Elder Care
Long Term Care for Senior Veterans
In the year 1919 President Woodrow Wilson proclaimed November 11 as Armistice Day to honor those Veterans
who served during World War I. On November 11, 1954, Armistice Day was proclaimed a legal national holiday and
the name was changed to “Veterans Day” to honor all veterans of all wars.
Every November 11, ceremonies are held throughout the United States honoring Veterans of wars. A National
Ceremony is held at Arlington Cemetery at the Tomb of the Unknown Soldier, where the laying of the presidential
wreath and military playing of “Taps” is presented. Since its establishment in 1930, the Department of Veterans
Affairs has evolved to supporting and aiding the nation’s veterans in numerous ways. One of these services for
example, the Veterans Health Administration, is the largest single provider of medical care in the United States. Its 22
regions with 154 hospitals and their associated 875 outpatient clinics offer the following services.
Hospital, outpatient medical, dental, pharmacy and prosthetic services
Domiciliary, nursing home, and community-based residential care
Sexual trauma counseling Specialized health care for women
veterans Health and rehabilitation programs for homeless
veterans Readjustment counseling Alcohol and drug dependency treatment
Medical evaluation for disorders associated with military service in the Gulf War, or
Treatment for exposure to Agent Orange, radiation, and other environmental hazards
HISA grants Other special benefits
The Department of Veterans Affairs provides three types of long term care services for veterans.
The first are health care benefits provided to veterans who have service-connected disabilities, who are receiving VA
Pension or who are considered low income. These services include free medical care, possible free prescription drugs,
orthotics and prosthetics, home renovation grants for disabilities, home care, assisted living, domiciliary care,
nursing home care, and a possible host of other services or benefits.
The second benefit is state veterans homes. The majority of these homes offer nursing care but some may offer assisted
living or domiciliary care. The Department of Veterans Affairs in conjunction with the states helps build and support state
veterans homes. Money is provided to help with construction and a federal subsidy of $72.71 a day is provided for each
veteran using state veterans nursing home services. These homes are generally available for most veterans and sometimes their spouses and in some cases for so-called “Goldstar parents.”
Veterans homes are run by the states, sometimes with the help of contract management. There may be waiting lists
in some states.
The third benefit for veterans is disability income programs. The most familiar of these benefits is an income for service-
connected disabled veterans called “Compensation.” The least known of these is a program officially called “Pension” but
popularly known as the “aid and attendance benefit.”
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All active-duty veterans who served at least 90 days during a period of war are eligible for Pension and the
additional income from aid and attendance or housebound allowances. A single surviving spouse of
such a veteran is also eligible. -
All qualifying veteran applicants over the age of 65 are eligible for pension but must meet income and asset
tests. Applicants under the age of 65 must in addition be totally disabled to qualify. Disability does not have
to be service-connected. -
A surviving spouse can be any age and there is no need
for disability.
The aid and attendance benefit can pay additional income to provide for the costs associated with home care, assisted living, nursing homes, adult day care and other unreimbursed medical expenses. It can also pay for a family member other than a spouse to be the care giver. The amount of payment varies with the type of care, recipient income and the marital status of the recipient.
Here are some examples of how this benefit can help veterans.
Example #1
The National Care Planning Council receives many
calls from family members of veterans, asking if there
is any help available to them. One such call came
from a woman who had been juggling her job and
caring for her father in her home for over five years.
She had just lost her job and with no income, did
not know how she would keep her home or give her
father the care he needed. She read an article that
had been written by the National Care Planning
Counciland published in her local newspaper and
called their phone number. The article
mentioned that a member of the family –
not including a spouse — can
be paid through VA to provide care for a loved one
at home who is either a war veteran or the surviving
spouse of a war veteran. Her father is a war veteran.
When told that she could get an additional $1,644
a month through her father by providing her father’s
care she was shocked. She was also extremely
grateful and ended up sobbing into tears over the
phone when she found out about the benefit and
realized it would help her keep her home and her
father may probably get a check for her retroactive
previous care from VA worth tens of thousands
of dollars.Example #2
Another recent caller’s mother is 89 years old and
has been in assisted living for four years. As a widow
of a veteran she did not qualify for the Aid &
Attendance Pension 4 years ago because her assets
were too high. In the meantime she has been using
up her assets along with her income to pay for the
assisted living. The local veterans service office has
not been helpful in getting this claim approved even
though she had reached the allowable asset limit
over two years ago. The family was considering putting
her in a less desirable facility under Medicaid. The
family knew this would be devastating for their mother.
Her health was still good and she had many friends
and comforts at the assisted living.The National Care Planning Council directed the caller
and his family to a more cooperative veterans service
office that will submit the claim and likely get it
approved retroactively so that this woman can get
a check for roughly $40,000 worth of previous care
costs for which she was not reimbursed. In addition,
she will likely get the full benefit of $1,056 a month to
help pay the cost of the assisted living where
she is happy.
These types of claims require medical evidence in order to receive a rating for aid and attendance or housebound
allowances. These ratings must be received or certain non-medical expenses associated with long term care are
not deductible from income. Special rules also allow for deducting the annual anticipated cost of month-to-month
long term care from household income in order to meet the income test. This special treatment requires
special documentation and evidence. In addition, those households with substantial assets will be denied for a Pension
income unless those assets are below a certain level determined for each case by VA. The personal residence, personal vehicles and personal property are exempted from this asset test. Finally, evidence must be supplied every year in January that the anticipated costsfor the previous year were actually incurred or VA will likely demand forits money back.
The National Care Planning Council has compiled the necessary forms, rules and information about claims together
in one book titled “How to Apply for the Veterans Aid & Attendance Pension Benefit.”
This book contains information about how a typical applicant receives a successful pension award. VA often tells callers to
go ahead and fill out the application but generally provides no information on the special treatment of annualization of anticipated recurring medical costs. The claims form also contains no information on this important issue. One simply has to know how to do it. This crucial information can make the difference between a successful award and being declined. All necessary forms for filing a claim are in the book.
Veterans who have substantial assets may need to do some estate planning and realigning of assets to qualify. An expert in this area should be sought to help with the application in order to avoid lengthy delays in awarding a benefit or a possible denial of benefits. For a list of individuals or companies in your area who understand how to get this benefit go to http://www.longtermcarelink.net/ref_veterans_consultants.htm
*** Did You Know? The AARP did a national survey some years ago and determined that probate costs
run on average 2 to 10% of a person’s estate. But on a $300,000 estate, that can still cost $6,000 to
$12,000. And in some cases, the costs can go much higher.
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How To Protect The Family Home From Medicaid Recovery
Because the home is the largest asset a couple can keep while still qualifying for Medicaid, it is also usually the main target of estate recovery.
Sidney and Rachel’s Story: Sidney and Rachel had lived in their home since it was new. They built it just after Sidney got a promotion to regional sales manager for a shoe distributor. Through the years, the house was remodeled twice and expanded to add a loft bedroom. Even when their children were grown with families of their own, they all remained close, with frequent family gatherings for holidays and birthdays.
Sidney and Rachel had paid off the mortgage and two second mortgages before Sidney retired. So in addition to being the center of family life, the house had also become the couple’s biggest asset.
Rachel always hoped the house would remain in the family when she and Sidney were gone. She often talked about leaving it to their oldest son, Mark, who promised that he and his wife would continue the tradition of hosting the family for holidays and birthday dinners. However, as Sidney’s Alzheimer’s disease progressed, Rachel worried that Sidney would need to move into a nursing home. With the high cost of long-term care, Rachel knew their savings wouldn’t last long. Sidney would eventually need to qualify for Medicaid to pay the bills.
Her biggest question was, “Will I lose my home?”
A Common Question Indeed
For a great many people who need Medicaid benefits for long term care, the home makes up most of their life savings. Often, it’s all a couple has to pass on to their children.
You may not know that the home is an exempt asset according to Medicaid. It continues to be exempt as long as the community spouse lives there. However, after both the ill spouse and the healthy spouse pass away, the property may no longer be protected.
What Is Estate Recovery?
According to the Omnibus Budget Reconciliation Act of 1993 (OBRA-93), the state has the right to take back whatever it paid for the care of a Medicaid applicant. And because you have to be “broke” to qualify for Medicaid, usually the only property of substantial value that a person on Medicaid is likely to own when they die is their own home. When OBRA-93 was passed, each state established an Estate Recovery Unit (ERU) to go out and find what assets they can take back from those that received Medicaid benefits!
Because the home is the largest asset a couple can keep (while still qualifying for Medicaid), in most states it is also the main target of estate recovery.
After both the community spouse and the ill spouse die, the state’s estate recovery unit has the authority to take just about any property that the Medicaid recipient had their name on. In most cases, that means going back to the house.
For example, if Sidney dies before Rachel after living in a nursing home for two years and Medicaid has paid the nursing home $3,000 per month, the state will have paid $72,000 for Sidney’s care ($3,000 per month times 24 months). If the family home where Rachel lives is worth $100,000, the state would have a claim for the first $72,000 that comes from the sale of the house.
So, the house is protected while Rachel is alive. However, when she passes, the state may force the sale of the house. Whatever’s left over after Medicaid is paid back ($100,000 minus the $72,000 taken out to repay Medicaid) would go to their children.
A Married Couple Strategy For Protecting The Family Home From Recovery
According to federal law, a married Medicaid applicant is allowed to transfer the home to his or her spouse – without any penalty. Once the transfer is made (meaning the ill spouse no longer has any interest in the house), the community spouse may be able to make some changes to that asset. In some states the community spouse can even give the house away!
That sort of gift, of course, would create a period of Medicaid ineligibility if the community spouse needs nursing home care within the five-year look-back period.
The family home remains one of the most difficult assets to protect because of timing, but there are proven strategies that make it possible to protect the home from Medicaid Recovery.
The Society of Medicaid Planners offers a free download of their report “Medicaid Secrets Revealed by Dan Stemen. The report offers information on qualifying for Nursing Home Medicaid without losing the family home to recovery or spending down your life savings.
The National Care Planning Council provides a resource for long term care planning with educational information and lists of professional elder care service providers.