FamilyOfaVet - Real world info about PTSD, TBI, & life after combat
FamilyOfaVet - Real World info about PTSD, TBI, & life after combat.



This "plan" for this list started out much differently.  As you'll soon see, the first part offers
a "problem" and then at least one (sometimes more) proposed solutions.  Ideally, that's
what we wanted to do.

But then, the shutdown happened... and one of the "fun" parts of all of us living *AND*
working is this PTSD/TBI/often challenging world we live in, is that things like that have a
HUGE impact on everything.

So, you have the "ideal" beginning... and then the raw, but still very relevant and
meaningful, thoughts and suggestions received from heroes and families listed "as is" at
the bottom.

Our hope is *NOT* to criticize the VA - though, obviously some of the feedback is critical.  
Our hope is to offer constructive feedback and also an honest look at the heart impact of
so many things that often go unnoticed, but often have far reaching ramifications in our
lives.


OUR HOPES...

STOP the “you’ve seen one VA, you’ve seen one VA” trap that wastes time and
leads to substandard care.
While there are state medical rules and regulations that
must be followed within each VA system, clearly documented, widely distributed policies
and procedures should be put in place (and then employees should be training bi-annually
to ensure those policies & procedures are known and followed) in relation to medical
center and clinic care, access, and programs.  The current process is not only infuriating,
but more importantly leads to an unfair gap between services and the quality of care
heroes (and those who facilitate their care) experience across the country.  The policies
and procedures should be publicly (transparently) available and a yearly request should
be posted PROMINENTLY in all facilities and on the VA’s main website to request feedback
about changes or improvements that can be made.  While this would be a labor intensive
process at the beginning, it would result in a savings of man hours (and money) ultimately
as employees and staff would be knowledgeable of VA policies and procedures across the
board and would result in a higher level of patient-centered care.

We don’t know what we don’t know. Many veterans and families, even those who are
extremely proactive, spend years accidentally “stumbling” on to a service, program, or
employee who is the answer - or at least part of the solution - to the myriad of issues they
are facing.  It’s a waste of precious time.  To make this situation worse, many times VA
employees are not aware of programs and resources within their own workplace.  It
becomes a broken process of the “blind leading the blind” (and veterans and families
drown in that process).  Each VA medical system and center should be required to
develop a comprehensive guide that is updated on an annual basis to all services,
programs, offices, and employees that includes contact information, office/building
location, and other pertinent details.  The guide should be available via the center/systems
website (both in PDF and as an interactive web version), should be distributed
(consistently, throughout the year) in print in abundant locations within the facility, and
every provider/treatment team should be prompted (by the VA electronic record system) to
notify the Veteran and/or caregiver about the guide at least three times per year.  Each
medical center or system should also provide a “Getting to Know Us” class.  The class
could be provided (in order to stretch funds) via recording that could be accessed via web
and played “on demand” in multiple locations throughout the facility.  Included at or near
the “on demand” locations should be copies of the guide referenced above AND a contact
card listing numbers for key contacts if the hero or family member has questions. All
training (and the guide) should include the VA Patient and Family/Caregiver Rights and
both should be required viewing by all facility employees.

    “I’m so tired of finding something by accident that would have been game changing
    YEARS ago…”

View family members & caregivers as key parts of not only a Veteran’s support
system but also their TREATMENT team.
Recognize our daily (often around the clock)
experience with the physical and mental health of our heroes and that we are often your
best source for accurate information and details.  *ONE* medical release form should be
instituted for use VA wide and electronically stored in a prominent location in the Veterans
records (instead of current system where a veteran or caregiver often has to spend
endless hours finding out IF existing releases are accepted for a new
purpose/provider/facility or IF the in place release is accessible by the new
provider/team/facility).  The medical release should not expire for at least a year, but in the
case of established patients/caregivers the releases should have longer viability periods.  
Veterans should be able to designate (again, in a prominent position in the VA electronic
records) his or her caregiver or primary family contact and be allowed to indicate if he/she
prefers that contact go through that person (instead of directly to the patient).  In an era of
a high level of psychological and neurological injuries, best practices for care MUST take
into account the memory, mood, cognitive, and coping deficits experienced by so many
heroes that necessitate such measures.

    “In a perfect world the VA would treat the veterans and family members with the
    respect they deserve. They would realize that the veteran's family member/spouse is
    the expert on the veteran. I should not have to show up in my scrubs or white lab
    coat to be taken seriously as a partner in his care, especially when he insistently
    and repeatedly states that I am his caregiver.”

    “Respect the caregiver! Trust my knowledge and please don’t ignore me!”

Making the claims process faster (and accurate) starts with including those who
care for and support a hero with memory, cognitive, or other deficits that impact
recall of details… not to mention seeing an accurate picture of heroes who DO
NOT WANT to be “broken” requires our insight.
 Currently, there is no national,
standard policy regarding Compensation & Pension (C&P) exams.  For most heroes, the
data and details gathered in those exams greatly impacts their disability rating.  In a time
where so many heroes are struggling with memory, cognitive function, have a hard time
recalling details - and since as an overall “rule” veterans loathe admitting being anything
less than in “fighting shape” - a national standard that specifically provides for the
WELCOME inclusion of a caregiver or family member who is most familiar with their
condition(s).  Without this insight, time and money is wasted (at a massive level) because
the result is inaccurate exams which then result in inaccurate disability ratings that must be
appealed (often, MULTIPLE times).  This process also greatly contributes to the backlog of
more than half a million outstanding claims for disability benefits - a lack of earned benefits
which contributes to the financial and emotional toll so many of us continue to buckle
under YEARS after injury.

Please give us EASY ways to communicate and facilitate the care of our hero.  For
many veterans and families there is an ongoing struggle to establish and maintain
effective communication with a wide range of providers across multiple specialties.  
Depending on where a hero lives, he or she may even receive care at 2 or 3 different
locations.  It is imperative that all aspects of open, regular communication be streamlined
and accessible.  Secure messaging through MyHealthEVet is a wonderful function that is
helpful… but only for communicating with the providers who choose to use it.  Even those
who are listed sometimes wait 2 weeks or more to respond, and by that point a veteran or
caregiver may have given up logging in and going through multiple steps to check for a
response.  Appointments in MyHealthEVet are not always accurate and paper/mailed
reminders sometimes arrive the day of… or a few days after… an appointment.  While of
course privacy laws and healthcare regulations have to be followed, there are multiple
methods through which all of these steps could be handled in a way that saved time for all
- and that saved money (in paper and printing as well as postage) for the VA.  
Communication needs and preferences vary across generations of the veteran population,
but allowing for more “modern” options (and a way to “opt in” to them) would relieve a
tremendous amount of stress for many.  

Clear appeal process for the Caregiver Program with procedures - and all who
will be participating - outlined to the Caregiver.
 Also, Caregivers should be allowed,
just like our heroes, to submit “letters of support” from individuals who routinely observe
the level of care we provide.  There is a great deal of difference across the country in how
the appeal process is handled and too often a Caregiver Support Coordinator [CSC] (who
initially removes a Caregiver or reduces his or her tier) is then a key component in the
appeal process.  This creates a potential for bias and too often appears to result in unfair
outcomes.  Ideally, no individual involved in the original reduction or removal of a
Caregiver should be involved in the appeal process.  The process should effectively
initiate a second look with completely “fresh” eyes.

Caregivers, close family members, and children NEED readily available access to
mental health care.
 Just like our heroes, our mental health is quickly declining - and
worse still, so is the mental health of our children.  We need more than “theoretical”
access to counseling and mental health services.  We need access that is timely, provides
“after hours” and from-home options (as for many full-time caregivers, leaving a hero at a
regularly scheduled time to drive 60+ minutes both ways to a counseling appointment is
impossible).  If we are unable to cope, we are also unable to give our Veterans the best
possible care.  AND we should be able to access this care even when our Veteran is
currently in a mental health state that prevents him or her from reaching out for help
themselves - since often those dark, desperate places in our Veteran are the EXACT time
we need MORE care and support, not less.

Patient charts and notes HAVE to be accurate.  With decades of care stretching in
front of many heroes (and those who are by their side day-to-day), accurate, thorough
patient records are crucial so that current health issues are closely monitored and any
progressive symptoms can be caught early.  It is a routine process of in the lives of most
caregivers to routinely read through hundreds of pages of treatment notes and records
per year and most of us know we need to do so because mistakes or incomplete
information is so commonplace.  Not only do those records impact the care of our heroes,
but they also impact the benefits and services they are able to receive.  At the very least,
the process for correcting and amending medical records should be streamlined and then
information about the process widely distributed and staff and providers who receive
regular requests for amendments or corrections should be required to complete additional
training on correctly documenting patient care.  However, in many locations correcting or
amending records is an antiquated, “hit or miss” process that receives little feedback or
follow through.  It would be more efficient for both medical staff and veterans or caregivers
if there was a way to “flag” a record in MyHealthEVet, explain or make note of a suggested
or needed change or addition, and then for that flag to “alert” appropriate medical center
staff who are involved in the steps of the change/correction process.  

Carefully pre-screen those who are hired as Patient Advocates to ensure they
are passionately committed to helping Veterans get the best possible care AND
change their “chain of command”.
 In order for our veterans to navigate an often
complex healthcare system while dealing with a long list of challenging injuries and
conditions, Patient Advocates need to be hired not only based on experience and
degrees, but from the perspective of internal drive and desire to truly help those seeking
care.  Ideally, the pre-screening process should place an emphasis specifically on hiring
those with prior service or who are members of their immediate family - which will also help
those advocates establish more effective relationships with those they serve.  Patient
Advocates should also be managed / overseen by someone from outside of the VA
medical center or system for which they work.  Too often advocates seem unwilling or
unable to “make waves”, even when those waves are desperately needed in order to
provide better (or even adequate) care for a hero.

Training, training, and more training in customer service and bed side manner
and a methodology to verify the conduct and care of those serving heroes and
families.
 Institute a “secret shopper” program through which patient advocates would
identify enough Veterans and/or Caregivers to ensure that every provider / treatment team
was reviewed at least six times per year.  If a provider or member of a treatment team
receives consistently poor reviews, mandatory training should be required (and in
consistent, grievous examples, pay or overall employment should be impacted).

    “Realize that we, as their caregivers KNOW what we are talking about - we live with
    them, we take care of them, we see everything - when we tell you something is
    happening, BELIEVE us and try to help us, don't sit there rolling your eyes…”

    “Hire people who truly respect and care about our veterans and their families - not
    those that somehow think the Veterans OWE THEM for taking care of their physical
    or mental health!”

    “Please hire staff that understand our heroes did not ask to be broken, they do not
    LIKE being broken.  I know mine would give anything to be happy and healthy
    again. Don't treat them as if they enjoy this... they are in pain, be respectful!”

    “I want the VA to change their attitudes and the way they talk to Veterans, and to
    actually listen. There is no point in a Veteran or the spouse having to repeat the
    same thing over and over because of an employee being too "busy" to listen.”

    “Stop treating my veteran as though he is an ignorant child, who doesn't know his
    own body. LISTEN to the spouses and family members.”

Make the complaint process straightforward - and provide adequate follow up.  
Too often (actually, a majority of the time), Veterans and caregivers do not know how to
submit a complaint or concern through their VA healthcare system.  And, even when they
figure the process out… they receive no response and don’t know if it was ever received
or acted upon.  In order to maintain an environment in which feedback, concerns, ideas for
improvement, and complaints from heroes and those who love them are properly facilitated
(and responsively addressed), this process should be clearly, obviously outlined in
multiple locations in every facility and on the facilities website.  The process should be
easy and not extremely labor intensive.  And, appropriate staff follow up should be
required.  There are multiple “customer support ticket” examples, programs, and software
options that could facilitate this process in an efficient and cost-effective way.

    “Please keep the veteran informed after they’ve made a complaint. Most of the time,
    we feel the complaint has fallen on deaf ears because we never know what happens
    next.  Right now it feels more like a place to vent than a way to get anything
    accomplished or changed.”

Have a “peer review” process that helps providers/physicians/staff help watch
for burnout and high levels of stress in fellow employees.
 Too often our heroes
and families see the impact of long term stress and strain in the providers and staff we see
at our VA’s (after all, many of us recognize the “symptoms” as they are something we, too,
experience!).  These symptoms can quickly lead to less than adequate care and concern,
which then not only means our Veterans aren’t receiving the best medical or mental health
care, but it can actually make it increasingly more difficult for us to get our heroes *TO*
treatment and appointments.  It creates a snowball effect for everyone involved.  There
should be an ongoing, quarterly process through which colleagues “review” each other for
signs of stress and burnout - as well as a policy in place for supportive steps that can be
taken to ensure that provider or staff member receives what they need to address those
symptoms.

    “Help providers who are experiencing burn out...they become apathetic, rude,
    insensitive, and discriminatory when they are burned out. They start to see the
    veteran as a number rather than a person and this can greatly hinder the care the
    veteran receives.”

On-site or nearby childcare at every location to allow caregivers to attend
appointments with Veterans.
 To minimize increasing costs in a time of already
stretched federal budgets, this could be implemented using a schedule of certain hours
that the care would be available and utilize volunteers in existing on-site space (carefully
screened or to minimize costs associated with screening, asking pre-screened employees
from community organizations, businesses, and faith-based institutions to participate),
could use nearby community centers, faith-based institutions, or other establishments
(many of whom are more than willing and regularly looking for ways to be more supportive
of veterans and families), or could be provided on an at-cost hourly fee scale. At the
MINIMUM every facility should have one or more child-friendly play areas set up in such a
way as to be accessible in all waiting areas.  We are young families, most of us have
young children, and often due to financial or other constraints we are left with few
options… we have to have a way to parent AND care for the heroes we love.

Good communication during and after inpatient stays.  Ensure that during inpatient
stays caregivers are kept informed and included in treatment plans and progress and that
the Veteran *AND* those supporting and caring for them after their transition home have a
clear understanding of aftercare plans.  A point-of-contact (POC) for family / caregivers
should be established on every inpatient floor or unit.  When the Veteran checks in, if at all
possible, he or she should immediately, clearly receive verbal information and a form (with
help to fill out, if needed) which gives permission for that POC to contact the listed family
member(s) or caregiver.  The POC should be required to contact (or at least attempt to
contact) those on the list within 24 hours.  When leaving inpatient care, clear, easy to
read, detailed instructions should be provided in writing that cover any medication
changes or follow up care plans.

    “I would like the VA to recognize me as his wife( who loves him) and when he is
    inpatient, not ignore me and avoid me while messing up his care.”

Access to emergency care, no matter location.  Clear, widely distributed guidelines
concerning the coverage of non-VA emergency care and a policy that more thoughtfully
considers how many of our families are in rural locations or otherwise located too far from
VA emergency care to be able to utilize it in a crisis (especially when many of our heroes
also have psychological or neurological injuries which make managing those symptoms or
behaviors extremely difficult if not impossible and unsafe if they are also ill or injured and
must endure a long drive).

    “I want emergency care to be more readily available. If we have an emergency in the
    middle of the night they want me to drive an hour and a half to the nearest VA
    hospital unless it is “life or death.” I’m not a medical professional!  When I take him
    in the middle of the night I don’t know how bad things are -and I’m not going to drive
    that far when there’s a non-VA ER that is 20 min away. So, we end up with medical
    bills that we can't pay for and they refuse to pay. If I could afford those bills then we
    would already have other coverage.”

When we’ve tried all of the “normal” options… help us look for what else might
work.
 Our heroes are typically faced with a wide range of injuries that impact their
physical, emotional, psychological, and neurological health which often ultimately have a
secondary effect multiple systems within their bodies, and this cumulative process can
mean they are “treatment resistant” or that a treatment plan or method works for a while,
then stops.  We have decades of caring for our heroes stretching in front of us.  We need
help (and support) while looking at alternative and holistic treatment options or supportive
mechanisms.  Be OPEN and non-judgmental in response to our questions - and preferably
well-informed about emerging research and practices that could help our heroes and
families survive better!

    “I want them to think outside the box. Just because their schooling, studies, or
    books say something should be a certain way, that doesn't mean my Veteran’s mind
    or body is going to respond that way. When a vet keeps coming back, in pain, after
    trying pretty much everything you asked of them, DON’T dismiss them like they are
    lying. Just because the doctor can't see it, doesn't mean it's not happening.”

ChampVA Coverage for those on the Caregiver Program needs to also cover the
caregiver’s children.
 For most families who do not yet have a “Total & Permanent”
rating where the Veteran is covered by VA healthcare and the caregiver is covered by
ChampVA, it is almost impossible to find a “child only” health insurance policy.  So, our
children go un-insured or we have to pay health insurance premiums that are far outside
of our budget.

More relevant, injury-specific training for caregivers.  Most “newer” Veteran
caregivers who are still in the most need of training and skill development are dealing with
behaviors, symptoms, issues, and challenges that are not yet effectively addressed by the
caregiver training.  Our days are consistently much too long and we never have enough
time to get done what is needed, much less any of the extras we would like to complete.  
As such, it is critical that training time not be wasted, but provide valuable, relevant, vital
information so that we can take better care of the heroes we love.


Direct (“unedited”) Quotes:

[There are a few of these statements that reflect a lack of knowledge about a VA program
that is in place in some or all/most VA's. However, we are leaving those statements “as is”
since several are from experienced veterans or family members and thus underline the
need for better, more thorough distribution of information about programs and people who
are available to help as well as illustrating the differences in level of care and services
between regions!]



VA Communication
Encourage cross communication between the various "houses" of the VA... VBA, VHA, Vet
Centers, etc. If you are under the umbrella of the VA, and have a universal consent, then
you shouldn't have to fill out dozens of forms. Also, VA caregivers should not have to get
dozens of consent forms for the same reason. Have a universal caregivers form that is
signed one time, and is good for a minimum of 1 year, preferably 3 years. It should be
accessible from any part of the records system.

Paperwork
It would help a ton if we wouldn't have to send everything at least twice because they
never fail to lose the paperwork at least once! We are living overseas and frankly, it is
expensive and takes time to re-send everything, time that could be used to process our
request faster.

Computer system
Number two: implement a nationwide Computer system for said Medical Records. One that
works (it is possible). Not the inefficient system used called EBenefits which appears to not
give accurate information.

The electronic system that care providers access needs to be more cohesive. It seems
that some providers have access to some information and others do not. Everyone needs
to have the same information.

Automated call system
caregivers need not spend more than 10 minutes on wait with an automation system.

Charts and notes
Number one I would start with TRUE AND CORRECT note/charting by the physicians
providing treatment.

Remove comments immediately, or at least addend comments made by staff that are or
could be seen as threatening, or at least not in spirit of working WITH the Veteran or
caregiver.

Secure Messaging
Access to secure message all of the patient's providers not just some of them.

Give EVERY doctor (including part timers) a secure messaging account via Healthy eVet
so they can communicate effectively with the patients & caregivers. "Officially" allow
approved VA caregivers to use the same account to simplify communication and accounts.

Notification of resolution
Allow the Patient Advocate service recovery process more freedom to inform the
Veteran/caregiver that the issue has been resolved (we often are left with no response or
resolution).

Appeals
Ways to appeal a claim should be followed up with caregiver/veteran in a way that reaches
out to us, not always letting the burden lie with us.

Case management
There are so many problems with the pipeline for how a vet can qualify for benefits. We
looked at it a couple of years ago and I wanted to cry. The VA had something called the
VAi2 Initiative that dealt with the whole case management process. That's one thing.

Prosthetics
Either more responsive prosthetics department or a clearer picture of how to get items
from prosthetics. It seems pretty hit or miss.

Fee basis
Create a policy and procedure with measurable results that allow for ease in fee basis
processing.

Provider collaboration
it would also be good if the PCP and the specialists could actually work together...we get
conflicting info from them all, including medication changes (PCP messes with something
Neuro prescribes or Psychologist changes something that PCP prescribes) treatment
plans etc...if they could all be on the "same page" so to speak, the veteran would get
better care.

If there was more coordination between primary care physician and specialists. If the
physicians would research(or apply their actual doctorate) to finding alternative solutions
to their patients. If they would actually listen to not only the patients concerns but their wife
or caregivers as well(we are the eyes and ears for our vets and they NEED to respect and
understand that pronto).

I also think having a "team" meeting every once in a while, every few months with the
group of professionals that the veteran and spouse are working with is a good idea, too
many times everyone is working on so many things that no one is on the same page all the
providers are confused about what we are doing and we are confused about things too.

Re-evaluation/overruling another doctor’s opinion
Make it possible to INDEPENDENTLY re-evaluate veterans when they have a steady
history of a particular diagnosis, even if one VA doctor or C&P examiner disagrees.

It's ridiculous that ONE doctor who sees your husband for 10 or 15 minutes can put a
crazy note in his records and 2 years or 4 years or 10 years later someone is still
questioning a diagnosis, etc, because of one guy who didn't take enough time to get to
know his patient.  There's got to be a way not just to change providers but to have that
record fully, completely removed.

Non-VA medical records
If they request medical files as proof for an injury, I would like them to actually read them.
We were told his injury is not service related when we sent them the exact documentation
of the injury that happened during his service!

Diagnosis
Follow through with symptoms until an answer is found. Performing tests that turn out to be
inconclusive, and dropping it and essentially saying, "sorry, goodbye," is not good
healthcare. Pursue a cause or a diagnosis to real problems until an answer is found.

I would like for the VA to properly and thoroughly diagnose and treat my husband, instead
of repeatedly asking for proof, then denying that proof and asking for more.

Flexibility
Deciding that one program is not a good "fit" should not mean that a veteran gets dropped
with no options. If a program is not a good fit, figure out what's going on, and enroll them in
a program that is more appropriate. Passing the buck is not acceptable.

Staff
Staff should be accessible.

I think and attitude adjustment for the workers at the VA would be nice. My husband has
said he feels like the people are always talking down to him like his sacrifices don't matter
and he is just some drug seeking POS. Also I have spoken to some nurses where they
often sound like they think I am some child and have not been taking care of my husband
the last nine years. Definitely new attitudes.

If you are a receptionist at the desk of any appointments, please be respectful and stay at
your desk unless you really need to leave, having to gossip is not a reason to leave your
desk. If you want people to quick crowding around your desk when you show up, try
staying there and taking their names as they come in

I would suggest that the VA employees stop acting like it is their job to control the
spending. If Dr, PT's, SW all VA employees felt free to say, "I think your veteran may
qualify for xyz, and then tell us to apply." It would go a long was in building relationships
and trust. Too many times from docs on down, I've been told no, or not told about things
that could have benefited my veteran.

Honesty
Become an HONEST organization. Stop with the propaganda of how improved the VA is.
After 30 + years of being in the system I can tell you this is not true. Let our Vets know how
long it will take to receive benefits and the full time job it is. This would help families
prepare and make it through.

I would have liked to be told the truth when I called about our claim. It might not be what I
wanted to hear but at least I would have known what is going on. We have been lied to
several times throughout the process.

Staff training
Each person paid by VA should be given training about (1) dealing with PTSD sufferers
and (2) showing proper respect to veterans no matter their rank or lack thereof.

If the physicians would research(or apply their actual doctorate) to finding alternative
solutions to their patients

Educate staff from the bottom up that Veterans have the right to move about the VISN if
they so chose, and when inpatient programs or care that would protect and improve a
veterans quality of life are unavailable, staff must know that they can certainly call other
VA's across the country to assist in finding appropriate placement.

Continuing with the training for staff members of all disciplines on Military Culture, current
and past military conflicts, current and trending health issues (The VA did an amazing job
on education ALL staff on MST) by allowing more on the job time access to the VA's state
of the art online/computerized educational system. Supplementing this online learning with
face to face education with professionals and Veterans and Caregivers would continue to
provide staff with top notch customer service skills.

Good news reports

Create a periodical of sorts that instead of current policy highlights a great job by the
employee, but the great examples of staff and patients working together toward the health
and recovery of VA's patients.

Community resources
I also think VA should put in place one individual on the campuses who is a community
resource person who's job is nothing but contact with community resources that can be
provided to veteran families for needed food, legal resources, and contact info for all local
VSOs who provide assistance to veterans, as well as being a reference point for the SSVF
funding in the area

As VA is so huge and it will never get to next day appointments or next week benefits, I
think it's important that VA step outside the box and assist veterans and families by
providing them with information and the means to survive until benefits and the three ring
circus of medical care runs its course. VA is union and you will only be able to push or
change a limited amount of dr and personnel issues. Veterans need someone working with
VA who is not paid by VA but has access to personnel in VA to help navigate the system
and who can develop a relationship with VA personnel to make things happen.

VA programs and resources
if the dr's/nurses/receptionist actually KNEW the programs within the VA...for instance
when I was knew to the caregiver program...only 1 person in the office knew anything
about the caregiver program..although I know it has been in place for a while.

Employment and training
Empower veterans to do better for themselves, and remove obstacles to
employment/training. For example, the current VA Acquisition academy model provides
training via the GI bill, but you have to have a job to get the training. But you can't get a
job without the training. Solving this "catch 22" by providing training based on GI bill
benefits alone, would mean that more veterans are qualified for good-paying jobs that are
not related to combat, and allow them to have pride in themselves and a future to look
forward to. VA job fairs that only offer "box carrying" jobs are a punch in the face to men
and women who have put their lives on the line for their country. Better quality jobs, that
offer a LIVING wage, and health insurance, are essential to a veteran's future.

Single vets
Of course one more thing. The VA must start providing more care for the mentally ill Vets
who are alone. This could be provided by more social workers and a push for volunteers
to assist this individuals.

Vets and under-reporting
Also, that Vets under-report what is actually happening. M- reports about 20% of what
happens, and either forgets or doesn't want to talk about it.

I think it would be easier for everyone if the VA would consider that what is seen or said in
an exam is not the same the behaviors symptoms that manifest themselves at home

Female vets
Sister Assister programs for women veterans...where a woman veteran is met on the VA
campus and another sister veteran walk with her from appt to appt.

Mental health
More mental health appointments! Need more providers so everyone can see the
therapists they need. More availability of intensive mental health appointments for those
who are willing and able to do the work.

Allow Caregivers rights to attend the Veteran when admitting after hours to locked psych.
The caregiver is instrumental (usually) in keeping the veteran calm and is able to relay
information from the admitting staff in a way the veteran can understand. No veteran
should be taken to a locked unit without their support (until doctor is seen?) if they so wish.
(Understanding that some cases it is just not prudent to allow this).

Suicide hotline
DO NOT REQUIRE A VETERAN TO PRESS BUTTONS OR SIT ON HOLD FOR THE
SUICIDE HOTLINE. This is a *terrible* system. If a person is that upset that they call the
suicide hotline, they need to speak IMMEDIATELY to a human being who cares, who can
offer real help / resources, and who doesn't just spout the VA "party line." If the VA cannot
do this, then outsource to military one-source or some group that CAN do it.

Support groups
Make support groups and coping skills groups more accessible for people with PTSD, TBI,
Mefloquine/Lariam toxicity or other brain injuries. This means, bringing them to their
neighborhoods, to their local communities. Maybe use tools like skype or google chat to
bring people together who have difficulty leaving their homes. Do not exclude people from
these support systems due to one doctor's opinion.

Alternative medicine
Allow referrals even for procedures or medications or diagnostic tests that may be "cutting
edge" ... especially when the DOD is already using them. The SGB shot, and
mefloquine/lariam toxicity are 2 examples. There should be a reasonable way for Veterans
to access DOD services and vice versa. Together, the system would be much stronger.

Natural healing

More naturopathic healthcare. More nutritional based care. So many health problems
including dental, vision, mental, etc. can improved with nutrient dense eating. More
acupuncture.

Dental
Badly need dental especially when we all know that many OIF and OEF Veterans now
have serious dental issues since returning.

Water therapy

More water based therapies / activities. Let’s use the new pool at the Seattle VA. Someone
please hire a life guard so we can use this new pool.

Caregivers
There would be some kind of flag on the patient's profile that indicates that they have a
caregiver. The caregiver would also have a VA Caregiver ID and would be actively
included in all of the patient's care.

Another thing that would help my family is don't shut out spouses as if we don't know
anything about our veteran, yes we respect you as the professional and take your opinion
very highly; HOWEVER we live with our veteran every day and we do know what they will
and won't do on a day to day basis- Do not act like we are stupid and please do not ignore
our questions, we ask for a reason, normally a big reason.

Dental care... I know it's in progress, in theory, but I know so many caregivers who have
teeth that are literally rotting out of their mouths.  It seriously impacts our health, and few
families can afford thousands of dollars of dental care.  I know we can't.

Caregiver support
Another thing that would REALLY help, is if they would design some sort of way, for
caregivers to meet each other, or know who else might be in their community. For many it
is hard to get to the caregiver meetings. It could be an all voluntary thing, but something
that the CSC could pass along. Heck they could even have waivers for each of us to sign,
so the VA would not be legally liable. If they are not going to have counseling for us, at all
facilities, it would at least be beneficial for us to be able to meet other spouses, or families
like ours. Even if it was just a phone list. I am pretty sure the caregivers would take it from
there.

Family therapy
The other thing that needs to be addressed is "family therapy". It's my understanding that
the VA can't treat the caregiver or spouse. They need to adopt a more inclusive view of
the veterans family.

Education for spouses/caregivers
On campus educational classes provided to spouses from doctors in every field to include
mental health and TBI, including constant updates on new medications and therapies.
(This would cause the docs to stay on top of new info and research). No veteran info
shared, just education.

Education for Caregivers based on their Veteran's health problems would also be
FANTASTIC.

Child care
Include child care during these classes.

Child Care for Veterans and Spouses to attend appointments.

Dependents
Ah yes and the prompt processing of dependents(we are not the typical example here)
have seen LOTS of families waiting WAY too long to have their spouse and/or children
added.

ChampVA
Make CHAMP VA easy to access for caregivers. Example: I have MS. Nobody takes
Champ VA for caregivers that treats MS. Result, I'm untreated, and a full-time caregiver. It
would be nice if there was one champ VA plan, and make it easy to access, maybe mirror
Tricare Prime or something. I need to know my health is protected so I can take care of my
husband.

Benefits available prior to rating
if the VA would really LISTEN to the veterans and their families. I kinda feel like we talk and
talk but they never really LISTEN. They need programs for veterans and their families that
don't have a rating. I'm sorry but having all these programs is great but what about the
veterans with no rating? I almost died a little over a year ago because I couldn't get
insurance. I couldn't get on the caregiver program because Kevin didn't have a rating. We
were broke, homeless, sad, and felt hopeless. Veterans with no benefits feel that way.
Why do you think there are 22 veteran suicides a day? So why are there not any
programs for them? That's where the idea of heros closet stemmed from. A place where
they can shop for what they need. For free. But really nothing comes free. Look at war and
what it did to them. Look at the price they have already paid. Nothing for veterans or their
families will ever be free. That's what needs to be realized.

As VA is so huge and it will never get to next day appointments or next week benefits, I
think it's important that VA step outside the box and assist veterans and families by
providing them with information and the means to survive until benefits and the three ring
circus of medical care runs its course. VA is union and you will only be able to push or
change a limited amount of dr and personnel issues. Veterans need someone working with
VA who is not paid by VA but has access to personnel in VA to help navigate the system
and who can develop a relationship with VA personnel to make things happen.

OCONUS
The medical care for Veterans living outside of the US could be better. The Foreign
Medical Program who is in charge of that is requesting a certain way of billing which
doesn't exist outside of the VA care, for sure not outside of the US. To get the billing the
way they want it, we would have to pay the doctors out of pocket for the extra work which
they won't reimburse us. The only thing we are actually sending in is the co-pays for
medication, we are letting everything else run through the German insurance as we are
terrified of the FMP refusing to pay the doctor bill and we would be left with high expenses
to pay our own and having to go through a 3+ months appeal process...




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