The combination of service-connected conditions and advancing age takes a serious toll on elderly veterans in this country. As their health and functional abilities decline, veterans’ family caregivers struggle to provide quality care and help them age in place for as long as possible. Fortunately, the growing need for better caregiver support was recognized in the MISSION Act, a VA reform bill that was signed into law in 2018.
While this bill included many measures intended to improve health care and medical benefits that veterans receive through the U.S. Department of Veterans Affairs (VA), it also set out to strengthen supports for veterans’ family caregivers. After a long wait, the VA expanded the Program of Comprehensive Assistance for Family Caregivers (PCAFC) on October 1, 2020.
What Is the VA Program of Comprehensive Assistance for Family Caregivers?
The PCAFC provides a wide range of supportive services and resources to family caregivers of veterans. Eligible veterans are permitted to select one primary caregiver and up to two secondary caregivers who can receive benefits through this program. Both eligible primary and secondary caregivers can receive caregiver education and training, mental health services and counseling, and travel, lodging, and financial assistance when traveling with the veteran to receive care.
Primary caregivers are also entitled to a few additional benefits that are especially useful, including a monthly stipend (payment for caregiving services), access to health care benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) if they don’t already qualify for another health care plan, financial planning and legal services, and at least 30 days of respite care per year.
Who Is Eligible for PCAFC?
Prior to October 1, 2020, only post-9/11 veterans who incurred or aggravated a serious injury in the line of duty in the active military, naval, or air service AND required personal care services related to this injury could qualify for the PCAFC.
The MISSION Act expanded this program to also include eligible veterans who incurred or aggravated a serious injury, illness or disease in the line of duty in the active, military, naval or air service on or before May 7, 1975. This means that WWII, Korean War and Vietnam War veterans (and their caregivers) may now qualify for VA caregiver support services through the PCAFC. Unfortunately, veterans who were seriously injured in the line of duty between May 7, 1975, and September 10, 2001, will not become eligible for the PCAFC until a second expansion goes into effect in 2022.
When determining eligibility, there is no longer a need for a connection between personal care services and the qualifying serious injury. According to a VA PCAFC Factsheet, “In most cases, the eligible veteran has multiple conditions that may warrant a need for personal care services. Veterans’ needs may be so complex that it can be difficult to determine what specific condition, out of many, causes the need for personal care services.” This change makes it much easier for veterans and their families to qualify for the PCAFC, even if their needs are not directly related to service-connected injuries.
Specific eligibility criteria for both veterans and family caregivers are detailed below.
PCAFC Eligibility Requirements for Veterans
- The individual must either be a veteran OR a member of the Armed Forces undergoing a medical discharge.
- The veteran or service member must have a serious injury or serious illness, which is a single or combined service-connected disability rating of 70 percent or more.
- The individual must have a serious injury or illness incurred or aggravated in the line of duty in the active military, naval, or air service on or after September 11, 2001, OR on or before May 7, 1975.
- The individual needs in-person personal care services for a minimum of six continuous months based on an inability to perform at least one activity of daily living (ADL) OR needs continuous supervision, protection, or instruction. The “inability to perform an ADL” means the veteran or service member requires personal care services each time they complete one or more of the ADLs. Only needing occasional assistance with one or more ADLs does not meet the definition for eligibility. (The VA’s accepted ADLs are covered in greater detail later on in this article.)
- It is in the best interest of the individual to participate in the program.
- Personal care services that would be provided by the family caregiver will not be simultaneously and regularly provided by or through another individual or entity.
- The individual receives care at home or will do so if the VA designates a family caregiver.
- The individual receives ongoing care from a primary care team or will do so if the VA designates a family caregiver.
PCAFC Eligibility Requirements for Family Caregivers
An eligible family caregiver must:
- Be at least 18 years of age.
- Be either the eligible veteran’s spouse, son, daughter, parent, stepfamily member, or extended family member OR someone who lives with the eligible veteran full-time or will do so if designated as a family caregiver.
- Be initially assessed by VA as being able to complete caregiver education and training.
- Complete caregiver training and demonstrate the ability to carry out the specific personal care services, core competencies and additional care requirements.
- Not have any determinations by the VA of abuse or neglect of the eligible veteran.
Understanding the PCAFC Stipend for Family Caregivers
An important aspect of the Program of Comprehensive Assistance for Family Caregivers is the financial assistance it provides to eligible veterans’ primary caregivers. Expansion of the PCAFC means that more family members can become paid caregivers for their disabled veterans. This change is noteworthy because it increases the likelihood that aging vets have the support and supervision they need to continue living in their own homes for as long as possible.
There are two levels of payment that are based on the amount and degree of personal services a caregiver provides. The VA measures these services in terms of whether a veteran is “not unable to self-sustain in the community” or “unable to self-sustain in the community.”
Primary family caregivers caring for veterans who are not unable to self-sustain in the community are entitled to a Level 1 stipend, which is 62.5 percent of the total available monthly stipend rate. Those primary caregivers who care for veterans who are unable to self-sustain are entitled to the Level 2 stipend, which is 100 percent of the available monthly rate.
These PCAFC monthly stipend rates vary depending on the locality pay area where the veteran lives and are adjusted annually by the Office of Personnel Management (OPM). For example, the rate for a primary caregiver to a veteran who qualifies for the lower Level 1 stipend and lives in Minneapolis in 2021 would be entitled to $1,765 per month ($21,180 annually), whereas a Level 2 stipend caregiver in Minneapolis would receive $2,824 per month ($33,888 annually). This is a game changer because these benefits are not need-based like VA pensions, and the funds are disbursed directly to the family caregivers of eligible veterans.
Defining Inability to Self-Sustain in the Community
Per the VA, “unable to self-sustain in the community means that an eligible veteran either:
- Requires personal care services each time they complete at least three of the seven activities of daily living (listed below), and is fully dependent on a caregiver to complete such ADLs; OR
- Has a need for supervision, protection, or instruction on a continuous basis. This means the veteran or service member “has a functional impairment that directly impacts their ability to maintain their personal safety on a daily basis.” (Alzheimer’s disease and other forms of dementia are good examples of conditions that require a caregiver to provide continuous supervision, protection and/or instruction.)
ADLs the VA Recognizes for the PCAFC
- Dressing and undressing
- Grooming oneself in order to keep oneself clean and presentable
- Adjusting any special prosthetic or orthopedic appliance that by reason of the particular disability cannot be done without assistance (this does not include the adjustment of appliances that nondisabled persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.)
- Toileting or attending to toileting
- Feeding oneself due to loss of coordination of upper extremities, extreme weakness, inability to swallow, or the need for a non-oral means of nutrition
- Mobility (walking, going up stairs, transferring from bed to chair, etc.)
How Can a Veteran and Their Caregiver Apply for PCAFC?
Veterans and their family caregivers will need to apply for this program together. Applications can be filed online at VA.gov, or applicants can download and complete a joint Application for the Program of Comprehensive Assistance for Family Caregivers (VA Form 10-10CG). The paper application must either be submitted by mail or hand delivered to your local VA medical center’s Caregiver Support Coordinator. If a veteran has a court appointed legal guardian, representative or durable power of attorney (POA), the representative must sign on behalf of the veteran and include a copy of the POA document or guardianship paperwork.
You can use the Caregiver Support Coordinator’s directory or call the Caregiver Support Line at 855-260-3274 to find contact information for your local coordinator. These coordinators are licensed professionals who can help veterans and caregivers explore the benefits they are eligible for and assist with applications and appeals. A complete list of VA caregiver supports and resources can be found on Caregiver.VA.gov.
Sources: The Program of Comprehensive Assistance for Family Caregivers (https://www.va.gov/family-member-benefits/comprehensive-assistance-for-family-caregivers/); VA publishes final regulation for its Program of Comprehensive Assistance for Family Caregivers (https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5494); Veterans Affairs Program of Comprehensive Assistance for Family Caregivers: Eligibility Criteria Fact Sheet (https://www.caregiver.va.gov/pdfs/FactSheets/CSP_Eligibility_Criteria_Factsheet_1-4-21.pdf#); Veterans Affairs Program of Comprehensive Assistance for Family Caregivers: Monthly Stipend for Primary Family Caregivers Fact Sheet (https://www.caregiver.va.gov/pdfs/MIssionAct/CSP_Stipend_Factsheet_092720_Approved_Final.pdf); Office of Personnel Management: 2020 General Schedule (GS) Locality Pay Tables (https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2021/saltbl.pdf)