VA Caregiver Support – Part 4 (Our PCAFC Journey)

In this post, part 4, I’ll discuss my redacted medical records and other documents to show you our local VA Caregiver Support (CS), Program of Comprehensive Assistance for Family Caregivers (PCAFC), processes and procedures. You can find all the forms and documents here. The forms, processes and procedures are used nationwide. Slight variations in processes and procedures can occur from one VAMC to another.

Note: I have redacted the names and sensitive information but you will see the name of the form, the questions on it and the title of the VA employee who completed the forms.

I had an established medical and mental health providers at my local VA medical center (VAMC) at time of our application: primary care provider (PCP), psychologist (meeting weekly) and a nurse psychiatrist (mental health medication). None of my doctors knew of the PCAFC, wasn’t involved and still are involved. My multiple request to involve my primary care team have been denied by my VA and the social workers. Yes, social workers are denying my request to allow my doctors to do their clinical responsibilities.

Note: A CSC/social worker, social worker (SW) or licensed clinical social worker (LCSW) is not a licensed medical doctor therefore a CSC/SW/LCSW cannot perform clinical responsibilities or make medical determinations of a licensed medical doctor. Reference 38 USC 1720G, (c) (1) A decision by the Secretary under this section affecting the furnishing of assistance or support shall be considered a medical determination.

Our VA CS, PCAFC, process and procedure for us:

Note: Our VAMC has four (4) social workers assigned to perform duties as a Caregiver Support Coordinator (CSC), 2 CS support clerks and 2 CS nurses. (Requirement is one (1) CSC/social worker at each VISN and VAMC to only provide support to eligible caregivers of both caregiver support programs according to the law.)

Note: The CS, PCAFC, operates off ‘verbal’ processes and procedures, and doesn’t follow the law, statue, regulation or directive because the social workers don’t believe our doctors can make appropriate medical determinations to prevent fraud. The VA CS is under the VA Social Worker Department and has created verbal processes and procedures to exclude Veteran’s primary care team in order to control all decisions affecting furnishings of assistance or support which are medical determinations, 38 USC 1720G. Note: Social Workers are not authorized to make medical determinations because they are not licensed medical doctors. 

  1. VA Form 10-10CG. I do not have a copy of our submitted form but I have provided a copy of a blank one.
  • We completed the form and were told to submit it to the CS office.
  • We submitted it to the CS office clerk.
  • We received a call from our assigned CSC/social worker to come in for an appointment to complete the Caregiver Support Administrative Eligibility Screening Tool. Note: Unknown to us, the CSC is a social worker.

2. Caregiver Support Administrative Eligibility Screening Tool (CSAEST)

  • Note: We had no prior knowledge of the processes or procedures or who was responsible.
  • Unknown to us, this was our first of two clinical eligibility assessment;
  • Unknown to us, a social worker trainee completed the form. Note: A CSC/SW/LCSW cannot perform clinical responsibilities or make medical determinations of a licensed medical doctor;
  • Unknown to us, 12 days later our CSC/social worker reviewed our CSAEST, my medical records and my psychotherapy notes to interrupt them to make a medical determination on 1) if I had any serious physical and mental health injuries, 2) if these serious injuries require assistance and 3) if it’s in my best interest. Note: I have never provided a CSC or social worker a written authorization to access my psychotherapy notes as required by HIPAA/Privacy and VA Privacy Policy. Note: A CSC/SW/LCSW cannot perform clinical responsibilities or make medical determinations of a licensed medical doctor;
  • Unknown to us, our CSC/social worker made the medical determination we meet the administrative and clinical eligibility requirement and approved us. Note: A CSC/SW/LCSW cannot perform clinical responsibilities or make medical determinations of a licensed medical doctor;
  • Unknown to us, our CSC/social worker started a second clinical eligibility assessment, Caregiver Program Clinical Eligibility Assessment. Note: A CSC/SW/LCSW cannot perform clinical responsibilities or make medical determinations of a licensed medical doctor.

3. Caregiver Program Clinical Eligibility Assessment (CPCEA)

  • Note: We had no prior knowledge of the processes or procedures or who was responsible.
  • Unknown to us, this was our second clinical eligibility assessment.
  • Unknown to us, the CPCEA consisted of two (2): Part1, Caregiver Program Clinical Eligibility Assessment (CPCEA) and Part 2, Caregiver Program Clinical Eligibility Assessment Child Note (CPCEACN). The CPCEA, Part, 1 consist of questions only (no approval or tier level assignment) and the CPCEACN, Part 2, consist of the approval/disapproval and tier level assignment.
  • Step 1: Unknown to us, the CSC/social worker sent my primary care provider (PCP) a request for her to input consults for an occupational therapy (OT) evaluation and a mental health evaluation. Once the CSC notified us, we asked my PCP about it and she told us we had to speak to the CSC/social worker because she didn’t know anything about the program or the employees. Our CSC told us she was following federal guidelines and I had to do the OT evaluation regardless if I needed it or not. Note: We haven’t been able to find these federal guidelines anywhere. Yes, a social worker told my PCP what evaluations to order for me. Note: A CSC/SW/LCSW cannot perform clinical responsibilities or make medical determinations of a licensed medical doctor;
  • Step 2: We completed the OT evaluation. The doctor voiced her frustration and lack of understanding of this program. She also stressed her lack of understanding why everyone who applies to this program is sent to her regardless of need. She was very nice to us;
  • Step 3: Unknown to us, CSC/social worker reviewed the OT evaluation and scheduled our mental health evaluation with a mental health provider. Note: A CSC/SW/LCSW cannot perform clinical responsibilities or make medical determinations of a licensed medical doctor;
  • Step 4: We completed the mental health evaluation with a mental health provider. We provided her a piece of paper listing the things my caregiver does for me, she looked it over and said we could leave. She didn’t ask us any of the questions. We found out via my medical records, it was the CPCEA, Part 1, and she is not a mental health provider, she’s a Staff Nurse. She answered the questions on the CPCEA, Part 1 and sent it to our CSC/social worker. The CPCEA, Part 1, only consist of questions;
  • Step 5: Unknown to us, our CSC/social worker reviewed my mental health evaluation aka CPCEA, Part 1. Note: A CSC/SW/LCSW cannot perform clinical responsibilities or make medical determinations of a licensed medical doctor;
  • Step 6: Unknown to us, our CSC/social worker completed the CPCEACN, Part 2, which consisted of the approval and tier level assignment. Note: A CSC/SW/LCSW cannot perform clinical responsibilities or make medical determinations of a licensed medical doctor;
  • Step 7: Our CSC/social worker contacted my applicant to inform him to complete the online caregiver competency training;
  • Step 8: Our CSC/social worker contacted my applicant to schedule the Caregiver Program Initial In-Home Assessment.

4. Caregiver Program Initial in-Home Assessment (B).

  • Note: We had no prior knowledge of the processes or procedures or who was responsible.
  • Step 1: Our initial home visit was completed by our CSC/social worker and the CS nurse at our home. I was having an anxiety/panic attack because two or three weeks prior I had asked for written documentation of the home visit requirements  because our CSC/social worker told us she had to inspect every room in our house. She had to look for things like cockroaches, bed bugs, holes in the wall, etc. This didn’t make any sense to me. We never received the documentation prior to the visit so, I asked again during the home visit and again, we were promised. We have never received it. The CSC/social worker kept insisting on inspecting my bedroom which after my four or five denials, she left.
  • Step 2: Our CSC/social worker contacted us to inform us we were approved and would receive a letter in the mail explaining everything. Note: A CSC/SW/LCSW cannot perform clinical responsibilities or make medical determinations of a licensed medical doctor;
  • Step 3: Our CSC/social worker told us our monitoring home assessments will occur every 90 days for a year then go to an annual assessments. Note: A CSC/SW/LCSW cannot perform clinical responsibilities or make medical determinations of a licensed medical doctor.

5. Caregiver Program Interim In-Home Monitoring Assessment.

  • Note: We had no prior knowledge of the processes or procedures or who was responsible.
  • Step 1: We went to our VAMC for our first home monitoring assessment. The CS nurse completed it by herself because our CSC/social worker was out of the office. Note: We handed her a reassessment request to adjust the number of caregiver hours awarded. We thought the hours were individual hours as the letter received from the VA stated my caregiver was awarded 25 hours. My condition worsened in July 2017 and we submitted the request on August 18, 2017. Note: Our CSC/social worker informed my caregiver we could do our first home monitoring assessment at the VA since I was upset during the initial home assessment.
  • Note: The CS nurse put in her notes on the form I had no changes to my medical and mental health which was inaccurate.

6. Caregiver Support Program Clinical Reassessment (No Official Form) (This is what started the investigation and complaints from us in August 2017.)

  • We submitted a reassessment request to the CS nurse during our home monitoring assessment on August 18, 2017. It was a written letter from us asking for a reassessment and listed the reasons. Note: We had no idea of what my caregiver was approved for or what they considered or what they pay my caregiver to do. He was just told he was approved and received a letter telling him how many hours he will get paid for.
  • Our CSC/social worker contacted my caregiver on August 18, 2017 to inform him the board might have an issue with my trip I took to stay with my parents in June 2017 without him. My caregiver informed me of this conversation and I cannot describe to you the roller coaster of emotional and trauma it caused me because I knew either she spoke to my psychologist or she read my psychotherapy notes. I had discussed how this trip had affected me and caused me to become bedridden. (My parents didn’t do anything wrong.).
  • Our CSC/social worker contacted my caregiver on August 25, 2017 to let him know the board indeed had an issue with my stay in June 2017 with my parents and wanted to kick us out of the program. She told him she fought for us because she knows I need a caregiver so the board agreed to allow us to remain in the program at the current amount of hours. Our request was denied for a reassessment. We didn’t know who or what the ‘board’ was until I got my medical records. The ‘board’ consisted of a total of 8 social workers. The 8 social workers discussed our request, my medical records and my psychotherapy notes. Yes, 8 unauthorized individuals who didn’t have my written permission to access my psychotherapy notes discussed them which is where our CSC/social worker read my discussing with my psychologist. Note: A CSC/SW/LCSW cannot perform clinical responsibilities or make medical determinations of a licensed medical doctor;
  • We started filing HIPAA/Privacy complaints with Health and Human Services (HHS), VA OIG, VA Privacy Officer and the patient advocate. I bet you can guess the answer to our complaints – no fault. Ok, HIPAA/Privacy and VA Privacy Policy state anyone other than the author of the psychotherapy notes must obtain a patient’s written authorization to access a patient’s psychotherapy notes. But, three of them found no fault and I have never heard from the VA OIG.

7. Caregiver Support Program Appeals (No official form)

  • Unknown to us, the VA CS has developed a verbal appeals process and procedure in violation of the law and VHA Directive 1041, Appeals of VHA Clinical Decisions. The VA CS established a Caregiver Support Program Clinical Appeals (you cannot find anything written on it) to use at the VAMC and VISN level. A Caregiver Support Program Appeals Team with predesignated members. The CSC/social worker prepares the packet to include what is put into the packet then submits to the appeal team members.
  • We submitted an appeal to our August 2017 reassessment denial. It wasn’t based on the denial of reassessment, it was asking our VA to allow my primary care team to perform the clinical responsibilities. It was denied.

We have learned a lot of the what happened ‘behind-the-scenes’ and the issues in the VA CS since discovering our CSC/social worker unlawfully accessed my medical records and psychotherapy notes in August 2017.

We cannot comment on the second caregiver support program, Program of General Caregiver Support Services (PGCSS) because my caregiver isn’t participating in it.

Multiple levels of CS employees, CSC and Social Worker Supervisor (SWS) have all told us they follow the CS National Director and CS Central Office verbal orders/directives regardless what is written in the law, statue, regulation or directive. Even when we show them their directive states it’s my primary care team they told us it doesn’t matter because it’s not their ‘verbal’ order/directive.

 

 

 

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