Transcripts For CSPAN2 Sen Aging Cmte. - Military Caregivers 20171111

[inaudible conversations] this hearing will come to order. Good afternoon. I welcome all of you veterans, caregivers and advocates, especially my former colleague , senator Elizabeth Dole who has been an extranet advocate for military caregivers. Our military families, heroes in plain clothing are serving in americas cities and communities every single day. The effects of military service do not end with a tour of duty. For many veterans and their family, the journey sometimes extends for a lifetime. For some with both visible and invisible scars, the transition home is not easy. Recovery to can take decades. Along the way, mothers, fathers, wives, and other family members and friends step in to serve. Today we will focus on those who care for americans veterans. In the United States there are 5. 5 million military caregivers. These family members and loved ones provide care on a constant and routine basis to our veterans. They are often vital in assisting veterans to make the transition all the way home. Military caregivers prove recovery, rehabilitation and reintegration of wounded, injured and disabled veterans. The number of military caregivers has been on the rise since veterans from iraq and afghanistan returned home. Approximately 20 of military caregivers today are caring for a post 911 veteran. The needs and experiences of post 911 veterans differ from those pre911 veterans. While they are aging and facing agerelated conditions including alzheimers and cardiovascular diseases, post 911 veterans tend to be younger and face higher rates of ptsd and traumatic brain injury. Today we will learn more about the unique needs of military caregivers and what we can do to better support them. We will also unveil a report commissioned by the elizabeth Old Foundation called improving support for americas Hidden Heroes. This report is the Research Blueprint for the future that offers a vision to advance our understanding of caregiver needs. Our military caregivers, like all caregivers make many personal and Financial Sacrifices to ensure their loved ones have the care they need. They may have to miss work, turndown promotions, or even leave the workforce altogether, creating what seems, at times, an enormous financial strain for families. The loss and productivity post 911 caregivers caused our nation approximately 6 billion. Year. Ive introduced Bipartisan Legislation that would better serve caregivers including our military family. The caregiver act would require the department of health and Human Services to develop a National Strategy to recognize and support our more than 40 million Family Caregivers. This bill, which i introduced with senator tammy baldwin, has passed the Health Committee and i look forward to seeing it signed into law one day. Its a result of the advocacy of many who are here. In addition, the bipartisan military and veteran caregiver improvement act would expand eligibility for the ba Caregiver Program for not just the post 911 generation. This is the program that helps veterans who are wounded and injured by supporting and providing resources to those who have taken on the caregiver role for them. And, the lifespan reauthorization act would reauthorize 15 million. Year over the next five years to allow fulltime caregivers to take a temporary break from it responsibly. This respite care is crucial. It protects the health and caregivers, decreases the need for longterm care and allows individuals, who need care, to remain in the comfort of their own home. Despite their enormous sacrific sacrifice, military caregivers typically do not receive awards and admiration for American Veterans deservedly do. We must never forget our military caregivers who are also true heroes. Americas military caregivers enable veterans living with visible and invisible injuries to recover, remain involved with their communities, and enjoy fuller lives. We should do all that we can to support them. I am now pleased to turn to our Ranking Member senator casey for his opening remarks. Thank you german collins. We appreciate you calling this hearing. I want to thank you and so many others today. I want to thank her former colleague, senator dole for your tireless work on behalf of military caregivers. Many of the brave men and women who have served our country in the armed forces return home during the marks of that service. Training us today are some of those who served briefly so that america can remain the land of the free. To paraphrase what what my father once said, we paraphrase for military families and loved one serving around the globe but we also pray for ourselves that we may be worthy of their valor. Thank you for your service to our country. In order to better serve you, we are holding this hearing to recognize that not only our veterans, but the Hidden Heroes of the military, the estimated five and a half million military caregivers across the country. Military caregivers come in many different forms. Spouses, family, friends, neighbors, and of course fellow veterans among them. The majority, roughly 60 of those caregivers are women. We will also hear from our witnesses were caring for a loved one and understand that caring for a loved one can be stressful, it can be stressful physically, emotionally and financially. Weve made progress in helping our caregivers, but as our witnesses will tell us, we have more to do. We must strengthen the support that is currently available and help more caregivers who need access to these supports. Whether it was soldiers who served in vietnam or afghanistan, there caregivers should receive the same benefits and support from the va. Thats why i am a cosponsor of Bipartisan Legislation to expand the supports and Services Available to caregivers. Ensuring veterans and their families receive the care they need is also why i will continue to fight against efforts to decimate medicaid. A report released by the Congressional Research service explains that not all veterans are eligible for medical care from the va. Any veterans cannot access va services because they dont have a facility nearby. Sometimes family members dont qualify for va services. That is when other Coverage Options become important. Medicaid provides health care to over 900,000 veterans, 340 of whom gain coverage following recent action by some states to expand medicaid, and 660,000 veteran spouses covered as well. For these families who served our country and for millions more children and individuals with disabilities and seniors, medicaid must be protected. Since it covers those 900,000 veterans and over 660,000 spouses, proposes to cut medicaid and change healthcare should be the subject of hearings. I look forward to hearing from our Witnesses Today about additional steps congress can take to better support our nations military caregivers and their families. Thank you. Thank you senator casey. This appears to be North Carolina day, but for the aging committee, its always been a pennsylvania day. We are very fortunate that both senators from North Carolina serve on the committee and one of our chief witnesses and some of our veterans and caregivers are from North Carolina. I would like to give senator burr and senator tellis the opportunity to welcome those from our home state. Thank you for holding this important hearing on military caregivers. I particularly want to thank you for allowing senator tellis and myself the opportunity of introducing the fine North Carolina witnesses. Military caregivers is an extremely important issue nationally and certainly in North Carolina where veterans make up 10 of our adult appellation. We have to empower couples fighting for our representatives. I want to welcome elizabeth told back to the senate. She has a long and distinguished Public Record of Public Service inandout of government that many here know well. From leading the department of transportation to serving as secretary of labor and president of the american red cross, senator dole has been the when her nation called. She has been there with grace and diligence. What i want to salute her today is for just the latest chapter in her story of Public Service and that is her veterans advocacy. Not only has she stood by the side of a certain army captain who also knows his way around the senate hauls, but she has also been a relentless advocate to the elizabeth all foundation of all of our nations veterans. Bob and Elizabeth Dole, whether they are in the halls of the senate or the halls of walter reed continue to serve our nation and speak up on behalf of the needs of veterans and their caregivers. Im glad our committee will be hearing from them today and learning important lessons about whats working and where we still need to improve. I think you senator dole for the grace and the steadfast attention you bring to any issue you tackle and i know your Senate Family as well as our military Caregiving Community will be well served by hearing your voice today. I now turn to my friend and colleague senator tellis who will make additional introductions. Thank you. Its great to see you here. I appreciate you and this advocacy for Hidden Heroes. You and i have had many discussions about it and i enjoy the kickoff and i look forward to continuing to provide support. Ive had the distinct privilege to introduce to other constituents, mary and tom ward. I met them on a few different occasions and from time to time i even get to pet the dog but they wouldnt let me do it today. Theyve traveled here, and it is a testament to their commitment to the issue of caregiving, not only for themselves but everyone else. I appreciate your leadership and advocacy. We love it when you come visit. His Service Dates back from 1972 1975. In 1993 i think you were 13 years in your marriage when tom contracted and cellulitis and had signs of cognitive difficulty. He was diagnosed with als, a progressive disease that veterans develop in rates higher than the general population. Mary will share her story as her challenge of a caregiver and still remain employed. Madam chair, i am pleased to have them here today and i appreciate their leadership. I look forward to the testimony. I will also tell you, tom and mary, im on the Veterans Affairs committee which is meeting at the same time right now and i will step out of this committee and try to get back because you all know the work we do is also directly related to this issue. You also have my commitment that we are trying to get this right from the time someone enters service until the time they move through veteran status. Thank you for being here today. Thank you very much. Although senator dole has already been introduced, i do want to add just a few comments about the work that she has done as the founder of the Elizabeth Dole foundation, and a champion for military caregivers. Through the foundation, senator dole has shed light on the immense challenges facing our nations 5. 5 million military caregivers. She has really worked across the aisle, she actually brought nancy pelosi and i together to write an oped in support of the bill, not that that is shocking, but around here these days, that kind of bipartisan collaboration can be rare indeed. That shows to me the work that senator dole has done to create a community of military caregivers to which they can connect, share advice, stories and advocate for more support. I want to point out that senator dole does this just as a volunteer. I think her leadership has been extraordinary. I am familiar with the dole Caregiver Fellowship Program and i just want to thank you for your service and i look forward to hearing your testimony. On the same panel, we will hear from someone who my staff was all excited about meeting, and that is ryan filippini. As many of you know, he is an actor, director and more important from todays perspective, he is also an ambassador of the Elizabeth Dole foundations Hidden Hero Campaign which helps connect military caregivers to Critical Resources and connect them with other caregivers. Ryan, think you for supporting our Hidden Heroes who care for our heroes each and every day. Senator dole, please proceed. Thank you so much. Thank you chairman collins, Ranking Member and members of the committee for calling todays hearing. By doing so the committee demonstrates its dedication to recognizing our nations military and veteran caregivers. Chairman collins, iou special thanks for your strong support of key legislation in the Hidden Heroes caucus which you are cochairing. You are sending a very powerful signal that our nations leaders must stand with americas military caregivers. Thank you so very much. This is not my first time testifying before the Senate Special committee on aging. Recently, i came across testimony i gave on june 29, 1978. That was 39 years ago. I was a member of the federal trade commission. Like each of you, i once sat up there as a member of this committee. To be honest, with the many issues before the senate, i did not know the enormous benefit military and veteran caregivers are making to our nation. As well as the huge personal toll it is taking. That all change for me in 2011 when my husband bob was hospitalized at walter reed. I became friends with young spouses, mothers, dads, sitting bedside, selflessly looking after loved one. They were carrying an emotional weight almost too heavy to bear. As they reeled over their injuries were asked to make extremely difficult decisions without any preparation and they work wrestling with the fact that they might be serving in this new role for the rest of their lives. Just as heartbreaking are the stories of pre911 care givers. They were struggling to care with those with undiagnosed posttraumatic stress, agent orange or brain injuries that are causing early onset dementia. These are just as terrified and isolated, just as important to their veterans. When they apply for the va care giver stipend, they are told that the timing of their veteran service does not qualify them for support. An incredible five and half million americans act as military and veteran caregivers. They are serving in each of your states right now, dressing, bathing and feeding our veterans, performing athome injections, managing medications, staying on constant guard for emotional triggers. For many, its a 24 hour job. I found it elizabeth o foundation in 2010 to raise awareness and support for these Hidden Heroes. We began by undertaking the First Comprehensive nationwide evidencebased research on military caregivers. The experts concluded that the most important factor to a Wounded Warriors recovery or improvement was a well supported caregiver. This statement could have been the headline of the report, but it was overshadowed by more alarming findings. The Research Uncovered high instances of isolation, physical ailments, depression, unemployment, death, legal challenge, and much much more. They are doing a tremendous job but they are clearly suffering under the circumstances. Theres also an economic argument for supporting military caregivers. They provide nearly 14 billion. Year as an unpaid volunteer workforce. Last september the foundation launched Hidden Heroes, a Multifaceted Campaign featuring the first of its kind website full of carefully vetted resources and a safe secure place for caregivers to connect with one another. They announced hidden hero cities, the galvanizing of communities to identify caregivers in their midst and the local resources to support them. I am proud to say we have recruited 100 cities to date. Ryan is the investor. He is an awardwinning actor and star of usa network where he plays the role of military veteran. More significantly he has close family ties to the military family and has become a passionate advocate for our caregivers. My heartfelt thanks to you. He flew in, got here this morning on a redeye, and tonight he heads back to california on another redeye. God bless you ryan. As you listen to him and our other panelists, i urge you to consider taking two actions after todays hearings. Make the bipartisan Caregiver Services improvement act the law of the land. This bill will expand essential services for caregivers of all eras. It will also provide direct assistance with some of the top challenges that military caregivers face every day including respite, childcare, financial advice, legal counseling and education heard i had with me a letter signed by 43 Hidden Heroes organizations. They are already here but me and they urgently hope that this particular lifechanging legislation is going to pass. Our second ask is that the congressman invest in the Critical Research needed to sustain positive outcome for our caregivers in the coming year. In the next panel, you will hear from the brand that will unveil a blueprint based on the urgent resource priorities. We urge you to listen carefully and champion this research which is critical to our ability to support military caregivers five, ten, 20 years down the road. I have to tell you, a somewhat we already know, we expect more alarming issues to be uncovered. Anecdotally, we are hearing more about caregiver Substance Abuse and caregiver suicide. Marriages are more vulnerable than ever. We have long respected our military men and women and always reserved a special honor for those who return with physical and emotional scar. They are empowered, appreciated and recognized for their service. In america where military caregivers are woven into the very fabric of the nations appreciation of our military. Think you so very much. Thank you so much senator dole for your very eloquent and persuasive testimony. Thank you for the kind words. Before i get started, i want to take a moment in light of this mornings tragic events and thank the capital police, the Alexandria Police and other First Responders are able to assist with congress and other members of the staff. Our thoughts and prayers are with them. House and i speak for everyone here when i say to senator dole, we are truly inspired by your leadership, vision and tireless work on behalf of military caregivers. You are a shining light. Thank you for being here today. Its truly a mama. Mikes parents growing up in a military family help prepare me for this role, for this moment. Both my grandfathers fought in world war ii. My dad was in the navy during vietnam, my uncles were both infantrymen during the same period of time. All the members of my family who served, thankfully returned. Ive worked with countless veterans and all of this adds to my deep respect for the vets in knowing that they are the nations true heroes. These days ive recently been working with the Elizabeth Dole foundation and thats how i learned about a different kind of hero, our Hidden Heroes. Family members and friends caring for those who return home with physical and emotional scars. We urge you to take action. If you know anything about senator dole, which you must, she doesnt take no for an answer. She will hold you accountable, she will hold all of us accountable because our nations military and caregivers deserve it. Over a lifetime they faced tremendous challenges and right now they have very few resources to help them. Its on all of us to fix that. Right now military caregivers are shouldering this responsibility of care alone. They dont expect or ask for help, but the work they do minutes more than just a display of gratitude. We owe our military and veteran caregivers. Purposeful action and lifelong support. Something struck me in her remarks that i want to emphasize. The Foundation Research found military caregiver playing a central role in the Recovery Process of our veterans and improving their quality of life. I quote, the best chance for a Wounded Warrior to recover and thrive is having a strong well supported caregiver. Yet this role imposes a substantial physical, emotional and financial toll on the caregiver and their families. We can do better. Thats why we are here. We need to sign into law some very important legislation. For starters im speaking specifically about the recently reintroduced Caregiver Services improvement act. Bipartisan legislation introduced in both the house and senate to make expanded Resources Available to military and veteran caregivers of all eras. This bill strengthens and extends vital programs to support caregivers nationwide and ensures they are recognized for their service in tangible ways. For example, if passed, pre 911 caregivers would have the same support we give to our post 911 caregivers. Bob dole served before 911. Were talking about caregivers for the heroes who served with him and the generations that followed. There caregivers not only need but deserve our assistance. The va Caregiver Program should be available to all caregivers caring for all veterans regardless of when they served. The bill also supports caregivers for veterans with service injuries in the same way that we help caregivers for veterans who have visible wounds. It shouldnt matter whether we can see this car or not to give our veterans and caregivers the resources they need. It also provides assistance with childcare, legal counseling and education which are all unmet needs. Ultimately, by signing on to this bill you will have a positive impact on health and wellbeing of our nations veterans and military families for a long time to come. As the Hidden Heroes investor, ive had the privilege to meet with caregivers crosscountry. As i speak before you now, i cant help but think megan and her husband matt, a marine corps veteran who honorably served to tours in iraq. They are high school sweethearts. They living connecticut. They are young couple in love, yet they have long road ahead of them. As a result of injuries received during his combat service, matt suffers from a dramatic brain injury. Megan, his wife and primary caregiver is by his side every day helping him struggle with wounds we can see. Invisible wounds that most of us cannot imagine. Megan explained that she never pictured herself as a caregiver for her husband, especially so since her marriage, but matt needs her. Its a day in, day out, 247 responsibility managing doctor appointments, juggling medications, always on alert looking for things that could trigger his pts, all while raising three young boys. She is making the most of things that she needs our help. In fact theres 5. 5 military caregivers like her quietly serving in communities across america and they can no longer go alone. They need us and they need you. Ask you again, members of the committee, and all of you here today to give your full support to military caregivers serving our nation. Senators, please sign onto the military improvement act and each piece of legislation outlined. To everyone here today, and watching across country, please seek out military caregivers in your cities in town, direct them to support and ask how you can help. Thank you. Thank you very much for your testimony and thank you all for your thoughtful acknowledgment of the bravery and extraordinary courage of the two Capital Hill Police officers this morning, during the attack that has saddened all of us. Without their bravery, the injuries would have been far worse. We heard at our republican lunch, a firsthand account from one of the senators who was present and its very clear that without the two Police Officers putting their own lives in harms way, and indeed both of them were wounded, that there wouldve been death as well as injuries resulting from this attack so thank you very much for acknowledging our Law Enforcement and First Responders. Senator dole, you mentioned two very important priorities. One is removing the disparity and the essential Services Provided so that it doesnt matter when you served your country. Second was the need to continue with Critical Research. Could you elaborate on the second area of the Critical Research . We are finding out that there are more connections between certain diseases and military service such as als then we ever realized, and if you could discuss that priority a little more, that would be helpful. Im so pleased that terry, who is one of the researchers in the 2014 rand report, for which so much else has flowed, will be here to testify just a little while. Let me start with that report because this was the First National comprehensive evidencebased research thats ever been done on this population. The rand report illustrated a number of areas where there were gaps in services, and the legislation that we are focused on today, the military and veteran Care Services act picks up on those gaps and that is why we are so anxious to see that path because they have pointed out through their Important Research exactly what is needed. Now theres legislation to provide whats needed. We need to pass that legislation. Now lets look down the road. So many of our caregivers are young. Theyre in their 20s and 30s. The post 911 caregivers. You think about that, they literally may be caregivers for a long time. I was making a speech recently , one of my caregiver fellows was with me and she made comments and when she finished her remarks she said im 30 years old and i will be a caregiver for the next 50 years. Now, do we know now how to prepare to support these caregivers five years down the road, ten, 20 years down the road . No, we do not. Thats why this research that terry will describe is so important. We need to understand how will the needs of the care recipient change over time . How does the caregiving responsibility impact the outcome on the caregiver . And also, we need Longitudinal Research but its very important, i cant stress enough how much we need your help to make sure this research is undertaken right away because once we get the results, the research that will be proposed today, we can then spread that to all of our partners. We have a National Coalition of about 300 organization and their many who will want to utilize that research along with us to come up with the right services to help these caregivers down the road. Right now, it is really alarming how little we know about how to care for them down the road. Many of them will be undertaking these Caregiving Services for decades. Thank you. Mr. Philip b, could you tell us what youve learned in your meetings with military caregivers . Are there certain lessons youve learned that you think we should know . Adding something that really stands out to me in the conversation ive had is the strain on the family unit itself. The fact that a lot of caregivers have to put their lives on hold, their dreams are occupations they mightve wanted to pursuits take care their veteran, i think some of the stress is related to that fulltime job and what it takes away from parenting or those sorts of things. Thats why i think the respite part is very important, giving some time off to be your own person and then return to your job as a caretaker with the required energy. That was something, keeping Families Together is a big part of this act. As a father, that is important to me. I think theres a lot of stress and strains that come with dealing with these injuries and being a military and veteran caregiver. They can be really disruptive to her relationship and the family unit. Thank you. Senator casey. Thank you madam chair. I will start with senator dole. During your testimony, you mentioned caregivers from every era should be treated equally. When it comes to the eligibility like the comprehensive assistance, i agree with you anything people in both parties do. But, its the state of the law now the only caregivers from veterans who served after 911 are eligible for the comprehensive assistance Family Caregivers program. Since you and your Organization Work with caregivers for veterans of all areas, can you describe to us in more detail how expanding the program would benefit those caregivers from pre911. The caregivers from pre911 have been providing services for years and theyve had no acknowledgment. They are not acknowledged for what theyre doing and they are receiving very little in the way of services. The illnesses and the wounds and injuries of these veterans from early errors are compounded as they age, by the aging process so you have not only the war related illnesses be of the compounding of those , the advent of als or parkinsons disease or, certainly mobility difficulty and chronic pain, some forms of cancer. So here are these pre911 caregivers dealing with all of this, totally unacknowledged with very little support. I think its clear they need to have the same kind of opportunities when they have the most severe injuries they are dealing with, they need to be part of the caregiver, the comprehensive Caregiver Program and this would mean they have respite care. Respite is so important. When you are almost burned out, how can you provide the best quality care for our veterans. We are talking about those who have borne the battle. Our country made a sacred vow to serve those who have borne the battle. Thats who we are talking about. The caregivers of these individuals, and they deserve to have the best possible care so they are not depressed and facing immune system problems and heart problems, but thats whats happening now. They have a great deal of stress and anxiety and depression. Its very important that we provide respite care that we ensure these caregivers are able to have some Mental Health counseling. If theyre in the comprehensive program, they will have a stipend. Theyre also going to have Health Insurance if they dont have Health Insurance. It would be provided by the va Health Insurance. They deserve this and its really unfair that they dont have it now. I think theres every reason to move quickly, and the sooner we can get the legislation passed, we can brinbegin our community to develop the services to meet these needs that are unique on the part of pre911 veterans and their caregivers. They are unique needs and we need to move quickly to tailor programs to service those needs. I think your testimony today will help us move that legislation. I think it goes without saying and we are grateful you are here. May i add, we have really been proposing this legislation for several years. It would be so nice to see it pass before the end of the year. Please. That is a good goal for the end of the year. Okay. Probably most cases you will be more persuasive than i will be. We will need you to come back. In the same vein about providing the best possible care and coverage, i mentioned earlier about medicaid that some veterans, some 900,000, because of their own circumstances are covered by medicaid. That is the coverage that they have. I also mention their 660,000 spouses who receive that benefit as well. To think medicaid can play a Critical Role in providing healthcare to veterans and caregivers and families . Whats your sense of that . I assume you run into people who have that kind of conflict. We know from our caregivers who are enrolled in medicaid that the Program Provides valuable, its inextricably of valuable supplement for some of the expenses that the va program does not cover. And then, for those who are not on their Veterans Health care plan, they would be under the same system as civilians. I think the rand report indicated 20 of military caregivers fall under the federal poverty line and those particular individuals would find that medicaid certainly would be one of the best options for their Health Insurance. I am now delighted to call upon one of the committees most active members, senator cortez master. Thank you both for being here. Senator dole, thank you for everything you are doing in this space in addressing this important issue for our caregivers. When you talk about respite car care, which i agree is key to really bringing some relierelief and additional services. If you dont mind, talk about the isolation piece as well. What occurs and why is respite going to bring relief . There are other things we should be doing to address isolation that i have seen with respect to caregivers. Its amazing, as we have met with many caregivers, they really dont understand that they are a caregiver, and i think our earlier Research Also pointed this out, that many of them dont see themselves as a caregiver. In other words, they see im just this mother, of course i will take care of him. Or im the spouse, im looking after my husband or my wife. They dont understand that they are caregivers and if they just raised their hand there are some Resources Available to them. We are trying to urge these caregivers to come out of the shadows and to go to, we have a stateoftheart website, its one of the kind, specifically designed for military and veteran caregivers. They go to the website Hidden Heroes. Org, they will find the whole community of caregivers they can talk to and compare notes and learn from one another and there are 700 carefully vetted resources on that website that will continue to grow those resources, but its vitally important, we find when a caregiver is so isolated, so alone, they dont know there are others out there. They are struggling trying to deal with everything all by themselves. You can imagine, think about this in a family where, lets say theres a difficulty, it may be posttraumatic stress or brain injury, the children in the family have to be very careful, they move around the spouse and theyre trying to prevent triggers that could set off an emotional response. The kids can have children over for a sleepover. Once they connect with one other person, one other caregiver, its like magic. As we bring them out in larger numbers they are able to support one another. They are like extended family of mind. That isolation, youre right. Its such a big issue. We need to bring them out of the shallow and connect them with others. Respite, how can they provide the quality of care that these heroes of ours deserve . How can they provide it if they are exhausted. The respite is so important. The lifespan respite care act is vitally important. We need to get that passed immediately. Thank you. Let me follow up on that. Let me open this up. How you make them aware of the Services Available to them. This is the biggest challenge. The education and awareness piece. How do you bring that back into the community and make sure they know there are resources and where to go to find out about it. Let me mention Hidden Heroes cities. This is something we initiated last september. I promise i wont talk too long because this is really a question. Hidden heroes, the idea is we now have 100 cities and we continue to grow these, but we are reaching out to mayors and other local leaders across the country and the idea is, they will form at committee, we will help them to understand how to inspire caregivers and that local community to come forward, to identify the caregivers in that community, and then they will determine what resources do we have at the local level that can be extended to these caregivers and where there are gaps in services, how can we fill those gaps. What will our strategies be. We found this is working very well as a way of reaching out to the caregivers. Also, interNational Coalition, we have so many wonderful organizations that have chapters all across america. We need to reach out to them where they are and thats at the local levels. We have to drive down to the local level what is happening. Clearly i think it is a matter of doing this in a number of different ways. Also, the kind of Awareness Campaign that we are involved in right now with ryan whos doing Public Service announcements for us, hes going to events, he speaking, our caregiver fellows are speaking at rotary clubs and other local organizations and the word is getting out more. We are trying to raise awareness in many different ways and many different levels. One of the things that came up time and time again talking with families was the frustration that the veterans programs and support groups vary so much from state to state, even city to county so there were families that i talked to who would move to an area where they knew there were better facilities, better programs, and i think part of what Hidden Heroes would like to eventually implement is some sort of national va standard for how we treat our military caregivers and therefore our veterans. I think as complex as that may seem, i think theres a way to do it. It just takes the right people behind it. I think we have the right people behind it. Thank you very much. Thank you, senator. I was going to move to the next panel but its my understanding that senator warren is on her way. Since we know how to filibuster, will go on to a little more until she arrives. There was actually a question that i wanted to ask you, senator dole, and that is, have you found that there is a difference in the need of military caregivers versus civilian caregivers . I dont know whether that is something youve looked into, but i was curious if you have what you found. The rand report has told us the military and veteran caregivers are experiencing a much higher rate of negative Health Consequences as a result of their Caregiving Services. They are experiencing these incredible difficulties in terms of anxiety and depression and immune system problems, and i think that something where we come back to the respite, its so very important to give them a chance to just break away a little bit and to be able to recharge the batteries. I think the caregiver act is also very important and i know that you are sponsoring that, and its important because it will provide for coordinating services across the government in a way that makes them more efficient, the Caregiving Services. We believe strongly in the need to coordinate between the va, the dod, the department of labor, hhs, and in others who are involved in any way in caregiving. It also will provide best practices and Lessons Learned that can be utilized by the military and veteran community , and any time you can spotlight whats going on, labor of love thats taking place in these homes, anytime we can spot like that, it is a wonderful thing to do. I hope that piece of legislation will pass because if we want to foster nation that supports Hidden Heroes, all Hidden Heroes, these wonderful care givers, then its important to pass both pieces of legislation. Thank you. Senator warren. Thank you all for being here with us today and especially thank you to the caregivers and the veteran spouses who are able to join us today. Senator dole, i want to say thank you for coming to see me earlier this year in order to tell me about the support that caregivers provide everyday to wounded or ill veterans and Service Members. Your foundation conducts a program in which caregivers are selected to advocate for caregivers and ensure they have the resources they need, and one of those caregivers is sitting right here in the front row. She is a former fellow from massachusetts and not only does she care for her husband charlie who has served in the army, she actually helps manage the caregiver fellow program and she is here today. I just want to say a very public thank you to emery. Thank you for being here. I am reminded by her being here that caregivers often need Additional Support for traveling to various appointments, childCare Services, Mental Health counseling, and other resources and current law authorizes the va to directly provide a stipend and other support services to caregivers of injured veterans from the wars of iraq and afghanistan, but does not authorize the agency to provide this direct Additional Supports caregivers of veterans from pre911 war. This seems wrong because elderly veterans are vulnerable group. Senator dole, i know you address this in your testimony , but this is really important so i want to come back and underline here. When it comes to providing Additional Support services directly to caregivers, what are the consequences of classifying caregivers of veterans from post 911 war separately from caregivers of veterans of earlier wars. Its a very unfair situation. We need the legislation focused on today so that as soon as possible we can meet the very unique needs of the 911 Service Member and their family members. They have been providing services for years with no acknowledgment. They dont have the resources to provide respite care. They need an opportunity to have a stipend which can be very helpful to them. They deserve to have the same benefits that post 911 do with mayor dealing with the most seriousl serious injuries and wounds and how they been compounded by the aging process which means, now you have the advantage things like parkinsons and als and some cancers. First, of all the things that happen, you are less mobile and you have more pain and they are dealing with all of this without the support that they absolutely deserve. I am hoping this legislation could be passed quickly so we can focus on the services they need. I know senator murray and collins introduced a bill on this and i really hope this goes forward. I know some scam artists have targeted veterans by charging them fees for tainting this benefit even though the application is free. I come from a military family. All three of my brothers served, but thats not as common as it used to be. Many people in our country no longer have a personal connection to our military. As a result, they often dont know about the sacrifices of the servicemember or the sacrifices of their caregivers. Senator dole, do you think the sense of isolation felt by some military and veteran caregivers is a reflection of a broader divide between ordinary citizens and our military . Do you have a few thoughts you might give us . How might we help heal that divide . I think the isolation, you are right on point. No question about it. When you realize that less than 1 are serving today, defending our freedom and security, most americans have no idea whats going on in military homes today. and certainly with the heated Heros Campaign that is all designed to raise awareness to help people to understand we need their support across the country. It is an example of driving down to the local level to identify caregivers. We have a lot of mayors and their teams working across america that leads them to the kind of support we can give them. Thinks and we appreciate it. Senator . Italy have to wrap up but with your own interactions you mention in with your testimony with your background the time that you spent in connecticut it, what can you tell us about the common themes that you hear . With the veterans and the caregivers raise . Anything you can share with concerns are any issues we did not cover today . Immediately it is the idea how unprepared they are. With the lack of education and training to be prepared to take care of a disabled vet that could be addressed in the bill. So now have these extra cost because only one works or maybe if they have a 24 7 job to take care of their revet so how to readjust their finances and allows support for a the children. Understand that mom and dad has this issue. It isnt the easiest thing to convey. Men and women are young with the actual physical trading experience. So that this is a big part of it. What happens to veterans . Then not shame is something we all share. So when a veteran is left alone were the caregiver cannot handle it it is up to was to offset that to keep Families Together. I just want to give you a chance. But with the compelling testimony but when he first came to see me it was after senator dole had a very rough year and was thin walls to read virtually the entire year. And i remember how repressed i was that rather than focusing just on her own situation she told me of the stories of the veterans and their family members whom she had met at walter reed. And that is what inspired you to get involved. And it is a typical of the selfless servants but you have given to your nation and i am very grateful for raising public awareness. And also thank you for making such an effort. Especially taking the red eye here and back. I know how brutal that is. But i wasnt surprised when you said you could not save note to Elizabeth Dole because all of us have found that is the case. [laughter] which is why i am cochair of the Hidden Heroes. [laughter] but it is indeed a worthy cause. We do need to eliminate the disparity. Ic within my own family with my own mother with the last eight years has taken care of my 91 yearold father who was a world war ii veteran and earning two purple hearts and a bronze star. In trying to get respite care is so difficult. I think that is the number one challenge. End so now we have iraq and afghanistan to play that caregiver role for the next 50 years. We need to do a far better job to give them the support for those who have borne the battle tougher and. Thank you very much for being here today and for sharing your fisa and guidance with us. Now with this second panel of witnesses. [inaudible conversations] and we have to service dogs with us today that are very important to the veterans and their families who are here. I invite them to testify as well if i could figure out how i know how smart they are thats for sure. Firstever like to introduce the senior Behavioral Scientist for the reincorporation former director of the rand center for military Health Policy research. Beating numerous studies and in the corporation 2014 study she directed at the new study on military caregivers called improving support in this is released today. Senator tellus mentioned our distinguished witness from North Carolina but i will give a little reminder. We will hear from very and thomas, both of whom will testify today and was a caregiver three 9 11 caregiver. Thank you both for your service and let forward to your testimony today. So now to individuals a 2016 fellow in day care giver to her husband post and 11 veterans serving in the army 18 years including 32 workers is in iraq. She has been her husbands caretaker for more than 10 years and helps him with his injuries and ptsd. In addition she has a degree in education and has taught in the military community from within 15 years. Thanks for your service. I look forward to hearing your testimony. It is my pleasure to introduce our witnesses from pennsylvania sgt we are grateful to you for your many years of service to our country and in the army and panama and iraq and afghanistan. Also we welcome your wife to the hearing today one is a hero in her or write a hit in hero and in addition to a caregiver for her husband, a fulltime student at university at pittsburgh johnstown and a caregiver fellow. Thank you for your Family Service to our country and the key for being here today. I add my thanks as well be will start. Thank you chairman callings a Ranking Member of the distinguished Committee Members said the Senior Scientist at the Rand Corporation study the health and wellbeing of Service Members in veterans their families and care givers. 20 million veterans who require ongoing care. That is a cadre of spouses and friends with that activity so with the support of the Elizabeth Dole foundation i have led three sequential studies on this population and in 2014 the yoda about today and provided the first indepth picture of a military veteran care givers. They expose the risks that they take four of the studys findings were of a particular surprise of that 5. 5 million caregivers 20 are supporting the individual serving after september 11. They are different than three 9 11 they are younger, well educated spouses and coming from the labor force which means they are working and providing care to a veteran. Third powless and a loving care givers were ineligible for many programs because of their age, relationship with the condition of their care recipients. We found significant threat to the future of military caregiving especially as parents serving as caregivers their aging themselves soon may not be able to fill those duties. The newest report is a blueprint designed to ensure better support it was by more than 175 stakeholders including Program Officials researchers and philanthropists and chair recipients. Regenerated consensus around those projections but today i will focus on those that underscore the need that track these issues over time to study how caregiving effects care givers to inform the programs and policies designed to medicate any adverse effects with regard to Mental Health and employment and family wellbeing as second priority is how caregiving affects the children of care givers no research has been yet documented so but most consider this to be a vital topic focusing on the impact on parenting as well as the short and long term effects of Children News Service caregivers themselves. A third priority is to examine how overtime to the needs and demands will change and that changes the strain on the caregiver. Fourth is to assess how programs and policies impact caregiver wellbeing we though very little of an Arab Military caregiver out, but yet knowing what works is the important consideration for sound policy and funding wordy efforts. To conduct studies to fulfill that blueprint a number of conditions must be met to take radical steps to facilitate the environment. To require research for Decision Making are making decisions about the future of Caregiver Support Programs. Also outlines strategies for using this blueprint including treating a Research Center of excellence specifically focused on veteran care givers. It will be important for center to have multi disciplinary expertise as well as a broad focus to ensure all of the allied research and populations important to the veteran Caregiving Community are included i will conclude by reiterating the role is to convey a vision for future investment and research thank you for the opportunity to share this testimony and a look forward to your questions. I would now like to call upon the of boards to testify. Afternoon things for inviting me and my husband to this hearing on military caregivers i am here as a force of asian i was a deal caregiver in 2016 but my journey started long before in 2010 he was diagnosed with als and in 1993 he was disabled and has required from me but a less i had a scare figured out and organize and tell als came along. Excuse me. It was like getting sucker punched. My grief has known no bounds. If i am not careful will take my life as well. The work ahead is daunting advest and i am certain i am not up to the task alone but i know i will have to be for the most part in 2008 those that are twice as likely to get als and more veterans and any other time have als. So to be qualified for benefits i have not considered myself his care giver is a was committed to our vows the caregiver meant somebody who was paid to come in to provide services and in 2013 i heard about Elizabeth Dole that was my epiphany. Als is catastrophic there is not a day then ungrateful for all of v. A. Does support him as he battles a less so to be sure he gets what he needs like a breathing masks or medication and so one. The matter those managing resources his need for assistance is nonstop he is moving towards independence rather than independence and will much change the with the financial aspect i can care for him but have done so at a significant salary reduction that affects my future Retirement Funds i love my family but as his dependence crow then i will have to provide outofpocket as the virginia only gives 28 hours per week in that will not be enough with full paralysis. My daughter is the second grade teacher in in charlotte msn is 14 years in the army and a drill sergeant. Their dad is a hero in good health and a heartbeat if possible the best they can do is grow their career. A Foundation Fellow to have built a lifelong relationships sorry to have solutions with each other but v. A. Offers me almost nothing and no support other then dave met national monthly, i am one voice among many who need help this carries heavy responsibility and and so we cultivate a better understanding for the kind that you hear about and we need action and would you consider passing the bill to Health Care Givers like me. Thank you for your time and consideration i welcome your questions. Thank you for your moving testimony. I cannot imagine anyone having listened to what you just said voting against our bill. I hope we can spread dirt testimony wide. Thank you for being here today. Mrs. Swoboda spent a good afternoon. Think you chairmen and Ranking Member for having us here at this hearing. My husband retired Sergeant First Class is a threetime combat veteran from Operation Iraqi freedom deployed during the initial invasion in 2003 and again 2005 and again 2007. Each time deployments were longer and longer into in 2003 the months in the 12 months and then 2007 overseas approximately 15 months during the initial invasion and in 2005 he had to injuries with two explosions he lost consciousness in one however because of the intensity of the fighting there was no time for him to be checked by medics so he should get off and remained in the battle years later the injuries sustained would become impossible to ignore. This a full year period of Rapid Deployment even when home he was not home when not at war he was training for war with field exercises so there is no time to recognize he was having any Mental Health or neurological issues. He had to push through it. After the third deployment he has to be given an assignment to train without being deployed however when he stopped going to combat that is when the problems really started. Refinery had the opportunity to slow down and his difficulty started to come to light. I knew he was struggling he was home but never really had come back from iraq. When a fellow soldier saw his struggle also in thankfully insisted he sea kelp for those overwhelming symptoms he was experiencing as a result of his traumatic brain injury and posttraumatic stress. The invisibility of his wounds and most of the army had never recognized him as being injured for once the symptoms begin to affect his work he was medically retired from the army in during processing a staff member for bending handed me application for the v. A. Caregiver program i feel that the paperwork but not sure of was applying for. Of course, even when still active duty i was his caregiver but had never recognized that i was just managing his medication and raising the kids alone and managing finances and helping him remember things that he could no longer remember. The love my husband and absolutely care for him regardless but having Caregiver Support Programs in place is so important to me because for the first time in 20 years i can breed for i cannot imagine how much harder this would be without those programs by no billions of care givers manage every single day. It is still stressful and theres still a lot to do with having the Financial Support receiving a stipend and the opportunity for respite care has been crucial for my family. There are id think i cannot go one to have this much stress and pressure on me not just on the bill also the stress of caregiving affects our children. Respite services give us all an opportunity to recharger and though support systems like the dole caregiver fellowship can help answer some unquestioned sam programs offered by the virginia v. A. Make this so sustainable for other caregivers negative upon support should be for all caregivers and it is really helping people into making a difference per i hope you will consider supporting and passing the military Caregiver Services improvement act to do just that. Beforetime afford to answering your questions. Thank you for sharing your story with our committee. Chairman and Ranking Member and members city for bringing us here today also things to the Elizabeth Dole foundation for taking the time to be here today. It is humbling to have voices like fares speaking on behalf of care givers like myself. It is my hope that a fair share a small part of my journey with his committee they can ensure future care givers do not face the same hurdles my husband and i have had to overcome. My husband was married long to the army long before he married me her in the 80s and arranger in panama on he still saw action with the ranger battalion. He suffered his first train traumatic brain injury later he was in an accident so much that the army said he cannot perform his duties anymore and released him. After 9 11 he could not do the job the army trade him to do so he had every wafer to get back into the reserves as a military police officer. He signed up for every deployment in deployed more than he wasnt during the course year and three purple hearts. He did his job and got every Single Person back alive then went above and beyond. He came back looking like the same person and not acting like the same person. If you speak to him for a few minutes he looks like everybody else if you talk a little bit longer you can see the issues in his eyes he undeniably still lives with the effects of the war. Once on leave he went to the backyard to girl he was gone for a while i glanced outside to see the flames on the side of the house. I ran outside he was sitting there staring at the fire eating or house i put out the fire then i realized he had serious issues and would need more help but the army did nazi it that way. From his last appointment the prime into the last major tbi the army said he was healthy to go back to civilian life in that 60 days between leaving the military and his old job i noticed more of the Little Things that were different. He was stuttering and could not process and was distant and i took him to do a the v. A. And pushed the issue he was not the same person the more i talked about the issue the more they realized i was right that i had to write to the senator to get the army doctors to agree to get the right benefits from the military that he had heard. It should not have been that difficult. The army was going to send him back to civilian life he could not hold the job. He could have ended up homeless or worse i could not or would not let that happen and i had to figure out everything on my own and make a right. I stepped up because he couldnt. I took control because he couldnt and i became his caregiver. When we had access to the Caregiver Program i have respite time it ended down time to focus on me. That stipend you cannot put a dollar sign on it. Considering how to improve the lives of caregivers know that the military veteran Caregiver Services act is important to of course, nation so when Service Members transitioned into civilian life to so many caregivers and veterans in the those are the policies that would have helped sam and i as a figure out our new life. I hope you will support this legislation and it will be signed into law faq for allowing me the opportunity to share. Thank you for your testimony and i want to think all of you for being here today and sharing your personal stories with us. It really makes the difference. A lot of times we talk about numbers here in the senate for example, five per lebanon military caregivers but if you put a human face on it in the you hear the individual stories of makes such a difference and makes it so rubio. Let me go across and basket question of all of you. I often hear that care givers are very reluctant to ask for help or support and it sounds like in your case you did not think of yourself as care givers initially in that role and others are just hesitant to ask for help . Or many are unaware of what help is out there i think we would all agree it isnt adequate for fair there is a disparity but how can we better help military caregivers overcome the of barriers with their own willingness to except help . For me personally which is probably true for many other care givers so to get diagnosed with payless and i probably would have benefited by having somebody reach out it is difficult how difficult it is for the caregiver because they are not the burden but it feels that way so would be okay for our 72 speak with us and help us to brush ourselves off to get this moving in the direction that we need to have the best life that we can. It would have been helpful to of lead to have more education during the process. There are many briefings held to help the soldier transition not of the military. And it could be very simple to train somebody who was already giving briefings about other aspects of that processing to present information to the caregivers. Much of the information i werent along the way came from social we get over organizations like Elizabeth Dole foundation the leading the way to disseminate information into Health Care Givers to self identify but i do agree it is difficult for us who love our spouses so much to identify as caregiving because we do that in sickness and in health and redo that literally. Ice agree with the fact that the veterans have their own processing in they are told what happens next. Especially if there is any insight into the issues the veterans are having a need caregiver or they may not it would be great if we were giving given the same outcrossing knees processing briefing they are so there is no local anything i was on my own and had to figure it out. We both did. He had the advantage of the military behind him but i did not have that. I am astounded to learn from your testimony that there has in a single study done on the impact of caregiving and children and we were talking about the impact of the balance of raising children of the same time. Why hasnt there been Research Done on though whole area of military and veteran care givers . In general looking at the literature it is astounding how Little Research has been done. Right. What you do find is what weve learned about caregiving is from to the elderly or individuals who suffer from aids related conditions and chronic conditions. But i should note those studies are relevant for a military and veteran caregivers with 80 percent of military veteran care givers are from pre9 11 tending to issues that are associated with age although veterans are at higher risk for some of those conditions. The v. A. Was a leader to do research on veteran caregivers are rammed the aidsrelated conditions of dementia but the challenge to get Research Conducted is to have awareness of what needs to be studied so awareness also funding available to implement studies on a specific population n or r disease or clinical condition area as we look toward Better Solutions to improve the care we can provide for a specific population then care givers are that offshoot population served so were hopeful by bringing attention and crafting the blueprint we could get this facilitation to fill in those knowledge gaps. I want to reiterate the things expressed to each of you for your testimony. This cannot be easy or the way you want to spend your day providing testimony in a Senate Hearing if i was struck by the personal reflections each of you had of the challenge of caregiving with your own experience the very you said early about getting the diagnosis was a sucker punch and what that was like for you or anyone. And melanie when you said having caregiver support for the first time in 20 years i can breed which i think gives us a sense of how difficult this is hand wanda you said i stepped up because he couldnt. That is something that each of you could say. Sometimes we have hearings in congress and i am not sure about the impact around the country but anyone who is watching this or will watch this later or read about this would be inspired by your testimony. I hope you understand you are hoping and others in a manner that you testified so in so many ways, you may think this type of service is a natural act for 77 most of your life with but in another sense considering what you had to be dealing with all these years is an indication that your have spent triumphant over something difficult were grateful to have a chance to hear of clothes in your testimony sir inyourface i know that you were once part of the comprehensive Caregiver Program by recently he would no longer be eligible you were informed. How does that change your ability to care for your husband and yourself . We were recently told me graduated. I guess that is supposed to be good but it is not. The stipend that i received we used that for my respite. He belongs to a hunting can and he goes there for his respite care and with his tbi he needs the solitude and that is where he would go but he cannot go by himself. Most of his cater is safety issues tonight cannot allow him to go there with several states away. He wed go away and have somebody to accompany him like a paid travel and meals and i knew he was being taken care of and care for so i had my down time and now we dont have that. It also allowed me to go back to school to get my degree because he is 100 percent disabled the not permitted to work so whatever we want in our lives will have to come from me. This stipend was enormous it wasnt a lot dollarwise but just to get me through schools like to get a career going to make the money were losing from him. I did not understand what they said that i graduated because today is the best i will be. It might be a little bit but you slip a little bit more. You may have a Common Ground but you still lose that shortterm memory issues will be there every day it gets a little tougher. You would just your life to it but i dont understand how they tell you that you graduated from the program when it feels like you just tap into it. You both understand with the same experience that v. A. Has initiated the internal review of the eligibility decisions placing a moratorium on any further benefit revocations so we are happy about that nobody has been discharged that is very little solace to you or others at this time to lose those benefits. We do have a letter to the v. A. Urging them to read enrolled those were discharged with insufficient explanation in told the review is completed so we will continue to work on this. Madam chair since i have been gone with the Veterans Affairs committee and was told i was here and now we need to make it a priority to look at addressing the things that the Ranking Member mentioned with those revocations and disruption of service. I never miss an opportunity we have a lot of red tape and the dod and v. A. Let your Senate Offices in the prostate we the scissors. I have been here two and a half years we have opened our 10,000 case 6,000 of which are veteran related so the next time you go to the v. A. With benefits the you are entitled to not getting the right answer let the next phone call me to the senator of your choice in your state we owe that to you first and foremost, thanks for your service to the spouse and the men have served. I just have to brag again they were happier for the senator dole kickoff for Hidden Heroes and advocating for als research continuing to serve in the battle your household by a Great Service for everybody else who needs your voice. But talking to somebody who was in a unique position to be in this Veterans Affairs committee and upon the talkedabout transitions and the need to do a better job to identify caregivers write a transition or in that life cycle. You suggested Additional Research can you give an idea of how we go through that entire chain to identify Service Members who may not even know that they need care . And also i think we have to touch on this economic case because of the burden continues to increase on caregivers then we have to pay a price for less care and less valuable care to the veterans. So to what extent should the research be focused with the dod, ed v. A. Organizations that comes together in addition to the Family Caregiver . So we can talk about funding is a dollar well spent. So what makes fiscal sense that some level. Give it is what motivates to Pay Attention some 02 quantified the cost saving is a line of the research priorities. Stakeholders that this was important and critical they wanted to include research to document the cost not just the savings but the cost accrued as well with financial and economic terms of the lost productivity were support programs for Health Care Utilization so that need that looks at the cost and effectiveness of those different programs to put in place so we need much more research. So with that transition peas in a 2014 study we made a series of record a condition recommendations the first was a round of powering care givers are strategies to help solve identify but also helping the system to identify them there are a number of new programs including department of defense to identify individuals serving as care givers to provide them with education and peer support the call attention to the needs of the Eligibility Criteria across federal agencies to ensure that Eligibility Criteria was defined in ways to target the population providing care and service to our military Service Members and veterans were also the need to put in place appropriate education and training so that individual may not be aware of what that entails also the need to create environments more sensitive to Health Care Providers they should be conducting caregiving need assessments interacting with patients is somebody indicates they have needs and the Health Care Providers should be asking to speak with their caregiver and learning more to do their own Needs Assessment tool understand what they care giver needs to have their Health Issues addressed as well. Just for a second, read the v. A. Implemented a Electronic Medical record system that with the same platform as the dod. Bill we have an opportunity to really talk about veteran integration and using the data with Electronic Health record using that analytics to increase our understanding for those who need the health of most. The result of group of people that have benefited from benefits that now we have pre9 11 veterans dating back to the vietnam war that may have had anything other than an Honorable Discharge that very much has something to do with tbi and we did not know how to categorize it so now we have to see that group of people to see that the care givers are struggling so that is something we need to look at going forward. Let me follow really quickly with this discussion or this blueprinting fake it is fantastic that there are many who can pick this up with wonderful ideas to address these issues were talking about today. But you brought up creating a Research Center of excellence so what do and vision of a book like . We identified the needs of the potential strategy with the Research Center to provide the opportunity to get a strategic pursuit to what we identified to have the mistake of funding and leadership to bring together the deal to jumpstart the needed research but also others we suggested it because weve got specifically focused on military veteran Caregiving Research that we could get started to fill that knowledge gap to pursue the Research Objective that is high importance. Bar their models already to be replicated to look to for best practices to jumpstart . There are many examples of given the topic to reestablish something at the federal agency there are vintages and disadvantages with those approaches. Alternately given the topic there are examples where they have had other samples of outside organizations to ensure the of leadership and defending of momentum in that multi disciplinary way to pursue a strategically and intentionally those Research Objectives that we identified. So let me just say thanks for being here. First of all, i will be your what the call the said. Thank you for your service not only your active service to protect our country to your continued service of sacrifice is made with you as militia family. Honestly im sitting here thinking this is unconscionable we have to have this discussion not doing everything we can to take care of you and your families when you put yourselves on the line this is ridiculous to me. I want you to know from our perspectives your words are not ringing hollow and we have to do something the last thing we want to do is have this it on the shelf with your words going nowheres you hear that commitment already and were already putting action items in place. So highlighting in the comments you were denied respite care a couple of months ago. Is that correct . Can you talk about that and why that occurred . I was tonight in the fall it was to come here fran toller at for the summit as a fellow in september. I put in for a respite care severity there to help tom. It is not like the invitation he absolutely cannot but he can feed himself but cannot cook for himself. A person from the v. A. Two did the intake i will be honest said he did not provide the full to come and cook and clean and i said but that is what i needed. I suppose i could have said other things but i told the truth so he made meatloaf of every night but that will never happen again i will never go away again without somebody there to care for him or have him come with me that is the way it has to be because the potential for a fall is too great. Thanks for telling your story today our goal is to make sure it is a difference in other peoples lives as well. Senator herb leventhal . Bloom involving q thank you for having this hearing and thanks for being here today. There are a few topics of greater importance to any of us who serve here and because i served on the Armed Services committee in fact, i apologize for being late because i just left the hearing at the Veterans Affairs Committee Proposal i would like to ask members of the panel since we are scrutinizing budgets if you think the budget is sufficient to help with care givers to expand this effort that we have led this suffer long before as the enthusiastic supporter and if it is sufficient or focused in the right areas . I would like to say it makes sense to me that if more care givers were out there for our veterans prefers let me say what it is like to be a combat veteran away from combat, i just read a world power to affect a few weeks ago at a place back home and they take time to spend time with veterans to give them a reason to be alive. Combat veterans, when overseas were so used to being an average edge and going about 1,000 Miles Per Hour then nothing happens. But you still go to 1,000 Miles Per Hour but nothing is going on. A combat veteran without support like my life being my caregiver grounds me. Of the veteran is grounded and given a purpose to continue into fall into a suicidal alcohol. This particular world war ii veteran had just come out of his house five years ago. He didnt want anything to do with anybody since world war ii. This is what caregivers do. E served, both the point, one in the marine corps and one in the navy. I know what you mean. Theyre probably in less native grounding than i am a lot of the the time. Not that anything we do heres is anyway similar to combat. Ive seen this and connecticut and i have tried to work through the virginia and i am asking a question about support of the veterans administration. It makes sense to me that if there were more caregivers the virginia would have to spend less money on Mental Health. They would spend less money on mileage to go to a dr. That caregiver is there and is being paid. My wife has a masters degree and is a school teacher. She has had to step down just to be there for me. She is happy to do that, and i would much rather have her than anybody else. But there is a sacrifice there. I want to thank you both for your service. I mean both of you. I think countless other caregivers for their service. We think the veterans for her or his service in the caregivers are equally deserving of things. I appreciate you being here and giving a face and voice to this. Thank you. Thank you senator. Today, we have had an extraordinary hearing. Hearing from the caregivers, seen our veterans who have served our country so well. Listening to such advocates and senator Elizabeth Dole and ryan has truly been a moving experience. I believe the testimony you have given us supported by the work the Rand Corporation has done will help us advance the three bills that we talked about today. This committee does not have as the ability to shine the spotlight on an issue that has not received the attention that it deserves. With your help, that is exactly what we have done today. I cannot help but think as i listen to the testimony today that there is a recent we use the word military family. As we have seen from the testimony of mary, melanie, of wanda, when a person joins the military the whole family serves. That service can last a lifetime. It is very clear to me our nations 5. 5 military caregivers who face such emotional and Financial Issues each and every day a far more support than we have been given. I am grateful that you are willing to come and share your personal stories with us, because that along with the Rand Corporation study and the determined advocacy of the woman who will not take no for an answer, senator elizabeth though, and the ambassador for the group will allow us to get something done. I want to assure you of my personal commitment in that regard. Senator casey, do you have any final comments . Thank you. I want to thank them are witnesses. Maybe wanda said it best. You said in your testimony about sam, he did his job, he went above and beyond his duty. That could be said of you, melanie, joe, mary, and tom. We are grateful you are willing to do that in your lives but also grateful you are willing to share it and give us both inspiration and information of why we need to pass these legislative items into do advocacy on behalf of of those we represent. Thank you for being here. Thank you for serving your country in more ways than one. Committee members will have until friday to submit questions for the record which we may be getting to. My profound thanks to eyeWitnesses Today, to our Ranking Member, and to all the Committee Members who could participated in todays hearing. Thank you also to our dedicated staff. We connect to it without them. This concludes the hearing. [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] [inaudible] topics be end into the congressional record separately. The presiding officer without objection. Mr. Durbin mr. President , i would like to speak a moment about veterans day which is two days away on saturday, november is 11, america will honor americas veterans they have served from bunker hill to baghdad a