Caregivers for Severely Disabled Vets Getting Expanded Mental Health Services as Part of Biden Order

Registered nurses answer calls at a VA facility.
Registered nurses answer calls at a VA facility. (Dept. of Veterans Affairs photo)

An executive order signed Tuesday by President Joe Biden will expand mental health services via telehealth for some caregivers of disabled veterans and suggests that the Department of Veterans Affairs broaden veterans' access to its family caregiver program as well as home health services.

Under the order, the VA must develop a new pilot program offering telehealth psychotherapy -- therapy provided over the phone -- for caregivers who are enrolled in the Program of Comprehensive Assistance for Family Caregivers, also known as the Family Caregiver Program.

The requirement, along with others in the executive order, seek to ease the physical and emotional strain of caregiving, according to Biden.

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"It is the policy of my Administration to enable families -- including our military and veteran families -- to have access to affordable, high-quality care and to have support and resources as caregivers themselves," Biden wrote in the order.

The new program is one of several White House initiatives aimed at improving child-care services nationwide and supporting those who care for disabled or elderly Americans.

The directive also recognizes the potential for other VA programs to help home-bound disabled veterans, recommending the expansion of several established home health programs at the department. But it fell short in mandating the improvements, using phrases like "shall consider" and "encouraged to" in order to avoid burdening agencies with unfunded requirements.

The order suggests that the VA expand its Home-Based Primary Care program, which provides veterans medical treatment at their homes, by adding 75 new care teams; recommends that VA expand its Directed Care Program, an initiative that gives veterans who need help with activities of daily living access to home health aides; and proposes widening a program that allows veterans to budget for and choose who provides that care.

Biden, while acknowledging that those changes are not required, encouraged the department to comply.

"Nearly every other advanced country makes greater public investments in care than the United States. Investing in care is an investment in the future of America's families, workforce, and economy," Biden said.

Many of the recommendations in the executive order mirror provisions in a bipartisan bill introduced earlier this year in the House and Senate, the Elizabeth Dole Home Care Act, which would expand disabled veterans' access to and increase support for home- and community-based care for veterans.

The bill calls for assessments of VA's caregiver and long-term care programs and review staffing and funding needs for the department's Office of Geriatrics and Extended Care and Caregiver Support Program Office.

Bill supporters say it allows veterans to safely age in their homes and provides them flexibility in deciding who cares for them. On Tuesday, Senate Veterans Affairs Committee Chairman Sen. Jon Tester, D-Mont., who co-sponsored the legislation along with the committee's ranking Republican, Sen. Jerry Moran of Kansas, praised the executive order as "critical" to ensuring that veterans age with dignity.

"This is great news for our aging and disabled veterans who deserve and have earned access to quality home-based care," Tester said in a statement released by his office.

Critics of the bill, however, including the advocacy group Veteran Warriors Inc., say it would shortchange the Family Caregiver Program by diverting funds to caregiver nonprofits, including the Elizabeth Dole Foundation, as well as home health corporations.

"Makes you wonder, is #Congress here to benefit the 'preferred partners' or the 'Veteran community?'" the advocacy group Veteran Warriors Inc. stated on its Facebook page in March shortly after the bill was introduced.

The administration estimates that 5.5 million Americans support disabled veterans in some way, providing care and assistance to those who need help with their day-to-day functions, from getting bathed and dressed, to cooking and cleaning, supervising and taking them to appointments.

At the VA, one of the most popular caregiver programs is the Family Caregiver Program, which provides health care and financial assistance to roughly 33,000 caregivers.

In the past three years, VA has expanded the program beyond its initial focus on severely injured or ill post-9/11 combat veterans to include war veterans of all eras. As part of the expansion process, the department rewrote eligibility criteria for the program that was more restrictive than the previous requirements and initiated a review of 19,000 "legacy" participants to determine whether they still qualified.

Those reviews were suspended in March 2022 following objections from caregivers and advocates who said the new criteria were too restrictive. VA officials later said that the new standards would have resulted in the removal of roughly 90% of the legacy participants from the program.

In September, VA officials announced that all currently enrolled caregivers would remain in the program through Sept. 30, 2025, as VA reviews the eligibility criteria and conducts program improvements.

The Biden executive order suggested that VA consider announcing, by Oct. 1, its proposal for modifying the eligibility criteria for the program.

The executive order also seeks to improve child-care services and subsidy policies across the federal government, including at the Defense Department, which it directed to improve child-care affordability for service members by September and take steps to increase recruitment and retention of DoD child development program workers.

In response to the executive order, Steve Schwab, director of the Elizabeth Dole Foundation, said the actions represent “an important step forward, but many more steps still must be taken" by government agencies, private corporations and nonprofits to implement changes.

"Military caregivers and their families still face a level of crisis that requires a comprehensive, nationwide response," Schwab said in a release Tuesday.

Editor's Note: This story has been updated to reflect that leadership of Veteran Warriors Inc. does not administer the group's social media pages.

-- Patricia Kime can be reached at Follow her on Twitter @patriciakime

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