VA Caregiver Support – Program of General Caregiver Support Service (PGCSS)

In this post, I want to share the information from the governing documents on this very unpublicized caregiver support program. The Program of General Caregiver Support Services (PGCSS) is for caregivers with pre 9/11 Veterans with serious injuries.

Public Law 111-163 and 38 USC 1720G enacted the Caregiver Support and established two (2) caregiver support programs: 1) Program of Comprehensive Assistance for Family Caregiver (PCAFC) and 2) Program of General Caregiver Support Services (PGCSS) to provide benefits, support and assistance to caregivers.

We are going to discuss the PGCSS in this post. Excerpts from Public Law 111-163 and 38 USC 1720G:

§ 1720G. Assistance and support services for caregivers.

(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).

(2) For purposes of this subsection, a covered veteran is any individual who needs personal care services because of—
(A) an inability to perform one or more activities of daily living;
(B) a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury; or
(C) such other matters as the Secretary shall specify.

(3)

(A) The support services furnished to caregivers of covered veterans under the program required by paragraph (1) shall include the following:

(i) Services regarding the administering of personal care services, which, subject to subparagraph (B), shall include—(I) educational sessions made available both in person and on an Internet website; (II) use of telehealth and other available technologies; and (III) teaching techniques, strategies, and skills for caring for a disabled veteran;

(ii) Counseling and other services under section 1782 of this title.

(iii) Respite care under section 1720B of this title that is medically and age appropriate for the veteran (including 24-hour per day in-home care).

(iv) Information concerning the supportive services available to caregivers under this subsection and other public, private, and nonprofit agencies that offer support to caregivers.

(B) If the Secretary certifies to the Committees on Veterans’ Affairs of the Senate and the House of Representatives that funding available for a fiscal year is insufficient to fund the provision of services specified in one or more subclauses of subparagraph (A)(i), the Secretary shall not be required under subparagraph (A) to provide the services so specified in the certification during the period beginning on the date that is 180 days after the date the certification is received by the Committees and ending on the last day of the fiscal year.

(4) In providing information under paragraph (3)(A)(iv), the Secretary shall collaborate with the Assistant Secretary for Aging of the Department of Health and Human Services in order to provide caregivers access to aging and disability resource centers under the Administration on Aging of the Department of Health and Human Services.

(5) In carrying out the program required by paragraph (1), the Secretary shall conduct outreach to inform covered veterans and caregivers of covered veterans about the program. The outreach shall include an emphasis on covered veterans and caregivers of covered veterans living in rural areas.

The regulation, 38 CFR 71, excerpts:

§ 71.30 – General Caregivers.

(a) A General Caregiver is a person who:

(1) Is not a Primary or Secondary Family Caregiver; and
(2) Provides personal care services to a covered veteran under this section, even if the individual does not reside with the veteran.

(b) A covered veteran, for purposes of this section, is a veteran who is enrolled in the VA health care system and needs personal care services because the veteran either:

(1) Is unable to perform an activity of daily living; or
(2) Needs supervision or protection based on symptoms or residuals of neurological or other impairment or injury.

(c) No application or clinical evaluation is required to obtain benefits as a General Caregiver. Veterans or General Caregivers may request any of the benefits listed in § 71.40(a) as needed, from the appropriate VA clinicians and staff at their local VA facilities.

(d) A veteran is not required to meet the eligibility requirements in § 71.20 to be considered a covered veteran.

§ 71.40 – Caregiver benefits.

(a) General Caregiver benefits. VA will provide to General Caregivers all of the benefits listed in paragraphs (a)(1) through (4) of this section.

(1) Continued instruction, preparation, training, and technical support. Caregivers will have access to each of the following services, which may be provided through:

(i) Online and in-person educational sessions.
(ii) Use of telehealth and other available technologies.
(iii) Teaching techniques, strategies, and skills for caring for the eligible or covered veteran.

(2) Information concerning the supportive services available to caregivers under paragraph (a) of this section and other public, private, and nonprofit agencies that offer support to caregivers.

(3) Counseling and other services, as described under § 71.50.

(4) Respite care to eligible and covered veterans in support of the caregiver that is medically and age appropriate for the eligible or covered veteran (including 24-hour per day in-home respite care).

§ 71.50 – Provision of certain counseling, training, and mental health services to certain family members of veterans.

(a) Benefits provided under this section. VA will provide consultation, professional counseling, marriage and family counseling, training, and mental health services to a family member when necessary in connection with the treatment of a disability for which the veteran is receiving treatment through VA. For the purposes of this section, provision of a benefit is “in connection with the treatment” of a veteran’s disability if, in the clinical judgment of a VA medical professional who is providing treatment to the veteran, the provision of the benefit to the family member would further the objectives of the veteran’s medical treatment plan. The listed benefits provided under this section are to be provided within the following guidelines:

(1) All benefits will consist of psychotherapy, counseling, training, or education; VA will not provide prescriptions or medications to family members. VA also will not provide inpatient services under this section.

(2) This section does not authorize the provision of clinical evaluation or treatment that is not necessary in connection with the veteran’s treatment or that involves treatment other than consultation, professional counseling, marriage and family counseling, training, and mental health services.

(3) Marriage and family counseling includes services to help the veteran address mental health issues, manage physical health problems, and strengthen environmental supports as specified in the veteran’s treatment plan. It also includes interventions to reduce the negative impact for the veteran of mental illnesses or other medical conditions in family members.

(b) Definition of family member. For the purpose of this section, which provides certain benefits and services to eligible family members, a family member is:

(1) A person related to the veteran by birth or marriage who lives with the veteran or has regular personal contact with the veteran;

(2) The veteran’s legal guardian or surrogate;

(3) A Primary or Secondary Family Caregiver or a General Caregiver; or

(4) The individual in whose household the veteran has certified an intention to live.

(c) Family members or caregivers who need treatment not related to the treatment of the veteran. Where a VA clinician believes that medical care or services are needed for a family member but cannot provide benefits under this section because such need is not necessary in connection with the treatment of the veteran, VA may refer such family member to an appropriate provider in the community, so that the family member may obtain care through other health coverage including care to which a Primary or Secondary Family Caregiver may be eligible under this part.

The directive, VHA Directive 1152 June 14, 2017, excerpt:

8. THE PROGRAM OF GENERAL CAREGIVER SUPPORT SERVICES
The establishment of the Program of General Caregiver Support Services is required
by 38 U.S.C. 1720G(b) and rules governing its operation are set forth in 38 CFR Part71. This is a program of support services for caregivers of Veterans who are enrolled in
the VA health care system, including caregivers who are not family members and do not
reside with the Veteran. For a definition of general caregiver, see 38 CFR 71.30.

a. Eligibility Criteria for the Program of General Caregiver Support Services:

(1) For purposes of this program, a Veteran is any individual who is enrolled in the
VA health care system and needs personal care services because the Veteran either:

(a) Is unable to perform one or more activities of daily living; or

(b) Needs supervision or protection based on symptoms or residuals of neurological
or other impairment or injury.

(2) No formal application or VA clinical treatment team evaluation is required to
obtain benefits as a general caregiver. However, these caregivers must be identified in
the Veteran’s medical record for purposes of care coordination efforts and tracked in the
designated Caregiver Support Program data system.

b. General Caregiver Benefits. Veterans or general caregivers may request any
of the benefits listed below, as needed, from the appropriate VA clinicians and staff at
their local VA medical facility:

(1) Education, Training and Technical Support. Online and in-person education
and training offerings are available for general caregivers. Referrals to VA-provided and
non-VA community services and supports are made and information concerning such
services is provided as clinically indicated.

(2) Telehealth. Use of telehealth and other available technologies.

(3) Teaching. Teaching techniques, strategies, and skills for caring for a Veteran.

(4) Respite Care. Respite care provided to Veterans that is medically and age
appropriate for the Veteran (including 24-hour per day in-home care).

(5) Counseling.

(a) VA provides consultation, professional counseling, marriage and family
counseling, training, and mental health to a general caregiver when necessary in
connection with the treatment of a disability for which the Veteran is receiving treatment through VA. NOTE: Provision of a benefit is “in connection with the treatment” of a Veteran’s disability if, in the clinical judgment of a VA medical professional who is
providing treatment to the Veteran, the provision of the benefit to the general caregiver
would further the objectives of the Veteran’s medical treatment plan. For further
guidelines on the provision of these benefits, see 38 CFR 71.50(a).

(b) In addition to general caregivers, the following individuals are eligible for
counseling described in paragraph 8.b.(5)(a) and 38 CFR 71.50:

1. A person related to the Veteran by birth or marriage who lives with the Veteran or has regular personal contact with the Veteran;

2. The Veteran’s legal guardian or surrogate;

3. A primary or secondary family caregiver; or

4. The individual in whose household the Veteran has certified an intention to live.

(c) When a VA clinician believes that medical care or services are needed for a general caregiver or other individual listed in paragraph 8.b.(5)(b) but cannot provide benefits because the need is not necessary in connection with the Veteran’s treatment, VA may refer the individual to an appropriate provider in the community, so that the individual may obtain care through other health coverage, including care for which a primary or secondary family caregiver may be eligible.

c. General Caregiver as Collaborative Partners in the Care of the Veteran. Caregivers in the Program of General Caregiver Support Services are to be recognized as collaborative partners with VHA providers in ensuring the overall care and well-being of the Veteran.

 

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