Who's eligible for V.A. long-term care benefits?
The V.A. provides nursing home and other long-term care -- the V.A. calls it "extended care" -- for many veterans. Those eligible for V.A. nursing home or noninstitutional long-term care include:
Veterans with a service-connected disability rating (or combined disability ratings) of 70 percent or higher.
Veterans with a 60-percent service-connected disability rating who are unemployable, or who have a rating of "permanent and totally disabled."
Veterans with a service-connected disability that's clinically determined to require nursing home care.
Veterans who require nursing home care for any nonservice-connected disability and who meet income and asset criteria.
Other veterans on a case-by-case basis, with priority given to veterans with service-connected disabilities and those who need care for post-acute rehabilitation, respite, hospice, geriatric evaluation and management, or spinal cord injury.
More detailed information about eligibility for these nursing home and other extended care V.A. programs is available from the V.A.'s Office of Geriatrics and Extended Care.
What nursing home benefits are available from the V.A.?
The V.A. provides long-term nursing home care through different types of facilities. There are the V.A.'s own nursing homes, and there are private nursing homes (called "community nursing homes" in V.A. language) that contract with the V.A. to care for veterans when no nearby V.A. facility is available. There are also the V.A.'s Community Living Centers, which provide short-term residential care along with ongoing outpatient care. And the V.A. pays a small part of the cost of residence in State Veterans Homes for some veterans who are not eligible for direct V.A. nursing home care.
Eligible veterans may qualify for residence in a V.A. nursing home if they have functional physical and/or mental impairment serious enough to require nursing home-level care. If there is no V.A. nursing home close to the veteran's home and family, or there are no available spaces in a nearby V.A. nursing home, the V.A. may pay for a veteran to reside in a nearby private nursing home if that facility has a contract with the V.A. to provide care to veterans.
Community Living Centers are another type of V.A. long-term care facility. They provide a combination of short-term residential care similar to assisted living and ongoing community care for veterans with chronic stable conditions, including dementia; those requiring rehabilitation or short-term special services such as respite or intravenous therapy; and those who need hospice or other palliative care at the end of life. Most Community Living Centers provide short-term rehabilitative or end-of-life care for up to 100 days. They can also provide longer-term care for veterans who require prolonged rehabilitation, are unable to obtain a place in a community nursing home, or otherwise lack a clinically appropriate community alternative.
What V.A. long-term home and community care is available?
The V.A. has several long-term community and home care programs to help veterans who do not qualify for nursing home-level care or who want to live at home but need regular nonmedical assistance with the activities of daily living.
Community Residential Care is a program that provides many of the same types of care and services found in an assited living setting. Under this program, veterans have room and board, plus limited personal care and supervision, for veterans who don't require nursing home care but aren't able to live independently because of medical or psychiatric conditions, and who have no family who are able to provide care.
Hospice/Palliative Care provides comfort-oriented and supportive services for a veteran who is in the advanced, end-of-life stages of an incurable disease. This can include respite care, which allows for short-term inpatient care for the veteran in a V.A. hospital or nursing facility, which temporarily relieves the veteran's spouse or other caregiver from the burden of caring for the veteran at home.
When a veteran applies for extended care, he or she is evaluated by a Geriatric Evaluation and Management (GEM) team. Based on the veteran's needs, the veteran can be provided with:
Home health care, which provides long-term basic medical care to chronically ill veterans in their own homes under the coordinated care of an interdisciplinary treatment team.
Homemaker/home health aide services, which are health-related and minor homemaking services provided by a public or private home care agency.
Adult day health care, which provides health maintenance and rehabilitative services to veterans in a group setting during daytime hours, either at a V.A. or community facility.
What's the cost to a veteran for V.A. long-term care benefits?
For extended care services, veterans may be subject to a co-payment of up to $97 per day. The amount of the co-payment depends on the veteran's V.A. health system priority group and individual financial circumstances, and on the type of care or service provided. The amount of co-payment for extended care services is based on the income, and for some services the assets, of both the veteran and the veteran's spouse.
For extended care services expected to last 180 days or less, the V.A. looks only at the income of the veteran and spouse, taking into account the veteran's expenses. For extended care services expected to last 181 days or longer (such as residence in a nursing home), the V.A. looks at the income and the assets of the veteran and spouse. Details of these financial calculations are available from the V.A.'s publication V.A. Copays and Charges.
How do I apply for V.A. long-term care benefits?
An application for V.A. long-term care is separate from the application to enroll in V.A. medical care coverage. To apply for nursing home or other long-term care, a veteran or veteran's caregiver must fill out a special application for extended care services.
Veterans receiving compensation or V.A. medical treatment for a service-connected disability need not file this separate application.
What will I need to apply for V.A. long-term care benefits?
When you apply for extended care, you will need to present evidence of the following:
Spouse's name, date of birth, and Social Security number
The current income of both the veteran and the veteran's spouse
The value of fixed and liquid assets of both veteran and spouse (only if applying for nursing home or other residential care)
Information identifying all health insurance, including all parts of Medicare (a copy of an insurance card and the veteran's Medicare card)
Where can I get help applying for V.A. long-term care benefits?
You can get free assistance with any V.A.-related question or problem by phone or in person through one of the V.A.'s Vet Centers, which are located in every state. You can also get assistance by contacting the V.A.'s Veterans Benefits Administration office nearest you. The V.A. also has a toll-free telephone help line at 800-827-1000.