APPENDIX C: VAC Caregiver Recognition Benefit comparison to DVA (USA) Caregiver Support Program

Program Background Info:

Having a disability sometimes means you need ongoing care to remain in your home. The Caregiver Recognition Benefit recognizes the important role a caregiver delivers on a day-to-day basis by providing them $1000 per month, tax free.

To receive this benefit your case manager will conduct or arrange an assessment to confirm that you require the assistance of a caregiver.

Who may be eligible?

You may qualify for the Caregiver Recognition Benefit if you have a Disability Award and

• as a result of the condition for which you have received the Disability Award you require ongoing care to the extent that:
  • you need a level of care and supervision that is consistent with admission to an institution or nursing home,
  • you need daily physical assistance of another person for at least four of your activities of daily living [See Q8: What are activities of daily living?],
  • you need ongoing direction and supervision during the performance of at least four of your activities of daily living, or
  • you need daily supervision and are only considered safe when you are left alone for short periods of time
• you have an informal (unpaid) caregiver who provides or co-ordinates your care;
• your need for care is ongoing (expected to last at least 12 months)
• your informal caregiver is 18 years of age or older and is not paid for providing or coordinating your care; and
• you are not a permanent resident of a nursing home or long-term care facility.

FAQs: https://www.Veterans.gc.ca/eng/housing-and-home-life/help-at-home/caregiver-recognition-benefit/crb-faq#q21

Q21. What if my Disability Award is for a mental health condition and not a physical condition? Can I still apply for the new benefit?

Yes. If you have a mental health condition, you may still be approved for the benefit, as long as you meet the criteria of needing assistance with the activities of daily living, or if you require ongoing care or daily supervision.

Program Background Info:

If you’re a family member caring for a Veteran with disabilities who was injured in the line of duty on or after September 11, 2001, you may qualify for health care benefits and other caregiver support through the Program of Comprehensive Assistance for Family Caregivers.

If you’re the primary caregiver, you may receive:

• Caregiver education and training
• A monthly stipend (payment)
• Travel, lodging, and financial assistance when traveling with the Veteran to receive care
• Access to health care benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)—if you don’t already qualify for care or services under another health care plan.
• Mental health services and counseling
• Up to 30 days per year of respite care

Who may be eligible?

Veterans eligible for this program must:

• have sustained or aggravated a serious injury — including traumatic brain injury, psychological trauma or other mental disorder — in the line of duty, on or after September 11, 2001; and
• be in need of personal care services to perform one or more activities of daily living and/or need supervision or protection based on symptoms or residuals of neurological impairment or injury.

Veteran Eligibility: A Veteran is eligible for the Caregiver Recognition Benefit under section 65.1 of the Veterans Well-being Act:

1. the Veteran has had an application for a disability award or pain and suffering compensation approved under section 45 of the Veterans Well-being Act:
2. the Veteran requires ongoing care as a result of the health condition(s) for which the disability award application was approved;
3. the Veteran has not been awarded a pension or compensation under the Pension Act;
4. an informal caregiver who is 18 years of age or older plays an essential role in the provision or coordination of the ongoing care to the Veteran in the Veteran’s home for which the informal caregiver receives no remuneration (see paragraph 4); and
5. the Veteran requires at least one of the following:

Veteran Eligibility. Pursuant to 38 CFR 71.20, an individual is eligible for a primary or secondary family caregiver if all of the following requirements are met.

1. The individual is either:
   1. A Veteran; or
   2. A member of the Armed Forces who has been found unfit for duty due to a medical condition by their Service’s Physical Evaluation Board, and has been issued a date for medical discharge from the Armed Forces.
2. The individual has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service on or after September 11, 2001.
3. Such serious injury renders the individual in need of personal care services from another individual (a caregiver) for a minimum of 6 continuous months based on any one of the following clinical criteria:

Information in Policy on how this is to be interpreted/assessed (VHA Directive 1152(1)):

For purposes of this directive, activities of daily living means:

1. Eating. Ability to feed oneself both meals and snacks. NOTE: This refers only to the process of eating, chewing, and swallowing, not preparing the food to be eaten.
2. Grooming. Ability to safely tend to personal hygiene needs (i.e., washing face and hands, hair care, shaving, applying makeup, teeth and denture care, nail care of fingers and/or toes).
3. Bathing. Ability to wash entire body safely.
4. Dressing and Undressing. Ability to dress and/or undress upper and lower body with or without dressing aids.
5. Toileting. Ability to maintain perineal hygiene and adjust clothing before and/or after using the toilet or bedpan; ability to manage an ostomy, including cleaning the area around stoma but not managing equipment; or ability to manage urinary catheter or urinal.
6. Prosthetic Adjustment (Use of Assistive Devices). Ability to adjust special prosthetic or orthopedic appliances without assistance. The adjustment of appliances that any person (with or without a disability) would need assistance with should not be scored (for example, supports, belts, lacing at back, etc.).
7. Mobility. Ability to transfer safely from bed to chair and/or chair to toilet, ability to turn and position self in bed, ability to walk safely on a variety of surfaces, or ability to go upstairs.

Information in Policy on how this is to be interpreted/assessed:

The phrase “most activities of daily living” is interpreted to mean a minimum of four (4) activities out of seven (7). Mobility is considered to be one activity of daily living.

Mobility (considered 1 ADL):

Transfers – changing the position of the body independently (e.g. positioning the body from lying to sitting, sitting to standing, lying on the back to lying on the side, etc.); and Ambulation – moving the body from one point in space to another (e.g. climbing stairs, walking, etc.).

Self-care (6 ADLs):

Feeding – eating and drinking of prepared foods (e.g. cutting up food, buttering bread, etc.).

Washing – washing of face, trunk, extremities and hair.

Dressing – putting on and taking off all pieces of indoor and outdoor clothing.

Grooming/Foot Care/Personal Care – brushing of hair and teeth, shaving and make-up application, skin and nail care, cleansing and personal care associated with toileting.

Toileting – continence of bowel and bladder, using toilet facilities.

Taking medication – preparing and self-administering medication.

Information in Policy on how this is to be interpreted/assessed (VHA Directive 1152(1)):

Need for Supervision or Protection Based on Symptoms or Residuals of Neurological or Other Impairment or Injury. The need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury means requiring supervision or assistance due to one or more of the following:

1. Seizures. Unable to manage seizures independently (i.e., seizures are not well controlled with medication or Veteran is not able to independently manage the medications, blackouts, or lapses in mental awareness).
2. Planning and Organizing. Difficult to plan and organize (i.e., complete daily tasks, make and keep appointments, adhere to medication regimen).
3. Safety. Unable to maintain safety with self and others (i.e., Veteran is a risk to self or others and/or is at risk of falling or wandering, cannot safely use electrical appliances, stove top or oven).
4. Sleep. Difficult to regulate sleep without intervention of caregiver.
5. Delusions/Hallucinations. Unable to maintain safe behavior in response to delusions (irrational beliefs) or hallucinations (serious disturbances in perception).
6. Impairment of Recent Memory. Difficult to remember recent events and learn new information.
7. Affective/Behavioral Dysregulation (Self-Regulation). Unable to regulate behavior without exhibiting any of the following behaviors: aggressive or combative with self or others, verbally disruptive including yelling, threatening and excessive profanity, impaired decision making, inability to appropriately stop activities, disruptive, infantile or socially inappropriate behavior.

1. are continuous, and unlikely to substantially improve; or
2. the duration cannot be determined, but are not expected to substantially improve for at least 12 months.

Information in Policy on how this is to be interpreted/assessed (VHA Directive 1152(1)):

In the Best Interest. In the best interest is defined as a clinical determination that participation in the Program of Comprehensive Assistance for Family Caregivers is likely to be beneficial to the Veteran. The determination includes consideration, by a clinician, of whether participation in the Program will:

1. Significantly enhance the Veteran’s ability to live safely in a home setting;
2. Support the Veteran’s potential progress in rehabilitation, if such potential exists; and
3. Create an environment that supports the health and well-being of the Veteran.

(5) 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.

(6) The individual agrees to receive care at home after VA designates a family caregiver.

(7) The individual agrees to receive ongoing care from a primary care team after VA designates a family caregiver.