Veterans Assisted Living Assessment and Benefits

Veterans returning from active duty face a unique set of challenges – especially if they have been injured. Following years of service and the resulting wear and tear on the body and mind, it is not uncommon for veterans to require assistance with activities of daily living. Fortunately for veterans and their caregivers, there are assisted living options that can help make the long-term care process smoother for all involved.

In general, there are two ways eligible veterans can obtain assistance with long-term care living options: they can receive benefits from the U.S. Department of Veterans Affairs (VA) or they can apply for residency in a Veteran’s Home. Veterans who served in the active military and were separated under any condition other than dishonorable may qualify for VA health care benefits. Current and former members of the Reserves or National Guard who were called to active duty by a federal order or completed the full period for which they were called or ordered to active duty may also be eligible.

This guide contains information to help you navigate the benefit programs available from the VA. Read on the learn whether you or your loved one are eligible, how to apply, and what programs are available in your state.

The Shared Decision Making Approach

What is Shared Decision Making?

One of the most important elements of planning long-term care for veterans is shared decision making. Shared decision making is a collaborative process used by the VA that empowers veterans, their caregivers and their healthcare team to direct and make choices that meet the veteran’s needs while still honoring their values and preferences. It is an effective tool when making difficult life decisions – such as entering into assisted living services.

Why it works

Shared decision making allows veterans to retain a degree of independence and allows them to participate in decisions that will inevitably affect their everyday lives. Veterans who play an active role in decision making are more knowledgeable about what to expect from assisted living arrangements, and they are also more trusting of the process.

Shared Decision Making Process for Veterans and Caregivers

The following self-assessment compiled by the VA can help you determine if you or your loved one are suffering from burnout or stress:

Geriatric Patient Aligned Care Team (GeriPACT)

For veterans with more complex needs, such as those with physical or cognitive decline, the Geriatric Patient Aligned Care Team (GeriPACT) integrates traditional health services with community-based services to help them maintain as much independence as possible and a high quality of life. GeriPACT combines multi-disciplinary teams and primary care providers to develop treatment and care plans with these veterans with specialized healthcare needs.

Is your veteran eligible for GeriPACT?

It’s important to be aware of who is and is not eligible for this program. GeriPACT is offered in about 66% of VA medical centers across the country. Veterans with any of the following health challenges may be eligible for GeriPACT services:

• More than one complex chronic disease, such as diabetes and heart disease
• Dementia or other issues contributing to cognitive decline
• Geriatric syndromes (e.g., frailty, falls, incontinence, memory loss, taking lots of medicines, age 85 or older)

Veterans with untreated substance abuse issues or those who only need refills for certain prescription medications are not considered appropriate for GeriPACT.

What services can veterans get through GeriPACT?

Veterans deemed eligible for GeriPACT can receive a diverse array of services. GeriPACT:

• Integrates and coordinates the provision of health services from the VA with community-based services
• Aims to optimize independence and quality of life
• Includes healthcare team members that have the expertise and advanced training needed to assess the illnesses and issues of vulnerable and aging veterans
• Serves veterans that require a level of care that is typically not available through other patient-aligned care teams

Types of Care for Veterans

The VA offers an array of care options for veterans. To speak with someone about these services, you should contact the VA Caregiver Support Line at 1-855-260-3274, or your local Caregiver Support Coordinator. Below is a description of the different options and what services they cover.

Adult Health Day Care Centers

Adult Health Day Care Centers provide constant supervision in a safe, active environment. These programs encourage veterans to get out of their homes to participate in social activities. Eligible veterans usually go two to three times per week, but they can go up to five if they so choose.

Home-Based Primary Care

For veterans with complicated medical issues, these programs bring routine health care to the home, such as medication management and nutrition counseling. The home-based primary care program also includes physical rehabilitation, social work services, mental health services and referrals to VA on the list of services.

Home Hospice Care

Home hospice care is appropriate for veterans who have reached the advanced stages of a terminal disease like cancer. This program offers comfort and supportive services for both the veteran and the family that lives in the home. Services are intended to help control symptoms in a way that respects the personal, cultural and religious beliefs and practices of the veteran. The interdisciplinary hospice agency staff is typically available 24/7 for beneficiaries.

Homemaker Services and Home Health Aides

Homemakers and home health aides help to keep veterans on a routine schedule and assist with personal care services, such as bathing, toileting, and dressing. This type of care is typically arranged by the VA medical center.

Home Telehealth

Telehealth care allows a veteran’s physician or nurse to monitor their medical condition remotely using home monitoring equipment. Home telehealth equipment can be used for any of the following:

• Blood pressure
• Blood sugar levels
• Pulse
• Weight
• Blood oxygen levels
• Heart and lung sounds

Respite Care

Respite care is a service that sends a paid home health aide to a veteran’s home or pays for a veteran to attend an adult day care program while the family caregiver takes a break. Veterans can also go to a Community Living Center for an inpatient stay while the caregiver goes out of town for a few days. This helps to keep caregiver stress levels in check.

Skilled Home Care

Skilled Home Health is a short-term health care service that can be provided to veterans if they are homebound or live far away from VA. The care is delivered by a community-based home health agency that has a contract with VA. Based on the veteran’s needs, skilled home care can include:

• Nursing care (such as wound care or catheter care)
• Therapy visits for physical, occupational or speech therapy
• Patient education (about managing your medicines or illness)
• A home safety evaluation
• Social work support

Caregiver Support Services

Caregivers must ensure they do not forget their own needs as they care for veterans. Taking care of yourself is the most beneficial thing you can do for the people who depend on you. The VA offers a number of services both inside and outside of the home to ensure family caregivers have the resources they need.

Caregiver Support Line

VA’s Caregiver Support Line (1-855-260-3274) is a resource that connects caregivers with caring, licensed professionals. The support line is available to you if you need to speak with a care coordinator or even if you just need someone to listen to you in a time of need. You can participate in a monthly telephone education group to discuss self-care tips and talk about a variety of other related topics. If you want to learn more about the monthly calls you can listen to a recording or view an educational handout.

Peer Support Mentoring

Peer support mentoring for caregivers is a program in which caregivers can serve as either a mentor or mentee to work through issues of caregiving. To take advantage of this service you need to commit at least six months to the process. Depending on preferences, email, telephone, or letter-writing are acceptable methods of communication.

Building Better Caregivers

Building Better Caregivers is a free, online workshop intended to help you build the skill set and confidence level needed to best care for your veteran at home. The program has been recognized for its ability to reduce caregiver stress and depression, and increase caregiver overall well-being.

Caring for Seriously-Injured Post-9/11 Veterans

The program for Comprehensive Assistance for Family Caregivers provides approved caregivers services such as a monthly stipend, travel expenses, health insurance, mental health services, and respite care.

REACH VA

REACH VA provides mentoring for the challenging areas of caregiving, including:

• Managing stress and mood swings
• Solving behavioral problems
• Keeping patients safe

The program is available for caregivers of veterans diagnosed with: ALS, Dementia, MS, PTSD or Spinal Cord Injury/Disorder.

Additional Support

Need more help? The VA offers a tips & tools resource for additional information on managing medicines, talking with your provider, caring for oneself, staying organized and moving around safely.

Paying for Geriatrics and Extended Care for Veterans

Paying for long-term care may seem overwhelming, but there are several different ways to finance this care for your veteran – namely through VA resources, federal and state programs like Medicare and Medicaid and through insurance or your personal funds. Eligibility for any programs is determined by the need for ongoing treatment, personal care and assistance, as well as the availability of a given service near your home.

Long-term care, as defined by the VA:

• Includes a wide range of services such as help with everyday tasks and support for managing an illness
• Is provided for an extended period when someone is not able to do everyday tasks themselves
• Can be provided in many settings, such as a person’s home, community sites, residential settings, and nursing homes
• May include support for family members or other caregivers who help people who are ill or disabled

VA Financing for Assisted Living

It is important to note that the VA will not cover assisted living expenses, but there are other programs to help offset the cost of certain aspects of long-term care depending on eligibility. Additionally, veterans must be enrolled in VA health care prior to applying for VA long-term care services. Below are the steps needed to apply for VA health care:

• Visit your local VA medical center’s New Patient Registration office to complete and submit the VA Application for Health Benefits, or
• Use the Online Application for Health Benefits to enroll online

Eligibility Criteria

To be eligible for assistance with standard medical benefits a veteran must be enrolled in VA health care and receive care through a VA facility on a regular basis. It is important to note that receiving financial compensation for a VA disability does not automatically mean your veteran is enrolled in VA health care. Further eligibility information can be found on the main VA Health Benefits website.

Once you or your veteran have enrolled in VA health care there are two major factors that determine your eligibility for services: your VA service-connected disability status and your income. The VA must bill any other insurance you may have (except Medicare) for any care needed that is not service-connected. Any payments received from your insurance company will lower the copays you have to pay to the VA.

Service-Connected Disability

“Service-connected” refers to illnesses or injury sustained as a direct result of time served in the military. Your disability is ranked on a scale of 0%-100%, with the ratings being higher for disabilities that make the great impact on your daily life. You must take one of the following steps to apply for service-connected disability status:

• Complete and mail VA Form 21-526 to your Veterans Benefits Administration (VBA) regional office – to find your VBA regional office, visit the facility locator site
• Complete the application online using an eBenefits account
• Work with an accredited representative or agent, such as a veterans Service Officer – you can search for a representative here, or visit your local VBA office for assistance

Your disability needs to be reviewed by the staff at a VBA office, and it needs to be assigned a rating before you can receive payments.

VA Disability Compensation

VA Disability Compensation is a monthly tax-free payment for veterans who have a service-connected disability. The higher your rating, the higher the monthly payments are. You have to apply for this compensation, as it is not automatically granted. Going through this process as soon as possible will help to ensure you do not overpay for VA health services and that you are considered eligible for the appropriate programs.

You can receive an additional special monthly compensation if you require significant help with your personal care needs because of your disability, or if you are bedridden because of your disability.

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To apply for special monthly compensation you need to do one of the following:

• Complete and mail VA Form 21-526EZ-ARE to your VBA regional office – to find your VBA regional office, visit the facility locator site
• Work with an accredited representative or agent, such as a Veterans Service Officer – you can search for a representative here, or visit your local VBA office for assistance

Medicare

Medicare also does not directly cover assisted living costs, but it can help offset the cost of care for seniors who receive rehabilitation services provided in assisted living facilities.

Medicare is the health insurance plan for seniors who are:

• 65 years or older
• Under 65 with certain disabilities
• Of all ages with End Stage Renal Disease

You can also buy a Medigap policy from a private insurance company, which can help pay for costs like deductibles, copays and coinsurance.

There are two types of Medicare – original Medicare and Medicare Advantage Plans. You can learn more about what is and isn’t covered under each Medicare plan by visiting Medicare’s website.

Original Medicare

Once enrolled in original Medicare, you are eligible to receive health services from any provider who accepts this insurance as long as your doctor requests the service, the service is considered medically necessary, and it falls under covered services. Original Medicare is broken into three distinctive parts:

• Part A is hospital insurance, which covers in-hospital stays, care in a nursing facility and certain home health care services.
• Part B is medical insurance, which covers certain doctor services, outpatient care, preventive care and medical supplies.
• Part D is prescription drug coverage. It is provided by insurance companies and private companies approved by Medicare. Enrollment in Part D is voluntary, and if you choose it you are subject to a premium – which can vary.

Regular Medicare patients have to pay Medicare premiums, deductibles and coinsurances. The coinsurance rate for regular Medicare is fixed at 20% of the cost of the service.

Medicare Advantage Plans

Part C, otherwise known as Medicare Advantage, is a plan in which a private company contracts with Medicare to provide Part A and Part B benefits. These plans include health maintenance organizations (HMO), preferred provider organizations (PPO), private fee-for-service plans, special needs plans, and Medicare Medical Savings Account Plans. The majority of Medicare Advantage plans offer Part D coverage, which includes prescription drugs.

Medicare and VA Health Benefits

You can have both Medicare and receive VA health benefits, but it is important to know that the two plans do not work together. Medicare does not pay for any care received at a VA facility because they are not Medicare-certified facilities. VA health coverage will not pay for the cost of deductibles, copayments or coinsurance associated with Medicare.

If you do not accept Medicare, then you will be unable to receive care anywhere outside of a VA facility. Many people choose to accept Part A because it is premium-free and covers hospital stays, but they often turn down Part B to avoid paying premiums for care they can plan to receive at a VA facility.

Skilled Nursing Facility (SNF)

Medicare recipients are eligible to receive care in a Medicare-certified skilled nursing facility for a limited number of days (100 days in a benefit period) if your doctor says you need skilled care following a hospital stay. Skilled care means services are provided by skilled nursing or rehabilitation staff, such as a nurse or physical therapist.

Your projected costs for skilled nursing facility services under original Medicare are:

• $0 for the first 20 days of your stay and care
• 20% of your care costs (about $150/day in 2013) for days 21 to 100 of your stay and care
• All costs for each day after day 100

If you selected a Medicare Advantage Plan, your costs will vary based on that specific plan.

Home Health Services

If your doctor says your health requires you to stay home-bound, then Medicare may cover home health services under both Part A and Part B depending on the nature of your needs. Covered services may include (but are not limited to):

• Intermittent skilled nursing care  
• Rehabilitation (physical/occupational therapy/speech therapy)
• Assistance with activities of daily living
• Medical supplies/equipment to use at home

Services must be ordered by a physician and provided by a Medicare-certified home health agency for original Medicare enrollees. Members of the Medicare Advantage Plan must use a home health agency that accepts their plan’s payment.

Enrolling in Medicare

The majority of people who are eligible for Medicare benefits (Part A and B) become automatically enrolled because they are already receiving Social Security benefits or Railroad Retirement Board benefits. For these people, Medicare takes effect on the first day of the first month in which you turn 65.

If you are under 65 and disabled, Part A and Part B enrollment starts after you receive disability benefits from Social Security or certain RRB disability benefits for 24 months. If you are enrolled automatically you will receive a red, white and blue Medicare card in the mail 3 months before your 65th birthday or your 25th month of disability benefits if under 65 years old. Instructions will be included with your card to decline Part B coverage if you do not want it.

If you or your veteran have not been automatically enrolled, you will need to sign up for Part A and Part B benefits. This most often occurs to people older than 65 who are not receiving Social Security or Railroad Retirement Board benefits. To sign up, you need to do one of the following:

• Visit your local Social Security Office
• Apply at ssa.gov
• Call Social Security at 1-800-772-1213
• If you worked for a railroad, call the Railroad Retirement Board at 1-877-772-5772

Medicaid

Medicaid is a joint federal-state program that provides health care coverage for low-income people — primarily children, pregnant women, parents, the disabled and the elderly. Medicaid may be able to help with Medicare premiums, copays and deductibles. Medicaid can also pay for some services not covered by Medicare.

Specific eligibility criteria will vary by state. The information provided is a general guide to eligibility, but you should speak with your VA social worker or state Medicaid office to determine your eligibility. This state-by-state resource from the National Conference of State Legislatures may help you understand what you can expect in your state.

Medicaid and VA Health Benefits

It is unusual for people to receive concurrent benefits from Medicaid and VA health insurance, so it is important to decide which health coverage better suits your needs. The major deciding factor for most people it the level of care they require.

For those who require home care or assisted living, it is typically advantageous to use the Veterans Homebound or Aid and Attendance pensions. While Medicaid does cover home care and assisted living in many states through waivers, usually these are not entitlement programs. This means that even if one is eligible for services, they might not receive them, as there are limited slots for assistance available. In addition, there are often long waits to receive assistance.

For those who require nursing home care, Medicaid is usually the better option. While the Aid and Attendance benefit can be applied toward nursing home care, the maximum benefit amount is far less than the average cost of nursing home care.

Medicaid Eligibility

There are three main eligibility categories that you or your veteran need to fulfill to qualify for Medicaid.

• General Eligibility: You must be 65 years of age or older, or younger than 65 with a permanent disability, or be blind. You must also be a US citizen or meet certain immigration rules and be a resident of the state in which you are applying.
• Financial Eligibility: Your income and the value of your assets determine whether or not you are eligible to receive Medicaid benefits. Although it can vary from state to state, the income level is usually set at about the poverty level, and the assets level is usually set at about $2,000 per person.
• Functional Eligibility: A medical professional will need to complete an assessment of your need for assistance with activities of daily living. Examples include eating, bathing, dressing, and using the toilet.

Medicaid Enrollment

To apply for Medicaid benefits in any state you need to:

• Complete an application, which you can find at your local state Medicaid office or online
• Provide documentation of general and financial eligibility requirements being met
• Complete a functional eligibility assessment

Medicaid and Long-Term Care Benefits

Medicaid covers the cost of nursing home services for all eligible people, but it may also cover Home and Community-Based Services for eligible people if they would otherwise need to be in a nursing home. This is because home and community-based services, including assisted living facilities, are a more cost-effective option than nursing homes as far as coverage is concerned. Assisted living facilities are not always covered under waivers, so it is best to speak with a Medicaid professional to ensure you know what your options are.

If you are determined to have enough income, your state may require you to pay for some portion of your Medicaid-covered services. Depending on your income, Medicaid may cover some portion of your premiums and copays if you also receive Medicare benefits. Talk with staff in your state Medicaid office to find out how this works in your state.

Personal Contributions and Long-Term Care Insurance

Private Pay

Even though the VA, Medicare, Medicaid and other funding sources cover the costs of some long-term care services and settings, many people ultimately need to use their own income or savings to pay part of the costs for long-term care services they need or prefer.

For example, people often use their own resources to pay for:

• Living in an assisted living facility or adult family home
• Paid caregiver assistance with personal care needs, chores or meals in their home

Long-Term Care Insurance

This type of insurance can be used to pay for long-term care services. Since long-term care policies vary, do your homework and choose wisely.

• Most policies will cover long-term care services for a pre-set number of years, after which time you become responsible for the costs of your care.
• Policies often include an “elimination period” of 30, 60 or 90 days before your benefits begin. This means you agree to pay for all of your necessary care for the first 30, 60 or 90 days.  
• Premiums are based in part on your age at the time of enrollment in a policy. They become more expensive as you get older.

It is important to note that if you already reside in a nursing home or assisted living facility, or if you already need help with activities of daily living such as bathing, dressing, or using the toilet, then you probably will not qualify for a long-term care policy.

Resources for Caregivers and Veterans