Caregiver Support in a Case of Posttraumatic Stress Disorder and Lewy Body Dementia

The US Department of Veterans Affairs (VA) Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides assistance for at-home caregiving of veterans and defers the costs of care for veterans. In October 2020, PCAFC eligibility expanded to include Vietnam-era veterans.

We present the case of a Vietnam-era veteran with posttraumatic stress disorder (PTSD) and Lewy body dementia (LBD) who over years of care developed worsening symptoms from his illnesses, including behaviors and psychological symptoms of dementia. Recurrent behavioral episodes and issues with home safety, along with his caregiver's financial need to continue working, led the patient to being placed in a VA-contracted skilled nursing facility. However, expanded PCAFC eligibility enabled a transfer back to in-home living. We discuss PCAFC expansion and examine trends in veteran health that point to a large burden of dementia and PTSD on both veterans and their caregivers.

This case demonstrates how the PCAFC expansion is likely to benefit other older veterans with service-connected disability, PTSD, and/or dementia. These veterans may now be eligible for a service and funds that may enable at-home living. This expansion has policy implications as the VA manages the budget of this program and institutes measures to limit abuse and waste, as well as research implications as the PCAFC is used to enable at-home aging as an alternative to aging with dementia in a facility.