Few nursing home facilities can appropriately serve veterans with SCI/D. VA operates six specialty facilities, only one of which lies west of the Mississippi River. Many aging veterans with SCI/D need VA facility-based care, but the department currently only has the capacity to provide it for about 180 patients.
Other SCI/D veterans would prefer to receive non-institutional care or home and community based-services (HCBS). VA HCBS must be more accessible to veterans with catastrophic disabilities. The Veteran Directed Care (VDC) program, which allows veterans to receive HCBS in a consumer-directed way, is not currently available at all VA medical centers and will not be fully expanded across the nation until fiscal year 2026. In addition, VA’s Homemaker and Home Health Aid program does not always provide the level of support required to help paralyzed veterans live whole, productive lives, particularly during times of home care worker (caregiver) shortages.
Congress should pass the Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act (H.R. 6823/S. 3854), which would make urgently needed improvements to VA HCBS, such as:
- Expanding access to HCBS programs, including for veterans living in US territories and to Native veterans enrolled in IHS or tribal health program.
- Raising the cap on how much VA can pay for the cost of home care from 65 percent of the cost of nursing home care to 100 percent.
- Coordinating expanded VA home care programs with other VA programs, like the Program of Comprehensive Assistance for Family Caregivers (PCAFC), and other federal programs.
- Reviewing existing service gaps in geriatric and extended care at VA.
- Establishing a pilot project to address home health aide shortages.
- Providing respite care to caregivers of veterans enrolled in home care programs.
- Establishing a “one stop shop” webpage to centralize information for families and veterans on programs available.
- Requiring VA to provide a coordinated handoff for veterans and caregivers denied or discharged from the PCAFC into any other home care program they may be eligible for.