Transcripts For CSPAN Military Caregivers 20170619

Sen. Collins good afternoon. I welcome all of you, veterans, caregivers, and advocates, especially my former colleague, senator Elizabeth Dole, who is an extraordinary advocate for our military caregivers. Our military families, heroes in plain clothing, are serving in American Cities and towns every single day. The effects of military Service Often do not end with a tour of duty. For many veterans and their families, the journey sometimes extends for a lifetime. For some with both visible and invisible scars, the transition home is not easy. Recovery, too, can take decades. Along the way, mothers, fathers, wives, husbands, and other family members and friends, step in to serve. Today, we will focus on those who care for americas 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 veterans. They are often vital in assisting veterans to make the transition all the way home. Military caregivers improve recovery, rehabilitation, and reintegration of wounded, injured, and disabled veterans. The number of military caregivers has been on the rise as veterans from iraq and afghanistan return home. Approximately 20 of military caregivers today are caring for a post9 11 veteran. The needs and experiences of post9 11 veterans differ from those of pre9 11 veterans. While veterans from past conflicts and wars are aging and facing agerelated conditions including alzheimers and cardiovascular diseases, post9 11 veterans tend to be younger, and face higher rates of ptsd, depression, Substance Abuse, and traumatic brain injury. Today, we will learn more about the unique needs of military caregivers, and how to better support them. We will also unveil a rand report, commissioned by the Elizabeth Dole foundation, called improving support for americas Hidden Heroes. This report is a 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 that their loved ones have the care they need. They may have to miss work, turn down promotions, or even leave the workforce, creating enormous financial strain for families. This toll affects the National Economy as a whole. The loss in productivity just among post9 11 caregivers costs our nation approximately 6 billion per year. I have introduced Bipartisan Legislation that would better serve caregivers, including military caregivers. The raise family caregivers 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 baldwin, has passed the help committee, and i look forward to seeing it signed into law as a result of the advocacy of many here today. In addition, the bipartisan military and veteran Caregiver Services improvement act would expand eligibility for Vas Caregiver Program to veterans of all generations, not just the post9 11 generation. This is a program that helps veterans who are wounded, ill, or injured, by supporting and providing resources to those who have taken on a caregiver role for veterans. And, the lifespan respite care reauthorization act would authorize 15 million per year over the next five years to allow fulltime caregivers to take a temporary break from their responsibilities. This respite care is critical. Is crucial. It protects the health of caregivers, decreases the need for professional longterm care, and allow individuals who require care to remain at home. Despite their enormous sacrifice, military caregivers typically do not receive awards and admiration that americas veterans do. That does not mean that they dont deserve it. 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. Sen. Casey thank you, chairman collins. I appreciate you calling this hearing. And i want to thank you and so many others today. I want to thank, as well, our 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 bearing marks of that service. Joining us today are some of those who served bravely so that america can remain the land of the free. To paraphrase what my father once said, we pray for military families and their loved ones serving around the globe, but we also pray for ourselves that we valor. Rthy of their thank you for your service to our country. In order to better serve you, we are holding this hearing todayto recognize not only our veterans, but the Hidden Heroes of the military the estimated 5. 5 million military caregivers across the country. Military caregivers come in many different forms spouses, family, friends, neighbors, and fellow veterans among them. 6 , ority, roughly roughly 60 , percentof these caregivers are women. We will hear from our witnesses that caring for a loved one can be stressful physically, emotionally, and financially. We have made progress in helping caregivers, but as our witnesses will tell us, we have more to do. We must strengthen the supports that are currently available and help more caregivers who need to access those supports. Whether a soldier served in vietnam or afghanistan, their caregivers should receive the same benefits and support from the va. That is 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. And many veterans cannot access va services, for example, because they do not have a va facility nearby. Sometimes, family members do not qualify for va services. That is when other Coverage Options become important. Medicaid provides health care to over 900,000 workingage 340,000 of whom gained coverage following recent action by some states to expand medicaid and 660,000 veterans spouses. For these families who served our country and for millions more children, individuals with disabilities and seniors, seniorsmedicaid must be protected. Since medicaid covers more than 900,000 veterans and 660,000 spouses, proposals to cut medicaid and substantially change health care 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. This appears to be North Carolina day. It is always main and andsylvania day, maine pennsylvania day. We are fortunate that both senators from North Carolina served on the committee and one of our chief witnesses, plus some of our veterans are from North Carolina. I would like to give senator burr and senator tillis the opportunity to welcome those who are here from your home state. Thank you chairman collins and Ranking Member casey for holding this important hearing on military caregivers. I practically want to thank you witnessesal carolina here to testify and represent. Military caregivers is an important issue nationally and certainly in North Carolina where veterans make up 10 of our adult population. We have two Power Couples fighting for veterans and for my half of the introductions, i want to welcome my former colleague in the senate, Elizabeth Dole back to the senate. She has a long and distinguished record of Public Service in and out of government that many here know well from leading the department of transportation and serving as secretary of labor to serving as resident of the American Red Cross as president of the amendment calls the American Red Cross, she has been there with grace. T i want to slit her today what i want to salute her for today is the latest chapter in her story of service and that is veterans advocacy. Not only has she stood by the side of a certain army captain who knows his way around the senate halls, but she has also been a relentless advocate through the Elizabeth Dole foundation of all of our nations veterans. Bob and elizabeth all Elizabeth Dole continue to serve our nation and speak up on behalf of the needs of veterans and caregivers at i am glad that our committee will be hearing from them today and learning important lessons about what is working and where we still need to improve. I thank you senator dole for the grace and steadfast attention you bring to any issue you tackle. 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 tillis. You tillis i appreciate and this advocacy for Hidden Heroes at and i have had many discussions. I enjoyed the kickoff. I look forward to continuing to provide support. Chairman collins ahead the distinct village to introduce to other constituents, mary and tom ward could im at the month a few different occasions and i even get to pet the dog. They would let me do it today. Here and iraveled have to say it is a real testament to their commitment to the issue of caregiving, not only for themselves but for everybody else. I appreciate your leadership and advocacy. Services dates back to 1975. 1993, think you are about 13 years in your marriage when tom contracted encephalitis and andr a lengthy treatment size of cognitive difficulties surfaced, in 2010, he was diagnosed with als a progressive disease that veterans develop an rate higher than the general population. Mary will share her story as caregiver for her husband. Madam chair, i am pleased to have the wards here today and look forward to the testimony. I will tell you that tom and mary, im on the Veterans Affairs committee which is meeting at the same time right now. I am going to step out of this committee and try to get back because you all know the work we do there is directly related to this issue. You have my commitment as a chair of the personnel subcommittee that we are try to get this right from the time someone is in active service until the time they move their way to veterans status. I want to add a few comments about the work he 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 tremendous challenges facing our nation, 5. 5 million military caregivers. She has worked across the aisle and brought nancy pelosi and me together. Bill. Port of a that shows the work that senator dole has done to create a community of military caregivers to which they can connect, share advice and stories and advocate for more support. I want to point out that senator old does this just as a volunteer. I want to thank her leadership has been extraordinarily extraordinary. I am familiar with the dole Caregiver Fellowship Program and had an individual from the state of maine participate and i want to thank you for your service and i look forward to hearing your testimony. Ryan is an actor, director and writer. More importantly from todays perspective, he is an ambassador of the Elizabeth Dole foundation s Hidden Heroes campaign which helps connect military caregivers to Critical Resources and connect them to other caregivers. Ryan, thank you for supporting our Hidden Heroes who care for our veteran heroes each and every day. Senator dole, please proceed. Ms. Dole thank you chairman collins, Ranking Member casey, and members of the committee for calling todays hearing. By doing so, the committee demonstrates its dedication to recognizing our nations Hidden Heroestheir honorable service, their enormous sacrifice, and their selfless daily, and often lifelong, journey of care. Chairman collins, i owe you special thanks for your support of key legislation and the Hidden Heroes caucus, sending a strong 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 39 years ago, as a member of the federal trade commission. And, like each of you, i once sat up there on the dais as a member of this committee. To be honest, with the many issues before the senate, i didnt know at the time the true benefit military and veteran caregivers are making to our nation. And the huge personal toll it is taking. That all changed for me in 2011 when my husband bob was hospitalized at walter reed. I became friends with young spouses, mothers, dadssitting mothers, dads sitting beside setting bedside selflessly , looking after their wounded, ill or injured veteran. Their strength was incredible. Yet, i could see they were carrying an emotional weight almost too heavy to bear. As they reeled over their loved ones injuries, they were being asked to make extremely difficult decisions without any preparation. And they were quietly wrestling with the fact that they might be serving in this new role for the rest of their lives. Just as heartbreaking is the story of pre9 11 caregivers who were supporting their loved ones for years without any acknowledgment, struggling to care for the latent effects of undiagnosed post traumatic stress, agent orange, exposure to burn pits, or decadesold traumatic brain injuries that are now causing early onset dementia. These caregivers are just as terrified. Just as isolated. Just as important to their veterans. But when they apply for the va caregiver stipend, they are told that the timing of their Veterans Service does not qualify them for support. An incredible 5. 5 million americans act you should legal challenges and much more. Doing a tremendous job but are clearly suffering under the circumstances. There is also an economic argument. Nearly 13,000 a year as an involuntary work force. Lester year, Hidden Heroes was launched. Full of carefully vetted resources and a safe secure place to connect. Cities aced hidden galvanizing of cities. I am proud to say we have recruited 100 cities from augustine to pittsburgh. By actorign is chaired tom hanks. The goodlooking guy sitting t to me, Brian Phillip bay stars. Illipe he has become a passionate advocate for our caregivers. And god here on the redeye and tonight will head back to california on another redeye. God bless you. As you listen to him and the other panelists, i urge you to take two actions. Improvementartisan act the law of the land. This would expand caregiving and all eras. This will include things like respite, child care, financial advice, education. 43ave a letter signed by Hidden Heroes partner organizations. They are right here behind me. Particularhis lifechanging legislation will pass. We also ask that congress and vest in the Critical Research necessary. Panel you will hear from someone who will identify Urgent Research priorities. We urge you to listen carefully and champion the research. I have to tell you, based on what we know, we expect more to be uncovered. We are hearing more about caregiver Substance Abuse and suicide. Marriage between caregivers and veterans. The long road ahead is becoming too much for too many. Our nation has long respected military men and women knew served our country so valley attlee and reserve a special honor for those who returned from service with physical and emotional scars. Is for caregivers to be appreciated and recognized for their service. Woven into the very fabric of the nations appreciation of our military. Thank you so very much. You to use so much. Thank you senator told for the kind words. Before you get started, i will take a moment in light of this events. S i speak for all of us when i say our thoughts and prayers are with them. I speak for everyone here when i say to senator donald, we are truly inspired by your tirelessp, vision, and work. You are a shining light on our countries Hidden Heroes. I want to thank each of you for the opportunity to be heard today. It is an honor. A experience growing up in military family helped prepare me for this role. My grandfathers fought in world war ii. The Pacific Theater and the world berlin. My uncles were infantry men. All the members of my family who served, thankfully returned. In each were affected in one way or another. Ive had the opportunity to work with countless veterans and those currently enlisted. This adds to my deep respect for our veterans and the fact that they are our nations true heroes. These days, i have recently been working with the Elizabeth Dall foundation and that is how i learned about our military caregivers. Hidden heroes. Family members or friends karen for warriors who return home or emotional scars. We urge you to take action. If you know anything about senator donnelly, which you must, she does not take no for an answer. She will hold you accountable, all of us accountable. Because our military veterans deserve it. Over a lifetime of care, deserve more. Rs right now, military caregivers are doing this alone. They do not ask for help but their caregiving is owed more. We owe them purposeful action and lifetime support. Elizabethstruck me in doles report. Best chance for a Wounded Warrior to recovery and thrive is to have a well supported caregiver. On this role places stress the caregiver and their families. We can do better and that is why we are here. We need to sign into law some important legislation. Im talking about the recent reinduced reintroduced caregiver act to make expanded Resources Available. This bill strengthen and expands important caregiving and ensures caregivers are recognized for their services and tangible ways. If passed, pre9 11 military caregivers would have the same support we give to our post9 11 caregivers. Were talking about caregivers for the people who served with bob dole and those who follow. They not only need in the service is dense should be available to all caregivers supporting all veterans regardless of one they served. This also gives support to wounds, with invisible the same as visible wounds. It should not matter whether we can see their wound or not to guess on the care they need. It also gives assistance with child care, financial advice, legal education, and other current unmet needs. Bill is foro this the health and wellbeing of our nations veterans and military families. As a Hidden Heroes ambassador, i have had the privilege to meet with caregivers across the country and i cannot help but think about make an and matt. Toitary veteran who did two to hours of a rock band. A young couple, in love. A long road a head of them. Matt suffers from hm at it brain pts. Y and macon is by his side every day, helping as he struggles with wounds we cannot see. Invisible wounds we cannot imagine. Macon said she never pictured herself as a character before her husband, is so soon into their message but marriage but matt needs her. Juggling doctor appointments, medication. On alert for anything that might whiler his pts and all raising three young boys. Macon needs our help. There are 5. 5 million military caregivers like macon quietly serving across america and they can no longer go it alone. They need us, they need you. I ask olive view to give your full support to the military caregivers serving our nation. Please sign on to the military caregivers improvement act and each of the pieces the legislation outlines. Seek out military caregivers in your cities and town. Direct them to Hidden Heroes. Org. Thank you. Thank you. Thank you for your testimony and thoughtful acknowledgment of the bravery and extraordinary courage of the two Capitol Hill Police officers this morning during the attack that has stunned and saddened all of us. Without their bravery, the injuries would have been far worse. Heard at our republican lunch today firsthand account from one of the senators that was present and it is very clear that without the two Police Officers putting their lives in harms way, there would have been deaths as well as injuries resulting from this attack. So thank you very much for knology now or Law Enforcement and first responders. Mentioned to important priorities. Inoving the disparities essential services provided. It does not matter when you served your country. Second was the need to continue with article research. Thed you elaborate on second area of the Critical Research . We are finding out there are more connections between certain diseases and military service such as als than we ever realize. If you could discuss our priority more that would be helpful. Pleased that terry of thebRand Corporation of Rand Corporation will be here. Report. Tart with that this was the First National comprehensive evidencebased research done. Illustrated at number of areas where there were and theservices legislation we are focused on Care Services Administration Takes up on those gaps. That is why we are anxious to see that passed because rand has pointed out what is needed. Now there is legislation to provide what is needed so we need to pass that legislation. Road. Look down the so many caregivers are young. They are in their 20s and 30s. The post9 11 caregivers. They may be caregivers for a time. I was making a speech recently. Wasof my caregiver fellows with me. She made comments and said, i am 30 years old and i will be a caregiver for the next 50 years. Towe know now how to prepare support these caregivers five years down the road . Road . S . 20 years down the no, we do not. That is why this research is so important. We need to understand, how will recipientof a care change over time . How does a caregiving responsibility impact the outcome on the caregiver . We also need Longitudinal Research but it is very important, i cannot stress enough how much we need your help to make sure researches undertaken right away. Once we get the results of the research that will come be composed today, we can spread that to all of our partners. We have the National Coalition, about 300 organizations and many will want to try to utilize the research to come up with the right services to help these caregivers down the road. Right now it is alarming, alarming how little we know about how to care for them down the road and many of them will be undertaking these Caregiving Services for decades. Thank you. Hillipe, can you tell is what you have learned in your meetings with military caregivers . What do you think we should know . Out to me is the strain on the family. Their lives onut hold. The occupations they might have wanted to pursue. Some of the stress related to that fulltime job and what it takes away from, parenting or other things. That is why i think the respite aspect is important. Giving some relief and time off to be your own person and return to your job with the required energy. Keeping Families Together is a big part of this act in my mind, as a father that is something important to me. There are a lot of stress and strains that come with these industries and being a military veteran caregiver that can be destructive to a relationship, to the family unit. That is something ive heard from quite a few people. Thank you. Senator casey. I will start with senator dole. You mentioned caregivers to veterans from every era should be treated equally when it comes to the eligibility for the a programs like the comprehensive assistance for family caregivers program. I agree with you and i think people in both parties do. But it is the state of the law now that only caregivers from veterans who served after 9 11 are eligible for the comprehensive assistance for family caregivers program. Since you and your organization for with caregivers veterans fall air as a conflicts, can you describe to us in more detail how expanding the program would benefit those caregivers from pre9 11 . Yes. The caregivers from pre9 11 have been providing services for years. They have had no knowledge meant. They are not a knowledge for they are are doing and receiving very, very little in the way of services. Andillnesses and the wounds injuries of these veterans from earlier eras are compounded as they age, by the aging process. See you have not only the war illnesses and injuries, but you have come pounding. The advent of als, parkinsons disease, mobility issues, chronic pain, some forms of cancer. Here are these pre9 11 caregivers dealing with all of this, totally unacknowledged and with very little support. 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 comprehensive caregiver program. This would mean they have respite care. Becauseis so important you know, when you are almost burned out, how can you provide the best quality care for our veterans . Were talking about those who have borne the battle. Our country made the sacred vow to serve those who have borne the battle. That assume we are talking about. The caregivers of these individuals deserve to have the best possible care so they are not depressed and facing immune system problems and heart problems. That is what is sapping now. A great deal of stress, anxiety, depression. It is important that we provide respite care and and show the have, for are able to example, some Mental Health counseling. If they are in the cup and the program they will have a stipend. They will also have Health Insurance if they do not have Health Insurance. It would be provided. So they deserve this. It is really unfair they do not have it now. I think there is every reason to move quickly. The sinner we can get the legislation passed, our community can develop these services to meet these needs that are unique on the part of pre9 11 veterans and their caregivers. They are unique needs and we need to move quickly to tailor programs to services needs. Drugs i think your testimony today will help us move that legislation. That doesnt that thing. We are grateful you are here. Donald may i add, we have been closing this legislation for several years. It would be so nice to see it pass before the end of the year, please. For theis a good role end of the year. Shoe will beost a more persuasive than i will be so we will need you to come back. Days youly on most will be more persuasive than i will be so we will need you to come back. Some 900 thousand veterans because of their own circumstances are covered by medicaid. Hat is the coverage they have i also mentioned there are 660,000 spouses who received that benefit as well. Do you think that medicaid can play a Critical Role in providing health care to veterans or caregivers and families . What is sure thought on that . we know from those enrolled in medicaid that the Program Provides valuable extra coverage or valuable supplement for some of the expenses the v. A. Program does not cover. Veterans not on their health care plan, they would be under the same system as civilians and i think the brand brand i think the rand report indicated some fall under the poverty line and that would be the best for their health care assistance. To call on one of the committees most active members, senator cortez mastos. Thank you. Thank you for being here. Senator dole, thank you for everything you are doing in this space and particularly addressing this for our military caregivers. You talk about respite, i agree. Relief. Y to bring talk a little bit about the isolation piece that occurs as well. And why respite care will bring relief that there are other things we should be doing to address isolation ive seen with respect to military caregivers as well. Donnelly senator dole many caregivers dont understand that they are a caregiver. Many do not see themselves as a caregiver. In other words, i am just his mother. Of course im going to take care of him. I am his spouse. Looking after my husband or wife. They dont understand they are caregivers and if they just raise her hand there are Resources Available to them. We are trying to urge the caregivers to come out of the shadows and go to, we have a stateoftheart website. One of a kind specifically designed for military and veteran caregivers. Adden heroes. Org, and community of caregivers were they can talk, compare notes, learn from one another. There are several hundred carefully vetted resources on that website and we will continue to grow that resource list. We find when a caregiver is so isolated, so alone, they do not know there are others out there. They are struggling trying to deal with everything all by themselves and you can imagine, think about this in a family where there is difficulty. It may be posttraumatic stress or brain injury. Children have to be very careful. Spouse is trying to prevent triggers. Its cannot have children over for a sleepover. It is a delicate situation. They are dealing with this and yet they do not even realize there are others they might connect with. Once they connect even with just one other caregiver it is like magic. Experience. Ing if we bring them together in larger numbers i think they are able to support and help one another. I feel like we have them from all 50 states. Like extended family. I consider them extended family. Is such a bigly issue. We need to bring them out of the shadows and connect them with others. And respite, how can they provide the kind of quality care these heroes of ours who are born to battle deserve . Provided if they are exhausted . You know . The lifeline respite act is vitally important and we need to get it passed immediately so states can begin to Tailor Services to caregivers. Thank you. Let me follow up because i agree. Your is the biggest challenge i see. Let me open this up to mr. Phillipe as well. How do you make them aware of the Services Available . This is the biggest challenge. The education and awareness. How do you bring that back into the community and let them know there are resources and where to go to find out about it . Dole Hidden Heroes cities, the idea is we now have 100 cities and we are reaching out to mayors and other local leaders across the country with the idea they will form a committee, we will help them to understand how to inspire caregivers and Night Community to come forward. To identify caregivers and that community and then they will determine what resources do have the local level that can be extended to these caregivers, and where there are gaps in services how can we fill those gaps . We find this is working very well as a way of reaching out to the caregivers and also when our National Coalition we have some many one of all organizations that have chapters all across america. We need to reach out to people where the they are. That is at a local level. We have to drive down to the local level what is happening. There is a way of doing this in a number of different ways. The kind of Awareness Campaign wherein right now with ryans phillipe. Serviceing public announcement. Going to events. Our caregiver fellows are speaking at rotary clubs and other organizations. The word is getting out more. Were trying to raise awareness in many different ways. Ryan one of the things that came up talking with families is a frustration that support groups vary so much from state to state, city to county. Families would move to an area where they knew there were better facilities, better programs. Wouldf what Hidden Heroes like to implement is some sort of a National Standard for how we treat our military caregivers and therefore our veterans. That may seem, i think there is a way to do it but it just takes the right kind of people behind it. I think weve got the right people behind it. That initial push. Thank you very much. Thank you senators. I was going to move to the next panel but it is my understanding that senator warren is on her way and since we know how to filibuster, we will go on to a little more until she arrives. And, there was actually a question i wanted to ask you senator dole and that is, have you found that there is a difference in the needs of military caregivers versus civilian caregivers . I dont know what that is something you looked into but i was curious if you have, what you found. The rand report tells us the caregivers are medicala lower rate of care. Anxiety, depression, immune system problems. You know, i think that is something where we come back to so veryite that is important. To give them a chance to break away a little bit. To recharge their batteries. Family that the caregiver act is important. I know you are sponsoring that and it is important because it will provide for coordinating services across the government in a way that makes it more efficient. The Caregiving Services. Important to coordinate between the v. A. , dod, department of labor, hhs, and others involved in caregiving. It will also include lessons learned. Any time you can spotlight what is going on, the labor of love taking place in these homes, anytime we can spotlight that is a wonderful thing to do so i legislationese of will pass because if we want to foster a nation that supports Hidden Heroes, all Hidden Heroes, these wonderful caregivers, then it is important to pass both pieces of legislation. Senator warren thank you for being with us here today. Thank you to the caregivers and veteran spouses able to join us today. Senator dole, i want to thank you for coming to see me earlier this year to tell me about the support the caregivers provide every day to wounded or ill veterans and Service Members. Your foundation conducts a Fellows Program in which caregivers are selected to advocate for caregivers and ensure they had the resources they need and one of those caregivers is sitting right here in the front row. She is a former fellow and is from massachusetts. Not only did she care for her husband, charlie, who served in the army but she actually helps manage the caregiver Fellows Program. Hair. You to her for being i am thank you to her for being here with us. Also, caregivers give support, travel to appointments, childCare Services, Mental Health resources and other resources. Able to directly provide a stipend to caregivers iraq andar from afghanistan but does not provide the agency to provide this to pre11 from pre9 11 wars. This seems particularly wrong because elderly veterans are a vulnerable group. Senator dole, i know you addressed it in your testimony but i want to come back to underline it. When it comes to providing Additional Support services, what are the consequences of classifying caregivers of veterans from post9 11 war separately from caregivers of veterans of earlier wars . Unfairs a very legislation. We need this legislation we are focused on today because as soon as possible we need to begin to meet the very unique needs of Service Members and their caregivers. It is frustrating to me because these pre9 11 caregivers have been providing services for years with no acknowledgment, without anyone really acknowledging the services they are providing and without the resources to provide some respite care for them. An opportunity to have a stipend, which can be very helpful. To have the same benefits as post9 11 do when they are dealing with the most serious illnesses, injuries, and wounds. Not only war related but how they have been compounded by the aging process which means now you have the advent of things like parkinsons, als, some cancers. Plus all of the things that happen is you get older. You are less mobile. Have more pain. They are dealing with all of this without the support they absolutely deserves so i am hoping this legislation really could be passed quickly before the end of the year so that we could begin to really focus on the kinds of services that they need. Passed, thet is quicker the community can provide services addressed to those particular individuals. Bill has been introduced on this and i just want to sam with you, i hope this goes forward and goes forward as soon as possible. I also want to ask another question. I know that some caregivers of requiringterans longterm inhome personal care can qualify for v. A. Aid and attendance benefit. But i know some scam artists have targeted veterans by charging fees or obtaining this benefit even though the application is free. Senator rubio and i also have a bill we are directing the v. A. To work with other federal agencies to track down these scams. I think it is really important here. If i can i want to hit one more point and if the chair would indulge me for a minute. I come from a military family. All three of my brother served. That is not as common as it used to be. America has the worlds best many peoplece but in our country no longer have a personal connection to our military. As a result, they often do not know about the sacrifices of either the servicemember or the sacrifices of the caregivers. , 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 about how we help heal that divide . , youthink the isolation are on point. When you realize less than 1 are serving today defending our mostand security americans have no idea what is going on in military homes today and it is amazing. Weve done our reach to a number of organizations as we put together a National Coalition. Whether we are talking about people in government, nonprofit organizations, or we are talking with business leaders. Maybe the faith community. Often i hear, i had no idea. What can we do to help . There has been such an outpouring from the soul group that we have this wonderful coalition but theres no question that people just do not know what is happening in the home so how are we going to address that . One of the major goals of my foundation is raising awareness. Brian phillipe is helping us ryan phillipe is helping us. The Hidden Heroes cities is soping raise awareness people understand we need their support across the country. Hidden heroes cities is an example to driving down to the local level the concern for finding and identifying caregivers. We have a lot of mayors and their teams working across america to raise awareness, find the caregivers, lead them to the kind of support we can develop. You are you for all doing. Toator casey i know we have wrap up soon but mr. Phillipe i want to ask you about your interaction with veterans and their families. You mentioned in your testimony your own family background and the time youve spent with people like makin and matt living in connecticut. What can you tell us about any kind of common themes you hear or things we should be aware of that veterans and their caregivers race . And can you share with us about concerned say have or maybe some issues we did not cover today or ryan what comes to mind is the way caregivers are not ready for the role they are cast into. What goes into having somebody ready to take care of a disabled veteran. That can be addressed. There is a bit in the bill about helping with financial aid, helping families that have extra cost because only one can work or maybe not at all of the ama 247 job taking care of their veteran. Readjusting their finances. Allowing for support for the children even, allowing for an understanding, ok mom or dad is having this issue and we have to be gentle for this issue. It is not always easy to convey for someone who is young. Some of these men in women are young and do not have the actual physical training or Life Experience that a nurse has in other capacities. That is a big part of it. I always come back to come if we do not help our caregivers what happens to our veterans. When something happens to our veterans, that shame is something we all share. You see the rates of selfharm. The rates of drug and alcohol abuse go up when the veteran is left alone, when the caregiver cant handle it anymore. It is best for us to offset those dresses and keep those Families Together and keep our veterans healthy. Thank you very much. I want to thank this panel for your truly compelling testimony. When senator dole first came to see me, it was after senator bob bad year and had been in walter reed virtually the entire year and i remember how impressed 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. I know that is what inspired you to get involved. It is so typical of the Selfless Service that you have given to your nation your whole life and i am very grateful for your raising Public Awareness of something that we truly need to act on. Dole thank you. And mr. Phillipe thank you a specially taking me read i hear especially taken the redeye here at back. I wasnt surprised when you said you could not say no to Elizabeth Dole, because all of us have found that is the case. That is why i am the cochair today. It is indeed a worthy cause. We need to eliminate this disparity. I see in my own family, where my mother for the last eight years, my mother is 90 years old, my mother has taking care of my now91yearold father who is a world war ii veteran who was wounded twice in the battle of the bulge. Earned two purple hearts and a bonds star. Soing to get respite care is difficult. I think that is the number one challenge. I really do. My mother has been extraordinary in doing that for eight years but as you both pointed out, we have direct we now bank and afghanistan veterans whose loved ones may be carrying havecare gavel we now iraq and afghanistan veterans whose loved ones may be carrying that role for many years. Thank you for your advice and guidance. Thank you. Thank you. I now want to call up our second panel of witnesses. While you are getting settled, i will note there are two service dogs with us today who id know are very important to the veterans and their families with us today. Testify,nvite them to too, if i can figure out how. I know how smart they are, that is for sure. Thank you. First on this panel i would like miss terry tonelli and. She is the senior Behavioral Scientist for the rand the center for Health Policy research. She has led numerous studies examining the needs of veterans and their families and codirected the Rand Corporation 2014 study, Hidden Heroes americas military caregivers. Tanielian cochair the newest study on improving support for americas Hidden Heroes, the Research Blueprint that is being released today. Tellis mentioned our distinguished witnesses from North Carolina but let me give a reminder. We will hear from mary and thomas, both of home will testify today. Is a 2016 elizabeth caregiver tond a her husband, a pre9 11 military veteran who lives with pre9 11 als. Thank you for being here. We will next hear from two individuals from the great state from levant, maine, to be specific. Melanie and Sergeant First Class joe swoboda. Mrs. Swoboda is a 2016 Elizabeth Dole the low end a caregiver to her husband, a post 9 11 veteran 18 served in the army for years, including three tours in iraq. Her husbands caretaker for more than 10 years and helps him with his physical injuries and posttraumatic stress syndrome. In addition, she has a degree in education and has taught in the military community for more than 15 years so i thank you both for your service and look forward to your testimony. I would like to ask our Ranking Members to introduce his witnesses. Thank you. I would like to richards our witnesses from pennsylvania. Wanda. And we are grateful to you, surgeon, for your many years of service to our country in the army and panama, iraq, and afghanistan. I am also pleased to welcome your wife, wanda, to the hearing today. Wanda is a hidden hero in her own right. In addition to being a caregiver for her husband, one day is a fulltime student at the university of pittsburgh at johnstown and a doll caregiver fellow. Thank you for your service to our country and for being here at this hearing. Thanks as well. We will start with miss te nelian. Thank you. I am a Senior Scientist at the Rand Corporation where i studied the health and wellbeing of Service Members, veterans, and their caregivers. Many of our nations 20 99 veterans have conditions or disabilities that require ongoing care. Supporting them as a cadre of spouses, parents, and friends who provide unpaid informal support with activities that allow them to lead fuller lives. With the support of the elizabeth told foundation i have led three sequential studies on population. Our 2014 study, Hidden Heroes, provided the first indepth picture of military and veteran regulars. And estimated the value they give to our societies and provided a written study. Four of the findings were of particular surprise. 5. 5 millione military caregivers, one. 3 million were supporting an individual who served after september 11. Second, post 9 11 caregivers were different than pre9 11 caregivers. Younger, more likely to be spouses, and more likely to be in the labor force which means they are working and providing care to a veteran. Regulars were11 ineligible because of their age, relationship to, or condition of their care recipient. Or is, we found significant threats to the future of military caregiving, especially as parents who are serving as caregivers are aging themselves and may soon be unable to for services. Caregiving this is a blueprint to provide better here. This was informed by and put of 100 75 stakeholders including policy and programming researchers, philanthropists, advocates, care recipients, and caregivers. We generated consensus around 10 High Priority Research objectives which are outlined in my written testimony. I will focus on four of them that underscore the need for Longitudinal Research that will track these issues ever time. One priority is to study how it affects caregivers. It will help inform programs and policies designed to mitigate at first affects of caregiving with regard to Mental Health, employment, and family wellbeing. A second priority is to examine how caregiving affect the children of caregivers. No research has documented the affective of caregiving on children the most stakeholders consider this to be a vital topic. Such studies should focus on the impact on parenting as well is the short and longterm effects on children who service caregivers themselves. A third priority is to examine how care recipient needs change over time as individuals age or recover. The needs and demands for caregiving change and this may affect the duties and strain on caregiver. The fourth priority for research is to assess how programs and policies impact caregiver wellbeing. We know very little about the impact of current programs on military caregiver outcomes. Knowing what works and for whom is an important consideration policies. Ping sound the blueprint we released today, a number of conditions have to be met. Members of the senate can take critical steps to facilitate an environment conducive. This means adequate, sustained funding as well as decisionmaking for the future programs. Er support our report outlines a several potential strategies including creating a Research Center of excellence specifically focused on military and veteran are givers. It will be important for such a center to a Party Disciplinary expertise as well as a broad focus to ensure all of the Research Objectives and special populations important to the veteran Caregiving Community are included. I will conclude by reiterating the role of our blueprint is to convey a vision that will lead to improved support. Thank you for the opportunity to share this testimony. I look forward to your questions. thank you very much. I will like to call on good afternoon and thank you for inviting me and my husband to this hearing on military and veteran caregivers. Im humbled to be here alongside a force of nature like senator dole, an advocate like Ryan Phillippe, and an expert like Terri Tanielian and my peers. I became a fellow in 2016. My journey started long before then. On june 21, 2010, tom was diagnosed with als. Prior to that, tom had an disabled. He required care since then, but the allencompassing care is intense. I had his care organized until aos came along. Excuse me. For me, it was like getting sucker punched. My grief has known no bounds. I know how this disease works. It will steal his life and if im not careful, it will take mine as well. The work is daunting at best. Im certain that im not up to the task alone. For the most part, i know i will have to be. In 2008, als was made a presumptive illness for veterans. More than 4500 veterans at any given time have als. Tom served in the u. S. Marine corps, so he qualified for benefits. Ive not considered myself toms caregiver until later in life. I was committed. A caregiver to me meant someone paid to come and provide services. Epiphanythere was my that i was a caregiver. Als is a catastrophic disease. Theres never a day that goes by that im not grateful for all the v. A. Does to support tom. The challenge lies in ensuring that he gets what he needs in a timely fashion, medication, equipment, and so on. The same time, im taking care of tom and teaching advanced placement online. Toms need for assistance is nonstop. Hes moving towards dependence rather than independence. One youd worry i have is the financial aspect. I Teach High School online but have done so at a significant salary reduction which has impacted my future retirement funds. Im concerned that as his dependence grows, i will need to pay for assistance outofpocket. Two Adult Children who cannot assist in their dads care. Our daughter is a teacher in charlotte. Our son is a Sergeant First Class. Their dad is their hero. The best thing they can do is continue to grow their careers. That is the help we want from them. Being a fellow has been lifechanging. Ive developed lifelong friendships. Senator Elizabeth Dole ha encouraged us to be solution rests. The v. A. Offers me almost nothing. I receive no caregiver training,and, no support, and a few months ago, was denied rest bite hours. I am one voice among many who need help as we carry this heavy responsibility. There is still so much that we dont know. We need to cultivate a better understanding through Research Like the kind you heard about. We need action. I hope you will consider passing the improvement act to help caregivers like me. Thank you for your time and consideration. I welcome your questions. Sen. Collins thank you so much, mrs. Ward, for your moving testimony. Having imagine anyone listened to what you just said voting against our bill. Can spread your testimony widely and i really thank you for being here today. . Rs. Swoboda good afternoon, senators, and thank you, chairman collins and Ranking Member casey, for having joe and i at this hearing. My husband, retired Sergeant First Class, is a threetime combat veteran of Operation Iraqi freedom. He was deployed during the initial invasion in 2003, again in 2005, and again in 2007. Each time the deployments were longer. In 2003, he left for eight months. In 2005, for 12 months. Overseas forwas approximately 15 months. During the initial invasion and again in 2005 joe sustained injuries in explosions. In one, he lost consciousness. Because of the intensity of the fighting, there was no time for him to be checked by medics. He shook it off and remained in the battle. Years later, the injuries he sustained would become impossible to ignore. The severalyear period of rapid deployments was a world when whirlwind. Even when joe was home, he was not home. When he was not at war, he was training in field exercises. There was no time to recognize he was having any Mental Health or neurological issues. He had to push through it, as did i. After the third deployment, joe asked to be given an assignment where he could train without being deployed. When he stopped going to combat, that was when the problems really started. When we finally had the opportunity to slow down and these difficulties he was having started coming to light. I knew he was struggling. He was home but he had never really come back from iraq. Soldier who is also a trusted friend saw his struggle too and thankfully insisted that joe seek help for the overwhelming symptoms he was experiencing as a result of his traumatic brain injuries and posttraumatic stress. Woundsisibility of his had never recognized joe as being injured. Once these symptoms began to affect his work, joe was medically retired from the army, and during his out processing, a staff member handed me an application for the v. A. Caregiver program. I filled out the paperwork but i wasnt really sure what i was applying for. Even when joe had still been active duty, i was his caregiver , but i have never recognized it. All the tasks i was doing were the ones you will hear any caregiver talk about. I was managing his medications, raising the kids alone, managing finances, and helping him remember things that he could no longer remember. I love my husband and i would absolutely care for him regardless, but having Caregiver Support Programs in place is so important because, for the first time in 20 years, i can breeze. I cant imagine how much harder this would be without those programs but i know millions manage every single day. It is still stressful. Theres still a lot i have to do. But having the Financial Support of receiving a stipend and the opportunity for respite care, has been crucial for my family. There are days when i think i cant go on like this, i cant have this much stress and pressure, and it is not just the stress on me. I see how the stress of caregiving affects our children too. Respite services give us all an opportunity to recharge. Dolert systems like the caregiver fellowship with knowledgeable caregivers who can answer so many questions, and programs offered by the v. A. , such as the caregivers support program, make this sustainable for me and so many others. This kind of support should be available to all military and veteran caregivers, whatever era their veteran served. It is really helping people. It is really making a difference. I hope you will consider supporting and passing the military and veteran Caregiver Services improvement act to do just that. Thank you for your time this afternoon. I look forward to answering any questions you may have. Sen. Collins thank you so much, mrs. Latona, for sharing your story with our committee. Ickes. Ickes thank you for inviting my husband and i to testify. I would also like to thank the Elizabeth Dole foundation, Ryan Phillippe a, and Terri Tanielian , for taking the time to be here. It is humbling to have voices like theres speak on behalf of caregivers like myself. It is my hope that by sharing a small part of my journey as a caregiver with this committee, that you can ensure future caregivers do not face the same hurdles that my husband and i and other caregivers have had to overcome. Married tohad been the army long before he married me. In the 1980s, he was an army ranger in panama and operation just cause, though he still saw action with the third ranger battalion. That is when he suffered his first tbi. Later he was in a bad accident. He got a lot of metal put into his body, so much that the army said he couldnt perform his duties anymore and released him. Couldnt not do the job the army trained him to do. He had every waiver so he could get back into the reserves as a military police officer. He signed up for every single deployment. He was deployed more than he wasnt. Sam learned three purple hearts. He did his job. He brought every Single Person back alive. He went above and beyond his duty. Sam came back looking like the same person but he didnt come back acting like the same person. When you meet him, speak to him for a few minutes, he looks like everybody else. Talk to him longer and you can see his issues in the way he talks. Sam undeniably still lives with the effects of the war. One day when sam was home on leave, he had gone to the backyard to grill dinner. After he was gone for a while, i glanced out the window and saw flames lapping the side of the house. I didnt hear sam doing anything about it. I saw that he was just standing there, staring at the fire. I pushed him away and closed the grill. That is when i realized he had some serious issues. That is when i realized he would need more help. The army didnt see it that way. When he came back from his last deployment, where he severed his last major tbi, the army released him and said he was healthy enough to go back to civilian life. In the 60 days of leave he earned, i began noticing more Little Things that were different about him. He was stuttering. He couldnt process things. He was very distant. I took him to the v. A. And pushed the issue. Sam wasnt the same person. The more i talked about the issues, the more the doctors realized i was right. I had to write to the senator to get the army doctors to reevaluate him so he could be given the right benefits from the military. It should not have been that difficult. The army should have sent him sorry,vilian life the army was going to send him back to civilian life and he couldnt hold a job. He could have ended up homeless or worse. I couldnt and wouldnt let that happen. I had to make it right for him and for us. When he came back, i stepped up because he couldnt. I took control because he couldnt. I became his caregiver. When we had access to the v. A. Caregiver program, it was very good for us. It allowed me to have respite , so that i can focus on me. That statement, you cant put a dollar sign on it. As you consider how to improve the lives of caregivers, know that the military and veteran Caregiver Services improvement act makes important strides in improving coordination between the department of defense and the v. A. When servicemembers are transitioning into civilian life , extending a stipend to so many caregivers and veterans in need, those are policies that would have helped sam and i as we figure out our new life. I hope you will support this legislation and health it to be signed into law. Thank you for allowing me the opportunity to share. Sen. Collins thank you so much for your testimony. I want to thank all of you for being here today and sharing your personal stories with us. It really makes a difference. A lot of times we talk about numbers here in the senate and 5. 5alk about that there are military caregivers, but when you put a human face on it, and you hear the individual stories, it makes such a difference. It makes it so real. Let me go across, starting with wards. I often hear that caregivers are very reluctant to ask for help or support, and mary and melanie, it sounds like in your case, you didnt think of yourselves as caregivers initially, as being that role. Just hesitant to ask for help. Of whatply are unaware help there is out there. I think we would all agree it is not adequate and it is not fair then theres this disparity. I would ask, starting with you, mrs. Ward, how can we better help military caregivers overcome the barriers of their own willingness to accept help . For me personally, i think i needed to have someone ask me to ask for help, which is probably true of many caregivers. I think for us, getting a enormous meant an amount of stress and work in the future. Benefited would have by having somebody reach out to me, maybe even separate from tom. It is difficult to be the care recipient and hear the kind of stress it will be for their caregiver, because they are not a burden but it could feel like a burden. I think it would be ok if we had somebody take us aside and speak with us, and be available for gettions and to help us moving in the direction we need to, to still have the best life weekend. Sen. Collins thank you. Melanie . Mrs. Swoboda i think it would have been helpful to have had more education about caregiving during my husbands process. During this process, there are toy briefings that are held help the soldier transition out of the military. Simple, be very training someone who is already giving briefings, about other processing, to present information to potential caregivers. Much of the information ive learned along the way came from social Media Outlets and organizations like the elizabeth Stall Foundation are leading the way in disseminating information and helping caregivers to self identify. I agree with you that it is difficult for us who love our spouses so much to identify as caregiving, because we do it because, in sickness and in health, we take that literally. Sen. Collins thank you. Wanda . Melaniees i agree with in the fact that the veterans have their own processing and they are told what happens next. We are not. Especially if theres any insight as to the issues the veterans are having. They might need caregiving. If we were great given the same briefing that they are. Resurfaced, he was and there was no local frg or anything to steer me. I was on my own. I had to figure it out as i went. He had the advantage that he had the military behind him, telling him where to turn and what to do. I did not have that. Sen. Collins thank you. Ms. Tanielian, im astounded to learn from your testimony that theres not been a single study performed on the impact of caregiving on children. Swoboda talked about the impact of having to raise children at the same time. Why has there been so Little Research on the area of military and veteran caregivers . Thank goodness for the Elizabeth Dole foundation. In general, when you look at the literature, it is astounding how Little Research has been done. Ms. Tanielian what you do find is that most of what we learned about caregiving is from research that has looked at caregiving to the elderly or two individuals who suffer from agerelated conditions and chronic conditions. Those studies and findings are relevant for caregivers, particularly as we know that 80 of our military and veteran caregivers are of the pre9 11 and are tending to issues that are also associated with age. In v. A. Has been a leader doing research on veteran caregivers particularly around those agerelated conditions. Often, the challenge in Getting Research conducted for programs initiated is having awareness that there are issues that need to be studied. Awareness is a challenge, but also funding, making sure theres funding available for researchers to implement studies on a specific population or disease or clinical condition area that also includes caregiving. As we look towards Better Solutions to improve the care we can provide, just as weve seen with support programs, caregivers become that offshoot or that incidental population that is served. We are hopeful, by bringing attention and crafting this blueprint, that we will give some facilitation to the research that needs to be conducted. Sen. Collins thank you. Senator casey. Sen. Case thanks very much. I want to reiterate the thanks that chairman collins expressed to each of you. This cant be easy. I know this is not the way you spend most of your days, providing testimony in a senate hearing. Struck by the personal reflections each of you had about the challenge of caregiving and your own experience. Said, getting the diagnosis, you said it was like getting sucker punched, what that was like for you, and would be for anyone. Having, when you said Caregiver Support Programs, for the first time in 20 years, i can breathe, which i think gives us a sense help difficult this is. Wanda, you said, i stepped up because he couldnt, which is something that each of you could say about your caregiving. Sometimes we have hearings in congress and we are not sure about the impact around the country, but anyone who is watching this or will watch it later i think would be inspired by your testimony. Hope you understand that you are helping others in the manner that you testified. Ways, you may think service yound of are rendering is simply a natural act. Sense, when we consider what youve had to be dealing with all these years, its an indication that you have been triumphant over something very difficult. We are grateful to have the up close inar it your testimony. Wanda, ill start my questioning with you. Case, yout in your were once part of the v. A. Comprehensive caregiver program, but recently the department informed you you would no longer be eligible. Changedthat decision your ability to care for your husband and yourself . We were recently. Old that we graduated i guess that is supposed to be a good thing. For us it is not. The stipend that we received, we used that for my respite. Sam belongs to a hunting camp and he goes there a lot for his respite care. He needs the solitude and things. That is where he would go, but he cant go by himself. Safety his care is issues for him. It is several states away. I cant allow him to go there himself. The stipend we received was used for our respite. He would have someone accompany him. I was able to pay them travel and pay for meals and to be away. That was his respite care and mine because i knew he was being taken care of. So i had my down time also. Now we dont have that. The stipend also allowed me to go back to school, to get my degree. Hes 100 disabled. Hes not permitted to work. Whatever we want for the rest of our lives is going to have to come from me. Stipend was enormous for us. It wasnt a lot dollar wise but we depended on it just to get me through school so i could get a career going and make the money that we are losing from him. Do you want to add anything . I just didnt understand, when they told me i graduated from a program, that today is the best im going to be. It might just be a little bit, but each day you slip a little more. You will find common ground, but you are still going to lose that shortterm memory. The issues are still going to be there. Every day gets a little tougher. You kind of a just your life to it, but i dont understand how they can tell you you graduated from a program when it feels like you just stepped in the river. Sen. Casey i appreciate that. Others have had the same experience. Initiated v. A. Has internal review of these eligibility decisions and placed a moratorium on any further benefit revocations. While we are happy about that, that no one is being discharged in that fashion, it is very little solace to you and others that lost those benefits. We have a letter to the v. A. Indicating that and also urging them to reenroll those who were discharged with insufficient explanation until the review is completed. To continue to work on this. Sen. Collins thank you. Senator tillis. Thank you, madam chair. I went to the Veterans Affairs committee and told them i was at this committee and we need to make it a priority to look at addressing some things that the Ranking Member mentioned, some of the revocations and disruption of service. I never miss an opportunity in this venue. Weve got a lot of red tape to cut through in the v. A. And the dod. Let your Senate Offices in your home states be the scissors. Here for ive been two and a half years. Weve opened up our 10,000th case helping people, 6000 of which are veteransrelated. The next time you deal with the via a on benefits you are entitled to and you are not getting the right answer, let your next phone call me to the senator of your choice in your state. Make it our job. I want to thank all of you for your service, both the spouses and the men who served. Tanielian, ive got to go back and brag again on tom and mary. They were at senator doles kickoff for Hidden Heroes. Theyve had dictated for als research. You are continuing to serve. Not only are you serving your household, you are doing a Great Service for everybody else. Talking toan, somebody who is in the unique position of being on this committee, and the chair of the personnel subcommittee, wanted to talk about transition. We talked about the need to do a better job of identifying potential caregivers right at transition or some point in the lifecycle of the veteran. I know youve suggested in the research one, how do we glued together that entire chain . How do we identify Service Members that may not even know they need care so we are better prepared at the time they do . Too, i really think we have touch on the economic case for doing this. If the burden continues to increase on caregivers, we will have fewer caregivers and we will end up having to pay a price for less care and less valuable care to the veterans. To what extent do you think research should be focused on veteransis v. A. , dod, service organizations, the network that comes together in addition to the family caregiver, and research on the Business Case so we can talk about why funding this is a dollar well spent for one thing it is a debt that we owe every single one of you. I think it makes fiscal sense at some level. Ms. Tanielian im going to start with your second austin first. Making the Business Case is often what motivates individuals to Pay Attention to something. Quantifying the societal cost savings of caregiving was one of our research priorities. While stakeholders felt this was highly important, they also wanted it to include research that would document the cost, not just the savings, but the cost they accrue as well in financial and economic terms. Associated with lost productivity, cost associated with support programs or Health Care Utilization as well. So really, a need to do research that looks at the cost as well as the costeffectiveness of programs we can put in place. We need much more research. , we madeansition piece a series of recommendations and they were in four categories. The first was around empowering caregivers through a number of strategies to help them self identify, but also help systems identify them. There have been a number of programs implemented including in the department of defense to identify individuals serving as caregivers and provide them with education, training, and support. Needlled attention to the to look at eligibility criteria, to ensure those criteria are defined in ways that were intended to target the population who is providing care and service. Need totalked about the put in place appropriate education and training so that individuals who may not understand that they are caregivers become aware of what it will entail. We also talked about the need to create environments that are more sensitive to caregivers, Health Care Providers. Health care providers should be conducting assessments when they are interacting with their patients. If someone indicates they have caregiving needs, the Health Care Provider should be asking to speak with the caregiver and doing their own assessment to understand what the caregiver needs. Sen. Casey if i may if i may, the v. A. Announced they are implementing Electronic Medical records system that is the same platform the dod has. Now we have an opportunity to talk about better integration, using the data and the Electronic Health record from the dod, using analytics to increase our understanding of the people who need the help the most. Theres a group of people out there at some level, each of you have benefited from some v. A. Benefits. Veterans,ve pre9 11 dating back to the vietnam war, veterans that may have gotten other than honorable discharge, and the circumstances may have had something to do with traumatic brain injury or pts and we didnt know how to categorize it. We have to look back and see that group of people, that never even had the safety net of v. A. Benefits. That is Something Else we need to look at. Sen. Collins thank you, senator. Senator cortez. Thank you, madam chair, and all of you. Let me follow quickly with ms. Tanielian. Thank you for this blueprint. I think its fantastic and i hope there are many folks, including here in congress, who pick this up. One of the things you brought up which im a big fan of his creating a Research Center of excellence. Can you talk more about that . Ms. Tanielian we suggested a potential strategy around creating a Research Center of excellence because it would provide the opportunity to give strategic pursuit to the objectives we identified by providing a mistake of funding and leadership to really jumpstart some of the research. There are multiple ways and examples of other Research Centers of excellence. We thought a center of excellence specifically focused on military and veteran Caregiving Research would go a long way to making sure we could get started on pursuing the Research Objectives that the community agreed are of high importance. Are there models out there that can be an elated or that we could look to, or best practices . Ms. Tanielian there are many examples that already exist. There are a number of different ways to go about establishing something in the federal agencies or federal sector. There are advantages and disadvantages with all those approaches. Topic,ely, given the there are examples where the v. A. Has established other centers of excellence where they conduct research in partnership with outside organizations to ensure the leadership, funding, and momentum to pull together the community in a multidisciplinary way, to pursue the Research Objectives that we identified. Thank you. Let me just say to the wards, thank you fors, being here. Thank you for your service. Not only are active service in our military, but your continued service. By theces made both gentleman as well as family members. Thank you. Part of me is thinking this is unconscionable, that we even have to have this discussion, but were not doing everything we can to take care of you and your families when you have put your lives on the line. It is ridiculous to me. I want you to know, at least from our perspective, that your words are not ringing hollow. Weve got to do something. The last thing we want to do is have this sit on a shelf somewhere. You are hearing that commitment already. We put some action items in place. Let me ask you this. Ward, you talked about this. You highlighted in your comments that you were denied respite care by the v. A. A couple months ago. Is that correct, and can you talk a little about that, give me background on why that occurred . Mrs. Ward i was denied respite care in the fall. It was to come here in washington, d. C. As a fellow for the summit in september. I put in for respite care so there would be somebody to help tom. He needed help cooking, getting dressed. Its not like he absolutely cant do a thing. He can feed himself, but he cant cook for himself. The person from the v. A. Who did the intake with me, ill be , here are the words. We do not provide people to cook and clean. I suppose i could have said other things, but i just told her the truth. I dont with it on a personal level. Nightde meatloaf every for a few nights when i was gone. We handled it. It will never happen again. I will never go away again without having somebody there to care for him. That is the way it has to be. Fall is tool for a great. Thank you all for telling your stories today and having your voices heard. Yougoal is to make sure make a difference in others lives as well. Thank you. Sen. Collins senator blumenthal. Thank you very much for having this hearing. I want to thank all of you for being here. There are a few topics of greater importance to any of us who served here, particularly because i serve on the Armed Services committee. I apologize for being late because i just left the hearing at the Veterans Affairs committee. I would like to ask members of , since we are scrutinizing the budget there, whether you think the v. A. s budget is sufficient to help with caregivers, and we are trying to expand this effort. Im an enthusiastic cosupporter. Sufficientources are and whether they are focused in the right areas. That it makes say sense to me that if more caregivers were out there for our veterans, and let me say this, what its like to be a combat veteran away from combat, i just met a world war ii veteran a few weeks ago. He was at a place back home called local museum. Veteransd time with and sort of ground them and give them a reason to be alive. We are so used to being so on , things going on around us all the time, and when you come home to the land of mcdonalds, nothing is happening. Going 1000 miles an hour, but theres nothing going on. A combat veteran will either, without support like my wife being my caregiver, she grounds me. If a veteran is grounded and given a purpose to continue on, they dont fall into suicide. They dont fall into 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. The guy has missed his whole life. Him, notfinally got to necessarily his caregiver, but something grounded him. That is why caregivers are so important. Onknow that theres no ieds i95 but we know in our brains that we have to look. You cant stop that. We need somebody to ground us. That is what caregivers do. Two of our children have served, one in the marine corps, the other in the navy. I know what you mean. They are probably in less need of grounding than i am a lot of the time, not that anything we similar toin any way combat, but ive seen this countless times in connecticut. I have tried to work through the v. A. And that is why im asking about support from the veterans administration. To me that ifnse there were more caregivers, the v. A. Would have to spend less money on Mental Health. They would have to spend less money on mileage to go to a istor because that caregiver being paid to be there for them. My wife has a masters degree. She has had to step way down just to be there for me, and shes happy to do that. I would rather have her than anybody else. But there is a sacrifice their. I want to thank you both for your service. I mean both of you. And i think the countless other caregivers for their service. We tend to thank the veterans for her or his service, and the caregivers are equally deserving of thanks. Appreciate you being there. Thank you. Thank you, madam chair. Sen. Collins thank you, senator. Today we have had an extraordinary hearing. Hearing from the caregivers, seeing our veterans who have served our country so well, listening to such terrific advocates as senator elizabeth e hasand ryan philipp truly been a moving experience. I do believe the testimony youve given us, supported by the Rand Corporation, will help us advance the three bills that weve talked about today. This committee does not have legislative jurisdiction, but what we do have is the ability to shine a spotlight on an issue that has not received the attention that it deserves. Exactlyr help, that is what we have done today. But think as i listened to the testimony today that theres a reason that we use the word military family. As we have seen from the testimony of mary, melanie, wonder, when a person joins the military, the whole family serves. Last a lifetime. Its very clear to me that our caregivers5 million who face such substantial emotional and Financial Issues each and every day need far more support than we have been giving. That you so grateful are willing to come and share your personal stories with us. That, along with the Rand Corporation study and the determined advocacy of the woman who will not take no for an answer, senator Elizabeth Dole, and the ambassador, Ryan Phillippe, will allow us to get something done. Of my want to assure you personal commitment in that regard. Senator casey, do you have any final comments . Sen. Casey i want to thank our 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 not only of sam, but of you, melanie and joe, mary and tom. We are grateful that youve been willing to do that in your lives, but also grateful that you are winning willing to share it and give us inspiration and information about why we need to pass these legislative items, as well as do advocacy on your behalf and those that we represent. Thanks for being here and thanks for serving your country in more ways than one. Sen. Collins Committee Members will have until friday, june 23 to submit any additional questions for the record which we may be getting. My profound thanks to all of our Witnesses Today, and to all the Committee Members who participated in todays hearing, and to thank you also to our dedicated staff. We couldnt do it without them as well. Thank you for being here. This concludes our hearing. [captions Copyright National cable satellite corp. 2017] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] this past week, the House Appropriations committee passed the first appropriations bill for military construction and Veterans Affairs. It topline budget has not yet been adopted. We spoke to a capitol Hill Reporter to learn more. Congress is facing a september 30 deadline to appropriate money to fund the federal government and niv ellis