The Department of Veterans Affairs provides three types of long term care services for veterans.
1. The first type is benefits provided to veterans in the VA healthcare system.
These are individuals who have substantial service-connected disabilities, who are receiving VA Pension or who are considered low income. Services include possible 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 long term care benefits. These services are not available to all veterans in the health care system. Availability depends on the local medical center's funds, the nature of the disability or whether the veteran is considered very low income.
2. The second type of benefit is state veterans homes. (see our national list)
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 $75.42 a day (2009) 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 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.
3. The third type of benefit is disability income for veterans who served on active duty.
The first of these disability incomes is called Compensation and is designed to award the veteran a certain amount of money to compensate for potential loss of income in the private sector due to a disability or injury or illness incurred in the service. In order to receive Compensation, a veteran has to have evidence of a service-connected disability. Most veterans who are receiving this benefit were awarded an amount based on a percentage of disability when they left the service.
However, some veterans may have record of being exposed to extreme cold, having an inservice, nondisabling injury, having tropical diseases or tuberculosis or other incidents or exposures that at the time may not have caused any disability but years later have resulted in medical problems. These people can apply to see if they could receive a benefit. In addition, some veterans may be receiving Compensation but their condition has worsened, and they can reapply for a larger amount based on a higher disability rating. There is generally no income or asset test for most forms of Compensation, and the benefit is nontaxable.
The second disability income benefit is called Pension. Pension is also called "Veterans Aid and Attendance Benefit." It is available to all active-duty veterans who served at least 90 days during a period of war. Applicants younger than age 65 must be totally disabled or a patient in a nursing home. Veterans younger than 65 receiving Social Security have a lesser burden of proof. Proof of disability is not required for applicants age 65 or over. Age is evidence by itself of disability.
The purpose of this benefit is to provide supplemental income to disabled or older veterans who have a low income. If the veteran’s income exceeds the Pension amount, then there is no award. However, income can be adjusted for unreimbursed medical expenses, and this allows veterans with household incomes larger than the Pension amount to qualify for a monthly benefit. For example, a veteran household earning $6,000 a month could still qualify for Pension under the right circumstances. There is also an asset test to qualify for Pension. The primary residence, most personal property and automobiles are exempt from this asset test.
Compensation and Pension claims are submitted on the same form (VA Forms, click here) and VA will consider paying either benefit. Generally, for applications associated with the cost of home care, assisted living or nursing home care, the Pension benefit is more money.
There are also several death benefit variations of the two disability incomes for single surviving spouses or dependent minor children or adult dependent children. Death Pension is a lesser amount based on the same rules for applying for a living Pension claimant. In other words, the deceased veteran must have met the rules for Pension -- with the exception of being totally disabled or over age 65 -- or have been receiving Pension in order for his or her spouse to receive the lesser benefit. In addition, in order to qualify for or to keep receiving the benefit, the surviving spouse must remain single.
Asset tests and income tests also apply to a death Pension, and, basically, all the rules are the same for obtaining the benefit as with the living veteran. Benefit levels are lower for a surviving spouse when compared to a single veteran. For example, (2009 rates) a single veteran with no dependent children is entitled to an MAPR (Maximum Allowable Pension Rate) of $11,830 without aid and attendance and $18,120 with aid and attendance. In comparison, a surviving spouse is entitled to an MAPR of $7,933 without aid and attendance and $12,681 with aid and attendance.
Pension income is paid in addition to other family income and can provide a substantial amount of extra money to help pay for long term care. The maximum monthly amount available in 2012 is $2,019.
Although the Veterans Administration does not differentiate between various Pension applicants, there are, in practice, two kinds of Pension applications. The first type of application or claim, as it's called by VA, deals with veteran households that do not generally require a rating for "aid and attendance" or "housebound" in order to receive a benefit or as VA calls it, an award. These applicants will have household income less than the monthly allowable Pension rate. In addition, they will have very little in savings or investments. And, with no ratings, the size of their Pension awards will be much smaller.
There is a second type of VA application generally submitted for a claim. Claimants in this category often have income above the maximum Pension rate and they may also have significant savings or investments. Typically, this category of application requires a potential beneficiary to be paying for ongoing and expensive long term care or other medical costs.
For veteran households receiving expensive long term care services and whose incomes exceed maximum Pension rates, a rating is almost always necessary in order to receive a benefit. In most cases, without a rating, there is no benefit. This larger group of roughly 10 million Pension beneficiaries can only receive an award under certain special conditions and typically only if they receive a rating.
What is surprising, when we combine the number of eligible veterans for both types of applications, a third of all people -- 33% -- in this country, over the age of 65, have a potential for receiving a Pension benefit. That's how many war veterans or their survivors there are in the US.
The potential for receiving a benefit is huge. However, in actuality, only 4.7% of this large population of potential beneficiaries was actually receiving a benefit in 2005. This number has not changed for 2008. This is truly astounding and appalling! Someone needs to do a much better job of getting the word out.
A local Regional Medical Center can pay a veteran a grant to allow for "home improvement and structural alterations" -- HISA grants. These are necessary alterations in order to accommodate disability in the home. As a general rule these grants are provided to veterans who are receiving VA health care and who are service-connected disabled. Certain service-connected disabled veterans can receive a lifetime benefit of $4,200 for home improvement projects to aid with disability.
A clause in the eligibility statutes opens the door for veterans who are on Medicaid or receiving pension with aid and attendance or housebound ratings to also receive these grants. Also very low income -- means tested veterans -- may also receive the grant. For this class of veterans the grant is a lifetime payment of $1,200.
Although they are reluctant to provide these grants to veterans who are not in the VA health care system, the medical center HISA Committee will do so if adequate documentation is provided to justify the grant.