Statement from Steve Schwab, Executive Director of the Elizabeth Dole Foundation, before The House Committee on Veterans' Affairs

Written Statement from Steve Schwab, Executive Director of the Elizabeth Dole Foundation, Before The House Committee on Veterans' Affairs, United States House of Representatives on A Draft Bill to Make Certain Improvements in the Family Caregiver Program:

Chairman Roe, Ranking Member Walz, and Members of the Committee, the Elizabeth Dole Foundation is pleased to present its views on the House Committee on Veteran Affairs' draft legislation, which makes modifications to the Program of Comprehensive Assistance for Family Caregivers (PCAFC).We thank the Committee for its continued leadership to support more than 5.5 million military and veteran caregivers serving across the nation. The PCAFC is a critical program that provides comprehensive caregiver support, helps offset the cost of income lost from caregiving responsibilities, and recognizes the service they provide to our nation's wounded warriors. As the preeminent organization empowering, supporting, and honoring our nation's military caregivers, the Elizabeth Dole Foundation seeks to strengthen and empower American military and veteran caregivers and their families by raising public awareness, driving research, championing policy, and leading collaborations that make a significant impact on their lives. We appreciate that the Committee has made this legislation a priority and has conducted an open process by convening focused discussions on this draft legislation with VSOs and caregiver support organizations and incorporating feedback into modifications to the draft legislation.Expanding the Program to Pre-9/11 VeteransWe are pleased that the Committee has put forward legislation that addresses what the Foundation has felt is the most significant deficit in the PCAFC; that only a limited scope of veterans and their caregivers are eligible under the current law. It is unfair that since the Program's enactment, pre-9/11 caregivers - who make up 80 percent of our nation's 5.5 million veteran and military caregivers - are arbitrarily barred from accessing the PCAFC because of their veterans' era of service or diagnosis with a service-connected illness. We appreciate that the Committee has demonstrated its intent to correct this injustice, and we are wholly supportive of expansion.While the expansion of the program in the draft legislation represents a momentous victory for the caregiver community, it comes with some significant trade-offs. The Committee's bill proposes more restrictive thresholds for eligibility to the program, including that a caregiver provide support with an increased number of activities of daily living. This provision will drastically reduce the number of eligible veterans and demonstrate a considerable tightening of the Program's criteria. We understand that the Committee has proposed this provision to reduce the overall cost of the program and ensure that the program is in place to serve those who need it most. However, the Foundation strongly recommends that the Committee eliminate, make modifications to, or adjust this eligibility-reducing provision - as it may be detrimental to current and future generations of veteran caregivers.Activities of Daily LivingThe Foundation is a strong proponent of expansion with unaltered eligibility requirements, as proposed in the Senate's Caring for Our Veterans Act, which passed the Senate Veterans Affairs Committee with overwhelming bipartisan support in November 2017. However, we recognize that the Committee would like to explore different options related to eligibility and standardization of the program.Under current law, participants must be in need of personal care services due to – among other criteria – the inability to perform one or more activities of daily living (ADLs). The Committee's draft increases the threshold to three or more ADLs. In 2012, the Foundation commissioned the RAND Corporation to conduct a study on military and veteran caregiving; the findings of which are detailed in a 2014 report "Hidden Heroes: America's Military Caregivers." The report found that, on average, post-9/11 caregivers help with 1.0 ADL, while pre-9/11 caregivers help with 1.3 ADLs (and instead help with an increased level of safety and supervisory assistance). The research did not provide analysis as to how many caregivers help with three or more ADLs. We believe that the proposed increased threshold may be too high and would severely limit the effectiveness of the PCAFC in supporting those who need the program most.There is a lack of available information on the number of veterans potentially affected by the proposed increase to the activities of daily living. Therefore, the Foundation recommends that the Committee either consider eliminating this provision entirely or allow the Secretary of Veterans Affairs to make any eligibility-restricting determination only after conducting a comprehensive impact analysis and following the appropriate rule-making process.Addition of Service-Connected IllnessesThe Foundation urges the Committee to consider expansion of the program to service-connected illnesses, not just injuries from all eras of service. The way the bill is written today, it still does not include service-connected illnesses, such as ALS or the hundreds of other illnesses included in the VA's Presumptive Disease List. That is unjust. We believe for this program to be genuinely inclusive of our nation's veterans and their caregivers, it must not exclude those with service-connected illnesses.The Inclusion of the Financial Planning ServicesThe 2014 RAND report examined characteristics of military and veteran caregivers and services available to them. The report indicated that, of the military caregiver-specific programs, few provide long-term planning assistance, including financial planning, for military caregivers.The Senate's Caring for Our Veterans Act includes a provision which would require the VA to include financial planning and legal services related to the needs of injured veterans and their caregivers as a service provided to caregivers. The bill language makes clear that VA should provide these services through the use of contracts with or the provision of grants to public or private entities. The Senate Committee intends that VA and VA employees not provide these services, but instead partner with public or private entities.We believe the financial planning services would be a critical improvement to the PCAFC program. We are also supportive of offering legal services to caregivers, but sympathetic to the VA's concerns that this might pose a conflict of interest. We urge the Committee to consider the inclusion of financial planning services to caregivers in the PCAFC.Grandfathering Current Program ParticipantsThe Foundation appreciates that Committee has added additional language to its current draft legislation to address what happens to current program participants who will be no longer eligible under the new criteria. However, we are concerned that the language allowing the Secretary of Veterans Affairs to develop a transition plan is too broad, creates further program uncertainty, and places the thousands of current program participants at potential risk of losing their caregiver benefits. The Foundation believes the legislation should explicitly protect current program participants from losing support as a result of these legislative changes.Thank you again for this opportunity to submit our comments on the Committee’s draft legislation. We look forward to continuing to work with the Committee to ensure support for our nation’s military and veteran caregivers.

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The House Committee on Veterans' Affairs Subcommittee on Health will be holding a Legislative Hearing on Tuesday, April 17, at 3:30PM. Click here for more information.

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