FREQUENTLY ASKED QUESTIONS: CAREGIVER ASSISTANCE

---

Program of General Caregiver Support Services (PGCSS)   

Program of Comprehensive Assistance for Family Caregivers (PCAFC) 

Caregiver Support Program (CSP) Resource List 

VA In-Home and Support Services 

Adult Day Health Care Centers (ADHC) 

ADHC Centers are a safe and active environment with constant supervision designed for veterans to get out of the home and participate in activities. It allows the veteran time to socialize with other veterans while the Family Caregiver is able to get some time for themselves. ADHC Centers employ caring professionals who will assess a veteran's rehabilitation needs and help a veteran accomplish various tasks so he or she can maintain or regain personal independence and dignity. The veteran will participate in rehabilitation based on their specific health assessment during the day (ADHC centers are generally open Monday through Friday during normal business hours). The ADHC Centers emphasize a partnership with the caregiver, the veteran, and Centers' staffs.  

Home-Based Primary Care (HBPC) 

Home-Based Primary Care (HBPC) is a program designed to deliver routine health care services to your home when the veteran you care for has medical issues that make it challenging for him or her to travel. Home-Based Primary Care is staffed with medical professionals who will come to your home. Services include primary care and nursing, managing medication, and helping plan and put together nutritious and tasty meals. Home-Based Primary Care can also include physical rehabilitation, mental health care for the veteran, social work and referrals to VA and community services. This program can help ease the worry and stress of having to bring a veteran to and from a VA medical center for routine medical appointments.  

Home Hospice Care

Home Hospice Care can offer comfort and supportive services for the caregiver and the veteran during the advanced stages of terminal diseases the veteran's home. An interdisciplinary team of health care providers and volunteers from a local community hospice agency is available for the caregiver 24 hours a day, seven days a week. Grief counseling is also available for the caregiver and other immediate family members.  

Homemaker and Home Health Aides 

The Homemaker and Home Health Aide Program is designed to help a Veteran with personal care needs, such as feeding, dressing, and bathing the veteran.  A home health aide will come to your home on a regular schedule to allow the caregiver their own time while the aide assists the veteran. 

Home Telehealth 

The Home Telehealth program is designed to provide ready access to a care coordinator by using technology (e.g., telephone, computers) in your home. The Home Telehealth program enhances and extends care management to the Family Caregiver. Home Telehealth services may also include education and training or online and telephone support groups.   

Remote Monitoring Care 

Remote Monitoring allows the veteran's physician or nurse to monitor the veteran's medical condition remotely using home monitoring equipment.  

Respite Care 

Respite provides a caregiver with time for relaxing and renewing their own energy. If a veteran requires a caregiver, you are eligible to receive up to 30 days of respite care per year. The care can be offered in a variety of settings including at your home or through temporary placement of a Veteran at a VA Community Living Center, a VA-contracted Community Residential Care Facility, or an Adult Day Health Care Center. Respite care may also be provided in response to a Family Caregiver's unexpected hospitalization, a need to go out of town, or a family emergency. 

Skilled Home Care 

The Skilled Home Care service provides a medical professional who comes to the veteran's home to help care for a homebound Veteran. A veteran may be able to receive basic nursing services and physical, occupational, or speech therapies. To be eligible for this service, the veteran must be homebound, which means he or she has difficulty traveling to and from appointments and so is in need of receiving medical services at home. The Skilled Home Care service is similar to Home-Based Primary Care, but it involves VA purchasing care for a Veteran from a licensed non-VA medical professional.

The Program of Comprehensive Assistance for Family Caregivers (PCAFC) is for eligible Veterans who have incurred or aggravated a serious injury in the line of duty on or before May 7, 1975 or on or after September 11, 2001. This program provides resources, education, support, a financial stipend, and health insurance (if eligible), beneficiary travel (if eligible), to caregivers of eligible Veterans.

Caregiver and Veteran will need to apply together and participate in an application process to determine if you’re eligible for the Program of Comprehensive Assistance for Family Caregivers. You'll both need to sign and date the application and answer all questions for your role. 

Options for veterans to apply to the program:

1. Submitting an online  application; or 
2. In person by bringing your completed VA Form 10-10CG to your local VA medical center's Caregiver Support Coordinator.
3. Mail your completed VA Form 10-10CG and any supporting documents to:

                 Program of Comprehensive Assistance for Family Caregivers
                Health Eligibility Center
                2957 Clairmont Road NE, Suite 200
                Atlanta, GA 30329-1647 

NOTE: Do not send medical records along with the application. VA will follow up after the application is received. If you need assistance with completing the application or would like to check the status of your VA Form 10-10CG application please call 1-855-488-8440, option 3.

If approved for the program, Veterans can select one primary caregiver and up to two secondary caregivers. Secondary caregivers serve as a backup support to the primary caregiver when needed. 

The services a caregiver receives will depend on whether they are the primary or secondary caregiver.  

Services for the Primary Caregiver: 

• A monthly stipend (paid directly to you as the caregiver.) 
• Access to health care insurance through Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), if the caregiver does not already have health insurance. 
• Mental health counseling. 
• Certain beneficiary travel benefits when traveling with the Veteran to appointments. 
• At least 30 days of respite care per year, for the Veteran. 

Services for the Secondary Caregiver: 

• Mental health counseling. 
• Certain beneficiary travel benefits when traveling with the Veteran to appointments. 
• At least 30 days of respite care, per year for the Veteran. 

NOTE:  Respite is short term relief for someone else to care for the Veteran while you take a break.

Locate your local Caregiver Support Team or Coordniator by clicking on your state or U.S. territory in the interactive CSP Directory. 

Caregiver Support Line: at 855-260-3274

Veterans can apply to the program online or by completing a VA Form 10-10CG.

Your options depend on the date PCAFC issued the decision.

You have two separate options to appeal decisions made before February 19, 2019.

Option 1 - Appealing through the VHA Clinical Review Process by contacting the Patient Advocate at your local VA medical facility for specific information on the Clinical Review Process.

Option 2 - Appealing to the Board of Veteran’s Appeals (Board) by submitting a completed VA Form 10-307, Program of Comprehensive Assistance For Family Caregivers (PCAFC) Notice of Disagreement (NOD) to:  

                                     Veterans Affairs Evidence Intake Center 

                                     P.O. Box 5154 

                                    Janesville, WI 53547  

Veterans and/or caregivers may use the following options to appeal PCAFC decisions made on or after February 19, 2019:  

1. VHA Clinical Review Process
2. Supplemental Claim
3. Higher-Level Review
4. Board of Veterans Appeal.   

Note: VHA will complete appeal reviews for the Clinical Review Process, Supplemental Claim, or request for Higher-Level Review.  Decisions resulting from the Clinical Review Process, Supplement Claim, or request for Higher-Level Review may be appealed to the Board of Veterans Appeals.

                              ******Option 1: VHA Clinical Review Process****** 

VHA Clinical Review Process is the lowest level appeal available, these appeals are submitted through the facility’s Patient Advocate, you will need to contact your Patient Advocate for specific information on submitting your appeal.  

• When doing a VHA Clinical Review Process, the caregiver will want to submit an appeal letter outlining the details of the veteran’s needs, referencing medical records to substantiate the claims, and document any discrepancies from the assessment which may have resulted in the decision that was rendered.  
• These appeals are reviewed by a Clinical Eligibility and Appeals Team (CEAT). 

NOTE:  VHA Clinical Review Process may be filed simultaneously with Supplemental Claims or a Higher-Level Review. 

• There are two levels for appealing a VHA Clinical Appeal:      

                         1- First level appeal (previously referred to as facility-level)       

                        2- Second level appeal (VISN level) If the first level of the VHA Clinical  

                             appeal is denied, you have the right to appeal to the second level 

                             for review by another Clinical Eligibility and Appeals Team (CEAT). 

                                      ******Option 2: Supplemental Claim****** 

Supplemental Claim is only allowed for decisions made on or after February 19, 2019, these appeals may be filed in conjunction with a VHA Clinical Review Process.  This appeal option is used when there is additional information that is new or relevant or was not reviewed or available for review when the decision was made, this includes medical records that are noted following the review and outside medical records.  

• New evidence is evidence not previously part of the VA record that was considered.  
• Relevant evidence is information that proves or disproves your claim. 

To file a Supplemental Claim the caregiver is required to send a completed VA Form 20-995 and any additional information (examples: new records, appeal letter) to:

                                   Veterans Affairs Evidence Intake Center         

                                   P.O. Box 5154          

                                  Janesville, WI 5354 VA 

NOTE: Supplemental Claims CAN BE FILED AT ANY TIME.

• A Supplemental Claim cannot be pursued simultaneously with a request for Higher-Level Review and/or request for review by the Board of Veterans Appeals.  
• The Supplemental Claim must have a decision rendered or withdrawn prior to requesting a Higher-Level Review or a review by the Board of Veterans Appeals. 

                                 ******Option 3: Higher-Level Review****** 

Higher-Level Reviews are only allowed for decisions made on or after February 19, 2019, these appeals may be filed in conjunction with a VHA Clinical Review Process.   This appeal option is to ask for a higher-level decision-maker in the Caregiver Program to look at your case.   

• A Higher-Level Review does NOT allow for any additional information to be submitted. 

To file a Higher-Level Review the caregiver is required to send a completed VA Form 20-996 to:               Veterans Affairs Evidence Intake Center                                                                    

                                  P.O. Box 5154                                             

                                 Janesville, WI 5354 VA 

NOTE: Higher-Level Reviews must be filed within ONE YEAR of the date PCAFC mailed notification of the decision. 

• *A Higher-Level Review cannot be pursued simultaneously with a Supplemental Claim and/or request for review by the Board of Veterans Appeals.  
• The Higher-Level Review must have a decision rendered or withdrawn prior to requesting a review of Supplemental Claim or a review by the Board of Veterans Appeals. 

                                  ******Option 4: Board of Veterans Appeals****** 

Board of Veterans Appeals decision is a final determination on a matter, this must be considered when deciding to appeal to the Board.   

• All three options listed above are appealable to the Board of Veterans Appeals.  
• An appeal to the Board of Veterans Appeals cannot be done in conjunction with Supplemental Claim or Higher-Level Review. 

To file an appeal with the Board of Veterans Appeals will require the claimant, typically the caregiver, to submit a completed VA Form 10182 (Notice of Disagreement) to:        Board of Veterans’ Appeals         

                                          P.O. Box 27063        

                                          Washington, DC 20038         

                                          FAX: 844-678-8979 

NOTE:  Appeals filed with the Board of Veteran Appeals must be filed within ONE YEAR of the date PCAFC mailed the notification of decision.  

If you have questions about any of the appeal forms or questions about appealing a PCAFC decision, you can call VA’s Caregiver Support Line (CSL) at: 1-855-260-3274. 

CSL expanded hours are:

• Monday-Friday 8 a.m.-10 p.m. ET
• Saturday 8 a.m.-5 p.m. ET

An accredited representative, attorney, or claims agent can also help you complete your forms.