Monday, October 29, 2018

Protect Your Family with a Disaster Plan

Have you ever considered what you would do if a disaster struck you and your family? Would you know what to do? Would you take the right step to take to protect your life and that of your family? Many of us assume that disasters only happen rarely and to other people. But unpredictable weather can affect any area of the country, and recently we've witnessed wildfires, tornadoes, floods and other natural disasters in places we least expected.

Although natural disasters can cause catastrophic loss of property and injuries, you can reduce their effect through careful planning and preparation.

The first step to planning a disaster response is to be informed. Especially if you’re new to an area, you should become familiar with its frequent natural disasters. Identify the known risks such as earthquakes, flood zones and frequency of extreme weather. Some information about the area can help you understand some of the initial responses to include in your plan. For example, if you live close to the water, you'll likely want to have a well-thought out plan in the event of a flood. 

Tornadoes are another example. As HomeAdvisor explains, “Although they are mostly associated with the Midwest and “Tornado Alley”, no state is immune to tornadoes. Even sunny California experienced seven of them in 2014. Therefore, it only makes sense to take some precautions and have procedures in place in the event of a tornado.”

After acquiring information about your particular disaster likelihood, the next steps to developing a plan is to consider these four questions with your family and friends:

How will emergency alerts and warnings be transmitted? What is your shelter plan? What is your evacuation route? What is your communication plan?

When answering all these questions, consider any particular needs of your family. Small children, seniors, people with special needs and even pets can all affect how you develop and execute your plan.

Next, consider what sort of supplies you should need if there is a disaster. Creating an emergency preparedness kit is simple, and although you hopefully will never have to use it, it’ll be the best investment you've ever made in the event disaster strikes. Having the following basic supplies can make a life or death difference:

-       Water - 1 gallon per person per day
-       Nonperishable food, such as canned goods
-       Flashlight
-       Battery-operated or hand crank radio and/or phone charger
-       Extra batteries
-       Medications
-       Personal hygiene items

And if disaster strikes, be ready to put your plan into effect. None of these preparations are useful in a state of chaos, so your plan should include designating someone to be in control.

And if a natural disaster hits, consider the impact on your pets as well. Contact your local emergency management office or Humane Society to see if a temporary shelter is available for your animals. Emergency shelters for people impacted by natural disasters can't always accept displaced animals, so your plan should provide for their care.

You can also reach out to friends and family members who aren’t affected by the disaster to see if they could temporarily house your pets. Other options include making a list of pet-friendly hotels in your area in case you have to find shelter quickly for the entire family.

When natural disasters occur, all too often victims are unprepared, believing that such calamities only happen to other people in other areas. Be prepared for these events, no matter how unlikely. It may be the best plan you ever put to paper.

Bradley Davis 

Monday, September 24, 2018

You Matter!

You Matter!  Caregiver Awareness & Self-Care
T KarcherYears ago.... self-care was an eye roll.  A weakness.  Last on the list.
Thankfully, this has changed; caregivers are no longer willing to be continually mentally exhausted, ill-nourished, overwhelmed, or physically unable to provide care, it causes too much additional family stress. While it is difficult to make time for yourself, you’ll hear it repeatedly: Make the Time for You.
Caregivers often have their head down, their task list in hand, and they execute logistics that would make a 4-star amazed. However, this focused effort is rarely sustainable. This will vary for everyone, but no one is a robotic machine forever. Please don’t wait until you fall ill or become so overcome that you don’t see which end is up. Sharing your experience and gaining perspectives with friends and other caregivers can be very beneficial.
You probably micro-schedule the rest of your life, so try to add good nutrition, exercise, relaxation, meditation, quiet, social time, or something that is yours into that schedule too. There are numerous options for small-group fellowship in local organizations, the faith-based communities, and sports facilities. Respite care is hard to find, so intentionally carving out time for you is necessary.  Every little bit helps. 
You need it.  You matter.  Take charge of your self-care.
Linda Kreter and the VeteranCaregiver Team

Thursday, September 6, 2018

SPAR - Sensitive Patient Access Report

See VHA Directive 1605.01, Sections 7-4 and 38-9 (copy & paste into browser

"SENSITIVE RECORDS" - Many caregivers have voiced concern over who is accessing a veteran's records, especially for evaluations.  While evaluations are to be conducted according to the caregiver law, alternative staff is sometimes accessing a veteran's medical records for evaluation or appeal records review.  

If you are concerned, have the veteran request their Medical Records be marked "Sensitive" by the Privacy Officer at your local VAMC. This means the LOG of all those accessing records will be supplied in a SPAR report (Sensitive Patient Access Report). Don't forget to request reporting time frame (all). 

VHA Directive 1605.01 (Sections 7-4 and 38-9) is also posted in our website Resources section.

Linda Kreter and the VeteranCaregiver Team

Tuesday, August 28, 2018

Obtaining CATS and PATS Records

CATS and PATS Records:   For those in the Program of Comprehensive Assistance for Family Caregivers Program and those anticipating joining the program, obtaining these records on a periodic basis is vital to understanding the entire CG Program picture.

CATS (Caregiver Application Tracking System) and PATS (Patient Advocate Tracking System) are NON-medical records completed by Caregiver Support Coordinators and Patient Advocates respectively.  The information contained is often used for program re-evaluations, continuing eligibility, and sometimes reflect different information than the medical records.  Without this information, you lack the capability to review for accuracy, correct errors, and understand the full picture.

We have concerns.  CATS and PATS were not openly disclosed and found only from patterns discerned through thousands of seemingly illogical caregiver decisions.  VACO has confirmed these records, and acknowledged in writing that both CATS and PATS usage will continue.  Once these non-medical databases became known and caregivers submitted requests (only available through FOIA requests, or Freedom of Information Requests), there have seemingly been deletions from the records, and apparent removal of information that may have assisted in reversing Caregiver Program decisions for Tier Reduction or Program Termination.

Starting the process means a Freedom of Information Request (FOIA) to your local VAMC staff outlined below.  To obtain these records, there is no form, and we suggest language similar to:

TO:              Privacy Officer, VA Medical Center __________ (name)

CC:              VA Medical Center Director ___________ (name)

FROM:        VA Caregiver ___________________ (name)       
                    Veteran _____________ (name)   _____ (last 4 of SS#)

(Caregiver Application Tracking System and Patient Advocate Tracking System Records)

Dear Sir or Madam,

This request is for specific records needed to respond to an appeal/eligibility to the VA Program of Comprehensive Assistance for Family Caregivers (PCAFC).  Our deadline for appeal is ___________ (date).     

We are requesting unchanged, unmodified, non-redacted, and complete CATS (Caregiver Application Tracking System) and PATS (Patient Advocate Tracking System) records from date of application __________ (month and year) to the VA Caregiver Program through today _________ (date) for Caregiver _____________ (name) of Veteran ___________ (name), last four of SS# ____.”  This information is critical to our timely documentation submission.

Thank you for your prompt response.

Very respectfully,

CG name and signature
Veteran name and signature

Submit this request to the Privacy Officer (or FOIA Officer at some centers) at your local VAMC and keep copies for yourself, noting the date and time of submission, the person submitted to, and any notes of conversations.  If you receive a response saying it will be an lengthy time period, exceeding your need for the information to appeal, provide a copy to your Caregiver Support Coordinator, their Supervisor, and request an extension of the appeal period in writing. 

Once records are received, review them carefully with the Veteran’s medical records for accuracy.  If there are errors, you must submit a line-by-line correction document, along with documentation (if available) requesting record corrections.  Submit these to the same Privacy Officer for submission and ask timelines.  Check for confirmation of this information.

There are further steps you may need to make, but please not only obtain these documents, but also document every single step in the ADL’s and Supervision/Protection provisions for program eligibility.  For those pre-9/11 veterans anticipating application into the program, do this documentation now, in advance, and be prepared to follow the same eligibility requirements.

We hope this information is helpful, and if you’re working with an advocate, cc them on the memorandum also.  If this process changes, we will let you know, and meanwhile, knowledge is invaluable, and sharing it with others is as well.

We recommend you print this blog posting and wish you the best of success.

Best to you,

Linda Kreter and the VeteranCaregiver Team

Wednesday, June 13, 2018

Loneliness: An Epidemic and a High Risk for Veterans

Loneliness: An Epidemic and A High Risk for Veterans

Loneliness has doubled in the U.S. In the 1970’s and 1980’s, Americans who responded that they regularly or frequently felt lonely was between 11 percent and 20 percent (depending on

the study).1 Just a few decades later in 2010, AARP performed a national survey that found that
loneliness had increased to between 40 and 45 percent among adults.2    And in 2017, former
U.S.   Surgeon General Dr. Vivek Murthy called loneliness an “epidemic” and stated that “loneliness shortens lifespans in a way similar to smoking 15 cigarettes / day”.3

The destructive effects of loneliness don’t end there. People who identified themselves as  lonely had a statistically significant 45 percent greater risk of death.4 "People aren’t [technically] dying of loneliness. But they are dying of cardiovascular diseases, cancer, accidents, suicide and diabetes. Based on your genetics and your environmental history, loneliness can make these conditions strike earlier than they otherwise would have," said Dr. John Cacioppo of the
University  of  Chicago’s  Center for Cognitive and Social Neuroscience.5    In fact, according to a
2018 study (by AARP, Stanford University, and Harvard University), Medicare spends $6.7 billion more annually on socially isolated older adults compared to adults that are not isolated.6

Isolated Veterans living at home have a high risk of feeling loneliness, so it’s that much more important to identify the warning signs that your loved one is feeling lonely.

Signs of Loneliness 

Here are some of the signs to look for so that you can seek help:

1.       Poor Sleep. Individuals who are suffering from loneliness often have poor sleep. According to Dr. John Cacioppo, "A handful of studies have shown that when you’re lonely, your brain remains alert for threats and you show more micro awakenings or sleep fragmentation. This has an adaptive purpose: If you’re isolated, you could be predated at any moment. It doesn’t matter whether you are sleeping next to someone—if you feel isolated, that causes the brain to remain on alert."7

2.       Frequent Sickness. Individuals that are lonely are more likely to get sick. Dr. Cacioppo stated, “We’ve found loneliness is associated with altered gene-expression, which makes you more susceptible to viruses, a correlation that has been shown in humans and animals.”8

3 See

3.       Longer, Hotter Showers. Studies indicate that lonely people take longer and hotter showers--the lonelier the person, the longer the shower and the hotter the preferred temperature. According to Dr. John Bargh, Professor of Psychology at Yale University and administrator at Yale's Automaticity in Cognition, Motivation, and Evaluation (ACME) Lab, "[P]eople tend to self-regulate their feelings of social warmth through applications of physical warmth, apparently without explicit awareness of doing so."9

4.       Buying More Stuff. Individuals that are feeling lonely may look to fill a void through more consumer spending. According to a study conducted by Dr. John Lastovicka of Arizona State, "We...find that material possession love is empirically tied to loneliness and social affiliation deficits, which suggests a compensatory basis of consumer well-being."10

5.       Having Friends Who Are Lonely. Loneliness can be contagious. According  to research published in the Journal of Personality and Social Psychology, individuals are "more likely to be lonely if a person they are directly connected to (at one degree of
separation) is lonely."11      Dr.  Cacioppo  theorizes  that loneliness is passed on through
negativity and lack of trust. "People who feel lonely view the social world as more threatening," he says. "They may not be aware they are doing it, but lonely individuals think negatively about other people. So if you are my friend, and I started to treat you negatively, then over time, we would stop being friends. But in the meantime, our interactions caused you to treat other people less positively, so you're likely to lose friends, and they in turn are likely to lose friends. That appears to be the means of
transmission for loneliness."12    Negative feelings can be passed on by people when they
frown or make unpleasant facial expressions, make negative comments, or even use anti-social body language.
 Ways to Overcome Loneliness

 Where caregivers of Veterans are actively trying to help, often Veterans are still isolated for long periods of time and may still struggle with loneliness. Still, there are ways to combat isolation and loneliness:

1.       Have a Purpose. Regardless of whether Veterans live alone, they can still have a purpose. Even with advancing age, there is a world of opportunity for Veterans to  identify a purpose for their lives. Veterans can record their personal and family history, learn a musical instrument, or start reading that volume of books about World War II that they’ve always wanted to.

10 See

One exciting way of having a purpose for seniors is starting a “Bucket List.” What have you dreamed of doing in this life? Where have you dreamed of traveling? Whether the answer to those questions is whale watching, eating a new food like calamari, or finally reading “War and Peace,” anything is possible.

Psychotherapist and author Ross Rosenberg recommends to those wanting to overcome loneliness: "Open yourself up, take risks, and allow yourself to be vulnerable. Since loneliness results in isolation, experiment by sharing aspects of yourself, including experiences, feelings, memories, dreams, desires, etc. This will help you feel more known and understood."13

2.       Get Involved. Veterans who are isolated are at greater risk of loneliness. "There's no hard-and-fast rule that everyone needs to be involved with others all the time, but we tend to feel better when we're with others, and we may feel worse if we're often alone," says Dr. Michael Craig Miller, a Harvard Medical School assistant professor of psychiatry.14

There are many ways to get involved in your community. From joining a club (e.g., bridge club, mahjong club, jazz club, etc.) to volunteering (e.g., helping provide information at a local shopping mall, delivering Meals On Wheels, becoming a mentor, tutoring, etc.), there are lots of ways to get involved. Most cities have local resources available for Veterans that has a calendar of events (e.g., women’s events, hikes, golf events, holiday ceremonies, encampments, job fairs, benefit open houses, gun shows, etc.).

If Veterans prefer to stay at home or have mobility limitations, there are more and more resources available online, including online book clubs, online family history, online games (e.g., chess, Scrabble, fantasy sports, etc.) and online classes (e.g., learning a musical instrument, cooking, dance, gardening, mechanics, learning a new language, lectures and podcasts, etc.).

"When you're alone, you focus too much on yourself and dwell on regrets or worries. When you're with other people, you turn your focus outward. When you're thinking less about yourself, you're worrying less about yourself," says Dr. Miller.15

3.       Take Advantage of New Technology. For decades aging Veterans have had very limited options for companionship while living at home, other than family or caregivers. A new company, Veras (, provides a cheaper and easier alternative. Veras provides senior home care via video calling and allows aging Veterans to stay in the place they most love--their homes.

Veras leverages simple video calling technology (similar to Skype or FaceTime) to pair aging seniors one-on-one with Veras Remote Companions to provide companionship and personal assistance. Veras Remote Companions provide medication reminders, schedule doctor appointments, play games, and provide companionship through conversation. Veras Remote Companions also help family members stay in the loop by sending weekly email reports about activities (Watch video at

Thankfully there is growing awareness around the problem of loneliness, and, where we all make efforts to help those around us, we can make a difference.

Ben Zimmer

Tuesday, January 23, 2018

Suicide Prevention: Helping Yourself and Others Step Away From the Ledge

Suicide Prevention: Helping Yourself and Others Step Back from the Ledge

Photo courtesy of Pixabay by PublicCo

By Jennifer Scott,

Chris Cornell. Robin Williams. Chester Bennington. What do all these names have in common? They all dealt with various addiction and substance abuse struggles. They all struggled with suicidal thoughts. And, ultimately, they all took their own lives.

There’s been a 40% increase in the suicide rate in the last decade. Nearly 80% of those who commit suicide are male. Suicide is one of the leading causes of death, and is expected to overtake cancer deaths within the next 15 years. In fact, one person commits suicide every 15 minutes.

Some argue that suicide has become an epidemic in our society - with someone taking their own life every fifteen minutes. This has led to comparisons between the suicide epidemic and the cancer epidemic, with suicide and depression estimated to overtake cancer as one of the leading causes of death in the next 15 years. Russell Brand has even theorized that cultural changes in the developed world have led to an increase in the number of suicides each year.

It sometimes feels like there’s a new report of someone committing suicide on the news each week. For those who are struggling with depression, substance abuse, or suicidal thoughts, it can feel like the world is bleak and that there is no hope to be found. Nothing could be further from the truth.

There’s an unspeakable amount of grief and disbelief when we lose someone to suicide. Suicidal thoughts can happen to anyone, but that doesn’t mean we’re without hope. Luckily, there are some things you can do to help yourself and/or your loved ones:

Here are some things you can do:

Reduce the Stigma
Talk about mental illness, depression and suicide in the same way that you would talk about diseases like cancer. Spread awareness. Help share resources, crisis hotline numbers and prevention strategies. Avoid criticisms, name-calling, casting blame or showing judgment. You never know what someone else was secretly dealing with. Mental health conditions are every bit as serious as physical conditions like cancer, and should be treated as such.

Emergency Resources
If you or a loved one are dealing with suicidal thoughts, it can be immediately beneficial to talk to someone for help. Not only does this let you know you’re not alone; it can also provide coping mechanisms to help get through your current situation. There are many nonprofits and resources available to assist those in need. Here’s a list of suicide prevention & crisis hotlines available around the world.

Long-term Prevention Strategies
Even if you’re not currently in crisis, it is helpful to have a longer term strategy in case suicidal thoughts ever return. Prioritize your mental health care and make lifestyle changes to assist you in coping with your depression during difficult times. This might include surrounding yourself with positive, supportive people; being aware of the suicide prevention resources listed above; becoming more involved in your local church or faith-based organization; kicking an addiction or substance abuse issue; or even picking up a healthy habit such as yoga or meditation.

Losing even one person to suicide each year is losing too many. Suicides are preventable. Please use and share the crisis resources and suicide prevention strategies listed above. You never know whose life they might save - possibly even your own.

Jennifer Scott

Thursday, March 2, 2017

VA Caregiver Program Changes & Awareness Recommendations

Points of new awareness about the VA Caregiver Program:

Please be certain to research beyond private, secret, and open Caregiver Communities on social media.  Rumors can spread like wildfire, even when the information is not accurate.  Rising anxiety levels within the family rarely does anyone good.  Find out the facts first.  Note that VeteranCaregiver goes directly to the VA Central Office with questions raised on specific processes, caregiver law, and changes.  The answers are not always clear and often raise more questions -- but these are direct responses from Caregiver Program Leadership.  

Something one Caregiver Support Coordinator tells you does not always confirm national guidance.  Each VISN has the flexibility to implement the program (*within the parameters of the Caregiver law*) differently.  We already posted the official response to new phrases used in 2016 regarding “short-term recovery program”, “graduation”, and the significant reductions in Tier 3 caregiving.  According to the VA, there are no quotas, no changes in eligibility requirements, and no changes in ADL measurement. Note possible discrepancies to the law, with date, person, VAMC, requests for clarification in writing and attach a Read Receipt to the short message.

ADL’s still form the basis for eligibility, as do safety and protection elements.  Here is an excellent example of the detail you may need to explain about only a single ADL:  bathing independently.  See below and other questions and responses may be found on’s website in the “Ask Questions Here” section on the Homepage:

This is a great example of when detail explains what the needs are. If you haven’t already, write all this down, since if the questions are not asked about detail, then assumptions are made. What you describe fits the definition of needing assistance with bathing, but if the right questions aren’t asked, or the vet glosses over his not wanting to say personal details, there is a chance that this will be overlooked. Write this up and ask that the evaluator/RN/PCM add it to his medical records.

If you need to appeal a VA decision, you will need to know the precise reasons to address points specifically in your appeals documentation.  Appeal justification is best explained using language similar to the clinical language provided to you as the reasons for the caregiver program change in status.  Specific points, evidence, and documentation is best delivered in a succinct document, and excess emotion removed. Abusive language is not advised even if you feel it is warranted.

Appeals timing of document submission will vary from VAMC to VAMC, but will be shared with you upon request.  Also ask specifically for "confirmation of the receipt of the documents for appeal", and again request "confirmation that the Appeals Panel reviewed the materials prior to their decision" in writing.  Note the timing of decision letters and the receipt of documents.

There are separate VA non-medical databases that contain feedback on the caregiver and veteran.  This information may not be available to those reviewing appeals, and request copies of both the Patient Advocate Tracking System (PATS) notes, and any Caregiver Application Tracking System (CATS) notes.  (This may mean a FOIA request.) The noted information may be used for decisions and unless you’ve verified the information is correct, or that information is missing, your status may be adversely affected.  It appears that access to this information varies per VAMC.

The specific reasons for Caregiver Program reduction or termination" will be explained to you in a transparent, understandable manner" per VACO.  It’s best to receive this in writing, and we have seen only a single VA do this in the status change letter.  You may request to record a Skype call if you’re far from the VA and a meeting is offered, and you may request to tape a meeting for an in-person meeting.  We recommend responses in writing so you can review and compare to your veteran’s needs, the responses used for the decision, if records were changed or missing, and to determine your response.

Trust, but verify information.  It is very possible to receive a VA response that is accurate, but literal.  If you don’t receive direct answers to questions, rephrase them politely in an email and request clarification of the response.  It should not be necessary when direct responses and transparency would be more efficient, but ... Make use of an outside advocate (AW2, Legion, AMVETS, etc.) when in doubt.

Please stay informed, use trusted resources and advocates, and know how absolutely vital caregivers are to the care of our nation’s wounded, ill, and injured.  We will continue to post direct VACO Caregiver Program responses to your questions for your increased awareness.

Linda Kreter & the VeteranCaregiver Team