Macabre news of bodies stacked in a makeshift morgue. Federal emergency teams swooping in to take control of state veterans homes where the coronavirus has killed scores. For veterans, getting care in their own homes has gone from a preference to a matter of survival.
"It's definitely scary," says Rob Grier.
His father, Robert Grier Sr., served in Korea and Vietnam, and Rob says if he weren't taking care of him, his dad would probably need to be in a nursing home. The VA has been good to them over the years, Rob says, especially when his father got lung cancer.
"We were just blessed to have a great team at the VA during his care for that, "he says, "but still, a pre-existing condition, that's not good for COVID."
Grier wants to keep taking care of his dad, but he's not sure he can without help from the VA caregiver program, which is not yet open to older veterans.
Since 2011 the VA has helped caregivers with a stipend, but only for Iraq and Afghanistan vets. In 2018 the VA MISSION Act promised to expand to veterans of Korea and Vietnam, and eventually all veterans who need it.
But who needs it? The VA finally announced its highly technical answer to that question in March after a two-year wait. Anyone with at least a 70% disability rating from the VA can apply. It's now available to veterans disabled by illness, not just injury. That's particularly important to Vietnam vets suffering from cancer and other diseases linked to the defoliant Agent Orange.
VA says this will significantly expand the program. Veterans advocates had a mixed reaction to the 56 pages of newly proposed rules.
"This looks to me like a significant restriction of eligibility for the program," said Bob Carey, a navy vet with the Independence Fund.
Carey says under the rules, vets qualify if they need help with one basic activity like eating or bathing, but only if they need help every single time they do it. And the caregiver in the program has to be doing all the vet's care and supervision, or they don't qualify. Carey says he's afraid rules like that will keep thousands of deserving vets out.
"We and other (Veterans Service Organizations) have been pushing for a long time for fundamental reforms to the caregiver program, and none of those were addressed," Carey says.
Among their requested changes was a permanent designation for catastrophically injured vets, so they don't have to check in yearly to reconfirm their status.
"I've been missing the same three limbs since June 26, 1965," says Dennis Joyner, who lost his legs and one arm to a landmine in Vietnam. He'd like to be able to get his wife Donna on to the new expanded caregiver program. After taking care of him for decades, she finally had to quit her full time job in 2008.
"I gave up my job, my pension. It's just everything that snowballed from that," she says. "You take on a lot when you're a caregiver. I might be getting older, but I'm doing probably more than ever."
The Joyners got excited in 2018 when Congress voted to expand the caregiver program to include Vietnam-era vets.
"They passed it, the president signed it. I'm thinking wow, I'm ready to go file," Dennis Joyner says. "Well, talk about taking the wind out of your sail — it's been a couple years now."
Joyner is pretty sure he'll qualify, but he still can't apply - the VA estimates that the new IT system to run the caregiver program won't be ready until later summer or early fall. The VA is not starting this process with a great foundation of trust — the current caregiver program was administered inconsistently, and the now the new one has kept older vets waiting — some have died since the law passed in 2018.
"Delay, deny, until they die," says Rick Weidman, with Vietnam Veterans of America. "It shouldn't have been this complicated."
He says VA shouldn't need a new IT system to see that a triple amputee like Joyner needs a caregiver. But the VA and many in congress have agreed that getting the system to work well is just as urgent as getting it done soon.
"When you expand to a very different population the challenges grow exponentially," says Meg Kabat, the former director of the caregiver program, now with Atlas Research.
Kabat says it's crucial for the VA to be transparent in how it implements the caregiver expansion.
"If I'm the caregiver of a veteran, I have to have a sense of whether we're going to qualify even before we apply. To do that VA has to make it crystal clear, more black and white," Kabat says. "It's a trade-off, though. The result of that may be that some veterans who were in the program previously may no longer meet that criteria."
STEVE INSKEEP, HOST:
More than 70 people recently died of COVID-19 at a veterans home in New Jersey. This is just the latest example of why many older veterans seek care at home as a safer option. There is a VA program to financially help caregivers at home, which began for post-9/11 veterans and has since been expanded to older vets. But as NPR's Quil Lawrence reports, help is still months away.
QUIL LAWRENCE, BYLINE: For decades, family members, usually wives, have taken care of America's disabled veterans. The care they give is often better than outside help, and it costs the government nothing. But it costs the caregivers a lot.
DONNA JOYNER: I gave up my job, my pension.
LAWRENCE: Donna Joyner has been taking care of her husband, Dennis, for years. A landmine in Vietnam cost him his legs and left arm. By 2008, Donna finally had to quit her job and take care of him full-time.
DONNA JOYNER: It's just everything that snowballed from that. Like I said, pension, Social Security - I've lost that. And, you know, you take on a lot when you're a caregiver. I might be getting older, but I do probably more than I've ever done before.
LAWRENCE: Dennis says he got excited in 2018 when Congress voted to expand the caregiver program to include vets like him.
DENNIS JOYNER: They passed it. The president signed it. I'm thinking, wow, I'm ready to go file.
LAWRENCE: Then the Joyners waited.
DENNIS JOYNER: Talk about, you know, taking the wind out of your sail. I mean, it's been a couple years now.
LAWRENCE: The rules of the program finally came up for public comment in early March to a mixed reception. The VA says it's growing the program, opening it to vets with not just injuries but illness, like Vietnam vets with cancer from Agent Orange. But there's the fine print. Bob Carey does veterans advocacy with The Independence Fund.
BOB CAREY: This looks to me like a significant restriction of eligibility for the program.
LAWRENCE: Carey says under the rules, vets qualify if they need help with one basic activity, like eating or bathing, but only if they need help every single time. And the caregiver has to be doing all the vet's care. Carey says he's afraid rules like that will keep thousands of deserving vets out.
CAREY: We have been pushing for a long time for some fundamental reforms to the caregiver program, and it appears that really none of those were addressed.
LAWRENCE: Veterans groups also want a transparent system for appeals when a vet gets denied or removed. That's been a big problem in the past, which means VA isn't starting with a lot of built-up trust. And VA keeps announcing delays with its new IT system for the program - delays for vets who've been waiting for help since Vietnam, like Dennis Joyner.
DENNIS JOYNER: What is the thought process - the longer we wait out, you know, the more die off and the less we have to pay? God forbid that would be a thought process that was real. But, you know, us veterans, sometimes we really think that.
LAWRENCE: The VA says the wait will be over by late summer or early fall. It's taken time to create one comprehensive system for vets from Iraq all the way back to Korea, says Meg Kabat, the former director of the caregiver program.
MEG KABAT: The current program has had a lot of challenges with really defining who is eligible. And when you go ahead and expand the population to really a very different population, the challenges just grow exponentially.
LAWRENCE: But the need to support caregivers has never been clearer, she says. That's echoed by Robert Grier, who takes care of his father, who might otherwise be at a veterans home.
ROBERT GRIER: Oh, it's definitely scary, especially now after COVID-19.
LAWRENCE: Grier's father, Robert Sr., served in Korea and Vietnam. Now he needs constant help. He's also a cancer survivor.
GRIER: We were just blessed to have a great team at the VA during his care for that. But that still is kind of a preexisting condition that can - you know, that's not good for COVID.
LAWRENCE: Grier wants to keep taking care of his dad. He's hoping by the fall the VA will help him.
Quil Lawrence, NPR News.
(SOUNDBITE OF MOONCAKE'S "MANDARIN") Transcript provided by NPR, Copyright NPR.