Thursday, March 03, 2011






Starting in DC with the US Congress. Some background: Caregivers are the people who take care of you when you need assistance. If you are a wounded veteran, your caregivers are often family, a spouse or a significant other. Caring for you may be temporary in that you recover and you have full or close to full use and ability and mobility as you did before your injury; however, that is not always the case. There are many veterans -- especially of the current wars -- who are badly injured and need a caregiver for the rest of their lives and/or around the clock. The person who fills that role -- whatever his or her relationship to the veteran -- isn't visited by the clock fairy who waves a wand and creates more hours each day for that person. The person in the role of the caregiver is doing hard work and a full time -- usually more than full time -- job. And you cannot be a caregiver in that situation and also maintain a full time paid job in the workforce. Which means that while you are providing care, you're not bringing in money. The bills don't go away and many veterans and their caregivers face huge financial hardship as a result. June 4, 2010, the mother of a veteran called in on the first hour of The Diane Rehm Show (NPR).
Marlene: My son was in Iraq for 15 months and directly effected by two IED explosions -- with shrapnel to his head. He continues -- my son continues to say everything is fine. But two weeks ago, the bank repossessed his car. He had been faithfully paying on this car prior to his diagnosis of PTSD. Now, as the Mom and the next of kin, I was not able to assist in any way. The bank would not work with my son other than to demand the total payment of the balance. There was no bailout for this soldier. Now I as the Mom had no right to advocate on his behalf. I called my Congressman, the military and who ever else I thought could help. My question is: Who does advocate for these soldiers?
Bills don't stop for the veterans because they're veterans and that's especially an issue if you're a disabled veteran or the caregiver for one. Hike for our Heroes is a non-profit started by Iraq War veteran Troy Yocum who is hiking across the country to raise awareness and money for veterans issues -- all veterans. Why did he start his 7,000 mile hike? As Katherine Gustafson (Tonic) reported last May:
Directing people's attention to the stress that many military families face is an idea that came to Yocum while he was stationed in Iraq, where he was distressed to receive emails from a friend, an Iraq veteran, who had lost his job and was losing his house. It brought to Yocum's mind memories of his grandfather, a World War II veteran who had faced the same problems and ended up committing suicide as a result.
Yocum contacted nonprofit organizations to find help for his friend, but everywhere got the same answer: There isn't enough funding to go around. Yocum made up his mind that he would find a way to help all those families when he got home and immediately started researching a game plan. He turned up the story of Terry Fox, a one-legged man who had run across Canada to raise money for cancer research. "That story was so amazing, and he raised millions and millions of dollars," said Yocum. "That's something I could do to help spread awareness across America but also raise millions of dollars to help military families."
He was determined to prevent more people from getting "into a situation like my grandfather where they lose their jobs and they have no other way out, or at least that's what they think, and then they kill themselves. Did you realize that 20 percent of all suicides are veterans?"
Money, debts and the stress from bills piling up do not help the health of any veteran -- even more so a disabled one. Doesn't help a caregiver either and you can't be a full time caregiver and also work in the paid work force. It's just not possible and Congress has been recognizing the time and work required of caregivers for many years with hearings in both houses. For example, June 4, 2009, the Wounded Warrior Project Anna Freese testified to the House Veterans Affairs Subcommittee on Health:
Let me begin by asking you to think about what it took for each of you to get prepared for the day today. I'm not talking about the first cup of coffee or your morning paper. I'm asking you to think about more basic activities. Raising your arm to reach for a bedside light switch. Moving a finger to wipe the sleep from your eyes. Getting out of bed, walking to the bathroom. While most of us take this for granted, severely injured service members, like my brother Eric [Edmundson], can no longer carry out these basic activities of daily living without assistance. Eric and other severely wounded warriors get the most intimate, devoted care from family members in the privacy of their homes, twenty four hours a day, seven days a week, 365 days a year.
After many hearings and many meetings with the effected populations, both houses of Congress agreed upon the Caregivers and Veterans Omnibus Health Services Act of 2010 (May 5, 2010) which was to go into effect January 30, 2011. This was a bill that had support from both political parties -- and support from independent Senator Joe Lieberman, Socialist Senator Bernie Sanders. In the Senate it passed by 98 votes (all present voted for it). In the House, it passed by 419 votes with all present voting in favor of it. President Barack Obama signed it into law May 5, 2010. It shouldn't have caused any problems because of the huge Congressional support it had -- universal support -- and because the Congress took so much care in investigating the issues, in taking testimonies from stakeholders, in evaluating and re-evaluating before they wrote the bill.
So this morning, in the US Senate, it might have been surprising to some to discover that the law that Congress wrote and understood and backed universally was taken by the VA to mean, "Do what you want with this." The US Senate Veterans' Affairs Committee took testimony this morning from VA Secretary Eric Shinseki and from the VFW's Raymond Kelley, Delware VA Medical Center's Maryann D. Hooker, AMVETS' Christina Roof, Paralyzed Veterans of America's Carl Blake, the American Legion's Tim Tetz and Disabled American Veterans' Joseph A. Violante. We're noting this exchange from the first panel. Senator Patty Murray is the Chair of the Committee.
Chair Patty Murray: Mr. Secretary, I have a great deal of respect for the work that you've done on homeless and women's issues and I know you're working diligently in a number of ways. But I wanted to bring up an issue that I'm very concerned about. I've already discussed the caregiver issue with you, I've talked about it with Jack Woo, I've talked with senior staff at the White House and I have spoken directly with the president of the United States. VA's plan on the caregivers issue was overdue and once submitted it hardly resembled the bill that unanimously cleared this Congress. Three weeks ago, my Committee staff requested information on how that plan was developed and to date no information has been provided. Rather than following the law, the administration set forth some overly stringent rules bureaucratic hurdles that would essentially deny help to caregivers. Sarah and Ted Wade who were staunch advocates and worked hard with us to get this passed were invited by the president to attend the bill signing at the White House, they won't be eligible for the program under the plan that the department submitted. We're also hearing a lot from veterans and caregivers from across the country who fall outside of this new line in the sand the VA has drawn, who have been left in limbo and now don't know if this benefit that they advocated and worked so hard for will support them. Mr. Secretary, it appears your that department is not complying with the law as we have written. Can you please tell this Committee why?
Secretary Eric Shinseki: Well, Chairman Murray, let me begin by expressing my regret that the implementation plan was late in getting to you. We did our best and uh, uh, we're looking forward at this point on how to accelerate the process. I will also add to that that the importance of family and caring for our nation's uh injured veterans has been a long standing uh, uh concern and issue for VA. And I think, as you know, we have eight decades of history of, uh, caring for the caregives. And we have demonstrated this dedication to them in a wide range of ways over those years. Benefits that are already offered including education, training, homemaker, home health services, respite care, uh, family support services. But more than programs, we see it in the thousands of acts of compassionate care provided by VA employees on the front lines. Through the caregivers bill enacted last year -- thanks to the leadership -- your leadership specifically -- but the leadership of Congress as well, Congress and the president built on this foundation by establishing landmark new benefits for Post-9/11 veterans that for the first time provide direct financial and broad health care support directly to the caregiver. We've not done this before and, uh, and we're working through the complexity of what this means. Implementation of the more unprecedented features of this law has taken longer than I had anticipated or would have liked and we understand the frustration that's been expressed on the part of some. We have responded by greatly expediting the required regulatory process through the use of what I described as the interim final regulation transmitted to the Office of Management and Budget on Monday. I assure veterans and the Congress that the administration will move quickly and we plan to have direct to caregiver benefits in place this summer -- early this summer. We also understand the concerns that have been expressed in the scope of the benefit as we've proposed in meeting our implementation plan. We have an obligation to get this right -- to get this benefit right -- and that means meeting the requirements of the law and also making sure that those VA employees on the front lines of caring for our veterans have a clear and consistent set of guidelines to apply. It has been a challenging exercise. I will state that. It's my personal obligation to be able to explain to an injured veteran why he or she would not be eligible for this benefit while someone else in his or her company with similar injuries would be. And that's the standard we're trying to establish here. That standard has guided our efforts to this point and I hope remains in whatever standard we finally establish. That said, I want to be clear, we are absolutely open to suggestions for different places to draw that line than what we have put forward, what we have put forward was a start place. But the standard must work in the real world, on the clinical front lines where the differences end standards and combinations of injuries mental and physical are unique as-as veterans themselves. To that end, Madame Chair, VA is willing -- and I am willing -- to work with you and this committee and members of your staff and all the veterans and families who are represented and have a stake in this. I welcome the input both from you and Ranking Member Senator Burr and others in trying to develop clear, clinical guidelines for this program. OMB is now reviewing the regulation. I'll take this opportunity to encourage all with a stake in this important new provide us the benefit of their insights and their comments and, uh, I will provide feedback to you at the appropriate time.
Chair Patty Murray: Well thank you very much, Mr. Secretary. I know that this is a new law. I think that we went through that as we prepared it and wrote it and worked with many, many people to get it done. But I think it is absolutely in this time of war with OIF and OEF soldiers coming home seriously disabled, a generation of soldiers that are facing very long term care with spouses or parents who are caring for them -- that's what we went through in our hearings and processes as we went to it. I am deeply concerned, first of all, in the lack of information we had and the lateness of this getting to us. We're past that now but a very unfortunate circumstance where the rules have gone to OMB and may be out in a few months and implementation takes awhile and you're now offering to us to look into different ways of writing the law but it's at OMB. So we have a real challenge in front of us to write it in a way that Congress intended. If the rule comes out as we saw the draft with the narrow definition, it will not be the intent of what Congress had. We're happy to work with you now to tell you how we feel that should be implemented but we're in a serious, difficult challenge to do that because of where we are today. So I am very concerned about that and we'll have more to talk about that. I think it's important to remember why we wrote this. We know that in every war, soldiers come home and need care. But in this war in particular, where we have saved the lives of many, many soldiers, they've come home with very serious, challenging issues to deal with at home and their spouses or their parents are now required to quit their job, lose their income and care for them. That was the intent of Congress. The narrow draft of what we saw of your rules excludes many people who we believe, in Congress, and we wrote the law to cover. So we're going to have to work on this. But I wanted to ask you today of the 180 million that the budget submission specifies for caregivers and veterans pact, how much is going to be actually allocated for the implementation of the family caregiver program?
Secretary Eric Shinseki: Uh, in the 2012 budget it's 66 million.
Chair Patty Murray: 66 million for the implementation. Okay. The legislation authorized an average of 308.4 million for this program each year. Can you tell us why the VA use about 21% of that?
Secretary Eric Shinseki: Madame Chairman, I'd just say that that again is where we established the start point. We expect this program will go -- grow.
Chair Patty Murray: Pardon me?
Secretary Eric Shinseki: We expect that this program will grow. The 66 million was based on our estimate of uh going through the veterans who are in various categories of serious injuries, severe injuries and, uh, the numbers on which, uh, 66 million are based was that initial eligibility start point.Roughly about a thousand.
Chair Patty Murray: Very narrowly defined, though. Not designed as the law was defined.
Secretary Eric Shinseki: That is correct.
Chair Patty Murray: And it was the intent of Congress that that law not be narrowly defined. So we have an issue between us on that one. Let me ask one other question and I will turn it to my Ranking Member -- and we will have a lot more discussion about this caregiver bill -- I recently saw a newsletter written by the Directoor of the Indianapolis VA Medical Center talking about a variety of cost saving initiatives that the VAMC will undertake and he indicated that he intended to seriously reduce bonuses but he also will be slowing the hiring of additional and replacement staff. Will those types of cost savings actually result in the degredation of quality?
Secretary Eric Shinseki: Madame Chairman, I'm going to call on Dr. [Robert[ Petzel to address the specific issue hear at Indianappolis. But what I would offer up front is that we now have a year long budgeting dialogue -- the beginning of the year, mid-year and end of year. And they're adjustments made. No VISIN Director of the 21 VISINS have come in and said they're unable to execute their programs the year and we hold them responsible for balancing resources and requirements.
Dr. Robert Petzel: Thank you, Mr. Secretary. Madame Chairman, the estimate that the letter you read -- and I also read -- was based on -- was an early estimate of what the budget might look like. Those estimates are refined almost weekly as the medical centers begin to spend their money. And if you were to look -- in fact, we have asked what the estimate is now, it is substantially reduced. As the Secretary has said, we review -- here in Washington [. . . Not including it -- Petzel was brought on to testify about things Shineski did not know about it. I would presume Shineski knows what he does each day at work and could have answered that himself.]
Chair Patty Murray: Well the Indianapolis director said that they were facing an $18 million gap this fiscal year.
Dr. Robert Petzel: That's -- that was the difference between what they wanted and what they got. It does not represent the difference between need and what they got. So if you were to look -- If we were to ask what is that gap now that it's not $18 million. It's been substantially reduced and if not actually disappeared. In addition to that, if that were true, if there was an $18 million shortfall between what they got and what they needed, the networks are able to make up those differences. They have reserve funds. The Secretary has a reserve fund. And we have, as I said, reviews at least 3 times a year here in Washington of the financial state of each one of the medical centers.
Chair Patty Murray: How many --
Dr. Robert Petzel: There would be money to take care of it.
And how many VISNS currently are facing a budget shortfall?
Dr. Robert Petzel: None.
Chair Patty Murray: Quickly on the issue of bonuses, I was surprised at the number of bonuses that were awarded last year. Among them actually was the director of the medical center in Dayton, Ohio where there have been serious problems we've been hearing about with respect to a dentist failing to practice basic hygene and overall poor management of resources, the dental clinic and other areas. Apparently he received more than $11,000 this year and $64,000 since 2006, problems going on the entire time with that. And executives at other troubled medical centers received significant bonuses as well. Mr. Secretary, I wanted to ask you, are you going to be seriously reducing the number of bonuses the same way the director of Indianapolis was forced to?
Secretary Eric Shinseki: Uhm, Madam Chairman, let me start and then call on Dr. Petzel for any details. I-I offer that since -- for the past two years we have, uh, paid specific attention to the way bonuses are paid and, uh, without making any statements about how it was run prior, I just didn't find as close a connection between performance and bonuses. And I do believe bonuses have a real role to play in the compensation programs -- designed to encourage best behaviors, superior performance. And when that happens, I think there's justification for them. Since -- for the past few years, we have looked very closely at it and I'd be happy to provide you with the details, the "outstandings" and the number of bonus payments actually adjusted quite significantly. To your direct question about Dayton? I can't justify the performance of what happened at Dayton. I think there is a failure of leadership and therefore I'm not going to try to describe why a bonus was sensible. But suffice to say this issue came up because VA workers thought we had a problem. This went on for an extended period of time where it wasn't brought to the attention of leadership and I again fault that to a failure in leadership that the climate wasn't conducive for the workforce to believe they could raise the issueand get satisfactory response. I own that and my responsibility is to correct that and that's what we're doing.
The Senate Veterans Affairs Committee released the following this afternoon:

(Washington, D.C.) – Today, Senate Veterans' Affairs Chairman Patty Murray, pointedly questioned Department of Veterans Affairs (VA) Secretary Eric Shinseki over the VA's decision to limit a benefit for the caregivers of severely injured Iraq and Afghanistan veterans. The VA's decision, which cuts back stipends for those who have left careers behind to care for their injured loved ones, ignores the will of Congress in passing the caregivers law last year.

"I have already discussed the caregivers issue with you, with Jack Lew, with senior staff at the White House, and I have spoken directly with the President," Senator Murray said at today's hearing. "VA's plan was overdue and once submitted it hardly resembled the bill that unanimously cleared this Congress.
"Rather than following the law, the Administration set forth some overly stringent rules -- bureaucratic hurdles that would deny help to caregivers. We are hearing from veterans and caregivers from all across the country who fall outside of this new line in the sand that the VA has drawn or who have been left in limbo – and now don't know if the benefit they have been advocating for will support them."

After questioning Shinseki about why the VA is not complying with the law, Murray also pointed out that the VA has only set aside a fraction of the funding authorized for the caregiver program. Secretary Shinseki acknowledged that all of the funding is not being used because of the narrowing eligibility requirements. Secretary Shinseki also acknowledged that the benefit has taken too long to implement.

The caregivers question appears at the 77 minute mark.

Yesterday's snapshot covered Secretary of State Hillary Clinton's appearance before the US House Foreign Affairs Committee. We'll again note this exchange:

US House Rep Dannis Cardoza: Madam Secretary, at least 70 people were killed during an attack last October on Our Lady of Salvation Church in Baghdad making it the worst massacre of Iraqi Christians since 2003. Less than two months later, extremists bombed the homes of more than a dozen Christian families in Baghdad as well. And on New Year's Eve 23 people were killed by a suicide bomber in Alexandria, Egypt while coming out of mass in St. Marks and St. Peter's Coptic Church. Since these tragic incidents in the Middle East have -- Since these tragic incidents, the Middle East has been rocked by wide ranging protests and regime changes as we've seen in the last few weeks. How has this ongoing instability effected the already heightened risk to vulnerable religious minority groups like Assyrians, Jews, Cops and others?

Secretary Hillary Clinton: Congressman, thank you for asking that question. I think this has not gotten the level of attention and concern it should. We immediately went into action when the bombings took place in Baghdad. Our Ambassador [] was deeply involved with the government, making sure that there was protection and security. The ambassador went to Mass in order to show solidarity with Iraqi Christians. But there's no doubt that Christians and other minority groups are feeling under pressure and are leaving countries from North Africa to south Asia because they don't feel protected. I think we need to do much more to stand up for the rights of religious minorities and obviously I'm deeply concerned about what happened to the Christians in Iraq and the Christians in Egypt. I'm also concerned about what happens to minority Muslim groups in Pakistan and elsewhere. So you have raised an issue that I think is one of deep concern and we have to be speaking out more. And we have to hold governments accountable. When I spoke with the prior Egyptian government after the Alexandria bombing, they expressed the same level of outrage that I felt. They said that the Cops are part of, you know, Egyptian history. As you recall from Tahrir Square there were a lot of inter-faith efforts with Cops and Muslims together, worshiping together. Let's hope that continues and let's do whatever we can to make that the future instead of what I am fearful of which is driving out religious minorities. And the final thing I would say on that because it's an issue that I have paid a lot of attention to, we want to protect religion and religous believers but we don't want to use some of the tools that other countries are proposing -- which is to criminalize defamation, criminalize in the broadest possible definition blasphemy -- and then use it to execute, harass and otherwise oppress religious minorities. So we have to come up with an international consensus about what we're going to do to protect those who are exercising their conscience.

Of her non-Iraq comments above, the story from McClatchy Newspapers and the Los Angeles Times on the events in Pakistan add weight to them. In Pakistan, Minorities Affairs Minister Shahbaz Bhatti, who was a Christian and who opposed the blasphemy legislation, has been assassinated; however, BBC News cautions that too many details on the assassination are unknown. On yesterday's Committee hearing, Kat covers it in "Is you're Congressional district in Tel Aviv or Jerusalem?," Wally covers it at Rebecca's site with "Pitching the State Dept. budget (Wally)" and Ava covers it at Trina's site with "Hillary's foreign policy aims (Ava)." Kat will cover Richard Burr -- Ranking Member on the Senate Veterans Affairs Committee -- at her site tonight. She long ago carved out Burr's participation on the Committee as her beat. And Monday's snapshot noted an article by Eric Ruder (US Socialist Worker) however the link had a period at the end of it which caused it not to go to the correct page. This is the correct link.