Aid & Attendance Handbook for Professionals & Consultants
Information for ALL Long Term Care Benefits for Veterans
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Philippines 0 0 0
Guam 0 0 0
Virgin Islands 0 0 0
TOTAL 133 9 30,255
Source: Armed Forces Veterans Homes FoundationHistory of State Veterans HomesOur nation was faced with a staggering number of soldiers and sailors in critical need of medical care following the Civil War, and although the national homes were in operation at the time, their capacity was inadequate to meet the demand. At that time, several states established veterans homes at their own expense to provide for those residents who had served so honorably in the military.In 1888, the U.S. Congress authorized federal cost sharing for state veterans homes--about 30 cents per resident per day. Since the creation of the Veterans Administration in 1930, the program's per diem payments have increased to $63.40 per day.
Challenges Facing the Construction of New HomesThe State Veterans Home Program is a partnership between the U.S. Department of Veterans Affairs and the States to construct or acquire nursing home, domiciliary, or adult day health care facilities. A state nursing home, domiciliary, or adult day care is owned and operated by the State.The Veterans Administration may participate in up to 65 percent of the cost of construction or acquisition of state nursing homes or domiciliaries or for renovations to existing state homes.Over the last five years, VA has awarded over $424 million in grants to the States for construction of or renovations to state veteran’s homes. That is 34 percent of all grants awarded since 1964.The Veterans Administration Secretary approved the 2005 Priority List on September 23, 2004. The Priority List contained 131 projects from the various States and was valued at over $690 million. There were 81 projects, valued at $435 million, with the required 35% state matching funds -- meaning legislators have set aside the money -- and are eligible for an immediate VA grant awards. These are priority #1 grants and should be built as soon as possible. Unfortunately, there is not enough money to build these priority #1 grant facilities. The States were lucky to complete only 8 or 9 projects in 2005 nationwide instead of the 81 that were eligible.The VA will commit to as many projects for which funds are available, but funding is woefully inadequate. The State Home Construction Grant Program 2005 budget was approved at $105 million. The President’s 2007 budget request is $85 million in grants for state construction programs. The 2007 budget proposal only represents about 12% of the projects on the priority list. At that amount, needed new facilities on the priority list may not be constructed until 10 or 20 years from now.
Nursing Home Daily RatesThe Veterans Administration pays the state veterans homes an annually adjusted rate per day for each veteran in the home. This is called the per diem. The current nursing per diem amount is $63.40 and for domiciliary care it is $29.31. Adult Day Health Care – up to one-half of the cost of care -- cannot exceed $38.43 per day. The goal of state veterans homes is to get Congress to increase the per diem rate for nursing care to 75% of the state private nursing rates. In most states the per diem falls well short of this goal.The per diem program and construction subsidies mean that state veterans homes can charge less money for their services than private facilities. Some states have a set rate, as an example $1,400 a month, and they may be relying on the aid and attendance pension benefit benefit with aid and attendance plus the per diem to cover their actual costs. Other states may charge a percentage of the veteran’s income but be relying on other subsidies to cover the rest of the cost. Most of the states with low set rates or income determined rates are selective about the veterans they accept. These states may rely on a variety of private and public sources to help fund the cost of care.Example of Subsidy from the VA and the State.Actual per veteran cost of operation $6,000 a monthVeteran’s out-of-pocket cost $1,400 a month
Per diem to subsidize the veteran’s cost $1,928 a month
and possible state or other subsidies $1,000 a month
and possible VA aid and attendance benefit $1,520 a month
Available to pay for care from all sources $6,048 a monthLegislation is pending in Congress to allow private long term care beds in states to be designated as state veterans home beds and to receive the per diem on behalf of veterans. But it is limited to adding only a hundred beds nationwide over the next three years. This will hardly put a dent in anything.States without set rate subsidies may charge 50% to 70% of the rate of private facilities based on private or semi-private room occupancy. If the veteran does not have enough income, these homes accept Medicaid or Medicare to make up the difference. In these states the veterans homes are Medicaid and possibly Medicare certified.
Services availableSome state facilities offer assisted living or domiciliary care in addition to nursing care. Some states even build facilities devoted entirely for domiciliary. According to the Veterans Administration the definition of domiciliary care is as follows: "To provide the least intensive level of VA inpatient care for ambulatory veterans disabled by age or illness who are not in need of more acute hospitalization and who do not need the skilled nursing services provided in nursing homes. To rehabilitate the veteran in anticipation of his/her return to the community in a self-sustaining and independent or semi-independent living situation, or to assist the veteran to reach his/her optimal level of functioning in a protective environment." A domiciliary is a living arrangement similar to assisted living without substantial assistance but is not intended as a permanent residence. Domiciliary rooms in veterans medical centers are designed around this concept and are used for rehabilitation recovery from surgery or accident, alcohol abuse, drug abuse, mental illness, or depression. The domiciliary concept does not work well in a state veterans home setting and in that context domiciliary is simply another name for assisted living without the assistance. This represents a form of independent retirement living with a little more support where the veteran can stay as long as he or she needs to. As far as state veterans homes go, one should think of domiciliary as a substitute for supported independent retirement living. Many state veterans facilities have set aside a wing for Alzheimer's patients. In some states this is the most popular service sought by veterans or their families, and waiting lists could require a number of years before a bed opens up. A small number of facilities offer adult day care.It appears that in most of the states, facilities are run by state employees through their state veterans departments. Some states may contract with third party nursing home administrators to run their programs.
Eligibility and Application Requirements for State Veterans HomesFrom state to state, facilities vary in their rules for eligible veterans. Even in the same state it is common, where there is more than one state home, for some homes to have very stringent eligibility rules and others to be more lenient. These differing rules are probably based on the demand for care and the available beds in that particular geographic area. Some homes require the veteran to be totally disabled and unable to earn an income. Some evaluate on the basis of medical need or age. Some evaluate entirely on income -- meaning applicants above a certain level will not be accepted. Some accept only former active duty veterans, while others accept all who were in the military whether active duty or reserve. Still others accept only veterans who served during a period of war. Some homes accept the spouses or surviving spouses of veterans and some will accept the parents of veterans but restrict that to the parents of veterans who died while in service (Goldstar parents). Federal regulations allow that 25% of the bed occupants at any one time may be veteran related family members, i.e., spouses, surviving spouses, and/or gold star parents who are not entitled to payment of VA aid. When a state home accepts grant assistance for a construction project, 75% of the bed occupants at the facility must be veterans.Domicile residency requirements vary from state to state. The most stringent seems to be a three-year prior residency in the state; whereas, other homes may only require 90 days of residency.All states require an application process to get into a home. Typically, a committee or board will approve or disapprove each application. Many states have waiting lists for available beds.A list of state veterans homes is provided in Appendix I.
CHAPTER 3 Veterans Health Care and Long Term Care Services
The Best Health Care System in America
Why the VA Health Care System Works so Well
What is Veterans Health Care?
Outpatient Pharmacy Services
Veterans Health Administration Long Term Care Benefits
Enrolling in the Veterans Health Care System
Copayments for Medical Services -- Veterans Means Testing
The Best Health Care System in AmericaIt comes as a surprise to some people who had experience with VA health care during the 1970s and 1980s that this same system is now considered the best medical care in the United States. To illustrate this we quote below articles and comments from the several sources. BusinessWeek, July 17, 2006 "The Best Medical Care in the Nation
How Veterans Affairs transformed itself -- and what it means for the rest of us"". . . Roemer seems to have stepped through the looking glass into an alternative universe, one where a nationwide health system that is run and financed by the federal government provides the best medical care in America. But it's true -- if you want to be sure of top-notch care, join the military." "The 154 hospitals and 875 clinics run by the Veterans Affairs Dept. have been ranked best-in-class by a number of independent groups on a broad range of measures, from chronic care to heart disease treatment to percentage of members who receive flu shots. It offers all the same services, and sometimes more, than private sector providers." "To much of the public, though, the VA's image is hobbled by its inglorious past. For decades the VA was the health-care system of last resort. The movies Coming Home (1978), Born on the Fourth of July (1989), and Article 99 (1992) immortalized VA hospitals as festering sinkholes of substandard care. The filmmakers didn't exaggerate. In an infamous incident in 1992, the bodies of two patients were found on the grounds of a VA hospital in Virginia months after they had gone missing. The huge system had deteriorated so badly by the early '90s that Congress considered disbanding it." "Instead, the VA was reinvented in every way possible. In the mid-1990s, Dr. Kenneth W. Kizer, then the VA's Health Under Secretary, installed the most extensive electronic medical-records system in the U.S. Kizer also decentralized decision-making, closed underused hospitals, reallocated resources, and most critically, instituted a culture of accountability and quality measurements. ‘Our whole motivation was to make the system work for the patient,’ says Kizer, now director of the National Quality Forum, a nonprofit dedicated to improving health care. ‘We did a top-to-bottom makeover with that goal always in mind.’ . . .”Robert Bazell, Chief science and health correspondent, NBC News Updated: 6:33 p.m. MT March 15, 2006
"We report a story tonight that is going to turn a lot of heads. The Veterans Administration Health Care System, once famously known for horrendous medical care,