美国国家公共电台 NPR Some VAs Are Dropping Veteran Caregivers From Their Rolls（在线收听）

RACHEL MARTIN, HOST:

Even with all the VA clinics and hospitals, that $180 billion budget for the U.S. Department of Veterans Affairs, even with all those resources, the day-in-and-day-out care of disabled veterans often falls to their own family members. Congress recognized that. And finally, in 2010, created the VA Family Caregiver Program. The program offers support and, in some cases, a little financial help for those family members. Veterans have signed up in huge numbers. NPR's Quil Lawrence reports that family caregivers in some cities say they are now being dropped from that program without any explanation.

QUIL LAWRENCE, BYLINE: Jim Graham wears thick, "Terminator" sunglasses indoors, even with the blinds drawn. Light is a big deal.

JIM GRAHAM: Light's a very big deal, actually.

LAWRENCE: Graham got knocked out by a mortar blast on his third deployment as a combat medic to Iraq in 2006.

J. GRAHAM: Part of my brain injury, one of the things is that I'm light-sensitive. So I have to wear the darkest sunglasses I can find all day, every day.

LAWRENCE: Otherwise, he gets migraines - not just headaches. Those he has all the time.

J. GRAHAM: I've had a headache ever since I got hurt.

LAWRENCE: You've had a headache for 11 years, almost.

J. GRAHAM: Yes. And then I get migraines on top of it. When I get one, it lasts for days, months. If I'm some way able to get rid of a migraine, I'm lucky if I get a week off before another one hits me.

LAWRENCE: The brain injury means he can't remember to turn off the kitchen stove or turn off the shower once he gets in it, or drive or pay bills. Graham also has post-traumatic stress disorder, which gives him panic attacks and makes it hard to leave his house in Jacksonville, N.C. The two-hour drive to the VA in Fayetteville is almost unbearable. Alishia, Jim's wife, takes care of him around the clock.

ALISHIA GRAHAM: I have not been able to work outside of our home since he was injured.

LAWRENCE: The VA's Family Caregiver Program was designed for people like Alishia, mostly wives, sometimes parents, who've had to leave their careers to help their veteran with daily living. Jim got rated at the highest tier in the program, which meant VA paid Alishia a stipend of nearly $2,000 per month. But I got in touch with Alishia Graham because of something I'd been hearing for over a year, caregivers claiming they'd been dropped from the program without cause.

A. GRAHAM: I was watching as all of these caregivers were going up to their reassessments. And one by one, they were sharing that they'd gone to their re-assessment, and they were dropped.

LAWRENCE: Alishia said around Fayetteville, everyone was scared. And she'd heard similar things around the country. Before I could make it down to see her, something came in the mail.

A. GRAHAM: The letter was sitting on the top. And my stomach dropped because I knew what it was.

LAWRENCE: Nothing about her case had changed. If anything, Jim's condition was a little worse. But the Fayetteville VA said he no longer qualified for a caregiver.

A. GRAHAM: And it's not even like, oh, we dropped you a tier because we think he doesn't need as much help. No, we think he's totally fine, and he doesn't need any help. I'm insulted for him because I know what he struggles with.

LAWRENCE: They're not the only ones stymied about why they were dropped. From the Graham's house, I drove down the road to visit another veteran couple, Brianna and Josh Schaudi.

JOSH SCHAUDI: Fourteen years in the Marine Corps, them just to say, OK, well here you go.

BRIANNA SCHAUDI: Met with the doctor for about 10 minutes and a few weeks later, got the letter saying bye-bye.

LAWRENCE: Then, on the phone, Drew and Kari Evans in Idaho Falls said the same thing.

KARI EVANS: Nothing changed from the time we were put on to when we were kicked off. And that's what I got frustrated about.

LAWRENCE: So did Chrissy Hogan, who takes care of her Army vet husband Sean in Cincinnati.

CHRISSY HOGAN: Yeah, I mean, it was a nice program. It helped, you know. I just got cut. I got the letter December 19.

LAWRENCE: And Jenn Wilmot and her husband George, who use the VA in Charleston, S.C.

JENN WILMOT: Home nurse came out. She didn't know anything changing or anything like that. So I'm thinking, OK, we're good. And then, seven days later, after her report went in...

LAWRENCE: NPR spoke with 10 couples who'd been cut from the program. But the VA says overall, the numbers have grown, not shrunk.

MEG KABAT: The program is not cutting back in any way.

LAWRENCE: Meg Kabat is director of the VA Caregiver Support Program. The program had a rocky start in 2011. VA expected to serve four or 5,000 caregivers. It's now serving over 22,000. Kabat says initially there were too few coordinators at some VA's.

KABAT: We've been able to expand the number of caregiver support coordinators and really continue to monitor that. We also train our staff on a regular basis because this is such a unique program and focuses in on family members of the veteran, which is very different than what anybody else is doing in the medical center.

LAWRENCE: Kabat says there's been no pressure nationally to push people off the program, though the eligibility requirements have gotten clearer. VA data does show it added 6,300 caregivers in the past three years. But the same data show it hasn't been consistent. The VA is infamous for inconsistency from station to station. Of 140 medical centers, most added caregivers. But 32 of them cut their numbers, some drastically. At Charleston, S.C., where Jenn and George Wilmot get care, there were 197 caregivers in 2014. Now there are only 11. So 95 percent of their caregivers have been dropped.

The Charleston VA says some of those vets improved and don't need the program; others probably never should have qualified. The Portland, Ore. VA cut 60 percent of its caregivers in three years. Seattle cut 50 percent. The South Texas VA cut half. To repeat, most VA's are adding caregivers. But if you're Alishia Graham taking care of your disabled Iraq-vet husband Jim out of Fayetteville and it seems like half the caregivers you know have been cut, that's because Fayetteville cut half its caregivers in the past three years.

A. GRAHAM: That means my family is - oh, nicer word, hold on - is janked (ph) out of $2,000 a month.

LAWRENCE: Alishia says she made sure never to live paycheck to paycheck. And she knows there were some people in the program who shouldn't have qualified. And Jim has a pretty high disability check from VA, so they're not starving. And she says Jim hates leaving the house, so it's not like they were going to save up for a big vacation anyway. But Jim says it's more about Alishia's hard work no longer being recognized.

J. GRAHAM: It's insulting because I know how much she does do, how much help I do need with everything. I gave everything I had to what I was doing, always did. To not get back the same or equivalent that I gave up is a slap to the face, basically.

LAWRENCE: The Fayetteville VA says Jim is no longer clinically eligible for the program and that the Grahams are welcome to appeal and that the VA, quote, "can't thank caregivers enough for the vital role they play in helping veterans recover from injury and illness." Quil Lawrence, NPR News.