Expanding to veterans of all eras a Department of Veterans Affairs program that pays family caregivers to provide home-based help is key to making sure all vets receive appropriate care, advocates told senators Wednesday.

“The caregivers from pre-9/11 have been providing services for years, and they’ve had no acknowledgment. They’re not acknowledged for what they’re doing and they’re receiving very, very little in the way of services,” former Sen. Elizabeth Dole, whose foundation advocates for military caregivers, testified before the Senate subcommittee on aging Wednesday.

“The illnesses and the wounds and injuries of these veterans from earlier eras are compounded as they age,” she said. “They deserve [care], and it’s really unfair that they don’t have it now.”

The VA’s Program of Comprehensive Assistance for Family Caregivers gives eligible participants a monthly stipend — some participants receive $2,500 — depending on the veteran’s needs and location. However, the program, put in place by Congress, is available only to veterans who served after Sept. 11, 2001. The operation and approval process for the caregiver program is under review by the VA.

Expanding the benefit could cost between $3 billion and $4 billion over the first five years, according to some estimates. The VA calculates as many as 80,000 pre-9/11 veterans would qualify for the expanded program.

The current program has a budget of $735 million this year and covers about 36,000 users.

A pair of bills to expand the program introduced this year in the House and Senate face an uncertain future. Although they have bipartisan support on Capitol Hill as well as support from the VA, similar legislation has in the past stalled due to forecasted costs, which many lawmakers consider too high.

There are 5.5 million military caregivers in the U.S., according to official estimates, but only about 20 percent of those care for post-9/11 veterans. About 60 percent of caregivers are women.

“We must strengthen the supports that are currently available and help more caregivers have access to these supports,” Sen. Bob Casey, a Pennsylvania Democrat who co-chairs the subcommittee, said during the hearing. “Whether their veterans served in Vietnam or Afghanistan, they should have access to the same services from the VA.”

— Amy Bushatz can be reached at amy.bushatz@military.com.