Long Term Care

What is long term care, and how can the Veterans Health Administration provide the caregiver assistance in obtaining long term care for the veteran?
Many people one day will need the assistance of another person to perform at least one task of everyday living. These tasks are known as activities of daily living and instrumental activities of daily living.  Activities of daily living include needing assistance with bathing, eating, dressing, toileting, or other similar activities.  Instrumental activities of daily living can include needing assistance with preparing meals or managing finances. Although the veteran for whom you care might need assistance with at least some of these activities, he or she otherwise might be able to live a fairly independent life.


Long-term services and supports provide the assistance individuals living with disabilities or who are aging need to allow them to continue to meet their daily needs.  Types of care that qualify as long-term services and supports include services that allow individuals to remain in their homes, sometimes known as non-institutional care; as well as residential care, sometimes known as institutional care. Long-term services and supports are not simply a particular setting like a nursing home. Respite care is considered to be long-term services and supports because it allows caregivers to recharge and helps to ensure the veterans for whom they care continue to receive the care veterans need to remain in their homes and communities.

Health insurance policies such as TRICARE, employer or individual plans, and Medicare do not cover long-term services and supports. Paying for long-term care is complex.

Options for receiving long-term care include purchasing long-term care insurance, using any savings or other personal financial resources, or Medicaid. Medicaid is a state-federal program that is dependent upon an individual’s financial need. In addition to financial qualifications, you also must meet the functional assessment (a determination of your need for assistance with activities of daily living) and be age 65 or older, blind, or have a permanent disability and be under the age of 65. You also must meet citizenship and state residency requirements.

Individuals who qualify for Medicaid long-term services and supports must be able to receive nursing home care. Some states also provide optional services that allow you to receive care in your home (home and community-base services).

Many veterans also have access to services and supports through the VA or their states. The VA provides a robust offering of care settings and services to meet the needs of veterans of all eras. Settings include VA nursing homes, nursing homes in the community, and state veterans’ homes. The VA also provides services that help veterans remain in their homes. These services include veteran-directed care, adult day health care, and homemaker and home health aide care.

What long-term care residential care assistance might the VA be able to assist in providing?
Many veterans have access to traditional nursing home care through the VA.

VA Community Living Centers

Traditional nursing home care in facilities owned and operated by the VA. Facilities provide skilled nursing care to residents at all times but also can provide care to help veterans who need to rehabilitate to regain function.

Community Nursing Homes

Traditional nursing home care provided in community facilities not owned by the VA. Instead, the VA contracts with these facilities to provide care to veterans who need the level of care provided.


For veterans who meet certain criteria, the VA is required to provide or pay for nursing home care if that level of care is needed.  Veterans eligible for VA-provided or paid-for care include those who have a service-connected disability rating of 70 percent or higher, those who need a nursing home level of care because of service-connected disability, and those who have a rating of 60 percent or higher and are determined by the VA to be unemployable or rated by the VA as permanently and totally disabled.  Veterans who do not meet these criteria still might be eligible for VA care depending on availability and their individual situations.

To be eligible for nursing home care, veterans must be enrolled in the VA health care system and require the level of care provided. To determine whether the veteran for whom you provide care is eligible, talk with the veteran’s social worker or case manager. For some eligible veterans, a co-payment might be required ( VA Form 10-10EC).  Veterans, including those who have a disability for which they receive VA compensation, who are receiving care because of a service-connected disability, or who are low-income are among those for whom no co-payment is required.

Another nursing home option is a state veterans’ home. All states provide veterans’ homes, which are owned and operated by the state; however, the VA inspects them annually.  States set eligibility criteria for the homes in their states. Veterans who reside in recognized state veterans’ homes may have some of their costs offset by VA.  The veteran’s social worker or case manager can help with determinations of eligibility and VA payment for services.

Other residential settings include adult family homes, assisted living facilities, and medical foster homes.

Adult Family Homes

Private homes with fewer than six residents who rent rooms. Residents share common spaces and possibly bedrooms or bathrooms. A trained caregiver who can assist individuals with activities of daily living is on duty at all times.

Assisted Living Facilities

Settings where individuals can rent apartments or rooms. Facilities may include common living areas, but some individuals might have their own kitchens. Trained caregivers are on duty at all times.

Medical Foster Homes

Private homes that serve as alternatives to nursing homes. Trained caregivers are available at all times. Although the foster homes are not VA-owned, the VA must inspect and approve all homes. Veterans also must be eligible for the VA’s home-based primary care* to use this option.

*More details on home-based primary care are available in the section on Community-Based Care.


The VA will not pay for these settings but might provide some services to veterans residing in them such as those available through the VA to serve veterans living in home- and community-based settings. The veteran’s social worker or case manager might be able to assist with determining eligibility for locating these settings.

More information may be found on the VA website.

Many veterans wish to receive the long-term services and supports they need while living in their homes and participating in their communities. The VA offers veterans enrolled in the VA health care system a variety of services designed to assist them in maintaining their health and a higher level of independence than would be possible in a nursing home or other similar residential setting. These services might include the assistance of a VA provided health care worker, a contract home health aide, nurse, or a personal care attendant that was located, hired, and trained by the veteran. Many of the home and community-based services the VA provides can be used in conjunction with each other to more fully meet the needs of aging or disabled veterans, including supplementing the care provided by a caregiver.

Basic eligibility is based on the veteran’s being enrolled in the VA health care system and having a need for the types of services offered. Many of these services are designed to divert the veteran from being forced to live in a more restrictive, residential setting. Co-payments might be required for some services. Veterans who receive compensation for service-connected disabilities are among those veterans, however, they do not have to pay co-payments.

One of the newer home and community-based services the VA provides is Telehealth care. This care allows a veteran’s VA health care providers to monitor the veteran’s blood pressure or sugar levels, weight, or pulse without the veteran needing to travel to a VA medical facility. Collecting and communicating the data might require specialized equipment the VA will provide to the veteran. Video services also might be used to allow veterans to communicate with their providers face-to-face. Co-payments are not required for telehealth monitoring but are required for visits with the veteran’s provider that occur using video services. Talk with the veteran’s care team to receive a referral.

Veterans who have complex health care needs and require interdisciplinary health care services might be good candidates for the VA’s Home-Based Primary Care program. The types of veterans for whom this care might be appropriate include those who have mobility impairments or difficulty receiving care in a clinical environment or those who often require coordinated care for multiple health disciplines. Services available through this program help veterans maintain function and quality of life with the goal of helping the veteran remain in the least restrictive setting. The types of services available include visits from primary care physicians, therapists, or other medical professionals; case management; or mental health services. A VA physician supervises these services. Talk with the veteran’s social worker or case manager about a referral. Complete VA Form 10-10EC to determine your co-payment (if any).

For veterans who need assistance with activities of daily living and who require temporary access to health care services in their homes, the VA can provide, on a short-term basis, skilled home health care. This type of care best serves veterans who have difficulty traveling to VA medical centers or community-based outpatient clinics but who need to receive therapy, learn more about their medical conditions or medications, or receive nursing care. Talk with the veteran’s social worker or case manager about a referral. Complete VA Form 10-10EC to determine your co-payment (if any).

The VA also provides Homemaker and Home Health Aide Care that helps veterans who need assistance with everyday activities. Assistance provided through this program is designed to assist veterans who need help with performing activities such as bathing, grocery shopping, toileting, or eating. Many times these services are alternatives to the type of care that might be received through a nursing home or another residential setting. The VA provides this care to veterans through contract aides. Aides may assist the veteran on a regular or an intermittent basis.

Veterans most likely to be good candidates for this program include those who need assistance with three or more activities of daily living or have a significant cognitive impairment; or, veterans who require assistance with at least two activities of daily living and who have two of the following characteristics: are age 75 or older; recently were discharged from a nursing home; frequently use of health care services; need help with three or more instrumental activities of daily living, such as food preparation; are clinically depressed; or are isolated. Talk with the veteran’s social worker or case manager about a referral. Complete VA Form 10-10EC to determine your co-payment (if any).

Sometimes, veterans, those who acquired disabilities at a younger age and those who aged into disability, want the opportunity to be more involved in directing the care and services they receive. Through the VA’s Veteran-Directed Home- and Community-Based Services program, veterans are provided with a budget they may manage to purchase the types of care they need. The caregiver also may manage this budget if necessary.

Veterans using this program have greater authority in how and from whom they receive care. For instance, participants may hire or fire their own personal care attendants. They also assign the work schedule and the types of activities with which they will receive assistance. There is no co-payment associated with using this program.

Veterans considering this program should evaluate whether they want to be responsible for coordinating their services and needs and the extent to which caregivers assist them as needed with coordinating, budget, and other management issues. Also, this program is not yet available throughout the country. Talk with the veteran’s social worker or case manager for more information, including whether the program is available at the veteran’s location.

In addition to care provided to veterans in their homes, VA also provides services designed to help veterans remain in their communities by providing a place for them to go during the day. The VA’s Adult Day Health Care program provides veterans with the opportunity to socialize and participate in activities. The goal of adult day health services is to address the veteran’s cognitive and physical needs while providing opportunities for the veteran to be with other people and for family caregivers to receive support. Veterans must have the same types of needs as those who are eligible for the VA’s Homemaker and Home Health Aid Care.

The VA’s Adult Day Health Care program might be available at VA medical centers, organizations in the community, or state veterans’ homes. Veterans may go to these day programs Monday through Friday or as little as twice week. Some programs are available on a half-day basis while other programs are full-day. Talk with the veteran’s social worker or case manager about a referral. Complete VA Form 10-10EC to determine your co-payment (if any).

The VA also provides veterans with services designed to help them remain comfortable when diagnosed with a terminal condition or when they are living with pain. For veterans who have received a diagnosis that will most likely result in death within six months, the VA provides hospice care. This care is designed to help comfort the veteran and his or her family as the veteran’s condition worsens. Palliative care is available to veterans who need assistance with pain management regardless of whether the veteran’s condition is terminal.

Hospice and palliative care are available in a veteran’s home or in a residential setting. These services are available to all veterans enrolled in the VA’s health care system. There is no co-payment. More information may be found on the VA website.

Caregivers need breaks. The VA’s respite care provides caregivers with the opportunity to focus on other family members, run errands, or spend time rejuvenating while the veterans for whom they care are assisted. Respite care is helpful for caregivers and the veterans for whom they care.

Respite care might involve someone coming to your home to take care of the veteran for whom you care. It also might involve the veteran staying in a facility for a short time. Respite care is appropriate for veterans who have difficulty with dressing, grooming, cooking, walking, or other activities of daily living.

Respite care is available to all veterans who are enrolled in the VA’s health care system and have a medical need for this type of care. A co-payment may be charged for respite care services for some but not all veterans, including those who have service-connected disabilities for which they receive VA compensation. Social workers or case managers can help arrange respite care.

Care is limited to a total of 30 days annually. The VA considers a single day of respite care to be a maximum of six hours during a 24-hour period in the home, more than four hours in a day at an adult day health care program, or 24 hours a day in a residential setting. Additional days of respite care may be approved particularly if a primary caregiver is ill or dies. Talk with the veteran’s social worker or case manager for a referral. Complete VA Form 10-10EC to determine your co-payment (if any).

For a comprised list of respite care resources and programs from the Elizabeth Dole Foundation, which also includes the VA's respite care program, please go here.


Resources:
VA Long Term Care
ARCH National Respite Network and Resource Center
EDF Respite Care: Resources for Caregivers

Medicare doesn't cover long-term care, solely, but will cover other services, which can be found here.

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