Transcripts For CSPAN2 Elizabeth Dole Testifies On Needs Of Military Caregivers 20170831

[inaudible conversations] this hearing will come to order. Good afternoon. I welcome all of you, veterans, caregivers and advocates, especially my former colleague, senator Elizabeth Dole, who is an extraordinary advocate for military caregivers. Our military families, heroes and plain clothing are serving in American Cities and communities 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 from a transition home is not easy. Recovery two 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 americans veterans. In the United States, there are fivepoint is million military caregivers. These family members and loved ones provide care on a constant and routine basis to our veterans. They are often vital in assisting veterans to make the transition all the way home. Military caregivers improve recovery, rehabilitation and reintegration are wounded, injured and disabled veterans. The number of military caregivers has been on the rise has veterans from iraq and afghanistan return home. Approximately 20 of military caregivers today are caring for a post9 11 werent. The needs and experiences to 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 dramatic brain injury. Today, we will learn more about the innate needs of military caregivers and what we can do 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 their loved ones had the care they need. They may have to miss work, turn down promotions or even leave the workforce altogether, creating what is at times an enormous financial strain for families. This toll affects the National Economy as a whole. The lawson product david e. With post9 11 caregivers, consternation of approximately 6 billion per year. Ive introduced Bipartisan Legislation that would utter serve caregivers, including our military families. The rays Family Caregivers act would require the department of health and Human Services to develop a National Strategy to recognize and support more than 40 million Family Caregivers. This bill, which i introduced by senator tammy baldwin, has passed the Health Committee and i look forward to seeing it signed into law one day as a result of the advocacy of many who are here. In addition, the bipartisan military and veteran Caregiver Services improvement not would expand eligibility for the Va Caregiver Program to veterans of all generations, and not just the post9 11 generation. This is a program that helps veterans who were wounded, ill or injured fine supporting resources to those who have taken on the caregiver role for them in 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 crucial. It protects the Health Care Coverage increases the need for longterm care and allows individuals who remain need care, to remain in the comfort of their own homes. Despite their enormous sacrifice, military caregivers typically do not receive awards and admiration that American Veterans deservedly do. We must never forget our military caregivers who are all so true heroes. Americas military caregivers enable veterans living with visible and invisible injuries to recover, and remain involved with communities and enjoy fuller lives. We should do all that we can to support them. I am now pleased to turn to her Ranking Member, senator casey, for his opening remarks. Thank you Committee Chairman collins. Appreciate you calling this hearing. I want to thank you in so many others today. What you think of solar 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 returned home, bearing the marks of that service. Joining us today are some of those who serve are usually so america can remain the land of the free. To paraphrase of my father once said, quote, we pray for military families and their loved ones around the globe, but we also pray for ourselves that we may be worthy of their valor. To thank you for your service to our country. In order to better serve you holding this hearing today to recognize not only our veterans, but the Hidden Heroes of the military, the estimated 5. 5 million military caregivers across the country. Military caregivers in many different foreign spouses, family, friends, neighbors and of course fellow veterans among them. The majority, roughly 60 of those caregivers are women. We will also hear from our witnesses have a hearing for a web one in understanding a hearing for a loved one can be stressful physically, emotionally and financially. We made progress in helping our caregivers other witnesses will tell us, we have more to do. We must strengthen the supports currently available and help more caregivers who need access to these supporters of other soldiers in vietnam or afghanistan, theyre caregiver should receive the same benefits and support of the va. Thats why im a cosponsor of the Bipartisan Legislation which support Services Available to caregivers. Ensuring veterans and their families risk the the care they need is also while i will continue to fight against efforts to decimate medicaid report released by the Congressional Research service, explains manuel veterans are eligible for medical care from the va. Many veterans cannot access these services, for example, because they dont have a va facility nearby. Sometimes family members dont qualify for va services. That is another coverage options. Medicaid provides health care to 900,000 900,000 working age veterans. 340,000 of whom game coverage following recent action by some states to ask the medicaid and 660,000 veterans spouses coverage as well. These families who serve our country and for millions more, childrens come individuals from the medicaid must be protected. Since it covers those 900,000 veterans in over 660,000 spouses, proposals to cut medicaid substantially change health care should be the subject of hearings. I look forward to hearing today from our witnesses on additional steps congress can take to better support our nations military caregivers and their families. Thank you. Thank you, senator casey. This appears to be North Carolina day, but for the committee is always pennsylvania state, but we are very fortunate that both senators from North Carolina serve on the committee and one of our chief witnesses, plus some of our veterans in caregivers are from North Carolina. So i would like to give senator byrd, senator tillis the opportunity to welcome those hear from your home states. Thank you, chairman collins and Ranking Member casey for holding this important hearing on military caregivers. I particularly thank you are allowing senator tillis and myself the opportunity to share the pleasure of introducing the fine North Carolina witness says we are here to testify and represent here today. Military caregivers is an extremely important issue nationally and certainly in North Carolina were veterans make up 10 of our population. We have to Power Couples fighting for veterans represented here today and for my half of the introductions i want to welcome my former colleague in the United States senate and good friend, Elizabeth Dole, back to the senate. Senator dole has distinguished Public Record of Public Service in and out of government that many no hear from leading the department of transportation to serving as secretary of labor, to serving as president of the american red cross, senator dole has been there with grace and diligence. What i want to this alert here today what i want to subvert her for today is just the latest chapter of first or a Public Service in the veterans advocacy. Not only has she stood by the side of certain army captain who also knows his way around the senate halls, but shes also been a relentless advocate through the Elizabeth Dole foundation of all of our nations veterans. Bob and Elizabeth Dole, whether in the halls of the United States senate or walter reid, continue to serve our nation and speak up on behalf of companies of veterans and their caregivers. Im glad that our committee will be hearing from them today and learning the important lesson about where we still need to improve. A thank you, senator dole for the grace and steadfast attention you bring to any issue you topple and they know that 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 to make additional introductions. Thank you, senator. Its great to see you here. I appreciate you in this advocacy with whom ive had many discussions about. Enjoy the kickoff and i look forward to continuing to provide support. Chairman collins, i have the distinct privilege to introduce two other constituents, mary and tom ward. I met mary and tom ward on a few different occasions now and from time to time a pet dog. They wouldnt let me do it today. They travel here and i have to say its a real testament to their commitment to the issue of caregiving not only for themselves, but for everyone else and appreciate your leadership and not to see and we love it every time you come up and visit. 1972 to 1975. 1993 you were about 13 years in your marriage when tom contract did encephalitis and after signs of cognitive difficulties surfaced. In 2010, tom was diagnosed with als. Als is a progressive disease that veterans develop an rates higher than the general population. Variable share her story is the caregiver for her husband come including challenges serving as a caregivers to continuing to remain employed and actually advocate on behalf of all caregivers. Madam chair, and please to have been here today and i look forward to their testimony. It will also tell you, tom and mary, im on the Veterans Affairs committee which is made at the same time right now and im going to step out of this committee because you all know the work we do there is directly related to this issue. Also coming up my commitment on the Senate Armed Services that we are trying to get this right from the time someone is in active service until the time they moved their way through. Thank you for being here today. Thank you, madam chair. Thank you very much. Although senator dole has already been introduced, i do want to add a few comments about the work she has done about the founder of the Elizabeth Dole foundation and military caregivers. Through the foundation, senator dole has shed light on the immense challenges a saner nations fivepoint i million military caregivers and shes really worked across the aisle. She actually brought nancy pelosi and me together to write an oped in support of a bill, not that that is not shocking, but around here these days, that kind of bipartisan collaboration can be rare indeed. That shows to me the work that senator dole has done to create a community of military caregivers through which they can connect, share advice, stories and advocate for more support. I want to play now that senator dole is this just as a volunteer and a thinker leadership has been extraordinary. I am familiar with the dole Caregiver Fellowship Program and had an individual from the state of maine participate in that and i just want to thank you for your service and i look forward to hearing your testimony. On the same panel, we will hear from someone whom i staff was all excited about meeting and matt is right in phillipe. As many of you know, ryan is an actor, director and writer and more important from todays youth, he is also an ambassador of the Elizabeth Dole foundations Hidden Heroes campaign, which helps connect military caregivers to Critical Resources and connect them with other caregivers. Ryan, thank you for supporting our Hidden Heroes to care for her veteran heroes each and every day. Senator dole, please proceed. Thank you so much. Thank you chairman collins come Ranking Member casey and members of the committee for calling todays hearing. By doing so, the committee demonstrates its military veteran caregivers. Chairman collins, i owe you a special thanks for your strong support of key legislation and a hit here as conference you are cochairing. You are sending a very powerful signal that our nations leaders must stand with the military caregivers. Thank you so very much. This is not my first time testifying before the Senate Committee on aging. Recently i came across testimony i gave on june 29, 1978, 39 years ago when i was a member of the federal trade commission. Like each of you, and once got up there is a member of this committee. To be honest with the many issues before the senate, i did not know at the time the benefit they are giving to our nation and a huge personal toll is taking. That all changed in 2011 when my husband bob was hospitalized at walter reid. I became friends with spouses, and has come a sitting bedside selflessly looking at their wounded ill or injured veteran. Their strength was incredible. Yet i can see they were carried an emotional plate almost too heavy to bear as they reeled over their loved ones injuries, they were being asked to make extremely difficult situation and they were wrestling with the fact he might serving in his new role for the rest of their lives. Just as heartbreaking are the stories of pre9 11 caregivers whove been supporting their loved ones for years without any acknowledgment, struggling to care for the latent effects of undiagnosed posttraumatic stress, agent orange, a decadesold dramatic brain injuries now causing early onset dementia. These caregivers are just as terrifying, just as isolated, just as important to their veterans. When they applied for the va caregiver when they are told the timing of their service does not qualify them for support. An incredible 5. 5 million americans caregivers are served in each of your states right now, dressing and bathing and feeding our veterans performing athome injections, managing medications, staying for emotional triggers. Its a 24 hour job. They are superiors and we begin by the Rand Corporation to undertake the First Comprehensive nationwide evidencebased research of the military caregivers. Rent experts concluded the most important factor to Wounded Warriors recovery or improvement was a well supported caregiver. This statement could have been the headline of the report but it was so shattered by more alarming findings, the Research Uncovered high instances of isolation. Physical ailments, unemployment, death, legal challenges and much, much more. They are clearly suffering under the circumstances. There is an argument with 14 billion as an unpaid voluntary force. Last september, the Elizabeth Dole foundation launched 10 years of Multifaceted Campaign featuring the first of its kind website full of carefully vetted resources for caregivers to connect with one another. We announced Hidden Heroes cities, galvanizing to caregivers in their midst in the local resource is to support them. Im proud to say weve recruited 100 cities today from augusta to pittsburgh, charlotte to las vegas. Our campaign is chaired by Actor Tom Hanks and the goodlooking guy sitting next to me, ryan phillipe is a Hidden Heroes ambassador. Ryan is an awardwinning actor and star of u. S. A. Network where he plays the role military veteran bob lee swagger. More significantly, ryan has close family ties to the military community and has become a passionate advocate for caregivers. My heartfelt thanks to you, ryan. You know, they stopped production. He got here morning on a redeye and tonight he will head back to california on another redeye. God bless you, ryan. As you listen to ryan and our other panelists, i urge you to consider taking two actions after todays hearing. First come and make the bipartisan military veteran Caregiver Services improvement act the law of the land. This bill will expand essential services for caregivers of all areas. It would also provide direct assistance at the top challenges military caregivers face every day, including respite, child care, financial advice, legal counseling and education. I have with me a letter signed a 43 Hidden Heroes partner organizations. In fact, they are all right here behind me and they urgently hope that this particular lifechanging legislation is going to pass. Our second for today is that congressman bass in the Critical Research necessary to sustain possible outcomes in the coming years. In the next day to you if your friend terry for rain to unveil the blueprint focused on identifying Urgent Research priorities. We urge you to listen carefully and championed this research, which is critical to our ability to support military caregivers five, 10, 20 years down the road. I have to tell you, based on what we already know, we expect more alarming issues to be uncovered. And it totally, we hear more about caregiver Substance Abuse and suicide. Marriages between veterans and caregivers are more formidable than ever. The strain of the urgent challenges now and the long road ahead is becoming too much for too many. Our nation has long admired and respected our military men and women who served our country so valiantly and weve always reserved a special honor for those who returned from service with physical and emotional scars. Our goal now is an america where their caregivers are empowered, appreciated and recognized for their service. An america where military caregivers are broken into the very fabric of the nations appreciation of our military. Thank you so very much. Thank you so much, senator dole for your very eloquent and persuasive testimony. Mr. Phillipe. Thank you, senator dole for the kind words. Before i get started i went to court this mornings tragic event and thank the capitol police, and other First Responders who were able to assist her members of congress and staff. I speak for all of us when i say our thoughts and prayers are with them. I also know i speak for everyone here when i say to senator dole, we are truly inspired by your leadership, vision and tireless work on behalf of military caregivers. Youre a shining light in our countries didnt hear us and we can all honor their service. I want to thank each one of you for the opportunity to be here today. Its truly an honor. My experience growing up in a military family helped prepare me for this role, for this moment. Both my grandfathers fought in world war ii on the pacific theater, the other was a bronze star winner in berlin. Id add is in the navy in vietnam. My uncles were both seabees and infantrymen during the same period of time. All the members of my family who served safely returns, but each and every one were affected. Ive had the opportunity as well to work with countless veterans and those currently enlisted on various projects and all of this adds to my deep respect for that than the understanding they are nations true heroes. These days, ive been recently working with the Elizabeth Dole foundation and thats how i learned about a different kind of hero, military caregivers. They are Hidden Heroes, family members and friends who returned home from service with emotional scars and today we are here to ask for your help to take action. If you know anything about senator dole, which umass, she doesnt take no for an answer. She will hold you accountable. She will hold all of us accountable because our nations military and veteran caregivers deserve it. Over a lifetime of military care, they face challenges in right now very few resources help the period of time all of us to fix that. Right now military caregivers shoulder the responsibility. They dont expect or ask for help in the work they do merits more than just a display of gratitude. We owe our military and veteran caregivers purposeful action and lifelong supporter. Something struck me as senator doles remarks i want to emphasize. The Foundation Research on the military caregivers at a central role in the Recovery Process and improving quality of life. And i quote, the best chance for a Wounded Warrior to recover and try this having a strong caregiver. This role imposes a substantial physical, emotional and financial toll in caregivers and their families. We can do better. That is why we are here. We need to sign into law some important legislation. For starters im speaking specifically about the recently reintroduced military veteran Caregiver Services improvement act, Bipartisan Legislation introduced in both the house and senate to veteran caregivers. This strengthens vital programs and support caregivers nationwide and ensures the caregivers recognized for their service in tangible ways. For example, if passed about pre9 11 caregivers would have the same support they give to post9 11 caregivers. Bob dole serving. We are talking about caregivers for the heroes who served with him in the generations that followed. Their caregivers not only need to deserve our assistance. The vas Caregiver Program should be available to all caregivers during fall veterans regardless. The bill also supports caregivers for veterans with Service Related invisible injuries like tbi and ptsd in the same way veterans have visible ones. It shouldnt matter whether we can see the scar or not for veterans and caregivers the resources they need. It also provides assistance for child care, financial advice, legal counseling and education, which are all top in currently unmet needs. Ultimately by signing onto this bill he would have a positive impact on health and wellbeing of the nations veterans and military families. As a Hidden Heroes ambassador, had the privilege to be with military caregivers across the country and as they speak before you now, i cant help but think about make an honor has been not commemorate corvette or honorably serving two tours in iraq. Megyn and matt are High School Sweethearts and when you meet them, you know it. They live in connecticut now, a young couple in love, yet they have a long road ahead of them. As a result of injuries received during combat service, and that now suffers from a traumatic brain injury and pts. Make him come his wife and primary caregivers by his side every day, every day can help as he struggles with as we can see. Visible ones most of us most of us in this room cant imagine. They can explain to me she never pictured herself as a caregiver for her husband, especially so soon into their marriage, but that needs or ended the day in, day out, 24 7 responsibility managing medications, always on alert looking for things that might trigger mass pts and all while raising three young boys. Megyn is make in the most of things but she needs our help. In fact, i put 5 million military caregivers like megyn quietly serve across america. They can no longer go it alone. They need us, they need you. I ask you again members of the committee and melody here today to give her full support to the military caregivers serving our nation. Senators, please sign on to the military Caregiver Services improvement act in each of the pieces of legislation outlined. To everyone here today watching across the country, please speak up military caregivers in their cities and towns. Direct them to resources that Hidden Heroes. Org and ask how you can help. Thank you. Thank you very much for your testimony and thank you also for your thoughtful acknowledgment, 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, far worse. We heard in a republican lunch today a firsthand account from one of the senators who was present and its very clear that without the two Police Officers putting their own lines in harms way and indeed both of them were wounded, that they would have been deaths as well as injuries resulting from this attack. Thank you very much for acknowledging Law Enforcement and First Responders. Senator dole, you mentioned two very important priorities. One is removing the disc rarities in the essential services that are provided so that it doesnt matter when you served your country. And the second was the need to continue with Critical Research. Could you elaborate on the second area of the Critical Research . We are finding now there are more connections between certain diseases in military service, such as als than we ever realized. If you could discuss that priority a little more, that would be helpful. Terry cumulate of the Rand Corporation, who was one of the researchers in the 2014 rand report, from which so much else has flowed and will be here to testify in a little while. So many of our caregivers are very young, they are in their 20s and 30s, the post 911 caregivers. If you think about that, they literally may be caregivers for a long period of time. In fact i made a speech recently and one of my caregiver bellows with me and she made comments and when she finished her remarks she said im 30 years old and ill be a caregiver for the next 50 years. Now, do we know now how to prepare to support these caregivers five years down the road, ten years, 20 years down the road, no we do not. That is why this research that terry will describe is so important. We need to understand. For example, how will the needs of a care recipient change over time. How does the caregiving responsibility impact the outcome on the caregiver . And also we need a Longitudinal Research. It is very important, i cant stress enough, how much we need your help to make sure that this research is undertaken right away because once we get the results of the research that we will be posted a weekend then spread that to all of our partners. We have the National Coalition of about 300 organizations and there are many that wanted to try to utilize that research along with us to try to come up with the right services to help these caregivers down the road. Right now it is 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. Mr. Penelope, could you tell us what you have learned in your meetings with military caregivers and are there certain lessons that you have learned or that we should know. Something that stands out to me is the strain on the family unit itself. The fact that a lot of caregivers have to put their life on hold, their potential dreams and occupations they might have wanted to pursue to take care of their veteran, i think that some of the stress is related to that fulltime job and what it takes away from even parenting or those type of things so the respite aspect to this act is important, giving them some relief and time off to be your own person and return to your job as a caretaker with the required energy. That was something that keeping Families Together as a big pact of this act in my mind, as a father that is something important to me. There is a lot of stress and strains that come with dealing with these injuries and being a military and veteran caregiver can be disruptive potentially to a relationship to the family unit. That is something i have heard from the people i have had with. Thank you. Senator. Thank you, madam chair. Ill start with senator dole. During your testimony you mentioned that caregivers to veterans from every era should be treated equally and when it comes to the eligibility for ba programs like the comprehensive assistant for caregivers programs i agree with you and i think people in both parties do but if the state of the law now that only caregivers from veterans who served from 911 are eligible for the comprehensive assistance for Family Caregivers program. Since you and your organization to work with caregivers for veterans of all eras and all conflicts, can you describe to us in more detail how expanding the program would benefit those caregivers from three to 11. Yes, the caregivers from pre 911 have been providing services for years and they have had no acknowledgment. They are not acknowledged what they are doing and they are receiving very, very little in the way of services. The illnesses and the wounds and injuries of these veterans from early eras are compounded as they age by the aging process. So you not only have the work related wounds, illnesses we have the compounding of those. For example, the advent of als or parkinsons disease and certainly mobility difficulties and chronic pain, some forms of cancer. Here are these pre 911 caregivers dealing with all of this totally unacknowledged with very little support and i think it is clear that they need to have the same kind of opportunities when they have the most severe injuries that they are dealing with they need to be a part of the company is a Caregiver Program and this would mean that they have respite care. Respite is so important because when you are almost burned out, can you provide the best quality care for our veterans and we are talking about those who have borne the battles. Our country made a sacred bow to serve those who have borne the battle. That is who we are talking about. The caregivers of these individuals and they deserve to have the best possible care so that they are not depressed in facing immune system problems in heart problems but that is what is happening now. A great deal of stress and anxiety and depression and so it is very important that we provide a respite care and that we ensure that these caregivers are able to have, for example, Mental Health counseling. If theyre in the comments of programs they will have Health Insurance and if they dont have Health Insurance it would be provided to the champ va Health Insurance. They deserve this and its really unfair that they dont have it now. I think its every reason to move quickly and the sooner that we can get the legislation passed, we can begin our community to develop the services to meet these needs that are unique on the part of pre 911 veterans and their caregivers. We need to move quickly to tailor programs to service those needs. I think your testimony today will help us move that legislation. I think that goes without saying. We are grateful you are here to make let me add that we have been proposing this legislation for several years and it would be so nice to see it past before the end of the year. Please. That is a good goal. Probably on most days you be more persuasive that i will be. It will need you to come back. In the same vein about providing the best possible care and coverage i mentioned earlier about medicaid that some 900,000 veterans because of their own circumstances are covered by medicaid and that is their coverage that they have and i also mentioned there 660,000 spouses that receive that benefit as well. Do you think that medicaid can play a Critical Role in providing healthcare to veterans, caregivers and families . What is your sense of that . Right. We know from our caregivers who are enrolled in medicaid that Program Provides valuable extra coverage of that valuable supplement for some of the expenses that the va program does not cover. Then for those who were not on their veteran Health Care Plan they would be under the same system as civilians. I think the rand report indicated that 20 of military caregivers fall under the federal poverty line and those particular individuals would find that medicaid certainly would be one of the best options for their Health Insurance. Thank you, madam chair. I am now delighted to call upon one of the committees most active members senator cortez. Thank you, madam chair. Thank you both for being here. Senator dole, i think. Thank you for everything you do in this and particularly addressing this important issue for our military caregivers. When you take to talk about respite care is key to bringing relief and additional services. If you dont mind, talk a little bit about the isolation piece, as well, that occurs and why respite care will bring some relief. There are other things you should be doing to address isolation which ive seen in respect to caregivers, as well. Right. It is amazing. As we met with many caregivers they really dont understand that there are a are a caregiver and our earlier Rand Research also pointed this out to that many of them dont see themselves as a caregiver. In other words, im just his mother, of course i will take care of him. Im the spouse, im looking after my husband or my wife. They dont understand that their caregivers and they raise their hands and there are Resources Available to them and we are trying to urge these caregivers to come out of the shadows to gt website and its a oneofakind specifically designed for military and veteran caregivers. They go to their website Hidden Heroes. Org and they will find a whole community of caregivers that they can talk to, compare notes, learn from one another and there are several hundred carefully bedded resources on that website and will continue to grow those resources. It is vitally important that when a caregiver is so isolated, so alone, they dont know there are others out there. They are just trying they are struggling with everything by themselves and you can imagine, think about this in a family where it lets say theres a difficulty and it may be a post medic brain injury and the children in the family are having to be very careful if they move around in the spouses trying to print triggers that can set off an emotional response in the kids cant have children over for a sleepover and its a delicate situation and they are dealing with all of this and in most cases they dont even realize that there are others they might connect. Once they connect even with just one other person, one other caregiver, its like magic. Its like a lifechanging experience and as we bring them together in larger numbers i think they are able to support and help one another. Thats been one of the joys. Feel like our caregiver fellows and we have them all 50 states are an extended family of mine and i consider them part of my family that isolation is such a big issue and we need to bring them out of the shadows and connect them with others. You know, how can they provide the kind of quality care that these heroes of ours who have borne the battle deserve and how can they provide it if they are exhausted . The respite is so important in the life span respite care act is vitally important. We need to get that passed immediately so that the states can begin to Tailor Services to the caregivers. Thank you. Let me follow up on that because i absolutely agree but heres the biggest challenge i see. Let me open this up to mr. Philippe as well. How do you make them aware of the services that are aware to them this is the biggest challenge, the education and awareness. How do you bring it back into the community and make sure that they know there are resources, number one, which is supported and were to go to find out about it. Yes, let me mention it in hero cities. This is something that we initiated last september and i want to talk too long, because i really think it is your question. Hidden hero cities, the idea is that we now have a hundred cities and we continue to grow and we are reaching out to mayors and to other local leaders across the country and the idea is that they will form a committee and we will help them to understand how to inspire caregivers in the local community to come forward and to identify the caregivers in their community and then they will determine what resources we have at the local level and where there are gaps in services how we can fill those gaps in what is our strategy. We find that this is working very well as reaching out to the caregivers. Also, interNational Coalition we have so many wonderful organizations that have chapters all across america and we need to reach out to where they are and that is at the local level. We have to go down to the local level what is happening. Clearly it is a matter of doing this in a number of different ways. Also, the Awareness Campaign that we are doing right now with ryan. Hes doing Public Service announcements, going to events, speaking at art caregiver fellows, speaking at rotary clubs and organizations in word is getting out more and more. Were trying to ways to raise awareness in many different ways, on many levels. Mr. Philippe. One of the things that came up time and again talking with families was there being a frustration that the Veterans Program and support groups varies so much from state to state and even counties and families that would move to an area that they were better facilities, better programs and part of what Hidden Heroes would like to implement some sort of national be a standard for how we treat our military caregivers and therefore, our veterans. I think as complex as that may seem it takes the right kind of people behind it. I think we have 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 has gone her way and we now have a filibuster we will go on to a little more until she arrives. There was actually a question that i wanted to ask you, senator dole. That is have you found that there is a difference in the needs of military caregivers versus civilian caregivers. I dont know whether that is something that you have looked into but i was looking, i was curious if you found the rand report has told us that the military and veteran caregivers are experienced seen much higher rate of negative Health Consequences as a result of their Caregiving Services. They are experiencing these incredible difficulties in terms of anxiety and depression and immune system problems and i think that is something where we come back to the respite, its so very important to give them a chance to break away a little bit and to be able to recharge their batteries. I think that the raised Family Caregiver act is also very important and i know that you are sponsoring that and it is important because it will provide for coordinating services across the government in a way that makes them more efficient, the Caregiving Services. We believe strongly in the need to coordinate between the va, dod, department of labor, hhs and others that are involved in any way of caregiving and it also will provide best practices and Lessons Learned that can be utilized by the military and veteran community, caregiver community. Anytime that you can spotlight what is going on, the labor of love taking place in the psalms, anytime we can spotlight that its a wonderful thing to do. So, i hope that that piece of adulation will pass. If you want to foster a nation that supports Hidden Heroes all Hidden Heroes and these wonderful caregivers then its important to pass both of these pieces of legislation. Thank you. Senator warren. Thank you, madam chair. Thank you all for being here with us today. Especially thank you to the caregivers and their better and spouses who are able to join us today. Senator dole, i want to say thank you for coming to see me earlier this year in order to tell me about the importance of the care that caregivers provide to wounded or ill veterans and servicemembers. Your foundation conducts a program in which caregivers are selected to advocate for caregivers and ensure that they have the resources they need. One of those caregivers, emery, is sitting right here in this front row. She is a former fellow and is from massachusetts. Not only does she care for her husband, charlie, who served in the army but she actually helps manage the caregiver Fellows Program and she is here today. I want to say a public thank you. Thank you for being here, emery. I reminded, though by emerys being here though, is that caregivers need Additional Support for traveling to various appointments, child care services, Mental Health counseling and other resources. Current law authorizes the va to directly provide a stipend and other support services to caregivers of injured veterans from the wars of iraq and afghanistan but does not authorize the agency to provide this direct Additional Support to caregivers of veterans. Eleven wars. This seems wrong. Elderly veterans are particularly vulnerable group. Senator dole, i know you address this in your testimony but this is important. I want to come back and underline here. It comes to providing Additional Support services directly to caregivers, one of the consequences of classifying caregivers of veterans from post 911 wars separately from veterans of earlier wars its a very unfair situation. We need the legislation we are focused on today to as soon as possible we can begin to meet the very unique needs of the pre 911 servicemembers and their caregivers. It is so frustrating to me because these caregivers, pre 911, have been providing services for years with no acknowledgment, without anyone really acknowledging the great work in services that they are providing and without the resources to be able to provide some respite care for them and opportunity to have a stipend which can be very helpful to them. They deserve to have the same benefits of post 911 do when theyre dealing with the most serious injuries, illnesses and wounds. But only those formulated wounds but how they have been compounded by the aging process which means that now you have the advent of things like arkansans, als, and some cance cancers. Plus, all the things that happen as you get older you are last mobile and you have more pain and they are dealing with all of this without the support that they absolutely deserve. I am hoping that this legislation really could be passed quickly for the end of the year so that we can begin to focus on the services they need the faster they get it passed, the faster the community can provide services addressed to those particular individuals. I know that chairwoman collins and senator kerry have introduced a bill on this and i am with you. I hope this goes forward. I hope this goes forward as soon as possible. I also want to ask another question. I know that some caregivers of elderly veterans require longterm, inhome personal care can qualify for vas aid and attendance benefits but i also know that some scam artists have targeted veterans by charging them fees or obtaining this benefit even though the application is pretty. Senator rubio and i also have a bill that would direct the va to work with other of other agencies to track down to crack down on these. Its important here. If i can come i want to hit one more point and if the chair will indulge me for a minute here. I come from a military family. All three of my brothers served but that is not as common as it used to be. America has the worlds best fighting force but many people in our country no longer have a personal connection to our military and as a result, they often dont know about the sacrifices of either the Service Member or the sacrifices of their caregivers. Senator dole, do you think the sense of isolation felt by some military and veteran caregivers is a reflection on a broader divide between ordinary citizens and our military . If you have a few thoughts you might give us. Im really out of time here but a few thoughts you might give us about how we help heal that divide. Yes, i think the isolation does exist and you are right on point. When you realize that less than 1 are serving today, defending our freedom and security, most americ what comes to mind immediately when you as that is the idea of how unprepared some of our caregivers are the world they are immediately inserted into, the lack of education and training that goes along with having someone be prepared to take care of the disabled vet and i feel like that is something that can be addressed and theres a bit of that in that and there are extra costs because if they have a 247 job taking care of their pet. Finding how to readjust their finances and to also allow for support for the children and an understanding of a mom or dad having this issue and they have to be gentle for this issue and its not always the easiest thing to convey to someone who is young. The caregivers are young and have had the Life Experience or the physical Training Experience that a lot of nurses have in other capacities. I think that is a big part of it. What i always come back to is if we dont help our caregivers what happens to our veterans . It was something happens to our veterans that is a shame that we all share. You see the rates of selfharm, rates of drug and alcohol abuse go up when a veteran is left alone, when the marriage does work and when their caregiver can handle it anymore and its up to us to offset those stresses to try to keep those Families Together and keep our pets healthy. You very much. Senator cortez, i just wanted to give you a chance. Thank you. I want to think this panel for your truly telling testimony when senator dole first came to see me it was after senator bob dole had had a very rough year and had been in walter reed virtually the entire year. I remember how impressed i was that rather than focusing just on her own situation she told me of the story of the veterans and their family members whom she had met at walter reed and i know that is what inspired you to get involved in this. It is so typical of the Selfless Service that you have given to your nation your whole life and i am very critical for your raising Public Awareness of something that we need to act on. Mrtonight, thank you for making such an effort. I learned that you took the redeye here and the redeye back. I know how brutal that is. I wasnt surprised when he said that you couldnt say no to Elizabeth Dole because all of us have found that to be the case. This is why i am cochair of the Hidden Heroes today. It is indeed a worthy cause and we do need to eliminate this disparity. I see my own family where my mother for the last eight years, my mother is 90 years old and she is taking care of my now 91 yearold father who is a world war ii veteran was wounded twice in the battle of the bulge and earned two purple hearts and a bronze star and trying to get respite care is so difficult and i think that is the number one challenge. I really do. My mother has been extraordinary in doing that for eight years and as you both pointed out we now have iraq and afghanistan veterans whose loved ones may be carrying the caregiver roles for 50 years and we need to do a far better job of giving them the support that those who have borne the battle have earned and thank you very much for being here today and for sharing your advice and guidance with us. Thank you. Untrained. I now want to call up our second panel of witnesses. While you are getting settled i will note that we have two service dogs with us today i know are very important to the veterans and their families who are here. Id invite them to testify as well if i could figure out how. I know how smart they are but that is for sure. Thank you. First, on this panel i would like to introduce she is the senior Behavioral Scientist for the Rand Corporation and former director of the rand center for military Health Policy research. She has led numerous studies, examining the needs of the veterans and their families and codirected the Rand Corporations 2014 study Hidden Heroes americas military caregivers. She codirected rands newest study on military caregivers called improving the port for americas Hidden Heroes the Research Blueprint which is being released today. Senator tillis mentioned our distinguished witnesses from North Carolina but let me give a little reminder that we will be hearing from mary and thomas ward, both of whom will testify today. Mrs. Ward is a 2016 Elizabeth Dole fellow and a caregiver to her husband, a pre 911 marine corps veteran who lives with Service Connected to als. I thank you both for your service and i look forward to your testimony today. Thank you for being here. We will next here from two individuals from the great state of maine. Melanie and Sergeant First Class to joe everyone has a hard name today. She is a 2016 Elizabeth Dole fellow and a caregiver to her husband a post 911 veteran who served in the army for 18 years including three tours in iraq. She has been her husband caregiver for more than ten years and helped him with his physical injuries and posttraumatic symptoms. In addition, she has a degree in education and has taught in the military community for more than 15 years. I thank you both for your service and look forward to hearing your testimony. I would now like to ask our Ranking Member to introduce his witnesses. Thank you, chairman collins. Its my pleasure to introduce our witnesses from pennsylvania. Sergeant samuel, sergeant we are grateful for your many years of service to our country. In the army in panama, iraq and afghanistan and im also pleased to welcome your wife, wanda to the hearing today and its a pleasure to meet both of you today. Wanda is a hero in her own right, a hidden hero, senator dole would tell us. In addition to being a caregiver for her husband wanda is a fulltime student at the university of pittsburgh at johnstown and a dole caregiver fellow. Thank you for your Family Service to our country and thank you for being here with us today at the hearing. I add my things, as well. We will start. Thank you. My name is terry and im a Senior Scientist at the Rand Corporation where i study the health and wellbeing of servicemembers, veterans, their families and their caregivers. Many of our nations 20 million veterans conditions or disabilities or require ongoing care. Supporting these veterans is a cadre of spouses, parents and friends provide informal support activities that are unpaid that a maple term to live full of lies. Support support of the Little Foundation i have led three sequential studies focused on this important population. Our 2014 study which you heard about today, Hidden Heroes, provided the first indepth picture of military and veteran caregivers. In estimated the value they contribute to our society and expose the risk they face as a result of their role. Four of the studys findings were a particular surprise. First, of the 5. 5 million military caregivers 20 or 1. 1 million were supporting an individual served after september 11th. Second, post 911 caregivers are different than pre 911 caregivers. They are 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. Third, post 911 caregivers were in eligible for many support core programs because of their age, relationship two or the condition of their care recipient. Fourth, we found significant threat to the future of military caregiving especially as parents were serving as caregivers are aging themselves and may soon be unable to fill those caregiving duties. Our newest report is a Research Blueprint designed to ensure better sports for military and veteran caregivers. This blueprint is informed by input by more than 175 stakeholders including policy and program officials, researchers, clinicians, blimp this from advocates, care recipients and caregivers themselves and we generated consensus around ten highpriority Research Objectives all of which are outlined in my testimony. Today, however i will look at the Longitudinal Research that will track these issues over time one priority that we identified is to study how caregiving affect caregivers. Such research could help inform programs and policies designed to mitigate any adverse effects of caregiving to delay with regard to Mental Health, employment and family wellbeing. A second priority is to examine how caregiving affects the children of caregivers. No research has yet been documented and the most stakeholders consider this a vital topic. Such study should focus on the impact that caregiving has on parenting as well as the short and longterm event on Children Service caregivers themselves. A third priority is to examine how caregivers needs change over time and individuals age or recover from their injuries their need and demand for caregiving will change. This may affect the duties and the strain on the 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 yet, knowing what works and for whom is an important consideration for developing sound policies and funding were the efforts. To conduct studies to celebrate when we released today a number of conditions must be met. Members of the senate can take critical steps to facilitate an environment conducive to research on military caregivers. This means providing adequate and sustained funding as well as requiring research for decisionmaking when making decisions about the future of Caregiver Support Programs. Our report also outlined several potential strategies for using this blueprint including creating a Research Center of excellence specifically focused on military and veteran caregivers. It will be important for such a center to have multidisciplinary expertise as well as a broad focus to ensure that all of these outline Research Objectives and special populations that are important to the veteran Caregiving Community are included in its mission. I will conclude by reiterating that the role of our blueprint is to convey a vision for vision future investments and research will be to improve support for military and veteran caregivers. Thank you for the opportunity to share this testimony with the committee and i look forward to your questions. Thank you very much. Id now like to call upon the wards to testify. Thank you. Mrs. Ward. Good afternoon. Thank you for inviting me and my husband tom. As caregivers, im humbled to be here alongside a force of nature like senator dole, an advocate like ryan. I became a dole caregiver fellow in 16 where my journey as a caregiver started long before then. On june 201st 2010 thomas was diagnosed with als. Prior to that in 1993, tom had been disabled from encephalitis. His required care for me since then but the allencompassing care of als is intense. I had is care figured out and organize until als coming along. It was a devastating time. Excuse me. It was like getting sucker punched. Tom and i are that couple that fell in love almost instantly in 1979 and my grief has known no bounds. I know how this and if im not careful it will take mine as well. The work ahead as his caregiver is daunting and i am 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 of veterans and veterans are trying like you to get als as nonveterans and more than 4500 veterans in any given time have als. Served in the us report in 197 19729075 so he qualified for benefits and enter the va into our lives. Im not considered myself caregiver until later on in my life. I was committed to our vows and looked at her and love for each other. It meant that someone was paid to become an invite services and in 2013 for an interview with senator Elizabeth Dole about caregivers and that was my its an catastrophic disease. Theres never a day that goes by that im not grateful for all the va does to support tom as he battles als. The challenge lies in ensuring that he gets what he needs in a timely fashion to correct breathing mask, medication, committee and so on. While i work on that managing Resources Available from the ba at the same time im taking care of tom and teaching advanced placement Us Government policies online. Company persistence is nonstop. Hes moving towards dependence rather than independence and that is never going to change. One huge story i have is the financial aspect. I Teach High School online so i can care for tom but have done so at a significant salary reduction which has impacted my future retirement fund. I save diligently but im deeply concerned that his dependence gross will need to pay for assistance on pocket at the ba will only provide 28 hours of care a week and that will never be enough. We have two Adult Children who cannot assist in their death care. Our daughter is a secondgrade teacher in charlotte and my son is a Sergeant First Class with 14 years in the army currently a drill sergeant. Their data is our hero and would help in a heartbeat if possible. The best thing they can do is to grow their careers. Be the Foundation Fellow has been lifechanging for me. I built lifelong friendships with fellows in senator Elizabeth Dole has worked with us to be inclusiveness. As a pre 911 caregiver at the ba offers me nothing and i received no caregiver training from the ba so ive had no support other than a multinational focused topics and a few months ago was denied respite hours. I one voice among many need help. We carry a heavy responsible decree for our veterans and their still so much that we dont know. We need to cultivate a better understanding of the needs of caregivers through Research Like the kind you hear about from terry and we need action. I hope you consider passing the military and veteran caregiver improvement act to help caregivers like me. Thank you for your time and consideration today. I welcome your questions for myself and my husband tom. Thank you so much, mrs. Ward, for your moving testimony. I cant imagine anyone having to listen to what you just said voting against our bill. I hope that we can spread your testimony widely and i really thank you for being here today. Good afternoon, senators and thank you chairman collins and Ranking Member casey for having joe and i at this hearing on military caregivers. My husband retired Sergeant First Class, joseph, is a threetime combat veteran of Operation Iraqi freedom. He was deployed during the initial invasion in 2003 and again in 2005 and again in 2007. Each time the deployments were longer and longer. In 2003, he left for eight months, in 2005 for 12 months and in 2007, joe was overseas for approximately 15 months. During the initial invasion and again in 2005 joe sustained injuries in two explosions. In one of which he lost consciousness. However, because of the intensity of the fighting there was no time for him to be checked by medics so he shook it off and remained in the battle. Years later the injuries he sustained would become impossible to ignore. The several year period of Rapid Deployment with a world when even when joe was home, he was not home. He was at war, he was training for war in field exercises so 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. However, 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. A fellow soldier who was also a trusted friend saw his struggle, too, and thankfully asked that joe seek help for the symptoms that he was experiencing from his traumatic brain injuries and posttraumatic stress. The invisibility of his wound went most of the army 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 at fort benny handed me an application for the ba Caregiver Program. I filled out the paperwork but i wasnt really sure what i was applying for. Of course, even when joe has been active duty i was his caregiver but i had never recognized it. All of the tasks i was doing for the ones you will hear any caregiver talk about. I was managing his medication, i was raising the kids alone, i was managing finances and i was helping him remember things that he could no longer remember. I love you and i would absolutely care for them regardless but having Caregiver Support Programs in place is so important to me because for the first time in 20 years i could breathe. I cant imagine this would help charter this would be without these programs but i know millions of caregivers manage every single day. Its still stressful and there is 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 and i can have this much stress and pressure on me and its not just the stress on me but i also see how the stress of caregiving affects our children, too. Respite services, give us all an opportunity to recharge. Support systems like the dole caregiver fellowship with a network of knowledgeable caregivers who can help answer so many questions and programs offered by the ba such as the Caregiver Support Program make this sustainable for me and so many other caregivers. This kind of support should be available to all military and veteran caregivers whenever a tent whatever era theyre better in service. Its really helping people and its making a difference. I hope that you will consider supporting and passing the military and veterans Caregiver Services improvement act to do just that. Thank you so much for your time this afternoon. I look forward to answering any questions you may have. Thank you so much. Thank you, chairman collins and Ranking Member casey. I would also like to thank Elizabeth Dole foundation in senator dole, and the others for taking the time to be here today. It is humbling to have the voices like theres on behalf of caregivers like us. It is my hope that by sharing a small part of my journey, my journey as a caregiver, with this committee that you can ensure furniture caregivers do not base the same hurdles for my husband and i and other caregivers have had to overcome. My husband has been married to the army longer than he had been married to me. In the 1980s he was an army ranger in panama and operation and though he still saw action the third ranger battalion. That is he suffered his first tbi. Later he was in a bad accident that he got metal put into his body so much of so much that the army that he couldnt perform his duties anymore and released him. After 911 he couldnt not do the job the army trained to do so he went and had every waiver needed to get back into the reserves as an mp, military police officer. He signed up for every single deployment and was deployed more than he wasnt. Over the course of those deployments he earned parts. He did his job. He brought everything to present back to life and went above and beyond his duty. He came back looking like the same person but not acting like the same person. When you meet him he looks like everybody else. Talk to him a little longer and he can see his issues in his eyes and the way he talks. Sam undeniably lives with the effects of the war. One day when sam was home he had gone to the backyard to grill dinner and after he was gone for a while, longer than dinner to the ticket, i glanced out the window and saw flames on the side of the house. I didnt hear sam doing anything about it i iran outside and saw that he was standing there wideeyed, staring at the fire. I pushed him away close to grill a foot of the fire. Thats when i realized he had some serious issues. Thats when i realized that he would need help, a little extra help in the army didnt see it that way. When he came back from his last deployment where he suffered his last meeting the army released him and they said he was healthy to go back to civilian life. In the 60 days of leave that he had earned between leaving the military and going back to his old job i began to notice more of the Little Things that were different on him. He was stuttering and couldnt process things, his memory was terrible and he was very distant. I took him to the va and i pushed the issue. Sam wasnt the same person. The more i talked about the issues he was having the more the doctors realized i was right. I had to write to the senator to get the army doctors to reevaluate him to be given the benefits of the right benefits, the ones that he returns. It should not have been that difficult. 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 mba when servicemembers servicemembers are transitioning into civilian life and extending the stipend to so many caregivers and veterans in need. Those are certainly policies that wouldve helped sam and i as we figure out our new life. I hope you will support this legislation and help ensure to be signed into law. Thank you for allowing me the opportunity to share and i look forward to your questions. Thank you so much for your testimony. I want to thank you all for being here today and sharing your personal stories with us. It really makes a difference. You know, a lot of times we talk about the numbers here in the senate and we talk about, for example, 525 military caregivers. But when you put a human face on it and you hear the individual story, it makes such a difference. It makes it so real. Let me go across starting with the words and then the swoboda and then the ickes and ask a question of all of you. I often hear that caregivers are very reluctant to ask for help or support. Mary and melanie, it sounds like in your case you didnt think of yourselves as caregivers initially i speed not roll. Others may be just hesitant to ask for help and many simply are unaware of what helped there is out there although i think we would all agree its not adequate and its not fair that there is disparity. I would ask starting with you, mrs. Ward, how can we better help military caregivers overcome the barriers in their unwillingness to accept help . So, for me personally, i think i wouldve needed somebody to ask me to have somehow. Which is probably true of any other caregivers. I think im just one of many when it comes to that. For arrests getting a diagnosis of als meant enormous amounts of stress and work in the future, work for me. I probably would have really benefited by having somebody reach out to me, maybe even separate from tom. Its very difficult to hear that kind of stress it will be further caregiver because they are not a burden, but it could feel like a burden. I think it would really be okay if we had somebody take us aside and speak with us and be available for us for questions and kind of hopeless brush ourselves off and get moving in the direction we need to do still try to have the best life we can. Thank you. Melanie. I think it would have been helpful to me to have had more education about caregiving during my hasbeens process. During this process there are many briefing that are held to help the soldier transition out of the military. And it could be very simple as having training someone whos already getting briefings about other aspects about processing to present information to potential caregivers. Much of the information i learned along the way came in social media outlet an organization like the Elizabeth Dole foundation are definitely leading the way in disseminating information and more importantly helping caregivers to self identify. But i agree with you, senator, it is difficult for us who love our spouses so much to identify as caregiving because we do it in sickness and how can we take that literally. Thank you. Thank you. Wanda. Well, i agree with melanie and the fact that the veterans have their processing and they are told what happened next. Especially if there is any insight into the issues the veterans are having that they might need caregiving, they might not be the same. It would be great if we were given the same out processing and briefing that they are. But in our case, he was a reservist and there was no local to steer me. I was on my own. I had to figure it out as i went. Hes had the advantage that it had the military behind him, telling him where to turn and what to do and i did not have that. Thank you. Im astounded to learn from your testimony that theres not been a single study performed at the impact of caregiving on children and mrs. Swoboda talked about the impact for her and trying to balance raising children at the same time. Why has there been so Little Research done on the whole area of military and veteran caregivers . Thank goodness for the Elizabeth Dole foundation. When you look at the literature, it is astoundinghow Little Research has been done. You are right. When you look at the literature, what we do find is most of what was learned from caregiving its research looked at caregiving through the elderly or individuals who suffer from agerelated condition and chronic conditions, dementia, cancer and the like. I should note those studies and findings are relevant for military and veteran caregivers, particularly as we know 80 of our military and veteran caregivers are in the pre9 11 era and are tending to issues also associated with age, although veterans are at higher risk for some of those conditions. The va had been a leader in doing research on veteran caregivers, particularly around some of those agerelated conditions, dementia, for example appeared but often come under challenge in Getting Research conducted or programs initiated as having awareness that there are issues that may need to be studied. I would say a awareness is a challenge, but also funding. Making sure there is funding available for researchers to implement studies on a specific population for a specific disease or clinical condition area that also includes caregiving. As we look towards Better Solutions to improve the care that we can provide for specific populations, just as weve seen with support programs, caregivers become kind of the offshoot or incidental population that is served. We are hopeful by bringing attention and crafting a blueprint that will give facilitation to the research that needs to be conduct you to answer some of those knowledge gaps including children. Thank you. Senator casey. Thanks very much. I wanted to reiterate that thinks that chairman collins express to each of you for your testimony. This cant be easy and i know that this is not the way to spend most of your days providing testimony in a senate hearing. I was struck by the personal reflections each of you had about the challenge of caregiving in your own experience. Mary, when you said early in your testimony about getting a diagnosis company said it was like getting punched and what that was like for you and like it would be for anyone. Melanie, when you said having Caregiver Support Programs for the first time in 20 years i can breathe, which i think gives us a sense of how difficult this is. And wanda, you said i stepped up because he couldnt, which is i think something 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. Anyone whos watching this or well watch it later or read about it or hear about it would be inspired by your testimony. I hope you understand you are helping others in the manner he testified. I guess in so many ways you may think you may think that this kind of service you are rendering is simply a natural act, an act of love for someone used in most of your life with. But in another sense, when we consider what youve had to be dealing with all these years, it is an indication that you and your own way have been triumphant over something very difficult and we are grateful to have the chance to hear it up close in your testimony. Ill start my question with you. I know that in your case you were once part of the va comprehensive Caregiver Program, but recently the department of foreign view you would no longer be eligible for the program. How is that decision changed your ability to care for your husband and also yourself . We were recently told that we graduated i guess thats supposed to be a good thing. For us it is not. The stipend that i received, and that we received, we use that for my respite. Sam belongs to a hunting camp and he goes there a lot for his respite care with tbi in ptsd, he needs the solitude and things and that is where he would go but he cannot go by himself. Most of his care for safety issues for him. At several states away. I cant allow him to go there himself. The money we received money we receive tremendous tape and we received was for both of our respite. He would go away. He would have someone accompany him. I was able to pay them travel and for nielsen to be away. And that was his respite care and mine because i knew he was being taken care of. He was being cared for, so i had my downtime also. Now we dont have that. The stipend also allowed me to go back to school to get my degree because he is 100 stable. Whatever we want for the rest of our lives is going to have to come for me. The stipend was enormous for rest it was an a lot taller wife, but just for a little bit of time 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 the program that today is the best im going to be. I slip. Every do you slip a little more tbi are ptsd. You are still going to lose that shortterm memory. The issues are still going to be there. Every day this gets a little tougher. I mean come you kind of adjust 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 into it. I appreciate that. I know you both understand others have had the phoenix periods. I know the va has initiated an internal review of these eligibility decisions and placed a moratorium on any further benefit revocations did so while we are happy about that, that no one is being discharged from the program and not fashion, that is very little solace to you and to others that this time. We have a letter to the va indicating that and also urging them to reenroll those who are discharged with insufficient explanation until the review is completed and the procedures can be improved. We are going to continue to work on this. Thank you. Thank you. Senator tillis. Thank you on a chair. Since i begun i went over to the Veterans Affairs to a untold amount that this committee and how we need to make it a priority to look at addressing some of the things are Ranking Member, senator casey, mentioned come to some of the revocations and disruption of service. He was one thing i asked. I never miss an opportunity in this venue. Weve got a lot of red tape to cut through in the dod. Between now and the time i get through it, but your Senate Offices and home state be the scissors. Every single one of us, ive been here for two and a half years. Thats how long ive been in the senate. Weve opened up our 10,000 case in those two and a half years helping people, 6000 of which are veterans related. The next time you deal with the va on benefits that you are entitled to and you are not getting the right answer, let your next phone call be to the senator of your choice in your state. Make it our job because we owe it to you. First and foremost im a thank you all for your service, both the spouses of the men here who served. Ms. Tanielian, i just have to go back and brag on tom and mary. They, for a number of things. They were a senator doles kickoff for Hidden Heroes did it come up and advocated for als research. You are continuing to serve. Not only your household, but out here doing it rate service for everybody else who needs your voice. But i want to talk more and youre talking to somebody whos just in the unique position of being on this committee, the Veterans Affairs committee and the chair of the personal subcommittee. One that talked about transition, talked about the need to do a better job of identifying potential caregivers try to transition our some point in the lifecycle is a veteran. I know you suggested in the blueprint additional research. Can you give me an idea of a couple things. One is how to be good together that entire chain . How do we identify Service Members that may not even know that they may need care so we are better alerted them better prepare the time they do. And also, i really think that we have to touch on the economic case for doing this. If the burden continues to increase on caregivers, we will have fewer caregivers and well end up having to pay a price for less care and less valuable care to the veterans. To what extent does your Research Think research should be focused on growing this va, dod, Veterans Service organizations, the network that comes together in addition to the Family Caregiver. Research on that and research on the Business Case we can talk about why funding this is a dollar well spent. For one thing at the debt we owe every single one of you. For another thing, it makes fiscal sense at some level. The thank you. Those are great questions. I will start with your second question first and turn to the other one about transition. Youre absolutely right. The Business Case is often what motivates individuals to Pay Attention to send them. And so, quantifying the societal cost saving, the caregiving in fact was one of our Research Priorities in the blueprint. And while he was highly important and very critical, they also wanted it to include research that would document the cost that the experience, not just the savings they contribute, but the cost they accrue as well in financial and economic terms. That can be costs associated with lost productivity, cost associated with support programs for Health Care Utilization as well. Really a need to do your research that looks at the cost has all the costs effectiveness of different programs that we can put in place. We need much more research in those areas. On the transition piece and what can we do to better identify caregivers. Her 2014 study was made a series of recommendations in four categories are the first really was around empowering caregivers through a number of different strategies to help them self identified, but also help systems identify them. There have been a number of new programs that have been implemented, including the department of defense to try to identify individuals who are serving as caregivers and provide them with education, training and peer support. We called attention to the need to look at Eligibility Criteria for different programs across different federal agencies to ensure that those Eligibility Criteria were defined in ways that werent in fact intended to target the population who was providing care and service to our military servicemembers and veterans. We also talked about the need to 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 an environment that are more sensitive to caregivers. Health care providers. Health care providers should be connecting caregiving Needs Assessments would interact with patients. If someone indicated their caregiving needs needs, the Health Care Provider should be a asking to speak with her caregiver in learning more and doing their own Needs Assessment to understand what it is the caregiver needs to have their Health Issues addressed as well. Thank you, not an chair. I may for a second, the va the week before last announced they are implementing a medical record that is the same platform the dod has. Now we have an opportunity to really talk about a better integration using the data in the Electronic Health record from the dod and using the right kind of analytics, even better increase their understanding on the people who need the help the most. Last thing i will leave you with is theres a whole group of people out there. At some level come each and everyone of you have benefited in some va benefits either now or in the past. We also have pre9 11 veterans particularly dating back to the vietnam war, it will cost the veterans that may have gotten other than Honorable Discharge and that the circumstances the discharge may very much had something to do with traumatic brain injury or pts and we simply didnt know how to categorize it. But we also have to do is look back and see the group of people that not only to caregivers are struggling, but they never even had a single bit of a safety net of va benefits coming out with an Honorable Discharge in that Something Else we need to look at going forward. Thank you, madam chair. Thank you very much, senator. Senator cortez. Thank you, madam chair. Thank you to all of you. I may follow up with ms. Tanielian. Thank you for the blueprint of fantastic yet i hope there are many folks including many here in congress to pick this up in a wonderful ideas how we can address some of the issues we are talking about today. One of the things you brought up, which i am a big fan of is creating a Research Center of excellence. Can you talk a little bit more about that and what you would envision not to look like . Sure. We identify the needs are suggested creating a center of excellence because it would divide the opportunity to give strategic pursuit to the research object as we identify by providing kind of a nest egg of funding and leadership to bring together the community to really jumpstart some of the needed research. So their are multiple ways and multiple examples of other Research Centers of excellence. We suggested it because they thought a center of excellence specifically focused on military and veteran Caregiving Research would go a long way to make sure we can get started on filling the knowledge gap we identified in pursuing the research object is the Stakeholder Community agreed are of high importance right away. Are there already models out there that can be replicated or emulated or however we can look to her best practices that can help jumpstart that . There are many examples that already exists given the topic and a number of different ways to go about establishing an thing in the federal agencies and the federal sector putting something into the private sector and their advantages and disadvantages with all those different approaches. Ultimately, given the topic and military veteran caregiving, theres examples of where the va established other centers of excellence where they conduct research in partnership with side organizations to really ensure the leadership in funding and momentum to pull together the Research Community and a multidisciplinary way to pursue strategically and intentionally at the object is identified. Thank you. Let me just say to the wards, thank you so much for being here. First of all, but may mirror what my colleagues have said. Thank you earlier service, not only are active service in protecting our country, but your continued service, sacrifice is made both by gentlemen, you as well as your family members. So thank you. Honestly, part of me sitting here thinking this is unconscionable that we even have to have this discussion, that we are not doing everything we can to take care of you and your families when you have put your lives on the line to protect our freedoms and democracy is. Its just ridiculous to me. I want you to know at least from all of our speaking for my colleagues that your words are not ringing hollow. The last thing we want to do is have Something Like this it on a shelf somewhere and have worked go nowhere. We are ready for some action and places youve heard. Let me ask you this. I think mrs. Ward, you talked about this. You highlighted in your comment that you were denied respite care at the va a couple of months ago. Is that correct and can you talk a little bit about that and give me background why that occurred . Yes. I was denied respite care in the fall and actually it was to come here in washington d. C. At the fellow at the summit in september. I put in for respite care a few hours today to help tom. He needs help cooking, getting dressed. Its not like an amputation, so its not like he absolutely cant do a thing. He can feed himself, that he cant cook for himself. In the person from the va who did the intake with me, we do not provide people to comment cook and clean. I said okay. Thats what i needed. I suppose i couldve said other things, but i just told her the truth. So i doubt without a personal level. I handled it for a few nights while i was gone and i had people check in with him, but it will never happen again. I will never go away again without having someone there to care for him or he will have to come with me. Fresh is the way it has to be. The potential for a fall, is too great. Thank you all for telling your stories today and having your voices heard. Our role is to make sure he can make a difference in other lives as well. So thank you. Senator blumenthal. Thank you very much, madam chairwoman and thank you so much for having this hearing. I went to thank you all for being here today. There are a few topics have greater importance to any of us who serve here and particularly because i served on the Armed Services committee and on the Veterans Affairs committee. I apologize for being late because i just left the hearing that the Veterans Affairs committee. So i would like to ask the members of the panel since we are scrutinizing the budget bear, whether you think that the vas budget is sufficient to help with caregivers and we are trying to expand this effort as you know senator murray in the Veterans Affairs committee has led this effort long before i was fair, but im an enthusiastic cosupporter. Whether the resource was sufficient and whether they are focused in the right areas. I would like to say, sir, that it makes sense to me that if more caregivers were out there for our veterans. First let me say this, what its like to be a combat veteran away from combat. I just meant a world war ii veteran a few weeks ago. He was at it plays back home and they take time to spend time with veteran and sort of ground them and give them a reason to be alive. Combat veterans, when we are overseas, we are so used to being so on average, things going on around us all the time. You are going a thousand miles an hour. And then when you come home to the land of mcdonalds, what i call it, nothing is happening. You are still going a thousand miles per hour, but there is nothing going on. A combat veteran leader, without support like my wife, me and 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. How many years has that been . This guy has missed his whole life until somebody finally got to him and not necessarily his caregiver, but somebody grounded him. And that is why caregivers are so important to combat veterans. We know that there is no ieds on i95. But we know in our brains that we have to look. You cant stop that. So we need somebody there to ground us and that is why caregivers do. Two of our four children have served, both applicable and the marine corps, the other in the navy. So i know what you mean. They are probably in less need of ground and then i am a lot of the time. Not that anything we do here it is in any way similar in any way to combat, but ive seen this countless times in connecticut and thats why i have tried to work through the va and thats why im asking a question about support. May i add, sir, it makes sense to me that if there were more caregivers, the va would have to spend less money on Mental Health. You know, they would have to send less money on mileage to go to a doctor because the caregiver is fair. The caregiver is being paid to be there for them. My wife has a masters degree. She is a schoolteacher. She has had to step way down just to be there for me. And she is happy to do that and i would much rather have her than anybody else, but there is a sacrifice they are. Well, i want to thank you both for your service. In naming both of you and think the countless other caregivers for their service. This point is one i made. We tend to think the veterans for her or his surveys and the caregivers are equally deserving of the banks. Appreciate you being here. Thank you. Thank you, madam chair. Thank you, senator. Today weve had an extraordinary hearing. Hearing from the caregivers, seeing our veterans who have served our country so well, listening to such terrific advocate by senator Elizabeth Dole and ryan phillipe has truly been a moving experience and i do believe that the testimony that you get a nice supported by the work the Rand Corporation has done will help us advance the three bills that weve talked about today. This committee does not have legislative jurist diction, but what we do have is the ability to shine a spotlight on an issue that has not received the attention that it deserves. And with your help, that is exactly what we have done today. I could not help but think as i listen to the testimony today that there is a reason that we use the word military family. Because as we have seen from the testimony of mary, melanie, wanda, when a person joins the military, the whole family served. And not surveys can last a lifetime. It is very clear to me that our nations 5. 5 military caregivers who face such substantial emotional and Financial Issues each and every day needs far more support than we have been given and i am just so grateful that you are willing to common share your personal stories with us because that along with the Rand Corporation study and a determined ad agency of the woman who will not take no for an answer, senator Elizabeth Dole and the ambassador of her group, ryan phillipe, will allow us to get something done. I just want to assure you of my personal commitment in that regard. Senator casey, do you have any final comments you want to make . To make us, briefly. Thank you, madam chair. I want to thank our witnesses. Maybe wanda said it best. You said in your testimony, you said he did his job. He went above and beyond his duty. That can be set not only of sam, that you, melanie, joe, mary and tom. We are grateful that you have been willing to do that in your lives, but also grateful you are willing to share it and give us both inspiration and information about why we need to pass these legislative items as well to do advocacy on your behalf and on behalf of those that we represent. Thanks for being here and thanks for serving your country in more ways than one. Committee members will have until friday, june 23rd to submit any additional questions for the record, which may be getting to you. Again, my profound thanks to all of my witnesses today, my Ranking Member into all the Committee Members who participated in todays hearing in thank you also to our dedicated staff. We couldnt do it without them as well. Thank you for being here and this concludes our hearing. 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And then also, i just picked up hunger, roxanne grays new book. That is my short list for summer reading. It is a real mix of things that im looking forward to devouring those and maybe going back and reading it again. When you think about a oneday festival, the National Book festival and you have over 100 authors from childrens authors, illustrators, graphic novelist, all of these different authors dare all day, over 100,000 people come in and celebrate oaks and reading. You cant have a better time i think. I am a librarian, but i have to tell you that any reader or anybody that wants to get inspired, the book festival is the perfect place. Informed on the constitutional war powers of the