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Feb. 26, 2023 - Stew Peters Show
56:47
The Richard Leonard Show: The VA Caregiver Program: Hindrance Or Help? II
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We'll be right back.
We'll be right back.
Last week, my good friend Robin and I brought you a lot of information about the VA Family Caregiver Program.
Today we're going to keep unwrapping all those issues.
I want to thank you for joining us here tonight, but stick with us.
Don't go away.
We start now.
Hey everybody, welcome here to the next episode of the Richard Leonard Show.
I want to thank you again for joining us.
Before we get started with Robin, I got her on the other line.
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Okay, so before we bring Robin in, I just wanted to recap on last week.
We started to unwrap this debacle that is the VA caregiver program.
And so we're going to continue doing that tonight.
And folks, I'm telling you, there's a whole lot more to come.
I don't know that we're going to even get through everything this evening.
But trust me, there's bombs that are going to drop eventually.
So last week we started with, we met Robin.
We did some introductions about the program and what it's supposed to be.
And so today we're going to continue on down that road.
So let me find Robin here.
There she is.
Hey Robin, how are you?
Hi, how are you?
I'm very good.
Thanks for coming back.
We really appreciate it.
Thanks for having me.
You are very welcome.
Let's dive right in.
So I think where we should start this week, Robin, is...
Can you give us some information on the inception of the program and how it progressed to start to derail?
And I understand that the derailment started before even maybe you were in the program, but you have a lot of peers and you guys are an amazing group of people.
Can you give us some insight about how it started to come off the tracks?
Yeah, so I think the program started in 2011.
They implemented it as law, I think, as the veterans, the caregivers omnibus of 2010.
I know I butchered that, but they wrote it into law.
They implemented it in 2011, and I think that people really enjoyed it.
It was the primary care provider would determine the eligibility and if it was in the veteran's best interest to participate.
And there was no time limit.
As we'll get into that in a little bit, I'd like you to remember that.
Okay.
But about, I think it's 2015, there was a leadership change.
I think the deputy director at the time took over the national director position.
And with that, we started to see clinical eligibility assessors.
These seem to contradict the law as it was written because, as I said, the primary care provider was to be making these determinations.
They treat the veteran, they see them, they interact with them, and they know their care needs.
And, you know, I think it was last episode we were speaking about the OBGYN that had assessed a triple amputee, wasn't a part of the care team, and just determined that they didn't need the third tier worth of support that they got, you know, knocked down to the first tier.
Right.
So we started seeing those problems, and with this leadership change, I think the program got new regulations and a new training module.
And that's kind of what we were going to start discussing today.
So this is where the program went from me getting evaluated by my primary care provider or a team of medical doctors or whatever the case may be to being evaluated by anybody.
I think we talked last week about anybody on some clinical team or a social worker?
Yes, I believe so, yes.
Okay.
All right.
Well, look, we're like five minutes into the show and I'm already sweating.
Let's continue.
Okay.
So I'm going to put these slides up on my Twitter.
And so if anybody wants to follow along, my Twitter handle is at Robin underscore Stitt.
And it's all lowercase R-O-B-I-N-S-T-I-T-T. We will have that in the description of the show, folks, in case you want to go over there and see.
And also, all these documents that we're talking about will also be up on my Telegram.
So they will be readily available to all of you, should you be interested in taking a look.
So we're just going to dive in.
So the first slide is the caregiver support program training and education presents challenging discussions.
So this is a work group And the members, I'm not really going to go over all the members.
There is one that sticks out.
I've seen her name quite often in this kind of this realm.
Her name is Leah Christensen, licensed clinical social worker, VISN 20 lead and caregiver support coordinator at the VA Portland Health Care System.
And remember, this is back from, you know, the 2015-2016 era.
I don't think that she is the caregiver support coordinator anymore.
She's in charge of the general program now.
And she's the one, Robin, if I'm not mistaken, that has been vocal about fixing this program, correct?
No.
No, okay.
See, I was wrong.
It's a good thing you're here.
No.
So we'll get into Ms.
Christensen later.
We have types of challenging news.
We have administrative and clinical ineligibility, tiered changes, revocations, appeal denial, and transferred cases.
So we're going to be talking about the challenging discussions we have over these topics.
So, communicating the nature of the program.
So they go in to talk about how the support, that's great, but then they get into recovery and goal-oriented.
Why are we talking about recovery and goals?
That's great for people that had surgery and might get better or they just had their injury and they're working towards getting back to health.
But that's not the case for everybody.
There's a lot of people that have their baseline was measured shortly after they were injured and they have gotten to like the maximum amount of function that they'll ever be at.
So I don't think it's very appropriate to even have that little portion in there.
Not to mention Robin that as we talked about last week That if we set goals with these veterans and they achieve them, then they're no longer eligible.
We will get there, yes.
You're a quick learner.
I'll let you drive, I'm sorry.
It says, how will being in this program help you reach these goals?
This is a clinical program, it is not a disability benefit.
If that's the case, if this is a clinical program and this is part of my veterans treatment plan, why are we letting outside people take the driver's seat on eligibility decisions?
Shouldn't it be someone in the medical chart that deals with my husband on a daily basis or each appointment?
These are people that they're not even treating providers.
My husband's never seen these people.
So we'll move on to goal setting with the veteran.
So we have measured the dyad's growth and or engagement in the program.
And we don't have time today, but in a later episode, I want to go over the query.
I think that's how it's pronounced.
It's the Q-U-E-R-I. It's the quality in, I think, engagement or Evaluation, quality evaluation and research.
So I didn't know that we had been a part of a research study this whole time.
Everybody that's been in it has been a part of this.
I was never asked if I wanted to participate in research.
That was really hard to find out about.
What kind of data are they collecting on you, unbeknownst to you?
Everything.
Everything.
So...
Be more specific.
What do you mean everything?
They collect our demographics.
They check to see if we're taking the veterans to their appointments, which is great, but they have studies showing where we actually cost the VA a lot of money.
And then now we have regulations based off of these studies that evidence-based research gets evidence-based policy.
Well, of course this program costs the VA a lot of money.
We're treating veterans.
It costs money to do that.
It costs money to shove them into harm's way and not necessarily worry a thousand percent about how they get the job done, but get it done.
And now we're now we're we're researching in secret families and veterans and and then making policy to restrict them when because it's too expensive or whatever the case may be.
That's going to be my first flag of bullshit tonight.
Well, we'll go over we'll go over there.
You know, we'll go over the studies another time.
But I'm going to move on.
It says, how can we support your efforts towards reaching the goals in this quarter?
What are your plans for when you transition from this program?
It's not an if, it's a when.
When the veteran transitions.
So they've already consigned them to being discharged.
So what are your goals towards increasing your independence?
Which, you know, I agree with that.
I agree with that.
But if they're going to be used to discharge you, then I don't agree with it.
And that's what this comes down to, folks.
When we read this, remember that this resulted in purges.
Uncountable people were discharged.
I mean, we know in just this last March, March 2022, over 90% were discharged.
So when we go to goal setting with the caregiver, it's a similar slide, but they say, what are your goals for when you, if you were to transition from this program, are you going to go to school?
Are you going to go to work?
What does recovery for the veteran look like to you as his or her caregiver?
And, you know, to that, I almost feel like that's cruel.
I mean, it's kind of cruel to ask somebody what recovery looks like.
We think about that all the time, and it's not going to happen in some cases.
Sometimes we're just maintaining what we've achieved, you know, the small wins.
Well, and it doesn't seem like the VA, in this instance, is...
Is fostering recovery.
And so, you know, maybe it is a little insensitive because veterans get into this program, if I'm understanding correctly, because they cannot perform daily living activities.
And so, to be able to think about going from, well, I can't put on my socks or I can't tie my shoes or I can't shower myself, to then, hey, are you gonna go to school?
How about if we are going to set goals, Robin, why wouldn't the goals be tangible?
Like, hey, how about you stand in the shower, bathe yourself, wash your hair, and dry yourself off?
If that's something you can't do, why shouldn't that be the first step of a goal?
Why are we talking about what it is we're going to do when we get out of this program?
Kind of putting the cart before the horse.
Absolutely.
So if we move on to consistent communication, so it says repeat and reiterate the program goals and objectives in writing and verbally throughout the relationship.
I know I ask you these questions each time we touch base.
I need to take a moment to review the roles and responsibilities document again.
Can we do that now?
I just want to acknowledge that it looks like you both have been working very hard towards your goals.
But this is a challenging discussions work group.
So why are we putting that these goals belong in this challenging discussion?
And it's because anytime these goals are met, you're discharged.
Yeah.
It's kind of a loaded question.
And so this is part of the training that these social workers are getting when they are allowed into the program to...
The caregiver support coordinators, yes.
Okay.
And the caregiver support coordinators are the ones that are social workers?
Yes or no?
Yes.
Okay.
All right.
Yes.
So if you go to communication through transitions, be upfront in the beginning that the veteran has the potential to transition within tiers and out graduation or revocation of the program.
Once again, if they are, you know, at the beginning of their journey and they do get better and they, you know, they transition out, then, you know, I support that because they don't need it.
But this was kind of like a blanket.
Everybody got kicked.
So it, you know, take it for what it is.
It says, stress the benefits of the caregiver support program, anticipated outcomes of providing support to the caregivers.
um so basically i guess i take this as our support is so mighty that we're gonna you're gonna we're just gonna support you straight out of this program you know if they're no longer clinically eligible remind that the stipend may continue for 90 days which i don't think that very many people were afforded that during the in this time frame in like the 2015-16 i think that they were Booted and like their stipends just stopped.
Just cut off.
There wasn't another month.
It was just like that you're done.
You're kicked out.
And it says caregiver support program is still available to support all caregivers.
You know, because once you're bounced out of the comprehensive program, you've always got the option to go into the general.
Well, I'll tell you what.
If you bounce me out, the general can go fly a kite.
I mean, I don't know.
It's like being promoted in the military, right?
And then 30 days later going, well, hey...
You know, we're going to keep your promotion, right?
So you can stay in the program, but you're just going to have, like, nothing to do.
So you're just going to be over here with no soldiers to lead or no responsibilities.
But, hey, you get to wear the rank.
You know, like, people don't get into these things With the idea that they want to be downgraded.
I would imagine that caregivers and their veterans are hard charging.
Of course, everybody wants their veteran to get better.
Yes.
But if you are in a situation where it is that you need to just maintain and not get worse, and then have that be a baseline where you can maintain it and then work on getting better.
And it doesn't happen overnight, I would imagine.
This is a long journey for a lot of people.
It's a lifetime journey.
Yes.
Well, for many, I'm sure it is.
But I would also think...
That there are people in the program that do get better, right?
That's a thing where these veterans get better and then they leave the program because, like you said, they don't need it anymore.
Right.
But I believe that that should be a discussion to be had between a veteran and their primary care physician.
A thousand percent.
Absolutely.
So we'll move on to the next slide.
It says depersonalizing Continued.
Caregiver support coordinator is the liaison between the dyad and the clinical team.
And the dyad is just the term that they use to describe veterans and caregivers as a pair.
It says, let me take this to your clinical team.
The clinical team's findings indicate a change in tier level is warranted.
And to that, I would say, no thanks.
Like, I'm not hidden.
And I can speak for myself.
I don't need anybody else to talk to the clinical team for me.
Like, let me talk to the clinical team.
Yeah, but you see why that's a threat, right?
Well, yes.
It says that the caregiver support coordinators need to preserve the clinical relationship between the caregiver support coordinator and the dyad after the tear reduction.
How can I help you with this change?
Can I assist you with an appeal?
So the same people that are bouncing and reducing tears are the same people that are pleading the appeals.
They're the ones creating the appeals and giving them back to the same people that bounced them.
And so this is where I wanted to kind of speak about Leah Christiansen.
So her facility was the first to be accused of purging caregivers and veterans from the program.
So I'm going to quote a, or I guess read from an article called The Oregonian Watchdog.
It says, Leah Christensen, the Portland caregiver support coordinator, says the agency is not under any directive to cull the ranks of participants.
She says the way Portland evaluates whether vets are eligible is considered a model for other regions.
We do what we can here to treat everyone equally according to the guidance that has come down.
Yeah, so somebody gave the guidance.
To start bouncing people.
Yeah.
Who?
I mean, you'd have to look to see who her boss is.
And so the article goes on to say, but the program in Portland is an outlier.
VA officials here are more likely to kick veterans out of the caregiver program than anywhere else.
Although the decisions can be appealed, vets in Portland are forced to rely on an opaque system that offers little explanation and not a single appeal case has been reversed here.
So, if we're preserving, as this, you know, depersonalizing slide would make us believe, if the caregiver support coordinators are assisting with the appeals to preserve our relationships, but none of the appeals are being won.
I'd say you need new counsel.
Right?
That's what I would agree.
Because this would also suggest that the folks that are bouncing people and denying appeals don't ever make mistakes.
They don't ever proceed without all the information, you know, or they don't ever misinterpret what they're reading on a piece of paper.
Or what I fear is more likely the problem is that they were just setting out to kick folks out for whatever reason.
Well, there's been OIG reports that have stated that the appeals weren't handled properly.
I think sometimes they just weren't even getting, they would just sit on desks for months and months.
I think one was like almost a year, just sat there.
I mean, and these are supposed to be the people that are supposed to be supporting us.
Some support.
Okay, well let me ask you this.
Do you think that maybe part of the issue was, and I'm just playing devil's advocate here, that they were understaffed and just so busy that they couldn't handle the appeals?
That could be the case.
That could be the case.
I wasn't in the program at this time.
I'm betting that's the excuse they used.
Whether or not it was true is another thing.
I think that there's a lot of excuses that get thrown out there.
Of course.
We'll move on.
It says ways to approach a difficult revocation case.
So here is where this one, this slide's hard to read.
It upsets me.
It says, we have greater clarity.
An error was made when your application was processed.
The tier was added correctly.
Or another excuse could be, line of duty wasn't established.
Or another excuse could be, you are a pre-9-11 veteran.
Like, I just don't even know where to begin on this, I guess.
First, like, so did we meet our goals and meet the purpose of the program and get discharged?
Or did you guys make a huge, like, did you guys make an error?
Like, these are unmistakable.
Like, how do you put...
A pre-9-11 veteran in a program that at the time they were only letting post-9-11 veterans in.
Well, here's what I bet happened, Robin.
What I bet happened was that there's ignorance and there's just lack of maybe intelligence, but lack of people that care.
They were just reading what they wanted to read.
They were letting folks in and then somebody checked them.
I would like to think that there are still some kind of checks and balances Situation going on in the VA and somebody went, well, hold on here.
Now we have veterans that served before 9-11.
This is a post 9-11 program.
So we gotta bounce these folks out.
So now that we're, you know, that case in particular, now we're bouncing folks out who got in And shouldn't have, but it's not their fault.
So now, here we are already, all the way back in 1516 or whatever this was, we're affecting veterans' lives negatively.
And the program is new.
And I'm sure that the hits just keep on coming.
But folks, stick with us.
We'll be right back for the next segment.
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Hey folks, welcome back here.
We're going to dive right back in.
Robin, so after all of our conversations, our conversation last week, and today up until this point right now, it really makes me wonder, and it's becoming a lot more clear, that it's very difficult for folks like you and your husband and other caregivers and veterans To be able to trust the VA that they actually have your husband's best interest in mind because after all,
this program is all about serving veterans and making sure that they have the support that they need.
Now, I also am starting to see that through this training stuff that we were talking about that it's very, very possible That some of these caregiver coordinators can be probably quite nasty, less than attentive to the needs of you and your family.
And if so, if that is true, can you provide us some insight about how to deal with that?
Because I would imagine that you don't really have a choice about who your coordinator is, nor can you probably say, you probably cannot say, I don't want to work with Sally anymore.
Her and I don't get along.
So what is the best way, in your opinion, to handle that issue, to make sure that you're still getting the support for you and your family that you need?
You know, I think that if you get an opportunity to attend, at your facility level, a listening session with the current Executive Director, Dr.
Colin Richardson, take that opportunity.
Take it, don't miss that chance.
I think that there needs to be a cultural change, a shift, and I think that she's the one that's bringing it.
She really does listen.
Tell her what works and what doesn't work.
Tell her, and she can help us.
And have you done this ever before?
Yes, yes.
Okay, so you have some context for why you're supportive of her.
Yes, yes.
Okay, good.
I had a listening session with her and she had some really, you know, great ideas on how to fix the problems that I had.
So I'm sure that she's got great things for the problems that the viewers may have.
And did it work out?
Yes.
Okay, well that's positive.
So, folks, I want to just make sure that we're pointing out here that Miss Robin and I aren't just getting on here for an hour to just bitch about the program.
But there are things that are really broken with this.
But yet, as we've just learned, there are people within the program that do care about Robin and her husband and many other caregivers and their veterans.
And so, Thank you, Robin, for sharing that because I think it's important to have that context to make sure that folks know that it's not just the big bad VA. I'm not trying to say that everybody at the VA is bad and I'm not saying that every caregiver support coordinator is awful.
I am saying that these are the documents that I am reviewing and this is what it's making.
This is my takeaway from it.
Well, you know, I think that it's...
I would really hope that these listening sessions are offered often.
You know, and let me ask you this.
When you and I and Ben Krause and others were in Washington, D.C. to go to the Federal Advisory Committee meeting, was she supposed to be there?
Well, I thought she would be there.
There was nobody there.
We were bluntly told nobody showed up.
So I actually reached out when I got home.
She sent an email back stating that she had, in fact, informed the Federal Advisory Committee two times that she was not able to attend on those dates.
And they went ahead and scheduled it anyway.
She was actually at my hospital.
I even asked if they would do a virtual option for me, which they weren't able to oblige.
Go to your listening sessions, folks.
If you get the opportunity, go.
It's important that she hears from everybody.
The good, the bad, and the ugly.
Well, and it seems like that she's the one that can really start this cultural shift that needs to happen.
I believe that, yes.
Well, so folks, there it is.
How does somebody, Robin, go about signing up for one of these sessions or finding them even?
You know, I'm not sure.
I think that, well, my local team called, my caregiver support coordinator called and asked if I wanted to attend.
So I imagine that she, you know, will probably do them.
I think that if you just even, you know, ask your coordinators, ask your caregiver coordinator if leadership will be showing up and, you know, make sure that you attend.
And are these one-on-one sessions or is it like a town hall type thing where there's...
I think it's like a town hall kind of a thing, yeah.
Okay.
But it was a really safe space when I did mine virtually and I did one this summer.
Okay.
Well, folks, there it is, right there from the horse's mouth.
I mean, it seems to me, Robin, that we're getting to a point in this process with this program and the VA... That it's going to take a village to help to start make some change.
It can't just be Robin Stitt and veteran warriors.
It's got to be more people.
You have to speak out.
If you are going through troubles with this program, don't sit down and take it.
We all know a squeaky wheel gets the grease.
So you have to be able to have the guts to stand.
Because there's a lot on the line.
There's a lot on the line for all these folks that are involved with this program.
And I would imagine that a lot of families are living with this idea of this impending doom coming in 2025 if there aren't changes made.
And so we need to be loud.
We need to be louder than we ever have been.
And really force their hand to make changes to protect these veterans and their caregivers.
I think that it's super important.
Robin, what's next?
What do we got next to unravel?
So we were going to go over some of the seat meeting minutes that they had from the earlier days when they were bouncing caregivers out.
So the first one says, would like to get the home health program to a more manageable size by referring people to the general caregiver program.
Letters will be mailed to approximately 140 veterans this week.
But the team addressed concerns with calls being filtered to the caregiver support team about the letters being mailed out and the veterans and caregivers thinking that the general caregiver program will include a stipend like the caregiver support program does.
So why are we bouncing people out of the home health program and sending them to the general program?
Well, hold on here.
Isn't being comfortable at home while receiving care the point of the program?
Yeah.
But these are from the home health program.
Like, why are we bouncing them out of a completely separate program that doesn't have anything to do with the caregiver program?
So these are commercial caregivers.
This is a program for commercial caregivers.
And we're bouncing them out of that paid caregiver program and into the general caregiver program.
Interesting.
I mean, do they have family caregivers?
Do they even have anybody at home?
So, but, you know, make sure that they know that there's no stipend.
We don't want to pass that out.
You know, the next one goes on to say, veterans on the program for three plus years, try to discuss transition with the veterans and their family members.
Transition to where?
To what?
At the upcoming home visit, discuss transitions with the family members, and the staff completing the home visits will do this.
So, anybody, remember earlier I said that they started training people, the caregiver support coordinators, to treat this as a program that has a time limit on it.
Even though it was never written by Congress to have an expiration date for the amount of time you could participate.
But just out of the blue one day, they woke up and said, you know what?
You've been in the program for three plus years.
You're gone.
So, and here's what ensued.
High threat towards staff.
Status of the panic button is unknown.
Request that veterans be given general information about the program.
The caller is not the decision maker.
That the caregiver support program is a temporary recovery based program, which we know different.
Requesting that the note be ghosted out, that the safety risk additional signers and that the doctors identified be removed.
Follow up with IT regarding the notes getting removed.
You know, and to that, the reason why I include that is because today, as it sits, we have 90% of Legacy was discharged with erroneous notes.
So if we have the means in 2015-ish, 16-ish, to have IT remove notes for the safety of the caregiver support staff, why can we not take these notes and remove them out of the Veterans chart today to ensure their safety?
Because I know, I've heard of veterans having trouble getting proper medication.
You know, new providers come into the scene and the last note that they view is these ridiculous seat determinations that don't even look anything like the veterans medical records.
Like this, they look like completely different people.
And then we've got doctors providing medications based on those.
I mean, these, I would say that would be harmful.
I mean, that's a threat, wouldn't you think?
Absolutely.
But let's unpack this for a second.
You had said that the staff was concerned about threats.
Is that threats of violence?
You know, I believe so.
I skipped a little bit of that.
They were talking about how the caregiver support coordinators have the right to take legal action outside of the VA, which I don't condone violence.
Nobody should make violent threats.
No, but I understand it, right?
Yeah, I get it.
And here's the thing.
We're talking about now how veterans were then told at some point, well, you've been in the program long enough, you're gone.
When the inception of this program, the Congress had written that there is no time limit.
So veterans are applying for a program thinking that this may be a potential long-term solution to their care issues.
And they get in, let's just say for conversation's sake, Robin, that they get in and everything's running smoothly.
And then you hit that 36-month mark.
Well, you know, Richard, you've been in for three years.
We've got to bounce you out.
Now, wait a minute.
I was under the assumption that this was going to be, this is my care plan, so then what's next?
And so my question would be, if they were kicking folks out at three years, what kind of warning did they get?
What kind of help with planning their next steps did they get?
Or was it just a blindsided, hey, you're gone?
It was a blindsided.
You're gone.
They would show up.
I've heard of caregiver support coordinators basically just showing up and then going back and saying they don't qualify anymore.
And then the caregiver didn't get a stipend deposited the next month.
And just like that, they were gone.
And so now when there are threats of violence, potential suicide issues, overdosing issues, whatever the case may be, this comes as a surprise to the VA. Let's make something really clear, Robin, that the men and women who are in this program potentially have been trained to take life and soldier on.
Now I am, I more than, not more than anybody, but just as well as anybody understand that combat jobs aren't the majority.
If you're a Marine, you're trained to be infantry first.
If you're in the Army, you're trained to use a rifle and do whatever you need to do to survive.
I don't know about the Navy and the Air Force.
I don't know enough about it.
But what I do know is that the men and women who chose to put on a uniform have been trained to destroy an enemy and move on to the next one.
And so there's no reason why anybody at the VA should be surprised that there may be some kind of threats or pissed off veterans and family members because now you've become the enemy.
You've now just taken right from under their feet the things that they were promised to have.
And so why is this a surprise to anybody?
Why are you messing with these people?
The whole point, in my opinion, of going to the VA for care, or any care for that matter, post-service, is to live out the rest of my days with nobody bugging me, leave me the hell alone, let me get the treatment that I need for the conditions and the issues that I obtained while serving this country, and don't mess with me.
Leave me alone.
But now we're surprised.
Now the VA is surprised that veterans are pissed off and they're making threats.
I would like to know, Robin, how many, and this is probably a dark topic, but I would still be interested to know how many veterans who are bounced out of the program with no warning and no help after that took their own lives?
There's been a few.
Okay, so now this brings me to the next point that everybody in this country is all up in arms about the veteran suicide rate.
Does nobody take these types of things into account when we're talking about 22 a day or 19 a day or 25 a day, whatever the hell the number they want to spew out is?
The fact of the matter is that 1, 5, 25, 22 is way too many.
So does the VA take this into account when they're talking about combating veteran suicide?
Hey, if we pull the rug out from these veterans and they got no other choice and they feel like all hope is lost, why is it a surprise?
Why is it a surprise at all?
And maybe you're not the one to answer that question, Robin.
I'm on my soapbox now.
I'm pissed off and I'm sweating and I have a lot of questions to ask people that I have no access to.
That's kind of the name of the game.
I digress.
Let's continue.
So many questions.
Yeah, I mean, they even say that the individuals are getting very upset.
They're angry.
They're impulsive.
They have mental health issues.
They're getting in conflicts with their caregivers and spouses.
Like, this is, I mean, they really, they just took the rug out from underneath of them.
And, I mean, there was no warning and there was no warm handoff.
As they say now.
You know, and then they said, and then this is redacted, and that means that the next little clip has little hidden parts in it.
It says, redacted, we'll email some details about appeal responses.
Do not tell the veterans and their spouses that the appeal is originally processed by redacted.
So we don't know who was processing those appeals or if they even were, you know, doing it You know, how they were supposed to, like, there's just so much secrecy.
And I don't understand if this is a program that's meant to help.
Why are there so many secrets?
Yeah.
I have the same question.
Those were kind of the, you know, the staff meetings.
And then so I have a few of the determinations that they, you know, some of the veterans brought their applications through.
And remember, we're using clinical eligibility assessors.
We're not using the primary care team.
And so we will get into Kind of their process of doing this.
And I think it's very similar to how we operate now.
Now we have centralized eligibility and appeals teams.
Well, these were clinical eligibility teams.
So they're basically the same thing.
They were just operating this way before we had put them into the regulations.
So, we have a wife is doing chores.
So, you know, VA has kind of taken advantage of this.
They call it wifely duties now, but I don't really think that, you know, if my husband took a, if he needed to go to the VA hospital, they call that wifely duties now.
Me driving him is a wifely duty.
It's not considered an IADL that makes you eligible for the caregiver program anymore.
This is just what you're supposed to do because you're your husband's wife?
Yes.
So, you know, I think about that and I'm like, you know, would Uber, you know, would the driver of Uber accept a pat on the bottom and a thank you, darling, for getting us here safe?
Are they going to accept that?
You know, because that's, you know, that's how you would treat a wife if it was something wifely.
It's just...
Well, let me ask you this.
Is it still a wifely duty if my father was in the program and me, his son, is taking him?
My father ain't patting me on the behind.
You know, I've asked the same thing.
I have asked, do they call it husbandly duties when the husband is the caregiver of a female veteran?
Because I don't think they do.
Stupid.
Stupid.
So this says, he is choosing to urinate in the bed, won't wear diapers.
So, you know, to that, remember this, at the time, was a strictly post-9-11 program, so, you know, this is probably a younger veteran.
He's not going to want to wear diapers.
But let's look at his eligibility criteria.
So he has a 30% for neuralgia of upper radicular nerve group.
So he has some form of spinal cord injury or paralysis or nerve impingement.
I'm not a doctor.
I don't claim to be.
But he also has a 30% cervical strain.
So something's wrong in his neck.
He has mobility issues.
And they're just saying he's just choosing to pee the bed.
And this is why they denied him?
Was he denied?
Yeah, because he could be doing more.
He could be doing more and it would be in his best interest to do more.
You remember me saying that the PCP, the primary care provider, used to determine what was in a best interest.
Right.
So that was going to be my comment.
And so who made this determination?
Was it the social worker on the clinical team?
Or was this the doctor that this particular veteran works with every time he goes to the VA? The person that he's built a relationship with?
The person that has been handling his care for whatever period of time?
Or is this just some person who doesn't know him from Adam?
And decides, well, you know, you should be wearing a diaper and because you don't want to do that, you got to go, pal.
These are clinical eligibility teams, so they are just comprised of random people that got together and reviewed these medical charts.
I don't know.
There was nothing in the regulation that required them to have any credentials.
They could just kind of be whoever, I think.
I'm not saying that everyone was adjudicated by a social worker, but Who's to say that they weren't?
There was no policy to follow.
They weren't following the law.
The law said the primary care needed to discern it, the treating provider.
So the recommendation is to put him in the home health program or get aid and attendance.
So we denied him the family caregiver program that cost half of what the home health program cost.
How is that even common sense?
I don't understand.
I don't get it.
I don't understand it.
I don't know.
I don't get where's the logic in any of this.
There isn't logic.
You had talked earlier about how folks have been talking about how caregivers cost the VA too much money, possibly.
But here we're choosing to remove veterans and caregivers out of programs and then shoving them into a program that costs more money.
Well, you know, and to that I sometimes wonder if it is not the form of caregiving that is being provided.
So a commercial caregiver Makes money for a corporation.
So the VA pays a corporation.
When the VA pays the family caregivers, the family caregiver gets that money.
So it might be determined on who was ultimately getting paid at the end of the day.
I don't have that answer, but...
Well, I think that that's probably irrelevant because, as I've said before, and correct me if I'm wrong, But this program, the whole purpose behind the Veterans Administration is to ensure that men and women who wore a uniform and serve this country honorably are taken care of.
They can live out the rest of their days comfortably, with dignity, and Unfortunately, or maybe not unfortunately, but it seems that at the least amount of cost, at least that's what they say.
But now we shove veterans into programs that cost more.
And so I'm thinking that you're probably on to something, Robin, where it's an issue where we need to start following the money and see who's getting paid on these contracts and all that other stuff.
But I know that we have more, but we got to get going.
We got a little bit left time in the next segment, but stick with us, folks.
Hey folks, welcome back here.
We got just a short time to finish up the show.
We covered a lot of information today, and some of it's dark, some of it may seem slow, but I'm telling you, the meat and potatoes are coming.
So stick with us.
Keep watching, because there's a lot of stuff to unpack here.
Robin, we got about four minutes and 20-ish seconds, so I'm gonna let you get out what you need to get out.
Go ahead.
You know, I think before we can take a relaxing breath and move forward with this program, we've got to see what the regulations are going to look like.
We're going to have to have these erroneous Assessments removed from our medical charts.
I think that Dr.
Richardson can get us there.
I think that the $1.9 billion question is, will her leadership allow her to do that?
Will her leadership allow her to do what needs to be done?
I know that everything we talked about today was hard.
It was I have a pit in my stomach.
I don't like talking about this stuff.
It's not fun.
It doesn't feel good.
I'm a happy person.
But I feel that it's important to touch on it at least a little bit.
If we don't know where we've been, how can we see where we're going?
You know?
And I would also...
I'd like to leave everybody with something for...
For a long while, I was really worried about retaliation.
And there just came a point in time where I was more worried about what would happen if I didn't say something.
The VA already kicked us out.
They already kicked us out.
You don't have to be afraid.
If we don't stand up now and say something, there won't be a program to come back to.
It's good time, guys.
Call your congressman.
Tell them your stories.
Let's demand some legislation and demand some equitable regulations for this program.
It can work.
It used to work in the beginning.
Give the power back to the primary care providers and we can do this.
Very well said.
I guess I don't know how to follow that up, Robin.
I think that I second your feelings.
Folks, these are tough issues.
And keep in mind that people, men and women like Robin, are the ones that live this every single day.
These are the folks that are worried about this program hindering their lifestyles and the way that she cares for her husband and the way that other caregivers care for their veterans.
Arguably, the veterans in this program are some of the most in need.
And so when we have conversations about these types of programs potentially going away, it's a big deal.
And on top of all that, there's just short of two billion dollars, two billion of your dollars, taxpayer dollars, spent on this program.
And the folks that live this program and all the things good and all the things bad about it every day are the ones that are here to tell us what is best for the veterans that they take care of.
But yet, we have all kinds of people who don't live this story every day making decisions about how this program is going to move forward.
And I'm not trying to say that the caregiver should have carte blanche on this program and how it's run and where the money's spent, but at least have a fair shake.
And have a voice.
And it seems like there are one or two people within the program at a higher level that are committed to making the change.
But Robin, as you said, will the leadership let that happen?
Well, I sure effing hope so.
Because if not, get the hell out of the way and let somebody who really cares about these people to invoke the change, or at least support it.
But having this program go away is not an option.
So anybody watching who is a caregiver, I urge you, I plead with you, stand up.
Stand up for yourselves and for all your comrades that are also using the program.
Or like Robin said, there won't be one to come back to.
And that would be extremely unfortunate.
I want to thank you for joining us this week.
We will be back next week with a lot more information.
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