VA Caregiver Support – Issues Part 1

My opinion of the issues with the VA Caregiver Support (CS) is based on the governing documents, my personal experience, my medical records, conversations with various levels of VA CS employees, etc. You can compare the below issues with the governing documents, information from your experience, information from your local CSC, from medical records, numerous social media comments from Veterans and caregivers, etc to make you own decisions. You can determine if it’s fraud, waste, abuse, gross mismanagement, abuse of authority, medical malpractice, etc.

The below issues were also the reasons for so many revocations in 2017 – the CSCs, social workers, are reviewing and interrupting the Veterans medical records, psychotherapy notes and home visits to make the medical determination if the Veteran and caregiver continue to meet eligibility. If not, the CSC performs a revocation. Note: The CSC is not qualified or authorized to make medical determinations of a licensed medical doctor.

The CS is in the VA Social Worker Department.

The CS  believes the Veteran’s medical and/or mental health doctors cannot make appropriate medical determinations to prevent fraud in the PCAFC so, the CSC must do it.  Note: The CSCs are in an administrative position regardless of their professional title, and are not qualified or authorized to make medical determinations and are not licensed medical doctors. Refer to the law and statue. Both caregiver support programs are for the CAREGIVER and the Secretary shall only provide support to eligible caregivers of both caregiver support programs. 

1. VA Medial Department (MD) is not managing the clinical responsibilities of both caregiver support programs such as writing the directive, application, forms, processes and procedures for clinical eligibility, reassessments, appeals and revocations.

2. VA CS is responsible for the management of the clinical and support responsibilities of both caregiver support programs.

3. VA CS is operating off verbal orders/directives to get around the law, statue, regulation and directive to mange the caregivers support programs, mainly the PCAFC, the way they want to in order to control all decisions and exclude the Veterans primary care team by doing the following:

a. VA CS is responsible for writing all clinical documents to include the directive, application, clinical administrative form, clinical eligibility form, initial and interim in-home assessments, clinical literature, etc. (Not authorized, qualified or licensed medical doctors.

b. VA CS is hiring clinicians to perform the responsibilities of the primary care team. (Not authorized)

c. VA CS is reassigning social workers who were hired for other positions into the role of a CSC. (Not authorized)

d. VA CS is hiring support clerks to assist them in performing the responsibilities of the primary care team. (Not authorized)

e. VA CS is providing fraudulent information to VA leadership, VA medical and mental health providers, Veteran Organizations, Patient Advocates, Privacy Officers, Veterans, Family Members, etc.

f. VA CS is providing fraudulent information to various providers to get them to perform certain clinical responsibilities for the PCAFC regardless if the provider is qualified.

g. VA CS makes the applicant and Veteran go through two (2) clinical eligibility assessments which the first one is completed by the CSC who makes the medical determinations to approve or disapprove to proceed to the second clinical eligibility assessment. The CSC also makes the medical determination to approve or disapprove and assign the tier level on the second clinical eligibility assessment.

h. VA CS developed PCAFC verbal processes and procedures for application, home assessments, reassessments, appeals and revocations. (Note: Slight variations may occur from one VAMC to another.

1. VA CS developed a verbal PCAFC application process and procedure which consist of two (2) clinical eligibility assessments. Note: The forms are in the VA computer system used nationwide, and slight variations to processes can occur. The steps are:

a. Caregiver Support Administrative Eligibility Screening Tool (CSAEST), is the first clinical eligibility assessment process:

1. The CSC receives the application.

2. The CSC schedules a telephonic or in-person appointment to complete the  CSAEST. The CSAEST is not an administrative screening tool, it’s the first clinical eligibility assessment. It contains the activities of daily living (ADL), protection and supervision clinical eligibility questions but in greater detail, and if it’s in the best interest of the Veteran. It has a lot of other administrative and clinical questions which some are unlawful eligibility questions.

3. The CSC reviews the Veterans medical record and psychotherapy notes after the completion of the CSAEST. Note: The Veteran is unaware and hasn’t provided a written authorization to the CSC to access her/his psychotherapy notes required by HIPAA, Privacy and VA Privacy. The CSC interrupts the medical record and psychotherapy notes to make a medical determination of 1) if the Veteran has any serious physical and/or mental health injuries, 2) do these injuries require assistance from a caregiver, and 3) is it in the best interest of the Veteran to have a caregiver. The CSC then makes a medical determination to approve or disapprove application. If disapproved, the CSC issues a disapproval letter or if approved, starts the second clinical eligibility assessment process, Caregiver Program Clinical Eligibility Assessment (CPCEA).

b. Caregiver Program Clinical Eligibility Assessment (CPCEA), is the second clinical eligibility assessment process:

1. The CSC makes a medical determination of what evaluations and/or tests to send to the Veterans primary care provider (PCP) to input consults.

2. The CSC schedules appointments for the evaluations and/or tests.

3. The CSC reviews the evaluations and/or tests.

4. The CSC makes the medical determination to not allow the Veteran to receive a treatment plan, if applicable, for those who have rehabilitating injuries.

5. The CSC has a nurse or provider to complete the Caregiver Program Clinical Eligibility Assessment (CPCEA), the second clinical eligibility assessment. It isn’t as detail and doesn’t include the additional administrative and clinical questions on the CSAEST. It only contains ADL, supervision and protection questions – questions only. The form doesn’t contain an approval and tier level assignment section. It’s on the CPCEA supplemental form, Caregiver Program Clinical Eligibility Assessment Child Note (CPCEACN) completed by the CSC once she/he receives the CPCEA.

6. The CSC reviews the CPCEA and completes the supplemental form, CPCEACN to make the medial determination to approve or disapprove and assign the tier level.

7. The CSC instructs applicant to complete the online caregiver training.

8. The CSC schedules the Caregiver Program Initial In-Home Assessment (B) (CPIHA(B)). The CSC with or without a CS Nurse completes the CPIHA(B)). The CSC claims the home assessment is to inspect every room in your house for bugs, holes in the walls, etc instead of assessing the caregivers ability to provide the personal care and the well-being of the Veteran according to the law, statue, regulation and directive.

9. The CSC makes the medical determination to approve the applicant.

10. The CSC makes the medical determination of the interim home monitoring frequency of every 90 days for the first year then annually afterwards.

11. The CSC with or without the CS Nurse performs the Caregiver Program Interim In-Home Monitoring Assessments.

12. The CSC reviews the Veterans medical records and psychotherapy notes every 90 days to make a medical determination if the Veteran and caregiver continue to meet eligibility. Note: The CSC doesn’t obtain a written authorization to access the Veterans psychotherapy notes required by HIPAA, Privacy and VA Privacy.

2. VA CS developed a verbal reassessment of tier level process and procedure. The CSC receives the reassessment request and prepares the packet for the Social Worker Board (SWB). The SWB contains an unspecified number of social workers to review the request, medical records and psychotherapy notes to make a medical determination to approve or disapprove.

3. VA CS developed a verbal appeals process and procedure instead of using the mandated Appeals of VHA Clinical Decisions, VHA Directive 1041. The VA CS established a Caregiver Support Program Clinical Review (CSPCR) and a Caregiver Program Appeals Team (CPAT) to process appeals at the VAMC and VISN. The CSC prepares the appeals packet to include what documents are included and submits it to the CPAT at the VAMC or VISN. (The Veteran and Caregiver are not provided a fair and impartial appeal.)

b. VA CS developed a verbal revocation process and procedure. Note: revocations are medical determinations. All reasons for revocation are performed by the CSC instead of the Veterans primary care team. Every 90 days the CSC will review the Veterans medical record and psychotherapy notes to make a medical determination if the Veteran and caregiver continue to meet eligibility. Interim In-Home Monitoring Assessments is used too if one is required during the 90 day or annual review to make a medical determination of continued eligibility.

To sum it up, the VA CS has 1) excluded the Veterans primary care team, 2) ensured they control all process, procedures and decisions, and 3) making medical determinations/decisions of a licensed medical doctor which they are not qualified or authorized to make.

Veterans and their caregivers are 1) not allowed to use their primary care team, 20 sometimes are sent to unqualified providers to complete clinical assessments, 3) not provided a treatment plan, 4) not monitored by their primary care team, 5) inability to rehabilitate since no treatment plan or monitoring is conducted by their primary care team, 6) caregiver isn’t assessed by the Veterans primary care team, provided a treatment plan for their Veteran to help them rehabilitate, discuss the treatment plan or additional instructions or assessed of their ability to follow a treatment plan and 7) caregivers are receiving support or inadequate support from the CSC, 8) denied for unlawful eligibility criteria by a social worker, 9) revoked for unlawful eligibility criteria and revoked by a social worker, 10) privacy violations by the CSC, 11) etc.

Just in case, excerpt from Public Law 111-163 and 38 USC 1720G:

§1720G. Assistance and support services for caregivers

(a) PROGRAM OF COMPREHENSIVE ASSISTANCE FOR FAMILY CAREGIVERS.—(1)(A) The Secretary shall establish a program of comprehensive assistance for family caregivers of eligible veterans. ‘‘(B) The Secretary shall only provide support under the program required by subparagraph (A) to a family caregiver of an eligible veteran if the Secretary determines it is in the best interest of the eligible veteran to do so.

(b) PROGRAM OF GENERAL CAREGIVER SUPPORT SERVICES.— (1) The Secretary shall establish a program of support services for caregivers of covered veterans who are enrolled in the health care system established under section 1705(a) of this title (including caregivers who do not reside with such veterans).

In my next post, part 2, I’ll list the VHA Directive 1152 June 14, 2017 violations.

 

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