Long Term Care Benefits for Veterans
What is Veterans Health Care?
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
An example of one of VA's 22 regions is Region 19. -- Geographically one of the largest in the system. Headquartered in Denver this region covers the states of Montana, Wyoming, Utah, Colorado and part of Nevada. Region 19 includes three health-care system hospitals and three satellite hospitals. There are also 33 outpatient clinics in urban centers scattered throughout the five states and 7 Vet Centers in urban areas that provide special services for veterans who served in combat.
The six hospitals in Region 19 offer a wide range of medical specialties and procedures and it is unlikely that any patient would have to be referred to the private care community for any services not offered by these hospitals. But if specialized services are not offered in the region, VA hospitals, region to region, share responsibilities for very specialized treatment and patients needing these specialties not offered in their region are referred to other VA facilities that do offer the care.
Hospitals in the VA system are typically associated with a local medical College where feasible. By acting as teaching hospitals the VA system has access to some of the best doctors and cutting edge medical treatments. In region 19, the Denver Medical Center is affiliated with the medical school, pharmacy, and nursing schools of the University of Colorado Health Sciences Center. The Fort Harrison facility near Helena, Montana is affiliated with nursing schools, pharmacy schools and physician-assistant schools in over 30 universities in the four adjoining states. The Salt Lake City Regional Medical Center is affiliated with the University of Utah Medical School which is located less than a mile away.
One of the disadvantages, in the past, of joining the health system was the difficulty of getting to a regional medical center for treatment. With the installation of outpatient clinics within easy driving distance for health-care beneficiaries, this challenge has become less of a problem in the past few years. The challenge still remains that major hospitalization, surgery and other specialized treatment must be obtained at a regional hospital. In the case of region 19 this could involve driving distances up to 600 miles one way to obtain the appropriate care.
VA is accommodating to certain low income patients who must drive long distances and the facilities offer, at no charge or reasonable charge, "hoptel" rooms in the hospital or nearby as an alternative to staying in a motel or hotel. Low income patients are also reimbursed at $.11 per mile for travel to the nearest VA health care facility that can provide their needed care.
Other services are also available to certain qualifying veterans who may receive dental care, vision care and hearing aids. In addition, Vet Centers provide special counseling for active-duty veterans who served in combat zones. VA is also the most experienced healthcare provider in the country in services for rehabilitating patients with missing limbs, with burn injuries or with other complications due to combat injuries.
Regional VA hospitals often include associated nursing facilities or domiciliary rooms. They will also contract for home health care and hospice services if needed. For those hospitals that don't have nursing homes or domiciliary, contracts for these services are maintained with facilities in the local community.
Emergency Care in Non-VA facilities is provided as a safety net for veterans under specific conditions. If the non-VA emergency care is for a service-connected condition or, if the veteran has been enrolled with health services at least 24 months and has no other health care coverage then emergency care is covered. Also, it must be determined that VA health care facilities were not feasibly available; that a delay in medical attention would have endangered life or health, and that the veteran remains personally liable for the cost of the services in case of a dispute.
What LTC Benefits Are Available from Veterans Healthcare?
A large majority of veterans in the VA healthcare system are older individuals. As a result, VA healthcare incorporates a very robust long-term care services system.
Nursing Home Care
The Department of Veterans Affairs (VA) provides both short-term and long-term care in nursing homes to veterans who aren't sick enough to be in the hospital but are too disabled or elderly to take care of themselves. Priority is given to veterans with service-connected disabilities. VA is required to provide nursing home care to any veteran who:
- needs nursing home care because of a service-connected disability
- has a combined disability rating of 70% or more, or
- has a disability rating of at least 60% and is:
- deemed unemployable, or
- has been rated permanently and totally disabled.
- Other veterans in need of nursing care will be provided services if resources are available after the above groups are taken care of.
Community Living Centers
Some VA Medical Centers have Community Living Centers (these used to be called Nursing Home Care Units or VA Nursing Homes). These centers are typically located within the VA Medical Center itself or in a separate building. To receive care in a Community Living Center/VA nursing home, a veteran must:
- be enrolled in the VA Health Care System
- be psychiatrically and medically stable
- provide documentation specifying whether short or long-term care is needed, an estimation of how long the stay will be, and when discharge will occur, and
- show priority for a stay in a Community Living Center.
However, meeting the above criteria does not automatically ensure admission. CLCs make decisions about whether to admit a veteran based on the following factors:
- availability of services in the CLC
- what sort of care the veteran needs, and
- whether the CLC can competently provide the type of care the veteran needs.
Co-pays are required for the following veteran patients:
- without a service-connected disability rated at least 10%, and
- whose income is higher than the VA's maximum annual Pension rate.
Community Nursing Home
VA contracting services with public or private nursing homes is also available to some veterans. Stays in these nursing homes can be limited, however, for veterans with ratings less than 70% and for veterans who do not need care due to a service-connected disability.
Any veteran who needs this contract nursing home care for a service-connected disability or is receiving VA home health care after discharge from a VA hospital is eligible for direct admission. To be admitted, all that is required is for a VA physician or authorized private physician to determine that nursing home care is needed. Veterans rated 70% or more service-connected are also be eligible.
Other veterans are eligible to be transferred into community nursing home care if the VA determines the care is needed and:
- the veteran is in a VA hospital, nursing home, domiciliary, or has been receiving VA outpatient care, or
- an active member of the Armed Forces who was in a DOD hospital, needs nursing care, and will be an eligible veteran upon discharge.
Veterans who are not in the priority groups for community living centers are technically limited to six months of care, but this may be reduced to 30 to 60 days if resources are limited. Veterans in the priority groups are technically entitled to unlimited free care, but again may receive shorter stays due to a lack of funding and resources to accommodate them.
Adult Day Health Care
Adult Day Health Care is a program Veterans can go to during the day for social activities, peer support, companionship, and recreation.
The program is for Veterans who need skilled services, case management and help with activities of daily living. Examples include help with bathing, dressing, fixing meals or taking medicines. This program is also for Veterans who are isolated or their caregiver is experiencing burden. Adult Day Health Care can combined with other Home and Community Based Services.
Health services such as care from nurses, therapists, social workers, and others may also be available. Adult Day Health Care can provide respite care for a family caregiver and can also help Veterans and their caregiver gain skills to manage the Veteran's care at home.
The program may be provided at VA medical centers, State Veterans Homes, or community organizations. For a list of State Veterans Homes locations, visit the National Association of State Veterans Homes. You can also use the Locate Services page, found on the left navigation menu, to help you find Adult Day Health Care programs.
Since Adult Day Health Care is part of the VHA Standard Medical Benefits Package, all enrolled Veterans are eligible IF they meet the clinical need for the service and it is available.
A copay for Adult Day Health Care may be charged based on VA service-connected disability status and financial information. Contact a VA social worker/case manager to complete the Application for Extended Care Benefits (VA Form 10-10EC) to learn the amount of your copay.
Adult Day Health Care can be a half-day or full-day program. Usually, you would go to an Adult Day Health Care center 2 to 3 times per week, but you may be able to go up to 5 times a week.
Based on availability and need, you can create a regular schedule that works for you and your family caregiver. You may be able to get assistance with transportation to and from an Adult Day Health Care center.
Home-Based Primary Care
Home Based Primary Care is health care services provided to Veterans in their home. A VA physician supervises the health care team who provides the services. Home Based Primary Care is for Veterans who have complex health care needs for whom routine clinic-based care is not effective.
The program is for Veterans who need skilled services, case management and help with activities of daily living. Examples include help with bathing, dressing, fixing meals or taking medicines. This program is also for Veterans who are isolated or their caregiver is experiencing burden. Home Based Primary Care can be used in combination with other Home and Community Based Services.
Since Home Based Primary Care is part of the VHA Standard Medical Benefits Package, all enrolled Veterans are eligible IF they meet the clinical need for the service and it is available.
A copay for Home Based Primary Care may be charged based on your VA service-connected disability status and financial information. You may have a basic copay each time a VA staff team member comes to your home for a medical visit (the same as if you went to a VA clinic). Contact your VA social worker/case manager to complete the Application for Extended Care Benefits (VA Form 10-10EC) to learn the amount of your copay. If you qualify for Home Based Primary Care, your care plan includes:
- Primary care visits at home by a physician, nurse practitioner or physician's assistant
- Care management through a nurse practitioner, physician's assistant, or nurse
- Coordination of your services by a social worker
- Therapy visits from a physical, occupational, or speech therapist
- Mental health services
- Nutrition counseling from a dietitian
- Help managing your medicines
Homemaker and Home Health Aide Care
A Homemaker or Home Health Aide is a trained person who can come to a Veteran's home and help the Veteran take care of himself and his daily activities.
Homemakers and Home Health Aides are not nurses, but they are supervised by a registered nurse who will help assess the Veteran's daily living needs.
This program is for Veterans who need skilled services, case management and help with activities of daily living. Examples include help with bathing, dressing, fixing meals or taking medicines. This program is also for Veterans who are isolated or their caregiver is experiencing burden. Homemaker and Home Health Aide services can be used in combination with other Home and Community Based Services.
Homemaker Home Health Aides work for an organization that has a contract with VA. A Homemaker or Home Health Aide can be used as a part of an alternative to nursing home care, and as a way to get Respite Care at home for Veterans and their family caregiver. The services of a Homemaker or Home Health Aide can help Veterans remain living in their own home and can serve Veterans of any age.
Since Homemaker Home Health Aide services are part of a service within the VHA Standard Medical Benefits Package, all enrolled Veterans are eligible if they meet the clinical need for the service. A copay for Homemaker and Home Health Aide services may be charged based on your VA service-connected disability status. Homemaker Home Health Aide services can be used in combination with other Home and Community Based Services. Services are based on your assessed needs. Talk with a VA social worker to find out what specific help you may be able to receive. For example, an aide may be able to come to your house several times a week or just once in a while. Examples of daily activities you may be able to receive help with include:
- Getting dressed
- Using the bathroom
- Moving from one place to another
- Shopping for food
- Doing laundry
- Paying bills or managing money
- Taking medication
- Getting to appointments
- Using the telephone
Hospice and Palliative Care
Hospice is a comfort based form of care for Veterans who have a terminal condition with 6 months or less to live. Palliative care is a form of treatment that emphasizes comfort care but does not require the Veteran have a terminal condition. Since Hospice and Palliative Care are part of the VHA Standard Medical Benefits Package, all enrolled Veterans are eligible IF they meet the clinical need for the service. Copays may be charged for palliative care, but there are NO COPAYS for HOSPICE care whether it is provided by the VA or an organization with a VA contract.
Hospice and Palliative Care provides treatment that relieves suffering and helps to control symptoms in a way that respects your personal, cultural, and religious beliefs and practices. Hospice also provides bereavement support to your family. You and your family are assessed by a care team and a plan of care is developed to meet your medical, social, spiritual and psychological needs. This care is available to Veterans in their home, community, outpatient or inpatient settings.
Respite Care is a service that pays for a person to come to a Veteran's home or for a Veteran to go to a program while their family caregiver takes a break. While a Veteran gets Respite Care, the family caregiver can run errands or go out of town for a few days without worrying about leaving the Veteran alone at home. Respite Care can be helpful to Veterans of all ages, and their caregiver. Veterans can receive Respite Care in an inpatient, outpatient or home setting.
The program is for Veterans who need skilled services, case management and help with activities of daily living. Examples include help with bathing, dressing, fixing meals or taking medicines. This program is also for Veterans who are isolated or their caregiver is experiencing burden. Respite Care can be used in combination with other Home and Community Based Services. Respite Care can help lower the stress the Veterans and their family caregiver may feel when managing a Veteran's long term care needs at home.
Since Respite Care is part of the VHA Standard Medical Benefits Package, all enrolled Veterans are eligible IF they meet the clinical need for the service and it is available. A copay for Respite Care may be charged based on your VA service-connected disability status and financial information. Contact your VA social worker/case manager to complete the Application for Extended Care Benefits (VA Form 10-10EC) to learn the amount of your copay. You may be able to get Respite Care in a number of ways:
- A paid Home Health Aide could come to your home
- You could attend an Adult Day Health Care center
- You could go to a Community Living Center (VA Nursing Home) or a VA medical center for a short inpatient stay
Depending on the Respite Care services in your area, you can choose which options are best for you and your family caregiver. For example: If your caregiver has lots of errands to run or appointments, you could have a Home Health Aide come to your home while your caregiver is out of the house. If your caregiver needs time at your home alone, you could attend an Adult Day Health Care center for the day. Or, if your caregiver is out of town for a few days, you could stay at a Community Living Center (VA Nursing Home) during the time they are away. No matter which option you use, trained staff will help you with your care needs.
Respite Care services may be available up to 30 days each calendar year. These 30 days may be used in different ways. For example:
- You might stay in a Community Living Center (VA Nursing Home) for 1 visit of 30 days, or have 10 short stays of 3 days each during the year.
- You might have a Home Health Aide come to your home to stay with you for up to 6 hours in a row, day or night. Each visit (even if it is less than the 6-hour maximum) counts as 1 day of Respite Care.
Skilled Home Health Care
Skilled Home Health is short-term health care services 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.
The program is for Veterans who need skilled services, case management and help with activities of daily living. Examples include help with bathing, dressing, fixing meals or taking medicines. This program is also for Veterans who are isolated or their caregiver burdened. Skilled Home Health Care can be used in combination with other Home and Community Based Services.
Since Skilled Home Health Care is part of the VHA Standard Medical Benefits Package, all enrolled Veterans are eligible IF they meet the clinical need for the service and it is available.
A copay for Skilled Home Health Care may be charged based on your VA service-connected disability status and financial information. Contact your VA social worker/case manager to complete the Application for Extended Care Benefits (VA Form 10-10EC) to learn the amount of your copay. If you are eligible for Skilled Home Health, based on your needs you may receive:
- 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
Home Telehealth, also known as Care Coordination/Home Telehealth, is a service that allows the Veteran's physician or nurse to monitor the Veteran's medical condition remotely using home monitoring equipment. Veterans can be referred to a care coordinator for enrollment in Home Telehealth services by any member of their care team.
A care coordinator gets health information that each Veteran provides through personalized questions answered on special equipment, and then checks in with the Veteran by phone, if needed. If any of the Veteran's health measurements do not seem normal, the care coordinator talks with their physician or nurse and then gets back to the Veteran with next steps.
Since Telehealth Care is part of the VHA Standard Medical Benefits Package, all enrolled Veterans are eligible IF they meet the clinical need for the service and it is available. Home Telehealth can be used in combination with other Home and Community Based Services.
There is no copay for Home Telehealth services. However, there may be a copay charge when in-home video visits are provided in addition to standard Home Telehealth services. Home Telehealth services are based on your care needs. Home Telehealth may be used to track your:
- Blood pressure
- Blood sugar level
- Blood oxygen level
- Heart and lung sounds
You may need a phone line to transfer your health information to VA, however technologies are also available for mobile/cell phone connections. A video screen and camera, or video phone, may also be given to you so that the care coordinator can see you when you talk together. You would be able to turn the video camera off when you are not using it to talk with your care coordinator.
Veteran Directed Care
Veteran-Directed Home and Community Based Services gives Veterans of all ages the opportunity to receive the Home and Community Based Services they need in a consumer-directed way.
Veteran-Directed Care is for Veterans who need skilled services, case management, and assistance with activities of daily living (e.g., bathing and getting dressed) or instrumental activities of daily living (e.g., fixing meals and taking medicines); are isolated or their caregiver is experiencing burden.
Veterans in this program are given a flexible budget for services that can be managed by the Veteran or the family caregiver. Veteran-Directed Care can be used to help Veterans continue to live at home or in their community. As part of this program, Veterans and their caregiver have more access, choice and control over their long term care services.
For example, Veterans can:
- Decide what mix of services will best meet their needs
- Hire their own personal care aides (which might include their own family member or neighbor)
- Buy items and services that will help them live independently in the community
Since Veteran-Directed Care is part of the VHA Standard Medical Benefits Package, all enrolled Veterans are eligible IF they meet the clinical need for the service and it is available. NOTE: This is a new VA program and is only available in certain locations. There is no copay with this program. However, you may still have a copay if you use Home and Community Based Services
If you are enrolled in this program, you can decide what mix of Home and Community Based services will best meet your needs.
VA Rolls Out New Community Care Program
The US Department of Veterans Affairs (VA) released final rules related to a completely retooled program that allows veterans more choice in health care providers, but some of the provisions will apply only to certain regions (for now), and other interpretations of the new rule—including whether physical therapists (PTs) will be considered primary care providers—will be made as needs arise.
The final rules released this week are related to implementation of the VA Mission Act of 2018, which consolidates VA's community care programs into a new community care program known as the Veterans Community Care Program. Among programs being consolidated is VA Choice, the program created in 2014 to increase access and reduce wait times for VA patients by allowing greater use of non-VA providers. The VA Choice Program will continue to provide care to veterans until the new program is fully operational.
Community Care Eligibility Criteria
The Veterans Community Care Program final rule provides the nuts-and-bolts guidance on the operation of the new Community Care Network, the centerpiece of the Mission Act, and specifically on 2 of the central features of the Mission Act: how and when veterans might qualify for receiving covered non-VA care, and who can provide it. The new community care provisions will apply only to certain regions of the country upon rollout and will expand incrementally.
When it comes to which veterans would qualify for non-VA care, the rule includes a long list of criteria, including the inability of a VA facility to provide the type of care the veteran requires, as well as factors including treatment frequency, geographical proximity of an appropriate VA facility, the veteran's ability to travel, and a "compelling reason" for the veteran to receive non-VA services, among others.
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