Veterans with significant disabilities, like spinal cord injuries and disorders (SCI/D), require specialized and long-term services and supports throughout their lives. Unfortunately, the number of veterans requiring this level of care greatly exceeds VA’s existing capacity to provide it.

Most 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. 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 direct care worker (caregiver) shortages. Furthermore, VA is limited on how much can be spent on each veteran’s home care. When VA reaches this cap, the only alternatives are to place the veteran in a facility or rely on the veteran’s caregivers, often family, to bear the extra burden.

PVA Position:

Congress should pass the Elizabeth Dole Home and Community Based Services for Veterans and Caregivers Act (H.R. 542/S. 141), 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, 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 comprehensive family caregiver program into any other home care program they may be eligible for.