[Congressional Record Volume 155, Number 40 (Friday, March 6, 2009)]
[Senate]
[Pages S2866-S2869]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself, Mrs. Hutchison, Mr. Begich, and Mr. 
        Udall of New Mexico):
  S. 543. A bill to require a pilot program on training, certification, 
and support for family caregivers of seriously disabled veterans and 
members of the Armed Forces to provide caregiver services to such 
veterans and members, and for other purposes; to the Committee on 
Veterans' Affairs.
  Mr. DURBIN. Mr. President, in the Spring of 2007, I met a 27-year-old 
Army Sergeant named Eric

[[Page S2867]]

Edmondson. Eric was injured while serving in Iraq. During surgery to 
treat his injuries, his brain was deprived of oxygen for a period of 
time, and is now seriously disabled. It has been my honor to get to 
know Eric and his family. I am humbled and inspired by their shared 
struggle, pain, triumph and sacrifice as they have worked to help Eric 
recover as much mobility and independence as possible.
  Today I am introducing the Veteran and Servicemember Family Caregiver 
Support Act of 2009, along with several other Senators. This bill 
proposes a program that would provide technical, financial and 
practical support for families like Eric's, families who are now caring 
for a veteran or a returning servicemember whose disability requires 
institutional or home-based care.
  The first version of this bill was introduced in the last Congress by 
then-Senator Hillary Clinton. She already knew what many of us are now 
learning. Families all across the country are figuring out how best to 
care for returning servicemembers and veterans who are coming home with 
serious disabilities. We are recognizing that these families need more 
support than what most of them are finding.
  This bill lays out a strong family caregiver support program. The 
program is for those seriously disabled veterans and servicemembers who 
have a family member willing and able to provide care at home. We want 
to recognize that sacrifice, which probably involved a significant loss 
of income, and the value of the care they are providing. So the program 
addresses four key concerns--training and certification, payment for 
services, respite care, and, finally, mental health and social support 
services.
  The first step is to provide training for those family members who 
become a primary caregiver for a seriously disabled veteran or 
servicemember. It is common for family members to have some informal 
training, but we should formalize that. Figure out what training 
caregivers need and make sure they receive it. From changing burn wound 
dressings to wheelchair transfers, caregivers need the skills and 
knowledge to offer high quality, home-based care. The bill I am 
introducing today calls on VA and DoD to develop and offer training and 
a certification program for family caregivers.
  We also need to pay for the services these trained and certified 
family caregivers provide. Amount of payment would be determined by the 
VA and DoD based on the amount and level of care required for each 
participant. Costs would be paid by VA, with DoD reimbursement to VA 
for services benefiting servicemembers. It is only fair that care 
provided by family caregivers, care for which the government would 
otherwise be responsible, is acknowledged. Qualified family caregivers 
are often forgoing other income, even while providing a service of real 
value.
  Respite care is another important part of this program. Caregivers 
need time off. They deserve time off. VA and DoD have respite care 
programs, but they are underutilized because the programs are 
inflexible, waiting lists are long, or providers are not available 
nearby. That is especially true in more rural areas. In this bill, we 
provide for an alternate caregiver to be trained and certified who can 
fill in for the primary caregiver as needed. We've also asked the VA to 
study further options to improve the availability of respite care.
  Finally, our bill directs VA and DoD to provide mental health 
services to family caregivers when those needs are related to the 
provision of care. For example, depression is almost twice as likely 
among caregivers as it in the general population. The caregiver program 
would provide an assessment of the caregiver's needs and referral to 
relevant services if necessary.
  Members of the armed services came forward and served when duty 
called. As many as 6,800 of them have come home from the Afghanistan 
and Iraq wars unable to perform daily functions or live independently. 
Now it is time for the U.S. to come forward with support for those who 
are able to live at home because a family member is willing to provide 
the care they need.
  The sacrifices these family caregivers make are substantial, and can 
greatly affect their long-term well-being. Most have to give up their 
jobs outside the home, relinquishing health and retirement benefits and 
future earning power in the process. It is not uncommon for a family to 
move across the country in search of the best care for their injured 
loved one. We owe it to them to provide assistance as they care for 
their loved ones, who are our heroes.
  A strong family caregiver support program also makes good economic 
sense. Right now, families are providing the care that VA and DoD have 
a responsibility to provide, but the families bear the cost. Because 
these families are providing care without payment or support, the costs 
of the care is made invisible to VA and DoD.
  The VA recognizes the economic benefits of providing preventive care 
to veterans, and acknowledges that informal caregivers are an important 
source of providing such care. A recent VA study notes that ``providing 
supportive services to caregivers will most likely help reduce the care 
costs for patients . . . as they will require less use of emergency 
care, institutionalization, and VHA services, while also improving 
caregiver and patient outcomes.'' Finally, support programs for 
caregivers keep the veteran with his or her family, delaying the day VA 
will be obligated to provide more expensive institutional care.
  In testimony before Congress in 2007, Donna Shalala, as co-chair of 
the Dole-Shalala Commission, stated: ``many families are caring for 
their injured servicemember at home--and many of these servicemembers 
have complex injuries. These families, forced into stressful new 
situations, don't need more anxiety and confusion, they need support. 
Families are unprepared to provide 24/7 care. Those that try, wear out 
quickly.''
  We have an opportunity to step up to ensure that veterans can have 
the best care possible in return for their service to our country. Many 
of those who have been seriously injured in Iraq or Afghanistan have 
families who have made enormous sacrifices to provide care. We owe 
these families a helping hand to ensure that they have the tools and 
resources they need to provide the best care for their--and our--
veterans.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 543

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Veteran and Servicemember 
     Caregiver Support Act of 2009''.

     SEC. 2. FINDINGS.

       Congress makes the following findings:
       (1) Since September 11, 2001, at least 6,800 veterans have 
     been injured and are living with disabilities severe enough 
     to require in-home type care.
       (2) Even with their disability benefits, the majority of 
     seriously wounded veterans and their families are not in a 
     strong financial position.
       (3) In testimony before Congress in 2007, Donna Shalala, 
     cochair of the Dole-Shalala Commission, stated that 
     ``families are unprepared to provide 24/7 care. Those that 
     try, wear out quickly''.
       (4) The best quality private rehabilitation facilities have 
     expertise in training family members to provide appropriate 
     care.
       (5) Current in-home care programs have limited availability 
     and are severely underutilized. Patients who obtain in-home 
     care from such programs receive only about \2/3\ of the hours 
     of care to which they are entitled.

     SEC. 3. PILOT PROGRAM ON THE TRAINING, CERTIFICATION, AND 
                   SUPPORT OF FAMILY CAREGIVERS IN PROVISION OF 
                   CAREGIVER SERVICES TO CERTAIN DISABLED VETERANS 
                   AND MEMBERS OF THE ARMED FORCES.

       (a) In General.--The Secretary of Veterans Affairs shall, 
     in collaboration with the Secretary of Defense, carry out a 
     pilot program to assess the feasibility and advisability of 
     providing training, certification, and support for eligible 
     family caregivers of eligible veterans and members of the 
     Armed Forces to provide caregiver services to such veterans 
     and members.
       (b) Duration of Program.--The Secretary of Veterans Affairs 
     shall commence the pilot program not later than 180 days 
     after the date of the enactment of this Act and shall carry 
     out the pilot program during the two-year period beginning on 
     the date of such commencement.
       (c) Locations.--
       (1) In general.--The pilot program shall be carried out at 
     not fewer than 6 facilities of the Department of Veterans 
     Affairs or the Department of Defense, or other appropriate 
     entity, selected by the Secretary of Veterans

[[Page S2868]]

     Affairs for purposes of the pilot program. Of the facilities 
     so selected--
       (A) at least one shall be a private facility with expertise 
     in providing rehabilitative care; and
       (B) at least one shall be a Department of Veterans Affairs 
     Medical Center in a rural area that serves eligible veterans.
       (2) Emphasis on polytrauma centers.--In selecting locations 
     for the pilot program at facilities of the Department of 
     Veterans Affairs, the Secretary shall give special emphasis 
     to the polytrauma centers of the Department designated as 
     Tier I polytrauma centers.
       (3) Private facilities.--The Secretary may not select a 
     private facility as a location for the pilot program unless 
     the facility is a licensed inpatient rehabilitation facility 
     with significant experience in traumatic brain injury, 
     traumatic spinal cord injury, burn, and amputee 
     rehabilitation.
       (4) Collaboration.--Private facilities and facilities of 
     the Department of Defense selected for purposes of the pilot 
     program shall collaborate with nearby facilities of the 
     Department of Veterans Affairs.
       (d) Eligible Family Caregivers.--
       (1) In general.--For purposes of this section, an eligible 
     family caregiver of a veteran or member of the Armed Forces 
     is a family caregiver of an eligible veteran or member of the 
     Armed Forces who--
       (A) agrees to provide caregiver services to such eligible 
     veteran or member;
       (B) is accepted by such eligible veteran or member as the 
     veteran's or member's provider of caregiver services; and
       (C) is determined, under regulations prescribed by the 
     Secretary of Veterans Affairs or the Secretary of Defense, as 
     applicable, to be qualified to provide caregiver services 
     under the pilot program.
       (2) Replacement.--If the Secretary of Veterans Affairs or 
     the Secretary of Defense, as applicable, determines that a 
     family caregiver who is determined qualified under paragraph 
     (1)(C) to provide caregiver services to an eligible veteran 
     or member of the Armed Forces, as the case may be, is no 
     longer qualified to provide such services--
       (A) such family caregiver shall no longer be considered an 
     eligible family caregiver for purposes of the pilot program; 
     and
       (B) such Secretary may, with the agreement of the veteran 
     or member of the Armed Forces concerned, designate as a 
     provider of caregiver services for such veteran or member for 
     purposes of the pilot program any other individual who 
     qualifies as an eligible family caregiver of such veteran or 
     member under this subsection.
       (3) Limitation.--The Secretary of Veterans Affairs and the 
     Secretary of Defense may not qualify more than one concurrent 
     family caregiver per eligible veteran or member of the Armed 
     Forces under paragraph (1)(C).
       (4) Construction.--Nothing in this section may be construed 
     to limit the authority of the Secretary of Veterans Affairs 
     or the Secretary of Defense to deny or discontinue 
     participation of a family caregiver in the pilot program if 
     such action is in the best interest of the veteran or member 
     of the Armed Forces concerned.
       (e) Eligible Veterans and Members of the Armed Forces.--For 
     purposes of this section, an eligible veteran or member of 
     the Armed Forces is a veteran or member of the Armed Forces--
       (1) who--
       (A) has a service-connected disability that was incurred or 
     aggravated on or after September 11, 2001; and
       (B) requires caregiver services because of such service-
     connected disability, as determined by the Secretary of 
     Veterans Affairs or the Secretary of Defense as applicable;
       (2) who is otherwise determined to be eligible for the 
     pilot program by the Secretary of Veterans Affairs or the 
     Secretary of Defense, as applicable.
       (f) Identification and Notification of Eligible Veterans 
     and Members of the Armed Forces.--
       (1) Identification and notification of eligible veterans.--
       (A) Identification.--Not later than 180 days after the date 
     of the enactment of this Act, the Secretary of Veterans 
     Affairs shall conduct a review to identify veterans eligible 
     to participate in the pilot program.
       (B) Notification.--The Secretary of Veterans Affairs shall 
     notify each veteran who is identified as an eligible veteran 
     pursuant to the review required by subparagraph (A) of--
       (i) the eligibility of the veteran to participate in the 
     pilot program; and
       (ii) the means by which the veteran may be accepted for 
     participation in the pilot program.
       (2) Identification and notifications of eligible members of 
     the armed forces.--
       (A) Identification.--Not later than 180 days after the date 
     of the enactment of this Act, the Secretary of Defense shall 
     conduct a review to identify members of the Armed Forces 
     eligible to participate in the pilot program.
       (B) Notification.--The Secretary of Defense shall notify 
     each member of the Armed Forces who is identified as an 
     eligible member of the Armed Forces pursuant to the review 
     required by subparagraph (A) of--
       (i) the eligibility of the member to participate in the 
     pilot program; and
       (ii) the means by which the member may be accepted into the 
     pilot program.
       (g) Training and Certification.--
       (1) Provision of training and certification.--
       (A) Training.--The Secretary of Veterans Affairs shall 
     provide training to each eligible family caregiver 
     participating in the pilot program in the provision of family 
     caregiver services. The training shall utilize curricula 
     developed under paragraph (2).
       (B) Certification.--Upon the successful completion by a 
     family caregiver of training provided under paragraph (1), 
     the Secretary of Veterans Affairs shall certify the family 
     caregiver as a provider of family caregiver services for 
     purposes of the pilot program. Successful completion of 
     training shall be determined utilizing certification criteria 
     developed under paragraph (2).
       (2) Training curricula and certification criteria.--
       (A) In general.--The Secretary of Veterans Affairs shall, 
     in consultation with the individuals specified in 
     subparagraph (B), develop for purposes of the pilot program 
     the following:
       (i) Curricula for the training of eligible family 
     caregivers in the provision of family caregiver services, 
     including training on techniques, skills, and strategies for 
     the provision of such services.
       (ii) Criteria for the evaluation of successful completion 
     of such training for purposes of certification under 
     paragraph (1)(B).
       (B) Consultation.--The individuals specified in this 
     subparagraph are the following:
       (i) The Secretary of Defense.
       (ii) A representative of family caregivers or family 
     caregiver associations.
       (iii) A health or medical employee of the Department of 
     Veterans Affairs with expertise in long-term care for 
     seriously injured veterans.
       (iv) A health or medical employee of the Department of 
     Defense with expertise in long-term care for seriously 
     injured members of the Armed Forces.
       (v) A psychologist or other individual with expertise in 
     the provision of mental health care to individuals in need of 
     home-based or nursing home care.
       (vi) An expert in the development of training curricula.
       (vii) A family member of a veteran in need of home-based or 
     nursing home care.
       (viii) A family member of a member of the Armed Forces in 
     need of home-based or nursing home care.
       (ix) A representative from a veterans service organization, 
     as recognized by the Secretary of Veterans Affairs for the 
     representation of veterans under section 5902 of title 38, 
     United States Code.
       (x) Such other individuals as the Secretary of Veterans 
     Affairs, in consultation with the Secretary of Defense, 
     considers appropriate.
       (C) Scope of curricula.--The Secretary of Veterans Affairs 
     shall ensure that the curricula developed under subparagraph 
     (A)(i)--
       (i) is based on empirical research and validated 
     techniques; and
       (ii) provides for training that permits recipients of the 
     training to tailor the provision of caregiving services to 
     the unique circumstances of the veteran or member of the 
     Armed Forces receiving such services.
       (D) Use of existing curricula.--In developing curricula 
     under subparagraph (A)(i), the Secretary of Veterans Affairs 
     shall, to the extent practicable, utilize and expand upon 
     training curricula developed pursuant to section 744(b) of 
     the John Warner National Defense Authorization Act for Fiscal 
     Year 2007 (Public Law 109-364; 120 Stat. 2309).
       (3) Travel expenses.--The Secretary of Veterans Affairs may 
     provide for necessary travel, lodging, and per diem expenses 
     incurred by a family caregiver in undergoing certification 
     and training under paragraph (1).
       (h) Payment of Family Caregivers.--
       (1) In general.--An eligible family caregiver of an 
     eligible veteran or member of the Armed Forces certified 
     under subsection (g) in the provision of caregiver services 
     under the pilot program shall be paid by the Department of 
     Veterans Affairs for the provision of caregiver services to 
     such veteran or member, as the case may be, under the pilot 
     program.
       (2) Amount of payment.--Payment provided a family caregiver 
     under paragraph (1) for care provided to a veteran or member 
     of the Armed Forces shall be in amounts the Secretary of 
     Veterans Affairs considers reasonable upon consideration of 
     the following:
       (A) The amount of care and the intensity of the care 
     required by the veteran or member.
       (B) The cost to the Department of Veterans Affairs of 
     otherwise providing such care through another 
     noninstitutional care provider.
       (C) Low-utilization payment adjustment mechanisms under the 
     prospective payment system for home health services 
     established under section 1895 of the Social Security Act (42 
     U.S.C. 1395fff) calculated for the geographic area of the 
     family caregiver.
       (D) Such other factors as the Secretary considers 
     appropriate.
       (3) Coordination with state self-directed personal 
     assistance services program.--The Secretary of Veterans 
     Affairs may provide payment under paragraph (1) to an 
     eligible family caregiver in coordination with the self-
     directed personal assistance services program of the State of 
     the family caregiver to the extent the State has elected to 
     provide medical assistance to an eligible veteran or member 
     of the Armed Forces under the State Medicaid program.
       (i) Respite Care.--

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       (1) Review of respite care programs.--The Secretary of 
     Veterans Affairs shall review the respite care programs of 
     the Department of Veterans Affairs and the Secretary of 
     Defense shall review the respite care programs of the 
     Department of Defense that are available to family caregivers 
     to assess the adequacy, flexibility, and age-appropriateness 
     of the facilities under such programs. The review shall 
     include a particular focus on respite care programs for rural 
     areas.
       (2) Study on enhancement of availability of respite care.--
     The Secretary shall carry out a study to identify appropriate 
     options for enhancing the availability of respite care for 
     family caregivers. The study shall include an assessment of 
     the advisability of allowing a veteran's primary treating 
     physician to approve respite care in excess of 30 days to 
     make as-needed respite care more available and convenient for 
     family caregivers.
       (3) Enhancement of availability of respite care.--The 
     Secretary shall take measures to enhance the availability of 
     respite care for family caregivers participating in the pilot 
     program, including the following:
       (A) Training and certifying alternate family caregivers 
     using the curricula developed under subsection (g)(2).
       (B) Paying expenses incidental to training of alternate 
     family caregivers, including travel expenses.
       (C) Such other measures as the Secretary considers 
     appropriate.
       (j) Psychological and Social Support Services.--
       (1) In general.--The Secretary of Veterans Affairs shall, 
     in collaboration with the Secretary of Defense, make 
     available to each eligible family caregiver participating in 
     the pilot program counseling and social services related to 
     the provision by the family caregiver of caregiving services 
     to an eligible veteran or member of the Armed Forces. Such 
     counseling and social services shall include the following:
       (A) An assessment of individualized needs of the family 
     caregiver with respect to the family caregiver's role as a 
     family caregiver.
       (B) Assistance with development of a plan for long-term 
     care of the veteran or member concerned.
       (C) Services and support relevant to any needs identified 
     under subparagraph (A) provided through--
       (i) facilities of the Department of Veterans Affairs or the 
     Department of Defense located in the community in which the 
     family caregiver resides; or
       (ii) in the case that no such facilities are available in a 
     timely manner, community-based organizations or publicly-
     funded programs.
       (2) Use of existing tools.--In developing and administering 
     assessments under paragraph (1)(A), the Secretary shall, to 
     the extent practicable, use and expand upon caregiver 
     assessment tools already developed and in use by the 
     Department of Veterans Affairs or the Department of Defense.
       (k) Reports.--
       (1) Two-year report.--
       (A) In general.--Not later than two years after the date of 
     the commencement of the pilot program, the Secretary shall, 
     in conjunction with the Secretary of Defense, submit to the 
     appropriate congressional committees a report on the pilot 
     program.
       (B) Contents.--The report required by paragraph (1) shall 
     include the following:
       (i) An assessment of the pilot program.
       (ii) An accounting of the costs to the Department of 
     Veterans Affairs and the Department of Defense of the pilot 
     program.
       (iii) A comparison of the costs to the Department of 
     Veterans Affairs and the Department of Defense of the pilot 
     program with the cost to the Departments of otherwise 
     providing caregiver services to the veterans and members of 
     the Armed Forces who received such services under the pilot 
     program, including the cost of providing care to such 
     veterans and members of the Armed Forces who would otherwise 
     require inpatient care.
       (iv) The recommendations of the Secretary with respect to--

       (I) the feasibility and advisability of extending the pilot 
     program or making the pilot program permanent; and
       (II) modifying the pilot program.

       (v) An assessment of the effect of the pilot program on--

       (I) the health of veterans receiving care under the pilot 
     program; and
       (II) the financial burdens of family caregivers caused by 
     the provision of caregiver services to veterans.

       (vi) Any determinations made by the Secretary under 
     subsection (o).
       (2) Bi-annual reports of medical facilities.--Not later 
     than 180 days after the date on which a medical facility is 
     selected as a location for the pilot program and not less 
     frequently than once every 180 days thereafter, the medical 
     facility shall submit to the director of the Veterans 
     Integrated Services Network (VISN) in which the facility is 
     located a report that describes--
       (A) the number of veterans enrolled in the pilot program 
     through such facility; and
       (B) if there is a waiting list to participate in the pilot 
     program through such facility--
       (i) the number of people on such list; and
       (ii) the average wait time before admission into the pilot 
     program.
       (l) Funding.--
       (1) Costs of care provided to veterans.--Any expenditure 
     under the pilot program relating to the provision of 
     caregiver services to a veteran shall be borne by the 
     Department of Veterans Affairs.
       (2) Costs of care provided to members of the armed 
     forces.--
       (A) In general.--The Secretary of Defense shall reimburse 
     the Secretary of Veterans Affairs for any expenditure 
     incurred by the Department of Veterans Affairs under the 
     pilot program relating to the provision of caregiver services 
     to members of the Armed Forces.
       (B) Source of funds.--Amounts for reimbursement under 
     subparagraph (A) shall be derived from amounts made available 
     to Defense Health Program for the TRICARE program.
       (m) Limitation on Spending.--In providing for the provision 
     of services under the pilot program, the Secretary of 
     Veterans Affairs shall make payment for services only to the 
     extent that payment for such services is not otherwise 
     covered by another government or nongovernment entity or 
     program.
       (n) Construction.--
       (1) Employment.--Nothing in this section shall be construed 
     to create an employment relationship between a family 
     caregiver and a veteran or member of the Armed Forces, the 
     Department of Veterans Affairs, or the Department of Defense.
       (2) Eligibility for benefits.--Nothing in this section 
     shall be construed to reduce, alter, or otherwise affect the 
     eligibility or entitlement of a veteran, member of the Armed 
     Forces, or dependent thereof, to any health care, disability, 
     or other benefit to which such veteran, member, or dependent 
     would otherwise be eligible or entitled under laws 
     administered by the Secretary of Veterans Affairs or the 
     Secretary of Defense.
       (o) National Expansion of Pilot Program.--Not later than 
     the completion of the two-year period described in subsection 
     (b), the Secretary of Veterans Affairs shall, in consultation 
     with the Secretary of Defense, expand the pilot program to 
     provide training, certification, and support for eligible 
     family caregivers nationwide unless the Secretary of Veterans 
     Affairs, in consultation with the Secretary of Defense, 
     determines that such revision would be infeasible or 
     inadvisable.

     SEC. 4. SURVEY OF INFORMAL CAREGIVERS.

       (a) In General.--The Secretary of Veterans Affairs shall, 
     in collaboration with the Secretary of Defense, conduct a 
     national survey of family caregivers of seriously disabled 
     veterans and members of the Armed Forces to better understand 
     the size and characteristics of the population of such 
     caregivers and the types of care they provide.
       (b) Report.--Not later than 540 days after the date of the 
     enactment of this Act, the Secretary of Veterans Affairs 
     shall, in collaboration with the Secretary of Defense, submit 
     to Congress a report containing the findings of the Secretary 
     with respect to the survey conducted under subsection (a). 
     Results of the survey shall be disaggregated by the 
     following:
       (1) Veterans and members of the Armed Forces.
       (2) Veterans and members of the Armed Forces who served in 
     Operation Iraqi Freedom or Operation Enduring Freedom.
       (3) Veterans and members of the Armed Forces who live in 
     rural areas.

     SEC. 5. DEFINITIONS.

       In this Act:
       (1) Appropriate congressional committees.--The term 
     ``appropriate congressional committees'' means--
       (A) the Committee on Veterans' Affairs, the Committee on 
     Armed Services, and the Committee on Appropriations of the 
     Senate; and
       (B) the Committee on Veterans' Affairs, the Committee on 
     Armed Services, and the Committee on Appropriations of the 
     House of Representatives.
       (2) Caregiver services.--The term ``caregiver services'' 
     means noninstitutional extended care (as used in section 
     1701(6) of title 38, United States Code), including homemaker 
     and home health aid services.
       (3) Family caregiver.--The term ``family caregiver'' means, 
     with respect to a disabled veteran or member of the Armed 
     Forces, a family member of such veteran or member, or such 
     other individual of similar affinity to such veteran or 
     member as the Secretary prescribes, who is providing 
     caregiver services to such veteran or member for such 
     disability.

                          ____________________