So that when and if this purge doesn't happen, as well as all the other BS that's happening with this program is not talked about or seen, we can say that it was out there and that nobody listened.
But you're listening, which is important.
So let me bring on Robin.
Hi Robin, there you are.
Hi!
How are you?
I'm doing well.
How are you?
I'm very good.
So, Robin, before we get started, I think that it's important that you were on the show last summer, although it was a pre-recorded interview you did with Ben Krause.
Now that we have you here in the flesh, tell us, just introduce yourself and tell us a little bit about you and maybe a little bit about your husband's service and we'll go from there.
Yeah, my name is Robin Stitt and I'm a wife and caregiver of a post 9-11 veteran.
He was in the army and he was a civil engineer and he served on the infiltration.
Awesome.
All right, so folks, now let's jump in.
Robin, can you help us to understand a little bit about the VA Family Caregiver Program and what the purpose of this program is?
Why is it there?
First, I want to say thanks for the opportunity to come on and talk.
It's really important that we, you know, talk about these things, the good and the bad and the ugly, maybe even more so the ugly.
But the purpose of the program, when it runs correctly, is that the caregiver, by supporting the caregiver, you're really supporting the veteran.
You're getting them the best possible care that you possibly ever could.
Caregivers are fierce advocates.
We will stop at nothing to ensure that our veterans are taken care of.
And folks, I've seen it firsthand.
You know, these caregivers are extremely passionate about the...
I don't even want to call it a job.
Robin, but it is kind of a job.
The job of taking care of their veterans.
It's not just wives, folks.
I think, Robin, when we were at the Federal Advisory Committee meeting, Mr.
Lopez was there, and he takes care of his father.
Yes.
Who is in need of a caregiver.
So it's not just wives, it's not just husbands, but it's also children that have decided to put their lives and their careers on hold to ensure that their parents, who are veterans, are getting the care that they need.
It's parents, it's children, it's everybody.
Yes, yes.
And so let's, Robin, let's talk about also...
What your personal experience has been like since you first got in the program and you've been in for some years and you have told me offline that when you guys, you and your husband first started in the program that it was great and that it was running well and that you really valued it.
So tell us a little bit about your experience through the years in the caregiver program.
So I loved it.
When I found out in 2018 that there was a program that could, you know, support me, I, you know, I applied.
It was painless.
I think that it was like maybe three months from application to approval.
I think my favorite part was my traveling nurse.
I know some people didn't like that part, but she was just the most wonderful woman.
I haven't seen her since COVID because they don't do that.
Well, I think they just actually restarted last month.
But from the time COVID happened until last month, they didn't have the traveling nurses come around anymore.
I can remember trying.
I think I had been trying to get somebody to get a consult in for like two weeks.
And I couldn't get it done.
And she showed up.
And I got a call the next day.
And they're like, well, okay, we need to schedule this.
And I'm just like, she knows what she's doing.
So I liked her.
And that's kind of where it stops.
So let me ask you this now.
So out of all the programs that are available, and I'll admit my ignorance on this.
I'm not exactly sure what all the programs out there are.
But why did you and your husband choose to apply for the caregiver program?
Because the kind of care that he needed was not something that could be provided by a commercial caregiver.
These were things that I was already doing.
I didn't even really realize that these were caregiving duties.
But when you really think about it, it is.
It is.
And then I found out that there was this program and it changed our quality of life tremendously.
I mean, anybody that, you know, has been in and been able to utilize the services that are there, I mean, they could probably attest that it was life-changing as well.
It's just traumatizing now.
What's that?
It's just traumatizing now, though.
The program, the way it operates now, is traumatizing.
Well, we're going to get into that.
Yes.
But I want to make it clear for the audience that are watching and listening to this that the great thing about this program is, and correct me if I'm wrong, is that the veterans and the caregivers that are part of this program I don't want to say there's no other option for care,
but when you are somebody who needs the level of care that the folks that utilize this program do, it's important to make sure that they're comfortable, that they'll follow through, that they'll participate in whatever care or rehab or whatever they need.
And furthermore, doing it in the comfort of their own home.
I mean, we know that veterans who suffer from things like PTSD and adjustment disorder and depression and anxiety and the list goes on and on and on.
Many people have a hard time being in crowds.
And I don't know about the VA where you're at, but I know our VA here in Minneapolis It's big, but boy does it get crowded.
I get uncomfortable in there at times, riding the elevator with 12 different people because everyone's scrambling to try to get to their appointments on time.
And so this type of care, in my opinion, because I don't know any better, it seems unique in a great way.
It is unique.
And one of the most important things that I think is that, you know, for continuity of care, you're not going to have a new nurse, you know, say you have a new nurse every day.
You're not going to be able to see that timeline of, you know, the things that upset veterans or, you know, may trigger them, the different cues that they may have.
You know, and I'll get into that later with respite services, but Really being, it's a really personalized program.
You know, and the level of trust that a veteran needs to have for a caregiver of this kind of magnitude is important.
I agree, a thousand percent.
I mean, I'll tell you what, about, it was maybe two or three years ago now, I started going to the VA in 2007.
And about two or three years ago, the therapist I had been seeing since my very first visit to the VA Hospital of Minneapolis, retired Dr.
Kennedy.
She was amazing.
To be honest, she felt like a whole other mother to me.
And I felt super comfortable going in there.
If I was going to cry my eyes out, it was all right.
If I was pissed off, it was all right.
But I really appreciate her because also she had no qualms about telling me I was being an a-hole or I was overreacting.
And checking me on the things in which we were talking about, which brought me a lot of clarity to the issues I was having.
And then she retired about three years ago.
And the lady that I see now, she's fantastic.
We get along good.
She also is really good at checking me on my BS, by the way.
Good.
But much to your point that you can't always have the same nurse, you can't always have the same care team when you're going, you know, every other Wednesday.
Well, that lady you saw last week may have the day off or her kids are sick or whatever.
So being able to have that, as you call it, continuity of care where you have people who know your They know your issues.
They know your triggers.
They know what makes you comfortable, what makes you happy, what pisses you off.
It's important.
If you need that level of care and you need to be working with the same person all the time, I'll tell you what, if I needed that level of care, I would love to have my wife do it.
Because who else can I... I mean, she knows everything.
So it would just be super helpful to have her there.
And so I think that this program is fantastic, at least on paper.
In theory, yes.
Yes.
Okay, so what do you think are...
We got about a minute and 20 seconds left in the segment.
What do you think is the biggest issue surrounding the program right now as it sits?
Oh, goodness.
The culture.
The culture is...
It has become a program of interrogation.
It's not accommodating.
It feels like these people don't care and that they have a goal and that that goal is to remove you from this program by any means necessary.
You have debt?
Gone.
You have kids?
Gone.
Your caregiver has mental health needs?
Gone.
It's And I can only speak for myself in that regard, but I've seen a lot of people on social media break down for how they've been treated in this program.
Well, you know, it's crazy to me that this type of stuff is happening, and folks, we're going to get into all of it.
But you don't hear about it.
You don't see a lot about it.
You know, recently, the last thing that we've heard about a whole lot from the VA is about the PACT Act.
And who knows if that's even operating the way it's supposed to, and if anybody's going to get the care they were promised.
But anyway, folks, stick with us.
We're out of time in the segment.
We'll be right back.
Hey guys, thanks for joining us this week.
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Hey folks, welcome back here to the next segment of the show.
Last segment we kind of just went over meeting Robin and a little bit about the program, what it's for.
Robin, now I would like to get into a little bit more about what this program is supposed to be offered as far as services and support to people like your husband and to yourself.
What is it that this program is supposed to provide you to provide this care to your loved ones?
Okay, with that being said, there's two programs.
There's the general caregiver program and then the comprehensive program for family assistance for caregivers.
So the first three I'm going to talk about are, they're for both programs.
If you're in the general or the primary, you can use either.
You can use these.
So there's training.
So I think that it was extremely important.
I'm a way better caregiver after taking the training.
There were things that I didn't even know I was doing wrong.
And it taught me de-escalation tactics.
All women love pretty rugs.
I didn't realize that that was actually a fall risk.
There's all sorts of things that I learned that...
I think we're great.
So that's something that was helpful.
There's mental health treatment, but it's different depending on what program you're in.
So if you're in the primary program, the stipend program, you can see a mental health provider.
But if you're in the general program and I'm not positive on this because I'm not in the general program, but your services have to be approved to benefit the veteran and they need to be related to your caregiving duties.
So I'm not quite sure how that works in theory, in practice.
Like, are they just...
Where do they draw that boundary?
Like, okay, well, you can't talk about that now because that's not going to help your veteran.
But so then there's respite, which I think the VA is kind of going a little hard on respite care right now.
And I think respite's great for the people that that works for.
If they can utilize that service and it's available, because I'm not quite sure how available it all is.
That's great.
I am all for it.
But for some, it doesn't work.
I have many hats.
I guess this is how I've always explained this.
I have many hats.
Caregiving is my most important hat.
One of my most important hats.
And I'm not letting anybody wear that hat.
It's not going to happen.
I'd let somebody wear my lawn mowing hat if they wanted to.
You know, they could wear my meal prep hat if they wanted to.
That would help.
That would take a lot off of my plate.
Even just once a week, that would be excellent.
But we're funding it for hands-on, you know, come to the house and care for the veteran.
So there's quite a few that aren't using that service.
Then there's the stipend, and now we're getting into things that are only available for the comprehensive program.
So there's the stipend, and I've never had any complaints about that.
It's always, you know, kind of come regularly.
I'm very appreciative of it.
I want to make that clear.
When you say stipend, you're talking about like financial...
Financial compensation.
Okay.
So then we move on to travel.
So if you're in the comprehensive program, you're eligible for travel reimbursement if you're taking your veteran to the VA. Or I think if you're participating in your own mental health treatment or if you're going to like your assessments and things or your wellness checks...
Then, or not your wellness check, sorry, but, like, if you're doing any kind of traveling for the caregiver program, then you're compensated, but the portal is complicated.
Like, I couldn't, I think it's supposed to be where they deduct your waiver, or your waiver, sorry, they have a waiver waiver.
They waive your deductible.
Sorry about that.
That's tongue twister.
But I've never gotten mine.
I don't know if you have to apply for it, but half the time the portal was broken, so we just use the regular travel benefit and pay the deductible.
Okay.
And then there's Champ VA. So this is a health insurance.
This is a health insurance for a caregiver, for the primary caregiver, not the secondary.
The primary caregiver in the caregiver program.
So let's...
Hold on a second.
Let's talk about that for 30 seconds.
Okay.
So as a primary caregiver...
You're eligible for CHAMPVA. Now you mentioned a secondary caregiver.
Does that mean that, so for your situation, if your husband's sister, for example, also wanted to be a caregiver of sorts, she could be listed as a secondary caregiver but has not as many benefits as you as the primary, correct?
That's correct.
And I'm not positive on everything that is available to a secondary caregiver of a veteran in the comprehensive program.
That might be some homework for next time.
I might look into that.
Okay.
So, the point I'm trying to make, I believe, with the CHAMP VA is that For any spouse that has a permanent and totally disabled husband at 100% rating, they already qualify for this health insurance.
It's already funded.
They have it underneath their spouse's award.
But yet we are funding it in the comprehensive program for caregivers.
We're funding it already.
So what happens to that funding?
You know, I have that question.
I would...
I think that it's, you know, important to know.
Did they, did they use it?
Like, did they reappropriate it?
Where does it go?
So let me just, so that we're all clear.
So you're saying that as a caregiver in the comprehensive program, you already qualify for CHAMP VA coverage, whether or not your veteran is 100% permanent in total?
That is correct.
Okay, so let's assume then your veteran is 100% permanent and total, so you already qualify.
So now also it's kind of a double dip type of thing if I'm understanding it correctly.
It is a duplication, yes sir.
Okay, so then that is a great question because here's the thing.
We are talking about millions, hundreds of millions of dollars To fund this program every year.
So when taxpayers are wondering, where the hell is my money going, and then now we find out here and there that there's a duplication of services, that's an excellent question.
Where is that money going?
Because you would have had it anyway.
So hopefully it's being reappropriated.
We would hope.
So go ahead.
And you would hope that that money was staying in the same realm or being, you know, I'd like to ensure that it's helping veterans and caregivers and that it's not going, you know, towards a staff bonus or a pat on the back to somebody.
It was funded for a reason.
It was funded to help the caregiver.
So I think that that's where it should stay.
That's just my two cents.
Or what if they reappropriated it into the stipend that caregivers get?
That'd be sweet.
Yeah.
Probably not going to happen, but it'd be cool.
Yeah, that's getting into waters.
I'm not sure.
So here's something pretty curious.
So with the Missions Act, Congress required VA to implement a new service of financial and legal support for caregivers.
And I think to caregivers and veterans in the comprehensive program.
So they drafted these new eligibility criterias and they came up with a regulatory, sorry, economic regulatory impact analysis.
This was, I think, published on July 30th of 2019 in the Federal Register or maybe it was regulations.gov.
Anyway, they have it there and you can look and see exactly, I think I even gave you the little clip of it, you can download what they anticipated this program to cost with expansion.
And they figured out, they figured up what the financial and legal services contract was going to cost.
And I don't have 2020's numbers because it didn't give me that in the final version, but I do have 2021 and 2022.
And they paid $12,786,327.
That's what Congress gave to the VA. For?
For the legal and financial services.
The problem is that that contract was just awarded this last fall.
And I would like to say thank you to Dr.
Richardson, Dr.
Colleen Richardson.
She's the Executive Director of the Caregiver Program.
She said at the 2022, it was the October 28th of 2022 Federal Advisory Committee for Veterans, Families, Caregivers and Survivors, that's long.
She made a statement that they just got that contract issued and that it should be running hopefully this spring.
Thank you, because I'm not convinced that we would have ever seen this service.
I don't think that we would have ever seen it.
And also, where did all those millions of dollars go that were appropriated a couple years back?
That's curious, too.
I'd like to know.
Maybe for when the program starts two years later?
I don't know.
So they also funded rental vehicles for the traveling nurses to come to the house and do their annual assessment.
But as I mentioned in the first segment, we haven't had traveling nurses since March of 2020.
Well, maybe you're not rural enough.
Huh?
Are you rural enough for them to come out to your house?
Well, they come out.
So the caregivers are assessed.
The caregivers and veterans are reassessed every year with an annual in-home visit.
That was part of the program.
We just stopped getting the in-home portion of that assessment when COVID happened because of, you know, keep six foot away.
Yeah.
So, but it doesn't matter.
It doesn't matter where you live.
Like if you're way out in the country, it shouldn't matter.
Our home health nurse, sorry, our home assessment nurse said...
You needed to be about four and a half hours.
You couldn't be any more than four and a half hours away from the VA before they did something different.
So they were willing to travel, per my hospital's guidance, four and a half hours away for an in-home assessment.
Wow.
All right.
So we have more millions of dollars for rental cars, but because of the flesh-eating COVID virus, we weren't doing that.
Nope.
So where'd that money go?
Right.
Curious.
I sense, Robin, that there's treachery afoot.
Very well for me.
Let's continue.
What's next?
Eligibility.
Oh, okay.
So let's then...
That's a good point.
Eligibility.
So...
Here's the thing.
I don't know that we should just be skipping past money yet because the benefits that you're afforded, the resources in which you're afforded, what is the total budget for this program, if you know, every year?
So I believe this last year was $1.9 billion.
$1.9 billion.
Yes.
And to the best of your knowledge, how many veterans are in the program?
Oh, I'm not positive on that.
Just a guess to me.
Maybe 30,000.
Maybe.
Maybe 40.
I think that's with expansion and legacy together.
Okay, so let's just say for conversation's sake...
30,000 veterans.
And if every one of them has only one caregiver, that's 60,000 people.
So you're telling me that $1.9 billion to a program that's supposed to support 30,000 families.
Now that's a lot of families, but $1.9 billion is a lot of money.
And when there are things happening, folks, like we're going to get to, I believe that you're also going to ask the same question as I am.
Where in the hell is all this money going?
Why is there millions of dollars going to rental cars?
Why is there millions of dollars going to programs that aren't starting for two to two and a half years later?
Where is your taxpayer dollars going?
And I think that it's quite an important question, and I'm guessing that we'll never get the answer unless we really push hard.
Yeah, I don't anticipate ever getting an answer on that.
It's just something that made, you know, the gears start turning.
When I started, you know, I saw all my peers just get dropped.
They're just dropping like flies out of this program.
They're saying, you know, my husband's a paraplegic and the VA's saying that he doesn't need any care.
There's people with, you know, end-stage dementia.
And the caregiver program is saying they don't need a caregiver.
And I'm like, if we're all kicked out, where's the money going?
I want to see the receipts.
And I've said that since March.
You know, I even told my caregiver program lead, I said, I'm a fast reader.
I said, I'm a fast reader and I will figure out what's going on.
You know, and I read an OIG complaint.
Stating that the VA, sorry, VHA, Veterans Health Administration, failed to govern the program's leadership.
And that, you know, there's been many OIG complaints and Government Accountability Office audits, and they all kind of mirror the same thing, that They just did what they wanted.
I mean, heck, there was even a comment in there that they were paying, the caregiver program was paying just random hospital administrators and random doctors and nurses.
And I mean, like when you really, when you start critically thinking about this, like, Why are they paying people that aren't...
And they're not detailed at the caregiver program.
And it even says that, like, you know, the caregiver program has the authority to kind of, like, consult out and ask people to come and help.
And they can pay for those services, but they've got to be detailed to some form of caregiver duty.
These people weren't.
These employees weren't.
And it doesn't say who or where, you know, because they're not going to tell on themselves.
The VA is investigating the VA. Mm-hmm.
But when you really stop and think about that, what comes to my mind is that I go to my doctor, my husband's provider, and I say, hey, we need everything documented for what he has going on, what he needs a caregiver for.
Can you help me?
And they say, you know what?
I can't.
I can't help you.
That's not part of my job.
Hmm.
So now we don't have the evidence that we need in our chart to qualify for the program because this is a clinical program and you have to have all the documentation in the chart.
So, you know, did that provider in turn get a staff bonus out of the caregiver pot?
You know, these are just thoughts.
I'm not saying that's what happened.
Maybe that's where the extra champ VA money goes to.
Huh?
Maybe that's where the extra champ VA money goes.
That's what I'm saying.
That's what I'm saying.
All these extra monies, where are they going?
And until they do a full audit, a public audit, where the taxpayers can see where that money went, we will never know because the VA investigates the VA. Well, I'm guessing that that would be a situation where you hope in one hand and crap in the other and see which one fills up first.
Folks, stick with us.
We'll be right back.
Hey folks, welcome back here to the next segment of the show.
We've covered a lot of stuff today, and Robin, I want to thank you for your candid talk and your clarity.
But let's move on now to eligibility.
You were telling me offline that eligibility was one thing, then it became another, and now it's being redone.
What is the eligibility standards for the VA caregiver program look like now?
Well, right now, you require assistance with activities of daily living, hands-on assistance, each time the activity is performed.
And it is supervision, protection, and instruction.
Activities of daily living.
What does that mean?
I think people are going to be wondering, what is that?
Yes, sorry.
So you need assistance with eating, grooming, bathing, dressing and undressing, toileting, mobility, prosthetics, all those things.
So just to get out of bed and function for the day?
Yes.
Okay.
Yep.
So, I guess I'm going to go into what, you know, the good things that they changed when they did the expansion, because that's when they changed the caregiver program eligibility, is when they did the Missions Act expansion.
So, the 2020 final rule...
They allowed illness or injury of any kind to be something that the caregiver program will help you for assistance.
It used to only be service-connected injuries.
So if you needed help ambulating, moving around because you were in a wheelchair, then that would be something.
But it had to be a service-connected injury.
And now we have opened to all eras of veterans, which I think is great.
They all raised their hand.
Every last one of them.
A veteran is a veteran.
They should all have the choice to participate in this program.
But then I'm going to get to the bad things.
So they removed the IADL portion.
And so what that means is that instrumental activities of daily living, these are things like cooking, planning and organizing, driving, driving.
Kind of the things that people that need supervision and protection and instruction would need.
But they removed those.
There's also, they changed all the definitions.
And I'm not quite sure How that's okay.
I don't think that Merriam-Webster would be okay with me just redefining what a tree is.
But that is exactly what the VA did.
They redefined need for personal care services.
They changed that serious injury now means that you have to be 70% or 100% service-connected in order to even think about participating in the program, which is unfortunate because I don't think that ratings necessarily equate to need.
And once again, if this is a clinical program, we should be looking at the needs and not what's written down on paper for a service rating.
Yeah.
So the problem that I take, and I think that the 90% denied and discharged take with the regulations for the activities of daily living is that now VA requires that these services are provided hands-on each time that the activity is performed.
So for instance, if, okay, like my dad had COPD. Mm-hmm.
So he could get up and use the restroom.
He could do that on his own.
It was a struggle, but he could do it.
But he couldn't get back into the bed because he got up.
He doesn't need help.
He doesn't qualify now.
So hold on here.
Let me try to wrap my mind around this.
So you're telling me that if...
Okay, let's say that my wife and I are in the program.
Okay.
And I have trouble getting out of bed.
But a couple days a month may be a good day.
And I say, honey, I'm going to do it myself.
And it might be a struggle, but I get myself up out of bed.
She's there to make sure I don't fall or whatever.
Which would be a sign to me, if I was a caregiver, that maybe this is a step forward to gaining some more independence.
That disqualifies me from the program?
That disqualifies you.
That instantly eliminates you as being eligible for this program.
So we want, hold on, I'm sorry.
We want veterans to stay in their, what I would call, in their misery.
Don't celebrate that win.
Don't celebrate that win.
We can't tell people, hey, guess what?
Joe, I got out of bed today on my own.
Nope.
Because now we may lose our benefits.
That is exactly true.
That's ridiculous.
If you have a lumbar injury and you can put your shoes on in the morning, but then after, you know, walking around and doing other activities of daily living, you have become so inflamed that you can't bend over and take your shoes off.
Nope.
You don't qualify.
You're out.
You're out.
And then on the flip side for the mental health portion, it's tailored strictly to safety.
They don't, VA, the way the regulations were written, because once, like I said, veteran warriors sued the VA, and we'll get to that in a minute, but they sued the VA and they changed it back to statutory language, which I'm thankful for.
Thank you guys.
I don't know whoever's doing that, but they are on it.
But, so it's tailored to safety now.
It's not for quality of life.
Like, you can't instruct a veteran on how to cook a meal or how to, you know, plan out a shopping list and then help them go to the store and drive them there and get these things.
It is strictly for safety.
So if they need instructed to not burn themselves when they cook, Then that might qualify them, but it's got to be constant.
Like, I'm not quite sure when they expect the caregivers that they would enroll, the veterans and caregivers that they would enroll.
I'm not sure when they would be expected to even sleep.
With how restrictive these regulations are.
Well, that was going to be my comment.
I mean, if you have to be there 24 hours a day to remind your husband, hey, you're making ramen, don't burn yourself.
And then three minutes later, hey, hon, don't, hey, be careful, don't burn yourself.
Are you able, are you supposed to just sleep when he, what if he's got insomnia and he doesn't sleep?
That means you don't sleep?
I guess.
I'm not quite sure.
I don't think that very many people got in under the SPI portion underneath the old rules.
And that's why the interim final rule that extended the legacy's participation until 2025 is so important.
Because veteran warriors' lawsuit...
Challenged all of these regulations and they won the SPI portion.
The Federal Circuit agreed and said, yeah, this, you guys can't redefine this, quit it.
You know, they told the VA, like, knock it off.
And so now we all have to be reassessed under new regulations.
And so they're cited 30 times in the interim final rule in the Federal Register.
I think that's pretty neat.
Nobody else, nobody else brought that policy change but veteran warriors.
Well, but let me ask you this.
We'll get to Veteran Warriors in a second, because I'm a little, my gears are grinding here, Robin.
You're fine.
Well, it pisses me off.
What is the point of all this care?
What is the point of veterans getting care in the first place?
Is it just to maintain where you're at and just stay at this deficiency, I guess I'll call it, until you die?
Or is the point of getting care getting better, having these wins that we just talked about?
Doing things to gain some independence, to gain some confidence, to be able to look your children in the eye and not have to feel like you're an invalid.
Hallelujah.
But here we're going to change eligibility standards.
I can barely even talk.
I'm upset.
But we're going to change eligibility standards so that our veterans have to stay on this level.
Ridiculous level where when and if they get up and be able to do something for themselves, we're going to penalize these guys and gals for that?
Well, that's bullshit if you ask me.
Why the hell does anybody...
Why would anybody even fight?
Why would any of these veterans even fight to keep their lives at all?
If I got to stay down in the dumps or lose my benefits or lose my payments, I lose my prescriptions, I lose my ability for my wife to have some kind of benefits, insurance, mental health, anything...
I gotta stay an invalid?
I can't get better?
That's asinine.
Don't you remember me telling you that this program was traumatizing now?
Yes, I do.
And I get it.
And I hope everyone who's watching and listening, I hope that you are grasping this as well.
Because as all of this information unfolds, it just becomes like it's an ongoing losing battle.
I would really hope that the focus of the VA and the point of this program is to build veterans up.
Because at one point in their lives, Robin, they raised their hand to serve their country.
They were in the right place at the right time, in the right uniform, doing the right thing.
Most of us were.
There are some shitbags in the bunch.
Now that we have sustained whatever conditions it is that we have because of our service, you're telling me I gotta stay down in the dumps.
I gotta stay in the dumpster.
I can't sit up high on some perch and be proud of my service and proud of who I've become.
And even though I fell down into the dumpster, I built myself back up, I can't do that or my family's gonna lose everything.
Yeah.
Sorry, let's continue.
So, you know, it takes a It's something, you know, it's important to kind of look about how we got here, how these, you know, regulations became, because it wasn't always like this.
And, you know, and I kind of, I've noticed, even just from going to the Federal Advisory Committee, how different people perceive this program, like the people that were entered in 2020 to now, versus the people that were in, because I was in, I got in in 2018.
And I loved it.
And then I talked to somebody that actually got in it in 2012 and they were like, we had like hero miles and we could fly our parents in and they could help us take care of our family.
And they paid for all this.
And I'm like, what?
Like we never had that.
You know, and I'm thankful for what we did have because there were many that didn't have even what I had.
But this program has the potential to operate so cleanly and smoothly.
Because it did at one time.
So like, why can't we just go back there?
But I guess let's look at how we got here.
So in 2011, we start the caregiver program and it was implemented at the VA as statutory language would have it ran, which means how Congress intended.
And then sometime in like the 2015-16-ish time, we start seeing the Centralized eligibility assessors.
It's kind of they're implementing a directive called 1152.
And these centralized eligibility assessors are basically going through and starting.
They're evaluating everybody on their tiers and their...
Their eligibility status.
Whereas before, when it was acted as Congress intended, the primary care team was making these decisions.
So the people, the providers that actually dealt with the veterans on the hospital floors were making these decisions.
So now we've given the authority for eligibility into these centralized eligibility assessors.
And I ran across an interesting article where there was a triple amputee, I think from Tennessee maybe, And an OBGYN dropped him from the highest paid tier down to the lowest.
And it was hot news.
What?
Wait a minute.
Wait a minute.
You're telling me that...
Well, first of all, since when does the VA have...
I guess they have OBGYNs.
I didn't know that, but it would make sense because there's women veterans and they have babies.
I get it.
But what the hell does a doctor who is trained to deliver my child that my wife is giving birth to, why is she making an assessment and a decision on the file of a veteran who has issues because he lost three of his limbs?
What does she know about it?
I think a lot of people had that same question.
I think there was some pretty big...
Nonprofit organizations were wanting to know the same things.
They were just, everyone was like, how did this happen?
This is ridiculous.
Why are these people being demoted?
And why are they having to check in annually to check if the limbs are still there?
He already lost them, didn't he?
They're gone.
Right, so why are we reassessing?
It just doesn't make sense to me.
But we will go through at a later episode on the guidance that was given and the training modules, maybe kind of how they were used during this time frame.
So we noticed, you know, that all these caregivers and veterans are getting demoted.
They're getting their tears dropped or they're just getting graduated out of the program.
So what does that mean?
Real quickly.
So there's tiers of benefits in the caregiver program.
So that is the old model.
It used to be three tiers and that was how they decided what your stipend rate was going to be.
Now there's only two levels.
So they took him from the highest paid tier down to the lowest paid tier.
Because his limbs grew back and he was able to care for himself?
Right.
And the baby doctor knew that.
The one delivering babies knew that.
Jesus Christ, sorry for interrupting you.
It's hard to wrap your brain around sometimes.
You think about the absurdities and how none of this is even common sense, it gets really frustrating very quickly.
So let me ask you this quickly.
I'm sorry I keep interrupting you, but I am made of questions.
So let me ask you this.
Who is evaluating these veterans?
Like, I really hope that you're going to tell me that if I was in the program...
And I go for my yearly re-evaluation.
Is that what they call it?
A re-evaluation?
Annual reassessment.
Annual reassessment.
So when I go for my annual reassessment, please, please, please tell me that I'm going to see my primary care doctor or a doctor I've been working with in polytrauma.
Absolutely not.
Absolutely not.
Well, who the hell am I going to?
A social worker.
What?
What?
What the hell do they know about my medical conditions?
Right?
Whose idea was this?
Leah Christensen's idea.
She presented...
I was wanting to get onto this on another episode, but we can talk about it briefly.
We've got about four minutes.
Okay, so Leah Christensen presented at the Special Medical Advisory Committee...
For the expansion and how they were going to do the eligibility and the assessments, I guess, is what I mean.
So she trained the staff in probing questions and the, let me see, it was the assessment criteria or assessors criteria was social workers, Someone else and the...
Anybody on the clinical team, I believe.
Yeah.
On that veteran's individual clinical team?
Or just a clinical team?
Anybody on the clinical team.
And I think, like, I don't think that there's...
They don't have to be credentialed at all.
They just have to have taken a training module.
They don't have to have any medical background.
I imagine it could probably even be a janitor.
Everything at the VA is governed by policy, and the policy states that social workers operate underneath other medical providers, and those medical providers don't even truly understand the nature of social work, so they can't even hold the social workers accountable.
But the social workers don't understand the medical, the doctor's job.
Yeah!
And this is what we're really talking about, right?
Like medical care.
So what the hell are these social workers...
Hey, if I need to know where I go to get welfare, and if I am a child in a home and being beat up by my parents...
Okay, social worker.
Yeah, let's talk to the social worker.
But when I'm going to get evaluated for the level of care I need for my daily living, for my medications, for my limbs that I lost, for anything that has to do with my physical well-being, that social worker can kiss my ass...
Because she doesn't hear, she doesn't know.
I feel like they are operating completely outside of the scope of their practice.
Absolutely.
I think that they have, potentially, the VA has a lot of malpractice lawsuits because...
And some workers shouldn't be evaluating medical.
I understand that they have their place when it comes to mental health, but I truly believe that when you cross into the realm of medicine, we wouldn't allow a receptionist to determine an MRI to say, oh, well, the patient needs surgery or not.
No, we would go seek the surgeon's opinion.
Absolutely.
Listen, I've had two surgeries at the VA, surgery on my throat.
I didn't go to the dentist to see.
I didn't go to the podiatrist to see about surgery on my throat.
I went and saw the guy that was going to perform the operation.
This is absolutely asinine.
And we're only in the beginning.
Like I said, in the beginning, the clinical team for the veteran, the primary care team, The primary care provider determined eligibility and now we go through social workers to assess the veteran.
Those assessments go to seats, which is a group of social workers, potentially a nurse, sometimes a psychologist, and then they will interpret those notes.
And they're not any more qualified.
It's like the blind leading the blind.
Unbelievable.
Unbelievable.
Should a social worker be on the team and maybe have a part of the conversation with the primary care?
Yes.
But to make the decision, absolutely not.
All right, Robin, we have about one minute and ten seconds left.
I want to make sure that we...
Give you the last minute or so to have the last word.
It's important to me.
So go ahead.
I'd like to leave everybody with a call to action.
I would like each one of you to really think about what this program means to you and what life looks like without it.
I know for me, I think of what it used to be like without these supports and services, and that's frightening to go back to.
I'd like each one of you watching to please reach out to your state and federal representatives, call your congressman, tell them your story, tell them everything that you've experienced, and tell them that we need some good legislation to get this program moving in the right track.
Yeah, I agree.
I agree.
And I'll tell you what, anybody that's watching or listening to this that has nothing to do with this program or veterans or the military, this is still important because one point something number billion dollars a year goes to fund this program.
And these veterans, it appears, and we're going to unpack a lot more of this in the weeks to follow, but it appears that veterans are not being taken care of the way that they should be.
So think about being a family, a caregiver to a veteran and losing everything.
In 2025, when this purge is set to happen again, unless they make some serious changes, which it doesn't seem like is happening, but they have time.
That's all we have for you this week We'll be back next week Thank you for joining us.
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