Aid & Attendance Handbook for Professionals & Consultants
Information for ALL Long Term Care Benefits for Veterans
NCPC Professional Edition - Return to Book Purchase Home Page
| Home Page | Front Cover | Preface | Table of Contents | Selected Pages | Back Cover | Software |
We have already mentioned that the income adjustment for unreimbursed medical expenses could make a large number of moderate or even high income veterans eligible for the aid and attendance pension benefit benefit as well. These people are probably in addition to those eligibles listed in the table above since most surveys for eligibility only look at current income and not adjusted income after medical expenses.About the only veterans related organizations that regularly promote this benefit are state veterans affairs departments, and these people are only able to get the word out at conferences or state fairs. None of these organizations have enough money for advertising.The VA Disability SurveyA survey by Veterans Affairs taken in 2001 reveals that 32% of the roughly 24 million veterans, or about 8 million veterans, reported having a disabling condition. About 3.5 million of these veterans indicated the condition was service-related. It is very likely that veterans left active duty having suffered from injury, non-disabling wounds, diseases, combat trauma, or other medical or emotional conditions that may not have affected them to a great extent at that time. But in later years these conditions could have evolved into disabilities. For these veterans there is still an opportunity to apply for compensation benefits with the VA. For those veterans who do not have service-connected disabilities, aid and attendance pension benefit may be an option.According to the results of the 2001 VA Survey
"More than 8 million veterans reported having a disabling condition (32.1 percent of the veteran population) as Table 7-1 displays. Table 7-2 illustrates that, among veterans with disabling conditions, 43.1 percent (3.5 million) indicated the condition was service-related. An additional 5.4 percent were unsure whether their condition was service-related. Almost 14 percent, or roughly 3.5 million veterans, reported they had received a service-connected disability rating. This latter number includes veterans who did not report that they had a disabling condition as well as those who did."
Table 7-1 Percent distribution of veterans with self-reported disabilities and disability ratings
Total
Disabling condition 32.1
Disability rating 13.8
Number of veterans† 25,196,000
Department of Veterans Affairs 2001 veteran survey
† Estimate of number of veterans is rounded to the nearest hundred.
Table 7-2. Percent distribution of veterans with self-reported disabilities by self-reported service-related disabilities
Total
Service-related 43.1
Not service-related 51.5
Unsure 5.4
Total 100.0
Number of veterans† 8,089,000
Department of Veterans Affairs 2001 veteran survey
† Estimate of number of veterans is rounded to the nearest hundred.
NOTE: This table only includes responses of those who indicated they had a disabling condition.According to the survey, “Veterans with a self-reported disabling condition who did not apply for disability benefits most frequently gave the following reasons for not applying: • Didn’t think was entitled or eligible (40.6 percent);
• Didn’t need the assistance (22.7 percent); and
• Not aware of VA service-connected disability program (12.7 percent).”
Percent distribution of veterans with self-reported disabilities by application for disability benefits and age
Total Less than
35 years 35-44
years 45-54
years 55-64
years 65-74
years 75 years
or older
Applied 43.5 65.7 55.6 58.2 40.4 31.5 34.7
Never applied 56.1 34.3 44.2 41.5 59.2 68.0 64.6
Unknown 0.4 0.0 0.2* 0.3* 0.4* 0.5* 0.7*
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number of veterans† 8,089,000 392,100 727,200 1,739,400 1,507,300 1,785,000 1,904,600
Department of Veterans Affairs 2001 veteran survey
*Low precision and/or sample size for the denominator between 30 and 59.
† Estimates of number of veterans are rounded to the nearest hundred; the total estimate is larger than the sum of the groups because some veterans did not provide their age.
NOTE: This table only includes responses from those veterans who indicated they had a disabling condition.
About State Veterans HomesAccording to the National Association of State Veterans Homes, “State veterans homes are one of the largest long term care providers in the United States. During 2005, State Veterans Homes furnished 6,852,875 days of nursing home care and 1,477,885 days of domiciliary (assisted living) care. As of February 13, 2006, there were 133 State Veterans Homes in 50 states and Puerto Rico with 30,255 total beds.”“These homes are constructed with funds from VA and the local state. They also receive operating subsidies from VA, from the states, and from donations. It is evident from the statistics above that most homes offer nursing home care followed by assisted living (domiciliary care) -- a ratio of about six nursing home beds to every assisted living bed. A small handful of facilities also offer adult day care. We will discuss state veterans homes in more detail in Chapter 2.”
About Veterans Medical Care The following was taken from VA's website."Perhaps the most visible of all VA benefits and services is health care. From 54 hospitals in 1930, VA’s health care system now includes 154 medical centers, with at least one in each state, Puerto Rico and the District of Columbia. VA operates more than 1,300 sites of care, including 875 ambulatory care and community-based outpatient clinics, 136 nursing homes, 43 residential rehabilitation treatment programs, 206 Veterans Centers and 88 comprehensive home-care programs. VA health care facilities provide a broad spectrum of medical, surgical and rehabilitative care.""To receive VA health care benefits most veterans must enroll. The VA health care system had 7.7 million veterans who were enrolled as of October 2005. When they enroll, they are placed in priority groups or categories that help VA manage health care services within budgetary constraints and ensure quality care for those enrolled."
CHAPTER 2 State Veterans Homes
About State Veterans Homes
The Appeal of Living in a State Veterans Home
Challenges for State Veterans Homes
History of State Veterans Homes
Challenges Facing the Construction of New Homes
Nursing Home Daily Rates
Services Available
Eligibility and Application Requirements for State Veterans Homes
About State Veterans HomesState veterans homes fill an important need for veterans with low income and veterans who desire to spend their last years with "comrades" from former active duty. The predominant service offered is nursing home care. VA nursing homes must be licensed for their particular state and conform with skilled or intermediate nursing services offered in private sector nursing homes in that state. State homes may also offer assisted living or domiciliary care, which is a form of supported independent living. Every state has at least one veterans home and some states like Oklahoma have six or seven of them. There is great demand for the services of these homes, but lack of federal and state funding has created a backlog of well over 130 homes that are waiting to be built. This problem will be discussed in the section entitled "Challenges Facing the Construction of New Homes".Unlike private sector nursing homes where the family can walk in the front door and possibly that same day make arrangements for a bed for their loved one, state veterans homes have an application process that could take a number of weeks or months. Many state homes have waiting lists especially for their Alzheimer's long term care units.No facilities are entirely free to any veteran with an income. The veteran must pay his or her share of the cost. In some states the veterans contribution rates are set, and if there is not enough income the family may have to make up the difference.
The Appeal of Living in a State Veterans HomeWe believe most veterans or their families seek out residency in a state veterans nursing home because they believe this service is one more VA entitlement that should be available to them. But there is also a similar entitlement available to anyone in most private sector nursing homes -- facilities that may be geographically closer to the family than the nearest veterans home. This is Medicaid. Veterans seeking long term care from VA programs generally don't have the funds for private pay in a nursing home; however, Medicaid will also cover these same people in a private sector Medicaid certified facility. Most families who are seeking help for their loved ones who are veterans generally look to VA first before considering Medicaid; or they are simply not aware of Medicaid. In many cases, Medicaid may be the better choice.Aside from seeking long term care because of an expectation of entitlement, are there any other reasons that veterans would prefer a state home? We ask this question of ourselves because we have noticed that in some states veterans homes are in distant rural areas. The fact that some of these homes are hundreds of miles from urban areas where the majority of veterans would tend to live, made us wonder why some veterans would move long distances to reside in these facilities. To answer this question, we contacted a number of rural state veterans homes by phone and asked them why a veteran or his or her family would seek out their services as opposed to seeking services in a closer nonveterans facility under Medicaid. Almost unanimously the answer we got was that some veterans like the idea of sharing their living arrangement with other veterans. The facilities almost always referred to this as "camaraderie" -- a band of brotherhood. Statistically, private sector nursing homes are mostly populated by older women who are generally in poor health. Some men may not feel comfortable in an environment where the activities and the social atmosphere are centered around women. In contrast, veterans homes are almost exclusively populated by men. In addition, based on our observation, we suspect the population of state homes is younger and healthier than that of private sector facilities. These demographics would suggest that activities and the social atmosphere revolve around the needs of men, not women. A younger, healthier population would also suggest veterans homes would offer more opportunity in the form of transportation or scheduled outings for the residents to be out in the community. One veterans home reported to us that they regularly scheduled fishing trips and outings to sporting events for their residents. These would be unheard of activities for the typical private nursing home.The second most common reason reported to us as to why veterans seek out state homes is for financial reasons. In many states the cost of the home is subsidized for veterans who meet an income test. The veteran’s income is considered sufficient to cover the cost. These veterans may own a home or other assets that they wish to protect from Medicaid and leave to their family. The state veterans home will allow them to give these assets to the family without penalty. Medicaid would require a spend down of those assets or impose a penalty for gifting.Another reason related to finances may be there are no available Medicaid beds in the veteran’s area. The veteran may be paying out-of-pocket for a nursing facility but have his name on a waiting list for a state home where the out-of-pocket cost would be much less. When his name comes up he will move to the state home.A financial incentive for the veteran is that all state veterans homes will apply for the aid and attendance pension benefit benefit for those residents who are eligible. Federal law prohibits VA from paying any more than $93 a month to single veterans who are eligible for Medicaid in a nonveteran nursing home. State veterans homes are exempt from this rule, and the single veteran can keep the entire aid and attendance pension benefit amount; although, most of it will have to apply to the cost of care. For those state veterans homes that also accept Medicaid, aid and attendance pension benefit represents additional disposable income. Medicaid is not allowed to apply the aid and attendance allowance from aid and attendance pension benefit towards the cost of care but must let the veteran retain that money. The fortunate veteran who has this additional $300-$400 a month can use this money for additional personal needs. One veterans home that has this dual arrangement with Medicaid and VA aid and attendance pension benefit reports that the veterans receiving this benefit, pool the money with other veterans in the facility, and it helps pay for dinner tickets, theater tickets, expensive outings, and other amenities that would not normally be available to private sector nursing home residents.
Challenges for State Veterans Homes The following is quoted from the Armed Forces Veterans Homes Foundation:"The demand for quality long term veteran care is growing at an astounding rate. Our nation faces the largest aging veteran population in its history. Today, roughly 10 million veterans are aged 65 and over, about 39 percent of all the veterans in America. This proportion will remain unchanged for the next 20 years. The number of veterans aged 85 and over will have increased by 600 percent from 1990 to 2010 and will total nearly two million in all.""The U.S. Department of Veterans Affairs has now designated the state veterans homes system as its primary provider of long term care service. One hundred new homes are slated to be built in the next 10 years, but even with such aggressive expansion, the demands for service will continue to far exceed the supply.""America's veterans homes face serious resource shortfalls. Ideally, home costs are shared equally by the Department of Veterans Affairs, state governments and residents. The reality is that 11 states currently provide little or no funding for their veterans home. And the others now face the worst fiscal crisis in 20 years, with two thirds of the states now reporting substantial cuts in programs serving low-income residents, including veterans.""In addition, nearly every home relies on support from its local veterans community to supplement its resources. Homes commonly log thousands of hours of veteran volunteer time each year, the equivalent of a significant number of full-time paid staff. But these veterans who contribute so generously of their time are dying at an alarming rate. An estimated 700,000 will die this year, and far fewer veterans will be there to follow in their footsteps.""State Veterans Homes are one of the largest long term care providers in the United States. During 2005, State Veterans Homes furnished 6,852,875 days of nursing home care and 1,477,885 days of domiciliary (assisted living) care. As of February 13, 2006, there were 133 State Veterans Homes in 50 states and Puerto Rico with 30,255 total beds."
Number of State Veterans Homes 133
Number of Veterans Served:
Nursing Home Care
23,915
Domiciliary Care
6,053
Hospital Care
287
Total Population Served
30,255
Women 8%
Average Age 77
Average Years of Military Service 4
Served in War Theater 95%
Served in World War II 70%
Served in the Korean War 15%
Served in the Vietnam War 15%Source: Armed Forces Veterans Homes Foundation
Overview of America's Veterans Homes
Nursing Home, Domiciliary and Hospital Care for America's Heroes
Number of Homes:
State: Currently: Soon Opening: Resident Capacity:
Alabama 3 0 450
Alaska 1 0 79
Arizona 1 0 200
Arkansas 1 1 224
California 3 0 2111
Colorado 5 0 630
Connecticut 1 0 671
Delaware 0 1 150
Florida 6 0 750
Georgia 2 0 742
Hawaii 0 1 95
Idaho 3 0 314
Illinois 4 0 1313
Indiana 1 0 580
Iowa 1 0 830
Kansas 2 0 435
Kentucky 3 0 525
Louisiana 3 2 785
Maine 5 0 490
Maryland 1 0 378
Massachusetts 2 0 830
Michigan 2 0 1001
Minnesota 5 0 864
Mississippi 4 0 600
Missouri 7 0 1250
Montana 2 0 245
Nebraska 4 0 952
Nevada 1 0 180
New Hampshire 1 0 250
New Jersey 3 0 968
New Mexico 2 0 231
New York 5 0 1220
North Carolina 2 0 250
North Dakota 1 0 150
Ohio 2 0 895
Oklahoma 7 0 1439
Oregon 1 0 151
Pennsylvania 6 0 1639
Rhode Island 1 0 339
South Carolina 3 0 615
South Dakota 1 0 180
Tennessee 2 1 380
Texas 6 1 1080
Utah 1 0 81
Vermont 1 0 216
Virginia 1 1 440
Washington 3 0 569
West Virginia 2 0 315
Wisconsin 2 0 955
Wyoming 1 0 123
U.S. Territories: