Caregivers for Severely Disabled Veterans Getting Expanded Mental Health Services as Part of Biden Order

Caregivers for Severely Disabled Veterans Getting Expanded Mental Health Services as Part of Biden Order

Caregivers for Severely Disabled Veterans Getting Expanded Mental Health Services as Part of Biden Order

Caregivers for severely disabled veterans face significant mental, emotional, and physical challenges, especially when the veterans are cared for by their family members. The daily caregiving demands eventually take a toll on family members who experience grief, frustration, guilt, and sadness as they grapple with changes in a relationship that goes from spouse or adult child to caregiver.

In an attempt to reduce the mounting stress on family caregivers, President Joe Biden issued an executive order for the U.S. Department of Veterans Affairs (VA) to expand mental health services for certain caregivers of disabled veterans.

The order requires the VA to develop a pilot program that offers telehealth psychotherapy (therapy provided over the phone) for caregivers enrolled in the VA’s Family Caregiver Program, which provides health care and financial assistance to roughly 33,000 caregivers. This program allows veterans who suffered certain serious injuries to be cared for by a parent, spouse, child, step-family member, an extended family member, or an individual who lives with the veteran but is not a family member who provides support to the veteran.

The administration estimates that 5.5 million Americans support disabled veterans in some way, whether providing personal care each day, such as bathing, dressing, grooming, cooking and cleaning, or taking them to appointments.

While acknowledging that many recommendations in his executive order are not required, President Biden encouraged the VA to comply.

“Nearly every other advanced country makes greater public investments in care than the United States,” President Biden said in a news release. “Investing in care is an investment in the future of America’s families, workforce, and economy.”

A 2020 study published in the Journal of the American Geriatrics Society found that caregivers who care for veterans with two or more trauma-based medical conditions reported intensive caregiving and significant levels of distress, depressive symptoms, and other negative consequences. These caregivers require comprehensive support services, including access to health care, financial assistance, and enhanced respite care.

Besides the White House, the U.S. House of Representatives has also been working on more ways to help caregivers and veterans. In December, Congress passed The Elizabeth Dole Home Care Act of 2023 to make home care services more accessible for veterans. According to the Congressional Budget Office, the bipartisan measure would, among other things:

  • Establish agreements with outside providers to furnish medical and social services to veterans not in VA nursing homes.
  • Require the VA to improve in-home assistance and support for caregivers of veterans and raise the limit on expenses for nursing home care provided outside of VA facilities.

Supporters of the bill say it allows veterans to safely age in their homes and provides them flexibility in deciding who cares for them. Sen. Jon Tester, D-Mont., the Senate Veterans Affairs Committee Chairman who co-sponsored the legislation with the committee’s ranking Republican, Sen. Jerry Moran of Kansas, said the proposed measures to help veterans are “critical” to ensuring that veterans age with dignity.

“This is great news for our aging and disabled veterans who deserve and have earned access to quality home-based care,” Tester said in a statement released by his office.

Caregivers Say Work Places Them Under Stress

The White House’s initiative to provide telehealth psychotherapy services to family members caring for veterans shines a light on the broader issue of the mental, physical, and emotional health struggles suffered by home health aides.

A survey of close to 3,000 workers, published in the American Journal of Public Health in 2021, found that home healthcare workers had worse general, physical, and mental health compared with low-wage workers in other industries. The survey also found that roughly 21 percent of the healthcare workers surveyed reported poor mental health.

In an interview with STAT News, Victoria Higgins, 36, spoke about issues she faced over the four years she worked as a home health aide. Higgins, who is 5-foot-2, said she was nervous working overnight shifts. She also said she was in “plenty of potentially dangerous and high-pressure moments” when unexpected strangers were in her clients’ homes when she had to move a patient twice her size, and when she had to handle a medical emergency for which she had not been trained.

“I felt like crying every time,” Higgins, a single mother of five, told STAT News. “But of course, I did my best, because I want to make sure that I’m taking care of this person—not only because the family is paying top dollar, but because this is a human being who deserves nothing but the best.”

Higgins said the companies she worked for did not acknowledge her concerns for safety or the exhausting demands of the jobs, in which she worked 10- to 12-hour shifts for $10 per hour. Higgins once said she asked for a $2 raise to increase her wage to $12 per hour. The company balked, Higgins said, and countered with a 25 cents per hour raise instead.

Higgins isn’t alone in experiencing challenges as a caregiver.

Duane Crichlow has worked as a home health aide for 20 years and has endured his share of humiliations, insults, and verbal attacks. The 49-year-old Brooklyn, New York resident frequently works 12-hour shifts. And if that weren’t enough, Crichlow travels one hour each way on two trains and sometimes a bus to reach his client’s home.

Crichlow said the job stress frequently affects his ability to sleep at night. As a way to find support, Crichlow said he tried psychotherapy and attended multiple sessions. The psychotherapy helped, and Crichlow assumed he no longer needed it. However, as time went on, Crichlow told STAT News, “I started to kind of mentally fall apart a little bit.” And talking about his experiences became difficult. “I don’t want to keep thinking about it because it’s going to make me more miserable.”

To provide more support for the overall mental and emotional well-being of home health aides, there needs to be extensive policy changes that address everything from their pay, benefits, and job security to their need for greater support from employers and unions, Emma Tsui, an associate professor at the CUNY School of Public Health, told STAT News.

Home health aides have been “literally and figuratively devalued” for too long, according to Tsui, the lead author of a study testing the benefits of emotional support calls to home health aides during the Covid-19 pandemic.

“One of the real pain points of this job is having a felt experiential day-to-day sense of why this work is so important,” Tsui said. “And then feeling societally that it is invisible and not recognized.”

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