I support the comments made by the Virginia Ability Alliance.

Specifically, the first paragraph under "Service Conflicts" on page 3 accurately describes the need to receive both Private Duty Nursing (PDN) and Skilled Nursing. Most of the Private Duty Nurses who cared for a family member where at best adequate for the best days. Only 5 nurses out of over 100 I oriented in 6 years were good enough for the worst days. Without Skilled Nursing, a family member, who was not a trained medical professional, had to intervene consistently to ensure proper medical care was administered.

Additionally, the paragraph on page 4 addressing customized rates accurately describes the need for better pay for PDN. The customized rate would help companies mitigate the problem described above by providing more nurses good enough for the worst days without the need for Skilled Nursing. In the final 2 years of trying to care for the family member in the home with 24 hours/day, 7 days/week PDN provided by the waiver, only 3 weeks out of the 104 were completely staffed. The customized rate would help companies recruit and retain more nurses so shifts could be filled.

The VA waiver system failed my family member. The results were institutionalization at greater expense to the VA taxpayer and a less inclusive environment for the individual far from the family.