Current Bill Developments

The Heroes at Home Act has been referred to the House of Veteran's Affairs for deliberation. For the bill to pass, it must first pass through the House of Representatives, then the Senate, and finally be signed and approved by the President. As the media focuses more on the Health Care Reform Act, decision making on this bill may be on the back burner and news coverage deferred to health care reform. Media coverage of this bill has been low, but there have been a few published articles regarding the bill in publications such as Waiting Room Magazine and Veterans Today. As supporters of this bill, we need to increase coverage and awareness of this bill and encourage our government representatives to bring this issue to the forefront. According to the CDC, of the 1.4 million Americans who sustain a TBI each year, 50,000 will die and over 200,000 will require hospitalization; the CDC even recognizes that military service (serving as a paratrooper, for example) increases the risk for sustaining a TBI. It is clear that our heroes deserve the recognition and preventative health care this bill will enact.

Contacting Key Stakeholders

In order to carry out our action plan to promote the passage of this bill, we have contacted the following key stakeholders and encouraged them to visit our blog and support this bill.

President Obama, the Commander in Chief of our United States Military, is a key stakeholder in the fate of our soldiers and their mental health. If this law is able to move through the House of Representatives, it will eventually need to be signed by President Obama. He needs to be aware of the positive impact that this bill could have on soldiers and their families. Because Obama is not a health care professional, those who have this knowledge need to alert him about the serious impact of PTSD and TBI. This blog makes the basic information on these important topics available in lay terms so that key stakeholders who desire more information on these topics have it readily available.

Eric Ken Shinseki is the United States Secretary of Veterans Affairs and also an important key stakeholder in the passing of Heroes at Home. Currently serving as the Secretary of Veterans Affairs, he works directly with both the military and federal government to keep troops safe and maintain programs that facilitate their rehabilitation once they come home. Because Heroes at Home includes a movement to increase telehealth program funding through the Department of Veterans Affairs, Eric Shinseki as the head of this department has a major role in whether or not this bill were to pass. This bill will put extra costs on the Department of Veterans Affairs but the benefits for our soldiers outweigh the financial impact the bill will initially have on this government office. Eric Shinseki is a veteran of the Vietnam War and is a recipient of the Purple Heart: he is well versed and knowledgeable on the wounds of war and hopefully will recognize the importance of this health promotion and preventative health care based bill for our military heroes.

Dr. Stephen Ondra, M.D. serves as the Senior Policy Advisor for Health Affairs in the Department of Veterans Affairs. Dr. Ondra also has direct contact with both the military and federal government in forming policy directed towards the health of our soldiers. His expertise in both medicine, specifically in spine surgery, neuro-surgery, and orthopedic specialties, along with his time spent in the military, provide him with the knowledge needed to advocate and create policy for our veterans. He suffered injuries while serving in the Military Academy, but reentered the military in time to be deployed to fight in Desert Storm. He knows the importance of receiving care from home after an injury and has medical knowledge that will make his support of this bill vital to its success.

Major General Carla G. Hawley-Bowland is the Commanding General of the US Army’s North Atlantic Regional Medical Command (NARMC) as well as Walter Reed Army Medical Center in Washington, DC. NARMC is responsible for the operation of medical treatment facilities in the northeastern United States. Proper medical facilities that cater to the needs of those who serve in our military are important in the improvement of the diagnosis and treatment of TBI and PTSD. One of the main goals of the Heroes at Home Act is to better the treatment of these two diseases, and without the proper facilities, this will be impossible to accomplish. Major General Hawley-Bowland is a key stakeholder in this bill because she has influence over a section of the US Army's medical treatment facilities and should be informed that this bill will increase the need for these important medical centers.

Congressman John T. Salazar currently serves in the House of Representatives and is a key stakeholder as the main sponsor of the Heroes at Home Act. Congressman Salazar plays a pivotal role in the passage of this bill as he is responsible for gaining support and facilitating the bill’s movement through the legislative process. As a veteran himself and actively involved in the Committee of Veteran Affairs, Congressman Salazar is committed to directing resources to meet the needs of our veterans, servicemen, and families. Through supporting the efforts of Congressman Salazar, we are indirectly contributing additional support for the Heroes at Home Act. We are also drawing the Congressman’s attention to the impact that this bill will have on the profession of nursing, which is a large body of support that often goes unnoticed.

The Virginia Nurses Association works to promote advocacy and education for nurses in order to advance the profession and influence the delivery of quality health care. Nurses in organizations such as these are key stakeholders in the passing of Heroes at Home because as health care providers they will be interacting with veterans in their practice. The VNA is very involved in influencing legislation and contact with them could result in greater awareness of this bill as there has not been a lot of media coverage. If the VNA was aware of and in support of this bill, they could provide a greater influence on Washington to pass Heroes at Home than we can as individual students. Passing this act also coincides with their mission to deliver quality care; care that the Heroes at Home Act will provide for veterans.

The American Nurses Association (ANA) is a professional organization that represents and advocates for the nation's registered nurses. This organization actively lobbies Congress for health care legislation affecting nurses and the public. Leaders and members of this organization are key stakeholders because they represent the workforce of individuals who will be providing care for the veterans with TBI and PTSD and who will also be educating their family members and other care providers. This organization also plays a large role in educating Congress on health care facts and statistics about TBI and PTSD, which members of Congress may not be aware of. The ANA could greatly increases awareness of the Heroes at Home Act and spread education about these types of injuries and how we can better provide for and protect our veterans once they return home.

We Support Heroes at Home

After reviewing the Heroes at Home Act, information and statistics on TBI and PTSD, and the effects that these injuries have on our current soldiers, veterans, and families, we feel that it is necessary to advocate for this bill to become a law. The prevalence of TBI and PTSD among those who have and are serving our country reveals the need for the education and support that this bill offers. Supporting this bill is a way to help ensure the continued support of our troops when they return home. The services that it will provide will not only improve the health of soldiers, but it will also increase their productivity when they return home. In the long run, it will be more effective to train family members early on in how to care for soldiers with these problems rather than to pay for acute care later. Treating them now will prevent them from missing work and dealing with subsequent illnesses later. It is time for the American people to support our troops both during war and when they return home.



Because of the important implications this bill has for our troops, we will be working to see that it is passed. This blog is a tool that we will be using to spread awareness of the bill and provide information regarding its progress. We will contact key stakeholders and legislators to encourage them to become educated about the importance of this bill and the need to support it. Veterans with TBI or PTSD, along with their families, health care workers, home care agencies, and legislators are several groups that will be encouraged to take part in this bill. The National Institute of Neurological Disorders and Stroke (NINDS) provides a list of resources and organizations for those with TBI. The list includes organizations such as the National Center on Caregiving, the National Rehabilitation Information Center, and the Brain Injury Association of America, Inc. These resources, as well as the others that are listed on this website, are generalized for all accounts of TBI. There are currently no specific organizations or resources for current soldiers, veterans, or their families that experience the problems associated with TBI and PTSD. The lack of support for these soldiers is evidence of the need for this bill to be passed.

Impact on Clients, Families, and Healthcare

The passing of the Heroes at Home Act will impact both veterans and health care professionals providing care for veterans in the acute and rehabilitation phases of traumatic brain injury. The program initiated by the passing of this bill will be located in each of the medical centers of the Department of Veterans Affairs; thus, higher patient census will lead to increased nursing opportunities. Doctors, nurses, and therapists will be expected to work together and provide interdisciplinary care to these patients as they initiate or continue their rehabilitation process. During the acute phase, nurses are responsible for stabilizing the patient and providing essential medical care. After the acute phase of the brain injury has resolved, nurses and health care providers take on a supportive role, providing continuing education and medical advice for family members who plan to take over the care of these veterans. Nurses may need increased or continuing education regarding the rehabilitation process in order to provide accurate and effective medical information. Various trainings are available through the Defense and Veterans Brain Injury Center. Nurses may want to attend the annual TBI Military Training Conference, which will provide health care providers and families with the most updated information regarding care for individuals who have experienced a TBI.

After the acute rehabilitation process, family members may take over care for a veteran who has suffered a traumatic brain injury. Under the jurisdiction of this act, a family caregiver of a veteran or member of the Armed Forces who receives certification as a personal care attendant shall be eligible for compensation from the Department of Veterans Affairs. The program's curriculum shall incorporate applicable standards and protocols utilized by certification programs of national brain injury care specialist organizations and shall be based on the clinical needs of the veteran or member of the Armed Forces. Reputable resources and information regarding the care and rehabilitation of veterans suffering from TBI can be found here.

Political and Social Impact of Heroes at Home

If the Heroes at Home Act were to pass, the objective would be to direct the Secretary of Veterans Affairs to establish a program to train caregivers of veterans suffering from TBI, and create increased awareness as to the symptoms of PTSD, TBI, and the services offered to veterans. Currently, the vast majority of this bill's political supporters are members of the Democratic Party, although the main sponsor happens to be a more liberal minded Republican.

Although the Department of Veteran Affairs will be responsible for the cost of training families, the passing of this bill will affect the government by reducing health care costs. If veterans with traumatic brain injury and/or PTSD are treated early on in the disease process, then the cost of complications secondary to the injury should decrease. In a study on mild traumatic brain injury in soldiers returning from Iraq, researchers found that 43.9% of soldiers surveyed met the criteria for PTSD after experiencing an injury while deployed. The study also found that soldiers who experienced mild TBI were more likely to report poor general health and missed work days than soldiers reporting other injuries (Hoge, et al). In addition, there may be a resulting reduction in the utilization of home care agencies if individuals with TBI and PTSD are able to regain the activities of daily living needed to function as independent members of society.

Evidence Based Support for this Bill

Often, veterans return from war and must find a way to fit in with the community once again. Although they have returned home physically rehabilitated, many veterans struggle after sustaining a traumatic brain injury (TBI) as they are expected to return to their "premorbid" lifestyle. Four community based rehabilitation modes have been identified: neurobehavioral, residential community, comprehensive holistic, home based. Home based CIR (community integrative rehabilitation) programs are more variable than other modes of rehabilitation. There is no identified treatment team, but instead, the patient uses resources such as telephone and web based support services independently. There is not enough evidence to support a specific community based intervention for veterans recovering from TBI, but the research suggests that they do play a role in recovery (Trudel, Nidiffer & Barth, 2007).

Telemedicine is being used more and more with veterans recovering from TBI after military involvement. The internet and video surveillance are being used to detect and treat signs and symptoms of TBI. Patients who were once at risk for having to handle their recovery alone are now able to communicate with health care providers throughout the recovery process. Telehealth is also being used to help diagnose patients experiencing signs and symptoms of TBI while they are still providing military service. The computerized tests being used to help identify mild TBI's are quite effective. Telehealth is also effective in helping home health care providers better understand the mental condition of soldiers returning from war after sustaining a TBI. Although the programs set up now are effective, there is a need for increased telehealth to provide care to the many veterans returning from war required care (Girard, 2007).

What is Heroes at Home?

The proposed bill H.R. 667, The Heroes at Home Act, addresses two main conditions: traumatic brain injury (TBI) and post traumatic stress disorder (PTSD). The bill aims to evaluate and improve resources and care available to veterans and current members of the Armed Forces. There is also a component of this bill focusing on telehealth and telemental programs, which is when care is delivered long distance via telecommunications. There will also be a focus on reaching rural areas via telemedicine. Training programs will also be offered through the Department of Veterans Affairs for the family members and care providers of the affected veterans.

John T. Salazar is the main sponsor of the Heroes at Home Act. He is a Republican from Colorado who is dedicated to working on rural and veterans affairs. He is currently serving in the House of Representatives. His passion for rural affairs stems from growing up on a farm with his five siblings, as well as his current occupation as a potato seed farmer and cattle rancher. He is also a veteran, and is committed to keeping the promises that America has made to veterans, servicemen, and their families. He currently sits on the Committee on Veterans Affairs, as well as the Military Construction subcommittee. He is now serving in his third term in office. He and Mary Lou, his wife of 30 years have 3 children, and one grandchild. To learn more about each individual co-sponsor, click on their name located on the blog sidebar.

The Importance of Heroes at Home

The public conception of war injuries is usually focused on the loss of life and limb, but what largely goes unnoticed is that many of our soldiers suffer the long term effects of brain injury. 6% to 11% of veterans of the Afghanistan war and 12% to 20% of veterans of the Iraq war have been diagnosed with traumatic brain injury (TBI) or post traumatic stress disorder (PTSD) (US Department of Veteran Affairs).

TBI is a form of acquired brain injury that occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Further information can be found at the National Institutes of Health.

PTSD is a mental disorder that can occur after living through a traumatic event such as combative warfare. Often individuals suffering from PTSD feel frightened and angry long after the initial event has passed. To be diagnosed with PTSD, symptoms must be severe enough to interfere with your daily routine. Symptoms often include: 1. Reliving the event 2. Avoiding situations that remind you of the event 3. Feeling numb 4. Feeling keyed up (hyperarousal). Further information can be found at US Department of Veteran Affairs.