How is the VA Handling Aging Veterans?

The Department of Veterans Affairs and veterans organizations across the country are working to care for a new generation of older veterans who are apt to have greater expectations for longevity and independence than earlier generations, yet also may struggle with more complex medical conditions, reports Military Times’ recent article entitled, “America faces a tidal wave of aging military veterans.”

“We’re kind of compounding multiple variables, in the sense that not only are people living longer, but … many of them survived something that wasn’t survivable,” says Scotte Hartronft, the director of geriatrics and extended care at VA. “A lot of veterans have survived significant injuries over the last couple of conflicts that [they] wouldn’t have survived in previous wars.”

In California, the most populous state and home to the highest number of vets, the State Department of Veterans Affairs, known as CalVet, the state’s veterans department, is working to create a modern facility that centers the needs and dignity of older veterans. Like VA facilities across the country, people charged with caring for veterans must address the same question: How do we best care for those who have served on our behalf as they grow old?

Other states also have issues: between 2021 and 2041, the number of veterans older than 85 is expected to increase by 31%. That’s partially because the overall number of veterans nationwide is actually decreasing. Between 2000 and 2018, the number of veterans in the country declined by a third — the bulk of Americans who have served in the military served decades ago.

Vietnam and Gulf War-era veterans represent a different slice of the population than veterans who fought in World War II and Korea: the number of women veterans over 65 is expected to increase by 237% between 2021 and 2041. Racial diversity is also increasing, and the geographic distribution of veterans is shifting. As a result, veterans’ care must change. Women, for example, have a greater life expectancy than men do. Women veterans will generally need more support to continue to live independently as they age for longer — a fact compounded by the fact that women, who tend to be informal caregivers to friends and family, often have more difficulty than men finding their caregivers when needed.

In addition to higher rates of post-traumatic stress and other conditions affecting mental health, veterans are more likely to be exposed to risk factors, such as traumatic brain injuries or toxic exposure, for Alzheimer’s and other dementias. Vets also have a higher chance of being diagnosed with certain types of cancer, like lung and skin cancer. Roughly 50,000 new cancer cases among veterans are reported annually; that number is expected to rise as veterans age.

Every VA medical center will offer veteran-directed care within the next two years. This popular program provides qualified veterans with a stipend to hire local caregivers to assist them with daily living or even companionship. VA is expanding home-based primary care — which provides health care to veterans at home, many of whom are housebound — to 75 new sites and expanding its Medical Foster Care program. This lets some vets live in a private home with a caregiver rather than in a nursing home. They’re also piloting a program using predictive analytics to help determine which veterans are at the highest risk of nursing home care in the coming years to connect them with preventive services.

Reference: Military Times (June 2, 2023) “America faces a tidal wave of aging military veterans”

What’s the Latest on Benefits for Families of Service Members?

Dependent care flexible spending accounts are one of six measures announced recently by defense officials to address some needs in parental leave, childcare, education and career advancement for military spouses.

Military Times’ recent article entitled, “DoD to offer tax-saving child care accounts, other benefits for troops,” reports that the memorandum, signed by Secretary of Defense Lloyd Austin, also expands eligibility for the popular My Career Advancement Account (MyCAA) financial assistance program, to include spouses of service members in paygrades E-6 and O-3. The program, which provides up to $4,000 for obtaining a professional license, certificate, or associate degree, was available to spouses of troops in pay grades E-1 to E-5, W-1 and W-2, and O-1 and O-2 only. In addition, Secretary Austin also requires improvements to the Exceptional Family Member Program within 90 days.

The dependent care flexible spending accounts will let service members earmark up to $5,000 in pretax income, through payroll deductions, for eligible dependent care expenses. Officials hope to implement these accounts for service members by this year’s open season, which begins in mid-November.

A recent DoD survey of active-duty spouses found that 38% of those with children at home routinely use childcare.

According to Internal Revenue Service regulations, a dependent care flexible spending account can be used to pay for home and child center care, preschool, summer day camp, before and after school programs for children up to age 13 and adult day care. The money is deducted from the service member’s gross pay and deposited into the account before taxes are calculated. Childcare bills are then paid with those funds. The end result is a lower tax bill.

In addition, married service members with one child with eligible childcare expenses could get a tax benefit by contributing $5,000 to a dependent care flexible spending account. For them, the tax decrease ranges from $382.50 to $1,382.50, depending on their overall income. A 2021 DoD demographics report shows that 35% of active-duty members have children. Of those, nearly 42% have at least one child, five or younger. Another 33% have at least one child in the six to 11 age group.

In addition to these new accounts and expanded eligibility for MyCAA, Austin’s memo announced improvements to the Exceptional Family Member Program, universal prekindergarten at Department of Defense Education Activity schools and professional license portability.

Reference: Military Times (March 22, 2023) “DoD to offer tax-saving child care accounts, other benefits for troops”

How Do Healthcare Professionals Help Aging Veterans Cope?

As our veteran population grows older, some will require mental health professionals to help them continue to live their best lives. Daily Nurse’s recent article entitled “Help Aging Veterans Cope with a Geriatric Mental Health Career” says that when it comes to providing for our aging veterans’ mental health, geriatric psychiatrists bring unique expertise to our team.

They focus on the prevention, evaluation, diagnosis and treatment of mental and emotional disorders in the elderly. However, the big difference for geriatric professionals is their experience with older adults who have multiple medical issues and take multiple medications.

Aging vets may have depression, anxiety, distressing memories from their military service, or stress related to health concerns. This may present as pain, trouble sleeping, or memory issues.

“Having access to a specialist who not only understands psychiatric medicine but the pharmacological goals of the elderly we care for has made a tremendous difference in our ability to keep our Veterans stabilized and safe in our memory care unit,” explained Edith Emerson, who works in the memory care unit at the Togus Maine VA.

The VA has a number of programs to support older veterans and their families and caregivers, both online and in-person at their facilities. They also provide specialized geriatric services for veterans and families to help them cope with complex mental health conditions in later life. However, the need for geriatrics professionals throughout the country is growing.

There are more than 11 million people aged 60 and older alive today who have served in the military, representing the largest population of veterans in the nation.

“Nationwide, there’s a shortage of geriatric services, in particular geriatric psychiatry,” said Dr. Isis Burgos-Chapman, a geriatric psychiatrist who provides community living center and outpatient consultation services through one of VA’s Clinical Resource Hubs.

With telehealth services, inpatient care positions and outpatient care support opportunities, there are many ways a mental health professional with a focus on geriatrics can reach out to aging veterans and demonstrate our core values—integrity, commitment, advocacy, respect, and excellence

Reference: Daily Nurse (Jan. 27, 2023) “Help Aging Veterans Cope with a Geriatric Mental Health Career”

Vets May See a Big COLA Jump Next Year

Federal officials aren’t expected to announce the Social Security benefits adjustment until mid-October. However, the nonprofit Senior Citizens League recently predicted a cost-of-living increase of about 8.7% for 2023, based on inflation data through the first eight months of the year.

Military Times’ recent article entitled “Vets benefits poised for biggest cost of living boost in 40 years” says that if the estimate is correct, it would be the highest annual increase since 1981. The 2022 cost-of-living adjustment was 5.9%.

For a veteran receiving about $1,500 in monthly payouts, that type of increase would result in roughly $130 extra each month.

Social Security and some other federal benefits are adjusted each year, to reflect increases in basic family costs like rent, groceries, and utilities. However, for veterans’ benefits, that process isn’t automatic. Congress must pass legislation annually to connect the two sets of benefits to ensure that veterans’ payouts keep pace with those increasing costs.

The House passed the legislation on September 15, and the Senate followed suit this week. Lawmakers called it a simple but significant move.

“With the global supply chain crisis continuing to impact Americans, disabled veterans, and military families, [this legislation] will ensure that the needs of our disabled veterans are being met,” bill sponsor Rep. Elaine Luria, D-Va., said in a statement.

The Department of Defense has announced several initiatives to improve quality of life for service members, including a boost in Basic Allowance in Housing for some troops. Senate leaders echoed that sentiment.

“We have a responsibility to ensure veterans’ benefits are keeping pace with a changing economy,” said Senate Veterans’ Affairs Committee Chairman Jon Tester, D-Mont. “That’s why I’m glad the Senate unanimously passed this bipartisan bill that’ll do just that — providing veterans and their families from every corner of the country with the support they need and earned.”

The COLA increase legislation would apply to payouts for disability compensation, clothing allowance, dependency and indemnity benefits, as well as other VA assistance programs. President Biden is expected to sign the measure into law in coming days.

Reference: Military Times (Sep. 23, 2022) “Vets benefits poised for biggest cost of living boost in 40 years”

Vets Closer to Toxic Exposure Benefits

Right after the Senate signed off on a military toxic exposure bill that could benefit millions of veterans, activist John Feal warned the crowd of advocates celebrating outside the Capitol about the moment they had been lobbying for and dreaming about for years: “The hard part hasn’t begun.”

Military Times’ recent article entitled “Now that PACT Act has passed, how soon will veterans see their benefits?” reports that Feal, who spent years as one of the lead advocates to award federal benefits to September 11 victims, first responders and their families, urged the crowd to make sure those payouts and resources are properly funded and administered. He cautioned that even well-written bills don’t always mean an easy transition to getting people the help they need.

“Getting a bill passed is easy, you just have to beat up the Senate and the House,” Feal said. “These people behind me, they have to take that and make sure Congress and the VA now do the right thing.”

This will be a big moment in the 13-year-old fight to expand benefits for burn pit victims sickened in Iraq and Afghanistan, and the decades-old quest to fully compensate Vietnam veterans for their exposure to chemical defoliants. Advocates say it won’t be the end of their work on the issue: the next step is delivering the benefits to veterans and their families. The estimated total is roughly $300 billion over the next 10 years.

“Veterans who were exposed to toxic fumes while fighting for our country are American heroes, and they deserve world-class care and benefits for their selfless service,” VA Secretary Denis McDonough said in a statement minutes after Feal’s speech.

“Once the president signs this bill into law, we at VA will implement it quickly and effectively, delivering the care these veterans need and the benefits they deserve.”

Apart from the congressional work, the VA has been overhauling the way that it approaches illnesses believed linked to burn pit smoke in places like Iraq and Afghanistan. In the past, the department adhered to strict scientific evidence before granting presumptive status for illnesses believed linked to military service. The VA now uses a broader set of metrics to evaluate the claims. This has resulted in adding 12 respiratory illnesses and cancers to the list of conditions presumed to be caused by burn pits (a designation that greatly speeds up the process of veterans receiving disability payouts).

Once the PACT Act is signed into law, those new processes will be codified, a move that veterans advocates say will be significant in the future to preventing long waits for department recognition of military injuries.

Other parts of the legislation will go into effect immediately. Vets currently get five years of medical coverage through VA after leaving the service, but will have that doubled to 10 years under the new law.

Reference: Military Times (Aug. 4, 2022) “Now that PACT Act has passed, how soon will veterans see their benefits?”

What’s the Latest in Legislation for Vets?

The leaders in the U.S. House and Senate had hoped to send the Promise to Address Comprehensive Toxics Act (or PACT Act) to President Joe Biden’s desk for final signature by the Fourth of July, after the Senate advanced the measure by a bipartisan 84-14. The measure would cost almost $280 billion over the next 10 years and provide new medical and disability benefits for as many as one in every five veterans living in America today.

Military Times’ recent article entitled “Major veterans toxic exposure legislation delayed again, but lawmakers insist it’s not defeat” explains that vets who served in Afghanistan, the first Gulf War, Vietnam and numerous other overseas locations could see new benefits under the plan. The bill would help many vets who are victims of on-duty toxic exposure injuries — in particular, smoke from burn pits used to dispose of waste in Iraq and Afghanistan.

The House passed the bill in March, but Senate leaders amended the bill to add phased-in implementation rules and more staff to help process claims in response to Republican concerns. However, the changes ran into trouble with rules that require new revenue requirements to start in the House, not in the Senate. A planned House vote to finalize the measure was postponed, and chamber leaders scrambled to make corrections to the measure before lawmakers began their two-week recess.

Senate Veterans’ Affairs Committee Chairman Jon Tester (D-MT) tried to push through a fix on the Senate floor late Thursday night, but the bid was blocked by Senator Pat Toomey (R-PA), one of the 14 senators to oppose the measure last week. Tester called that a disappointment.

“There is a [technical] issue and we have to fix it,” he said. “But in the process of our debates, we shouldn’t be denying health care to veterans, which is exactly what [Toomey] is doing today.”

However, the procedural issues aren’t fatal for the future of the PACT Act, but instead represent a temporary delay.

House Veterans’ Affairs Committee Chairman Rep. Mark Takano, D-Calif., said he still wants to get a House vote on the measure “once the Senate resolves this procedural speedbump.”

“House and Senate leadership are not shying away from passing the PACT Act,” he said in a statement. “This comprehensive package addressing toxic exposed veterans has been my number one legislative priority and I will continue to be unrelenting in getting it to President Biden’s desk.”

President Biden has already indicated he will sign the measure into law when it is finalized by Congress.

Reference: Military Times (June 24, 2022) “Major veterans toxic exposure legislation delayed again, but lawmakers insist it’s not defeat”

Will Vets Now Get a COLA Increase in Benefits?

The measure was filed by Representatives Elaine Luria, D-Virginia and Troy Nehls, R-Texas, along with Senators Jon Tester, D-Montana and Jerry Moran, R-Kansas. In joint statements, they called the proposal critical to bolstering veteran’s finances, reports Military Times’ recent article entitled “Lawmakers move to guarantee cost-of-living boost for veterans benefits.”

“We have a responsibility to take care of our veterans, many of whom rely on VA for financial support,” said Moran, ranking member of the Senate Veterans’ Affairs Committee.

“As rampant inflation is driving up the cost of living, this legislation helps make certain that veterans are able to keep up with our changing economy and receive the benefits they have been promised.”

The bill linking the two government benefits is largely routine. Lawmakers typically approve the annual proposal to couple VA benefits increases with Social Security benefits increases by large bipartisan margins.

However, this isn’t automatic. Even with the efforts of advocates in the past, an annual cost-of-living increase in veterans benefits requires congressional action.

Social Security benefits, in contrast, are adjusted based on an automatic formula that is triggered whether lawmakers vote on it or not.

In 2021, as inflation pressures began to impact the American economy, that increase was 5.9%. Officials haven’t said what this year’s adjustment may be. However, continued rising costs across the economy could push that figure even higher. The VA COLA increase legislation would apply to payouts for disability compensation, clothing allowance, dependency and indemnity benefits and other VA assistance programs.

“Transitioning from active duty to civilian life is not always easy, and a cost-of-living adjustment is the least we can do for the men, women and families who served our country,” said Luria, herself a Navy veteran.

Tester, who serves as chairman of the Senate Veterans’ Affairs Committee, said the bill will “ensure [veterans] benefits are keeping pace with the changing economy.”

No timetable has been set for when either chamber could vote on the proposal.

Reference: Military Times (May 23, 2022) “Lawmakers move to guarantee cost-of-living boost for veterans benefits”

What’s the VA Doing about Long Wait Times?

In his recent testimony before the House Appropriations Committee, Veterans Affairs Secretary Denis McDonough said he’s concerned about delivering accurate information on appointment timeliness to veterans as they seek to resume care that was deferred or canceled in recent years, reports Military Times’ recent article entitled “VA secretary promises improvements in medical wait time data.”

“If you look at our average wait times across the system, they’re good, but it’s a big system and we’re coming out of a pandemic,” he said. “So, I fear that there are outliers where people are waiting too long.”

Wait times at VA facilities made headlines in 2014, after whistleblowers revealed that officials were manipulating data to cover up long delays in care to meet performance metrics. During President Trump’s administration, the department began posting wait-time data online for all VA hospitals and clinics in an attempt to show more transparency into how long veterans have to wait for routine or specialty appointments.

However, in a report released Thursday, the VA Inspector General’s office said much of that data remains confusing and misleading.

“The Veterans Health Administration] has sometimes presented wait times with different methodologies, using inconsistent start dates that affect the overall calculations without clearly and accurately presenting that information to the public,” officials wrote.

In response to similar concerns raised by lawmakers, Secretary McDonough said that “we have to do a better job with that” and said he expects an announcement on changes related to the wait time issues in coming months. We’re working really hard on it because I am frustrated with it myself.”

Broad legislation has been stalled in the Senate over concerns about cost and potential workload burdens on Veterans Affairs workers. That’s raised concerns about pressure on the VA health care system, and if veterans could see a significant increase in the time it takes to schedule appointments.

Health officials have touted new pandemic telehealth options within the department as a way to help ease the burden on facilities facing increased requests.

However, lawmakers said that in rural areas — locations with some of the longest wait times already — a lack of reliable internet access may restrict the availability of those services.

Reference: Military Times (April 8, 2022) “VA secretary promises improvements in medical wait time data”

What’s Going on with Veterans Affairs Medical Centers?

In addition to closing or overhauling 35 VA medical centers, 14 new major VA hospitals would be built along with 140 multi-specialty community-based outpatient clinics, reports The Military Times’ recent article entitled “Dozens of VA medical centers slated for closure, total rebuilds under new infrastructure plan.” The plan in total would add 80 new medical buildings to the VA’s existing inventory of more than 1,200 across the country.

The proposals represent a massive overhaul of VA’s footprint in the U.S. in the near future, which may affect millions of veterans seeking medical care and hundreds of thousands of VA employees. However, the plan must also get approval from both an independent commission of veterans advocates and Congress before moving ahead, leaving any potential changes years away.

VA Secretary Denis McDonough said the changes are a critical rethinking of where VA facilities are located and how the department delivers care to vets.

“We will be shifting toward new infrastructure or different infrastructure that accounts for how healthcare has changed, matches the needs of that market and strengthens our research and education missions,” he said. “Most of all, we’ll ensure that veterans who live in [any] location have access to the world-class care they need when they need it.”

Congress mandated a reassessment of VA’s nationwide infrastructure in 2018 as part of a review styled after the military base closing rounds of the 1980s and 1990s. Under the plan suggested by McDonough, 17 medical centers in 12 states would be completely closed. They include three sites in New York state (Castle Point, Manhattan and Brooklyn), and two sites each in Pennsylvania (Philadelphia and Coastesville), Virginia (Hampton and Salem) and South Dakota (Fort Meade and Hot Springs). Other facilities recommended for closure are:

The Central Western Massachusetts VAMC
The Dublin VAMC in Georgia
The Chillicothe VAMC in Ohio
The Fort Wayne VAMC in Indiana
The Battle Creek VAMC in Michigan
The Alexandria VAMC in Louisiana
The Muskogee VAMC in Oklahoma; and
the Palo Alto Livermore VAMC in California.

Seven of the 17 sites recommended for closing are located in the northeast, where the number of veterans (and the overall population) has declined in recent decades. Services at those sites would be replaced by smaller inpatient and outpatient clinics to be added in those areas, or by construction of new VA medical centers in nearby communities.

The plan calls for the construction of two new major medical sites in Virginia (Newport News and Norfolk) and Georgia (Macon and Gwinnett County), as well as a new New Jersey facility in Camden to offset the loss of some of the New York sites. The new construction list includes:

A medical center in King of Prussia, PA
A medical center in Huntsville, AL
A medical center in Summerville, SC
A medical center in Grand Rapids, MI
A medical center in Colorado Springs, CO
A medical center in Everett, WA
A medical center in Anthem, AZ and
And a medical center in Rapid City, SD.

A total of 18 medical centers would be rebuilt, either on their existing land or at a nearby new location. Three New York state centers are on that list (Albany, Buffalo and St. Albans), as are several other major metropolitan areas: Miami, Atlanta, Phoenix, Indianapolis, San Antonio and Washington, D.C. Other replacement sites include:

Bedford VAMC in Massachusetts
Wilkes-Barre VAMC in Pennsylvania
Beckley VAMC in West Virginia
Roanoke VAMC in Virginia
Durham VAMC in North Carolina
Tuskegee VAMC in Alabama
Hines VAMC in Illinois
Shreveport VAMC in Louisiana; and
Reno VAMC in Nevada.

McDonough stated that the plan will not displace any VA workers or patients in the short-term. Efforts will also be made to minimize disruptions over the long-term. The plan also calls for many improvements to VA staff pay and benefits as a way to strengthen retention efforts, and improving care throughout the system.

The full recommendations would cost about $98 billion more over the next 30 years than simply maintaining the department’s current infrastructure, and about $41 billion more than modernization efforts projected to be needed over that time frame.

Reference: Military Times (March 14, 2022) “Dozens of VA medical centers slated for closure, total rebuilds under new infrastructure plan”

What Does New VA Budget Include for Veterans?

Even with many years of significant budget increases, the Department of Veterans Affairs will need billions more in funding in fiscal 2023 to keep pace with the health care and support services needs of veterans and their families, according to a new report released by advocacy groups.

Military Times’ recent article entitled “VA needs more money to keep pace with veterans’ needs, advisory group warns” reports that The Independent Budget—an advisory spending plan compiled by Disabled American Veterans, Paralyzed Veterans of America, and the Veterans of Foreign Wars — calls for a 23% increase in VA program spending over the latest White House request to add funds for priorities like mental health services, caregiver support and homeless veterans assistance.

Advocates say the administration’s plan for fiscal 2021 falls about $4 billion short of the needs of America’s veterans. In fiscal 2001, the entire VA budget totaled about $45 billion. By fiscal 2011, it was about $125 billion, almost triple that total. Ten years later, in 2021, the department’s budget was nearly double that again, at $245 billion.

The White House budget request for fiscal 2022 — which began last October — was $270 billion. Lawmakers have not yet approved a full-year budget for the VA, but are expected to advance discussion on that issue in coming weeks. The administration’s fiscal 2023 budget plan for VA is also expected to be released sometime next month.

Authors of the Independent Budget said their requests for more VA money next year are not wishful thinking but a real assessment of the challenges ahead for the department.

“As we enter into 2022, COVID’s impact remains a challenge for VA, with the spread of the virus and disruptions to health care systems continuing,” said Randy Reese, executive director of DAV’s Washington Headquarters. “In this environment, we made cautious recommendations based on historical trends to ensure the needs of our nation’s ill and injured veterans are met.”

Under the Independent Budget plan, VA officials would see a $1.8 billion uptick to health programs to “close the gap in clinical care” at department medical centers.

“The lack of adequate health care staffing has been a major driver of longer waiting times for veterans seeking VA care, and ultimately has the effect of suppressing the true level of veterans’ demand for care,” the report states. “It also forces many veterans who would prefer to receive their care from VA providers into community care providers.”

The organizations have also called for $490 million above the pending White House request for caregiver support programs, $395 million more for homeless veterans’ programs and $288 million more for mental health services and suicide prevention efforts.

Reference: Military Times (Feb. 7, 2022) “VA needs more money to keep pace with veterans’ needs, advisory group warns”

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How is the VA Handling Aging Veterans?

What’s the Latest on Benefits for Families of Service Members?

How Do Healthcare Professionals Help Aging Veterans Cope?

Vets May See a Big COLA Jump Next Year

Vets Closer to Toxic Exposure Benefits

What’s the Latest in Legislation for Vets?

Will Vets Now Get a COLA Increase in Benefits?

What’s the VA Doing about Long Wait Times?

What’s Going on with Veterans Affairs Medical Centers?

What Does New VA Budget Include for Veterans?

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How is the VA Handling Aging Veterans?

What’s the Latest on Benefits for Families of Service Members?

How Do Healthcare Professionals Help Aging Veterans Cope?

Vets May See a Big COLA Jump Next Year

Vets Closer to Toxic Exposure Benefits

What’s the Latest in Legislation for Vets?

Will Vets Now Get a COLA Increase in Benefits?

What’s the VA Doing about Long Wait Times?

What’s Going on with Veterans Affairs Medical Centers?

What Does New VA Budget Include for Veterans?

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