By Grace Vitaglione
John David Large, 42, is a caregiver for his father, John Meade Large, a veteran with esophageal cancer in Buncombe County. The 75-year-old served in the Vietnam War from 1969 to 1971. He’s undergone radiation and is now on home hospice care.
Large does the cooking, cleaning and shopping and takes care of his father’s medications so his mother can stay with his father.
When the family learned that then-Hurricane Helene was headed for western North Carolina, Large said they weren’t too worried at first.
‘But then all of a sudden [we realized], ‘Oh goodness — this is going to be a little worse than we thought,’” he said.
Their house wasn’t damaged in the storm, but they lost power for a couple weeks and were under the water boil advisory for a month and a half.
A few days after the storm hit, their neighbor Kristen Barlow knocked on the door. She and her family were evacuating, but she wanted to drop off food and bottled water first. Barlow, who works with the regional VA system, learned about John Meade’s condition and directed the family to the Caregiver Support Program through the local team at the Charles George Department of Veterans Affairs Medical Center in Asheville.
“My heart had just gone out to them after hearing their story,” she said.
The Asheville caregiver support team currently serves 546 veterans and 618 caregivers, according to manager Patricia Kitlasz. The program provides resources such as monthly stipends, respite care, support groups and training. The Asheville team was able to process around 60 more applications for the program since Helene hit in late September, Kitlasz said, despite some staff losing family members and being without water or electricity.
The devastation caused by the Helene stormwaters and winds is particularly challenging for medically vulnerable groups, such as disabled veterans and others with chronic medical needs.
The younger Large was able to get a stipend through the program to support him and his parents. He had to retire from working in construction for 20 years to take care of his father around two years ago. The first installment of the stipend for a month and a half was around $5,000 — he put most of it in savings.
“Just in case something happens with the house or Dad needs something, I can make sure I can get it for him and it’s there if I need it,” he said.
Expanded access
The Caregiver Support Program is made up of two other programs. One program offers enhanced clinical support and services — such as a monthly stipend — for caregivers of eligible veterans who have a serious injury or illness and require in-person personal care services. The second provides resources such as peer support mentoring, skills training and coaching to caregivers.
The Caregiver Support Program was started in 2008 and started accepting post-9/11 veteran applications for comprehensive assistance in 2010, according to Colleen Richardson, a doctor in clinical psychology and executive director of the Caregiver Support Program in the U.S. Department of Veterans Affairs. The federal VA MISSION Act passed by Congress in 2018 expanded the program to veterans of all service eras in phases.
Richardson said the program’s funding is determined by the president’s budget each fiscal year. While it can change year to year, the program has been “well-funded for many years,” she said.
The U.S. Department of Veterans Affairs also announced a proposal to expand the comprehensive assistance program’s eligibility Dec. 5, as well as to reassess eligibility less frequently and expand access to telehealth. The proposed rule is open for public comment.
Richardson pointed to respite care as one of the most important pieces of the program, as it allows caregivers time to recover and re-energize while someone else takes care of the veteran.
The monthly stipend, which comes to families through the comprehensive assistance side of the program, is based on 40 or 20 hours of care a week, until the veteran either improves and is discharged from the program or dies.
The program also offers 90 days of the stipend and additional resources after the veteran dies, she said.
The Asheville program is unique in that they have dementia care groups, Richardson said, as well as book clubs and drop-in groups where caregivers can share what’s going on in their lives.
‘Little wins’
Barlow, the Larges’ neighbor, is a clinical psychologist and works on the Centralized Eligibility and Appeals team, which reviews applications for the Caregiver Support Program to determine whether they’re eligible. The team is within the regional VA system, known as VISN 6 . That’s how she knew to point the Larges toward the program, although she wasn’t involved in their application process due to the conflict of interest.
After returning home to the Asheville area, she and her family went trick or treating and stopped at the Larges’ house first. John David told her they had been approved for the program.
“The Asheville team really were the boots on the ground in the middle of the biggest natural disaster to ever hit this area,” Barlow said.
Kitlasz, who manages the Asheville caregiver support team, said one of the reasons they worked to approve Large’s application so quickly was because his father was on hospice care.
Kitlasz’ team includes registered nurses and social workers who gather information from the veteran and caregiver and send it to the department where Barlow works to review for eligibility. If the veteran is determined eligible, the application goes back to the local team. The caregiver then receives training, and the local team does a home visit to make sure that the veteran has what they need to remain safe and that the caregiver can give them the best care, she said.
The staff got John Meade Large onto service within 20 days. Most people are enrolled within 60 to 90 days, she said, but the team was able to process 60 applications since the storm hit.
“We’ve kept up a pace which is pretty remarkable,” Kitlasz said.
Some team members had to wash in a creek behind their house while without water or electricity. One couldn’t leave his neighborhood for two days. Some lost family members.
Meanwhile, the staff worked “however they could,” she said. Some drove to where a cell tower was operating and worked from there. The staff also kept an updated list of resources in the affected areas and had help from the VISN 6 team, who conducted wellness checks and helped process applications.
Throughout Helene recovery, there have been “little wins,” Kitlasz said. A few days ago, one of her team members said their three daughters were finally able to shower in their own bathrooms for the first time since the storm hit.
Community connection
The Larges also received a $3,400 grant through a VA benefit that helps pay for home improvements or structural alterations to a home to facilitate caregiving. The family used those funds to install a walk-in shower for John Meade. He only got to use the shower once before becoming too feeble, Large said.
“It really sucks for him,” Large said. “He at least got to use it one time. That was kind of a kick in the you-know-whats.”
Large said he would like to become a mentor to other caregivers after his father passes away.
Barlow said the experience made her realize how important it is to just knock on your neighbor’s door.
“The community and the neighbors helping veterans — and the community outreach — it just brings tears to your eyes when you think about it,” she said.
For those interested in applying to the Caregiver Support Program, they can call the hotline at 855-260-3274 to connect with a social worker. They can also visit the website to learn more. Critical updates about the emergency response to Helene aimed at local veterans are available here.
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