VA’s Caregiver Support Program can revolutionize healthcare

This relatively unknown program established by Congress and signed into law by President Obama in 2010 is having far reaching effects on Iraq and Afghanistan veterans with significant physical and mental injuries.  The Caregiver Support Program is so important because it takes the fight for improving veterans and their family’s lives into the home, focusing not only on the veteran, but their caregiver as well.  This is being done through the use of caregiver support coordinators (CSC) who are providing caregivers with the tools and support they need to care for their veteran. 

The VA also provides incentives, benefits, training and services, with the coordinators monitoring and engaging with veterans and their caregivers to obtain better outcomes.  These coordinators, vital for program success, have for the most part been clinical social workers, but highlighting the Gulf Coast Veterans Healthcare System, a visionary social worker there has pushed to add registered nurses with mental health backgrounds to the mix.  This combination is what the military would call a force multiplier, adding a tremendous capability working on the front lines (homes), not only providing caregivers with direct engagement, but triage assessment for the veteran’s physical and mental health needs as well.

{mosads}Having caregiver support coordinators visit the home per program guidelines is an absolute necessity for success.  Although there are some Veterans or caregivers that might not want mandated visits to their homes by a CSC, what better way for VA healthcare professionals to engage with and assess disabled veteran’s needs, and encourage veterans and caregivers to participate in activities designed to improve the veteran’s lives.  From these in-home visits, caregiver support coordinators are able to document in the charts identified issues that need to be addressed by primary care and mental health providers who are also using new thinking such as telehealth.  Working with these providers, the coordinators help in developing better plans of care for the Veteran, and provide caregivers the level of support they cannot get on their own.

The Caregiver Support Program provides a sound foundation for the VA to improve its outcomes across the board with veterans.  Tracking and analyzing the data already being collected by the RN and social worker coordinators would be a very cost effective way in improving patient outcomes and overall effectiveness of VA programs.  The coordinators already have well thought out participation criteria, policies, and procedures for caregivers that are applying to the program.  The team approach of social workers and RNS with counseling backgrounds is spot on, but unfortunately, there are limiting factors tied squarely to the VA’s bureaucracy.  VA leaders must be willing to adjust resources for a program expanding at a phenomenal rate since its inception or it is at risk.  VA leaders cannot sit on the sidelines while their coordinators drown with the overwhelming increase in workload.  Coupled with the inability of the VA to adjust manning quickly is the fundamental leadership failure of not being able to deal effectively with negligent employees. 

Secretary McDonald, you have a new program with substantial potential in revolutionizing healthcare for veterans.  The caregiver support coordinators are already collecting tremendous amounts of information related to veterans and their care at the point of the spear…in the home.  The program has been in place long enough where data should be providing first looks at the impact caregivers are having with the outcomes of veteran’s care.  Adding registered nurses with counseling backgrounds as c oordinators is forward thinking that must continue. 

Congress needs to understand that the VA has some great visionary thinking going on…new thinking that can have revolutionary consequences for the health of veterans and their families.  This new thinking is being executed by some highly dedicated employees that need servant leadership they have not been getting.  Finally, Secretary McDonald and Congress must accelerate fixing the one thing that continues to haunt the VA, the inability to fire negligent employees who have direct access to Veterans.  Taking over a year to fire a toxic employee, and another six months to hire a replacement is just unacceptable.     

Bartley is a retired Air Force colonel and veteran’s advocate.