Do Veterans Benefits Cover Long Term Care or Assisted Living?
by Vicki Rackner MD
Veterans Affairs (VA) benefits provide for a range of long-term services which include residential care, adult day health care, geriatric evaluation and respite care. Nursing home benefits may be provided if specific qualifications are met. The following long-term care services are available to all enrolled Veterans.
Geriatric evaluation is the comprehensive assessment of a veteran's ability to care for him/herself, his/her physical health, and his/her environment, which leads to a plan of care. The plan could include treatment, rehabilitation, health promotion and social services. These evaluations are performed by inpatient Geriatric Evaluation and Management (GEM) Units, GEM clinics, geriatric primary care clinics and other outpatient settings.
Adult Day Health Care
The adult day health care program provided by the United States Department of Veterans Affairs is a therapeutic day care program, providing medical and rehabilitation services to disabled veterans in a combined setting.
Respite care provides supportive care to veterans on a short-term basis to give the caregiver a planned period of relief from the physical and emotional demands associated with providing care. Respite care can be provided in the home or other non-institutional settings.
Skilled home care is provided by VA and contract agencies to veterans that are homebound with chronic diseases and includes nursing, physical/occupational therapy and social services.
Hospice/palliative care programs offer pain management, symptom control and other medical services to terminally ill veterans or veterans in the late stages of the chronic disease process. Services also include respite care as well as bereavement counseling to family members. There are no co-pays for hospice care provided in any setting.
Financial Assessment for Long-Term Care Services
For Veterans who are not automatically exempt from making co-pays for long-term care services, a separate financial assessment (VA Form 10-10EC, Application for Extended Care Services) must be completed to determine whether they qualify for cost-free services or to what extent they are required to make long-term care co-pays. Unlike co-pays for other VA health care services, which are based on fixed charges for all, long-term care, co-pay charges are individually adjusted based on each veteran's financial status.
The following are services with limited benefits for veterans:
VA Nursing Home Programs
While some Veterans qualify for indefinite community living center (or nursing home care) services, other veterans may qualify for a limited period of time. Among those that automatically qualify for indefinite community living care are veterans whose service-connected condition is clinically determined to require nursing home care and veterans with a service connected rating of 70 percent or more. Other Veterans may be provided short-term community living care, if space and resources are available.
A veteran must be in need of such care and seeking nursing home care for a service-connected (SC) disability, or is rated 60 percent SC and unemployable, or is rated 60 percent SC and permanently and totally disabled (P&T) or for any condition if the veteran has a combined SC disability rating of 70 percent or more.
The care will be provided in a VA nursing home or contract nursing home. Non-service connected (NSC) zero percent SC veterans can apply for long term care in the VA but could be subject to long term care co-payments. Veterans with a compensable service-connected disability are exempt from long term care co-payments. NSC veterans applying for extended care or the nursing home care unit may be required to complete VA Form 10-10EC to determine the family's current income and assets. Veterans may be discharged from a VA nursing home care unit without consent when VA nursing home care is no longer needed. For example, if the veteran's needs can be met at home or in a private nursing home close to the family.
Veterans requiring nursing home care for a service-connected condition or a veteran rated 70 percent or more have mandatory eligibility for admission to extended care services; and, those veterans are eligible to have indefinite care provided to them in the VA or in a VA contracted nursing home.
If you qualify for indefinite nursing home care, generally that care will be furnished in a VA facility. Care may be provided in a private facility under VA contract when there is compelling medical or social need. If you do not qualify for indefinite care, you may be placed in a community nursing home--generally not to exceed six months--following an episode of VA care. The purpose of this short-term placement is to provide assistance to you and your families while alternative, long-term arrangements are explored.
Domiciliary care provides rehabilitative and long-term, health maintenance care for veterans who require some medical care, but who do not require all the services provided in nursing homes. Domiciliary care emphasizes rehabilitation and return to the community. VA may provide domiciliary care to veterans whose annual income does not exceed the maximum annual rate of VA pension or to veterans who have no adequate means of support.
Veterans' Special Pension with Aid and Attendance
If you are a United States veteran or surviving spouse of a veteran, you may qualify for the Aid & Attendance Program and receive monthly benefits to help cover the costs of assisted living care. The Veterans' Administration offers a Special Pension with Aid and Attendance (A&A) as part of the VA Improved Pension program, which allows for veterans and surviving spouses who require the regular attendance of another person to assist in eating, bathing, dressing, undressing or taking care of the needs of nature to receive additional monetary benefits. The pension also includes individuals who are blind or a patient in a nursing home because of mental or physical incapacity. Assisted care in an assisted living facility also qualifies.
How do you qualify for the benefit?
In order to qualify for this benefit, the veteran would have had to serve at least 90 days of active duty. One of those days needs to be during a recognized period of war. The veteran or the surviving spouse (or married couple) would have to have less than $80,000 in assets. This excludes a primary residence and a vehicle. The veteran or surviving spouse must spend the financial assistance on out-of-pocket medical expenses. The veteran or surviving spouse would need assistance with their activities of daily living.
The 2011 monthly Aid & Attendance rates are as follows:
Surviving Spouse $1,056
Healthy Veteran with Sick Spouse $1,291
Single Veteran $1,644
Sick Veteran with Spouse $1,949
The social work department at your nearest VA medical facility can provide specific information about services or other assistance available through VA and your local community.
1. United States Department of Veterans Affairs. (March 22, 2005) Do VA benefits cover nursing home care? Retrieved June 29, 2009 from the United States Department of Veterans Affairs Web Site. https://iris.va.gov/scripts/iris.cfg/php.exe/enduser/std_adp.php?p_faqid=387
2. United States Department of Veterans Affairs. (July 28, 2008) Department of Veterans Affairs Health Care Overview. Retrieved July 8, 2009 from the United States Department of Veterans Affairs Web Site: http://www.va.gov/healtheligibility/library/pubs/healthcareoverview/#LongTerm
3. VeteranAid.org. (December 1, 2008). Introduction to the veterans' aid and attendance special pension. Retrieved July 8, 2009 from the VeterAid.org Web Site: http://www.veteranaid.org/
About Dr. Vicki
Vicki Rackner, MD is a board-certified surgeon and clinical faculty member at the University of Washington School of Medicine. She left the operating room to be on the cutting edge of healthcare consumerism. She is now a full-time patient advocate, helping people get the health care they want, need and deserve. Dr. Vicki is an author, speaker and consultant.