VETERANS AID AND ATTENDANCE BENEFIT
Long Term Care Benefits for Veterans

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CHAPTER 1

Overview of Veterans Long Term Care Benefits

About Long Term Care
About the Department of Veterans Affairs
Facts about the Department
Chronological History of the Department of Veterans Affairs
Veteran Demographics and the Need for Long Term Care
Who Is a Veteran?
How Many Veterans Need Long Term Care?
Comments from the Armed Forces Veterans Homes Foundation
Percent Distribution of Veterans by Age and Gender
Percent Distribution of Veterans by Functional Limitation and Age
VA Disability Programs
Two Important Disability Programs
More about Aid and attendance pension benefit
The VA Disability Survey
About State Veterans Homes
About Veterans Medical Care

About Long Term Care

When a person requires someone else to help him with his physical or emotional needs over an extended period of time, this is long term care. This help may be required for many of the activities or needs that healthy, active people take for granted and may include such things as:

• Walking
• Bathing
• Dressing
• Using the bathroom
• Helping with incontinence
• Managing pain
• Preventing unsafe behavior
• Preventing wandering
• Providing comfort and assurance
• Providing physical or occupational therapy
• Attending to medical needs
• Counseling
• Feeding
• Answering the phone
• Meeting doctors' appointments
• Providing meals
• Maintaining the household
• Shopping and running errands
• Providing transportation
• Administering medications
• Managing money and paying bills
• Doing the laundry
• Attending to personal hygiene
• Helping with personal grooming
• Writing letters or notes
• Making repairs to the home
• Maintaining a yard
• Removing snow

The need for long term care help might be due to a terminal condition, disability, illness, injury or the infirmity of old age. Estimates by experts are that at least 60% of all individuals will need extended help in one or more of the areas above during their lifetime. The need for long term care may only last for a few weeks or months, or it may go on for years. It all depends on the underlying reasons for needing care.

Temporary long term care (need for care for only weeks or months)

• Rehabilitation from a hospital stay
• Recovery from illness
• Recovery from injury
• Recovery from surgery
• Terminal medical condition

Ongoing long term care (need for care for many months or years)

• Chronic medical conditions
• Chronic severe pain
• Permanent disabilities
• Dementia
• Ongoing need for help with activities of daily living
• Need for supervision

Long term care services may be provided in any of the following settings:

• In the home of the recipient
• In the home of a family member or friend of the recipient
• At an adult day services location
• In an assisted living facility or board-and-care home
• In a hospice facility
• In a nursing home

About the Department of Veterans Affairs

The following information was taken from the Department of Veterans Affairs website.

Facts about the Department

"The Department of Veterans Affairs (VA) was established on March 15, 1989, succeeding the Veterans Administration. It is responsible for providing federal benefits to veterans and their families. Headed by the Secretary of Veterans Affairs, VA is the second largest of the 15 Cabinet departments and operates nationwide programs for health care, financial assistance and burial benefits."

"The Department of Veterans Affairs (VA) offers a wide variety of programs and services for the nation’s 24.3 million veterans. In 2005, about 5.3 million people were treated in VA health care facilities, 3.5 million veterans and survivors received VA disability compensation or aid and attendance pension benefits, 498,000 used GI Bill education benefits and more than 2.4 million owned homes purchased with GI Bill home loan benefits originally valued at $236 billion. About 93,000 veterans and family members were buried in VA’s national cemeteries and 369,000 headstones and markers were provided for veterans’ graves worldwide."

"Of the 24.3 million veterans currently alive, nearly three-quarters served during a war or an official period of conflict. About a quarter of the nation's population, approximately 63 million people, are potentially eligible for VA benefits and services because they are veterans, family members or survivors of veterans."

"The responsibility to care for veterans, spouses, survivors and dependents can last a long time. Five children of Civil War veterans still draw VA benefits. About 440 children and widows of Spanish-American War veterans still receive VA compensation or aid and attendance pension benefits."

"VA's fiscal year 2005 spending was $71.2 billion -- $31.5 billion for health care, $37.1 billion for benefits, and $148 million for the national cemetery system. President Bush sought $73 billion in the fiscal year 2006 budget for VA, a $1.8 billion increase in budget authority, primarily for health care and disability compensation."

"As of February 28, 2006, VA had 235,974 employees on the rolls. Among all departments and agencies of the federal government, only the Department of Defense has a larger work force. Of the total number of VA employees, 217,343 were in the Veterans Health Administration, 12,899 in the Veterans Benefits Administration, 1,512 in the National Cemetery System, 3,285 in the Veterans Canteen Service and 434 in the Revolving Supply Fund. The rest – 3,786 employees -- are in various staff and facilities offices."

"VA is a leader in hiring veterans. About 50 percent of all male employees are veterans. As of February 28, 2006, VA had 9,895 women employees who served in the U.S. armed forces. More than 7 percent of all VA employees are disabled veterans and three hold the Medal of Honor."

Chronological History of the Department of Veterans Affairs

• "1930....The Veterans Administration created by Executive Order 5398, signed by President Herbert Hoover on July 21. At that time, there were 54 hospitals, 4.7 million living veterans and 31,600 employees.
• 1933…The Board of Veterans Appeals established.
• 1944....On June 22, President Franklin Roosevelt signed the ‘Servicemen's Readjustment Act of 1944’ (Public Law 346, passed unanimously by the 78th Congress), more commonly known as ‘The GI Bill of Rights,’ offering home loan and education benefits to veterans.
• 1946....The Department of Medicine & Surgery established, succeeded in 1989 by the Veterans Health Services and Research Administration, renamed the Veterans Health Administration in 1991.
• 1953....The Department of Veterans Benefits established, succeeded in 1989 by the Veterans Benefits Administration.
• 1973....The National Cemetery System – renamed the National Cemetery Administration in 1998 – created when Congress transferred 82 national cemeteries from the Army to VA. The Army kept Arlington National Cemetery and the U.S. Soldiers' and Airmen's Home National Cemetery in Washington, D.C.
• 1988....Legislation to elevate VA to Cabinet status signed by President Reagan.
• 1989....On March 15, VA became the 14th Department in the President's Cabinet."

Veteran Demographics and the Need for Long Term Care

Who Is a Veteran?
According to VA, a veteran is

"Someone 18 and older (there are a few 17-year-old veterans) who is not currently on active duty, but who once served on active duty in the United States Army, Navy, Air Force, Marine Corps, or Coast Guard, or who served in the Merchant Marine during World War II."

"There are many groups whose active service makes them veterans including: those who incurred a service-connected disability during active duty for training in the Reserves or National Guard, even though that service would not otherwise have counted for veteran status; members of a national guard or reserve component who have been ordered to active duty by order of the President or who have a full-time military job. The latter are called AGRs (Active Guard and Reserve). No one who has received a dishonorable discharge is a veteran."

How Many Veterans Need Long Term Care?

VA estimates the number of veterans aged 75 and older has increased from about 2.6 million in 1995 to about 4.9 million in 2005. The older a person the more likely the need for long term care.

According to the Department of veteran affairs, there are currently about 3,500,000 male World War II veterans and about 164,000 female World War II veterans still alive. Since the war ended over 61 years ago, most of these veterans are going to be in their 80s or older. This is the time of life when people are most likely to need long term care. The Alzheimer's Association estimates about half of all 85-year-olds suffer from some form of dementia. Roughly half of all nursing home residents are age 85 and older and other government sources estimate that at least half or more of all people over age 85 need some sort of physical or emotional support from someone else.

Data from table 511 below indicate about 466,000 of these World War II veterans were receiving payments from VA for service-connected disabilities (compensation) and non-service-connected disabilities (aid and attendance pension benefit) in 2005. Based on the incidence of long term care need for this veterans group, those beneficiaries receiving payment probably represent only about 30% of veterans who may be eligible for disability payments from VA but who have never applied or are probably not even aware of what is available. This estimate does not even include Korean Conflict veterans or Vietnam Era veterans who may also be in need of long term care support.

The National Care Planning Council estimates approximately 22% of the U.S. population over age 65 is receiving some sort of long term care help. Applying this estimate to the 9,348,000 veterans over the age of 65 from the chart below, this means that at least 2 million veterans may be receiving long term care help from family members or formal caregivers. A limited number of these veterans may be receiving financial help from Veterans Affairs, but the majority is probably not even aware of VA programs that could help pay the cost of long term care.

Comments from the Armed Forces Veterans Homes Foundation

"The demand for long term care services among America's veteran population is growing at a significant rate. Currently, more than 9.2 million veterans are aged 65 or older. This number will remain fairly constant through the year 2020. However, veterans aged 85 or older will grow to nearly 2 million. Many elderly veterans lack the financial resources necessary to sustain them in their final stages of life. A group of veterans' organizations recognized the growing need to assist less fortunate elderly veterans with the opportunity to live out their lives in dignity. This goal required collaboration among the organizations and the result was establishing a foundation. The foundation provides the means for America to keep its covenant with veterans by means of a public-private partnership to combat the four enemies of the elderly: boredom, loneliness, helplessness and hopelessness."

Percent Distribution of Veterans by Age and Gender

Total Males Females
Less than 25 years 1.1 0.8 4.7
25-29 years 2.7 2.4 7.9
30-34 years 5.3 4.9 12.6
35-39 years 5.3 4.8 13.6
40-44 years 6.7 6.1 16.4
45-49 years 8.1 7.8 13.6
50-54 years 13.4 13.8 6.5
55-59 years 11.1 11.5 3.8
60-64 years 8.6 8.9 2.8
65-69 years 10.1 10.6 2.4
70-74 years 10.7 11.2 3.4
75-79 years 9.5 9.7 6.4
80 years or older 6.8 6.9 5.5
Unknown 0.6 0.6 0.4*
Total 100.0 100.0 100.0
Number of veterans† 25,196,000 23,712,400 1,483,600
Department of Veterans Affairs 2001 veteran survey

Percent Distribution of Veterans by Functional Limitation and Age

Total Less than 35 years 35-44 years 45-54 years 55-64 years 65-74 years 75 years or older
None 67.2 83.7 76.4 70.8 71.6 63.5 45.8
IADL only 7.1 4.5 4.9 5.2 6.2 8.7 11.9
One to two ADLs 16.3 8.9 11.7 14.1 13.8 19.3 25.8
Three to four ADLs 5.4 1.7 3.8 5.6 5.3 5.3 8.6
Five or more ADLs 3.9 1.1 2.9 4.2 3.0 3.2 7.8
Unknown 0.1 0.1* 0.3* 0.1* 0.1* 0.0 0.1
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number of veterans† 25,196,000 2,288,600 3,030,300 5,415,100 4,946,000 5,256,400 4,116,100
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

Percent distribution of veterans by period of service and gender
Total Males Females
World War II 20.5 21.0 12.0
Between World War II and the Korean Conflict 6.7 7.0 2.4
Korean Conflict 16.9 17.7 5.0
Between the Korean Conflict and the Vietnam Era 25.6 26.7 8.0
Vietnam Era 36.1 37.3 16.2
Post-Vietnam Era 27.9 26.3 53.8
Gulf War 13.9 12.4 37.0
Number of veterans† 25,095,000 23,629,800 1,465,200
† Estimates of number of veterans are rounded to the nearest hundred; percent estimates will not sum to 100 because veterans could indicate more than one period of service.
NOTE: This table excludes veterans who received a medical discharge from the National Guard or Reserves but never served on active duty.

VA Disability Programs

Two Important Disability Programs

The veterans benefits described in this section relate specifically to disability. However, for the most part, long term care is disability. As a general rule, most eligible veterans with long term care needs would qualify for these benefits from VA.

Disability compensation -- a VA income benefit -- is money to compensate the veteran for loss of lifetime income due to disability incurred while in the service. The surviving spouse death benefit associated with compensation is based on the same principle. A large number of veterans may have service-connected disabilities; but, for whatever reason, never bothered to apply for compensation. It is not too late, and VA may accept a late application which will then give the veteran, not only more money, but possibly other VA long term care services as well.

Aid and attendance pension benefit is another disability income program. This benefit is available to active duty veterans who served at least 90 days during a period of war. A death benefit is also available to the surviving spouses of these veterans. Aid and attendance pension benefit is probably the most underused and misunderstood long term care benefit for veterans. The misunderstanding comes about because aid and attendance pension benefit is based on income. Many veterans or their surviving spouses are going to have incomes greater than the aid and attendance pension benefit rate ceiling and as a result would normally never receive this disability benefit. A quirk in the way VA calculates aid and attendance pension benefit can allow a veteran household to qualify even if family income exceeds the aid and attendance pension benefit income test.

To explain this, VA, in calculating aid and attendance pension benefit, allows the veteran to reduce the family income by the amount of recurring, future unreimbursed medical expenses. These are expenses that are paid out-of-pocket and not reimbursed by insurance or other government programs. As an example, suppose the aid and attendance pension benefit income test for a veteran receiving care in a nursing home is $18,234 a year or less in income. If the veteran has an income of $30,000 a year, he or she would not normally qualify for aid and attendance pension benefit. But the veteran can subtract from his income the $50,000 a year in nursing home costs. This new income is the income now used for the test above. This adjustment makes the new income for the income test negative, and the veteran would now qualify for an additional $18,234 a year from VA -- the maximum allowable.
Annualized deductions are allowed for the recurring cost of insurance premiums, home care aides, assisted living, or the cost of a nursing home. The rules allow VA to count 12 months worth of these future expenses instead of just the current month's expenses and subtract these expenses from 12 months of estimated future income in order to calculate a monthly retirement benefit. We will provide examples of aid and attendance pension benefit benefit estimates in other chapters in this book.

The medical long term care programs as well as the HISA Grant described in Chapter 3 are additional benefits available to veterans who are receiving compensation or aid and attendance pension benefit. Because of the income or disability status of receiving aid and attendance pension benefit or compensation, the veteran can enjoy free medical, and possible additional free long term care services, from his or her regional VA medical Center.

More about Aid and attendance pension benefit

The aid and attendance pension benefit program, more than any other long term care benefit from VA, is probably one of the best kept secrets in the country. Because of the way benefits are calculated by subtracting recurring medical costs, aid and attendance pension benefit is extremely valuable in helping disabled veterans or their survivors pay for the high costs of home care, assisted living, or nursing home care. We will discuss aid and attendance pension benefit