Paying for Long Term Care, and the Veterans Aid and Attendance Benefit

Long term care is costly. The resources for financial assistance are limited and usually follow strict income guidelines, making it difficult to obtain benefits to defer costs.

In my previous blog, I addressed what Medicare pays for, or more of what they won’t pay for. Here I address and explain other resources for financial assistance, particularly the Aid and Attendance benefit for Veterans, and their spouses.

Anyone who has entered the long term care system, whether it is a nursing home, rehabilitation facility, assisted living facility or homecare knows the difficulty obtaining financial assistance. Many people are confused by Medicare and Medicaid. Everyone is eligible for Medicare if they have reached 65 years of age, and they or their spouse have worked at least 10 years in Medicare covered employment. There is also a Medicare disability benefit for disabled persons under 65 who qualify.

Medicaid is a health program designed for low income persons of any age. The criterion of eligibility is not so easy to understand. Although this is a nationwide program, the criterion varies from state to state. Medicaid payment for long term care has functional criteria as well as financial. Financial criteria are based on income and assets. The well known “spend down” principal is the nice way of saying if you spend everything you have, including loss of assets, you can qualify for Medicaid. Basically when you go broke, you can get help.

The two alternatives to losing everything to obtain financial assistance are Long Term Care Insurance and Veterans Benefits. If you haven’t purchased LTC insurance in younger years, it becomes basically unaffordable as you age and need assistance. Currently I see very few seniors with LTC insurance since historically, this was a newer concept. This is now a growing industry. What I have seen is beneficiaries having trouble accessing benefits due to the wording and criteria of these policies. When some of these policies were written we didn’t have the variety of options in long term care that we do today, and the insurance companies did not expect to pay the influx of benefits they are now paying. If you do have a policy and are having problems receiving benefits, you may be able to obtain advocacy from the care provider you’re using, whether that is an assisted living facility, nursing home, or homecare. Many policies used wording that doesn’t apply in your state, so they deny the claim. For instance, the policy may say the benefit will be paid to a licensed homecare agency. Licensure varies by state, and not all states license homecare agencies. I fought for 4 months to get a client benefits paid by a well known LTC Insurance company because of that exact wording. She finally received benefits. Don’t give up if you’ve been denied.

The second alternative is Veterans benefits. There are health benefits available through the Veterans Administration Health System, with additional benefits for service connected disability. You can access this information at http://www1.va.gov/opa/vadocs/current_benefits.asp Visiting Angels services Veterans with homecare paid for by health and disability benefits. Veterans Administration qualifies a veteran for these benefits based on military service and percentage of connected disability. There is a priority group classification system that balances the demand for benefits with the resources available. Priority groups classified as 1 through 8 also determine co-pays, if any. Group 1 is the highest priority, with 8 being the lowest. The VA can approve a specific amount of hours a week for homecare assistance to the Veteran, and may allow a number of visits for respite care if a family member is caring for the veteran. The VA offers some great benefits in additional to typical inpatient and outpatient care, including low cost prescriptions, dental care, travel reimbursement, home modification, and several other benefits.
A new ruling came into effect January 2009, which may change eligibility based on income. Veterans who fell into group 8 classification may now become eligible, when they were previously denied. To check eligibility and classification go to www.va.gov/healtheligibility.

The last benefit that is growing in popularity, but still few know about is the Aid and Attendance Benefit for Veterans, and spouses, even if the Veteran is deceased. This is a special pension benefit that most Veterans who are not on Medicaid would qualify for.
The criteria for qualification include;

• Veterans must have served 1 day during an active war and had no less than a 90 day service.
• Surviving spouses must still have been married to the veteran when they passed.
• You must have a doctor’s order insisting you need the aid and attendance of another every day.
• You must have less then 80K in checking and savings even less if you are applying as a single(not including your home or vehicles) if you have IRAs and CDs they are included as income.
• You must have received an honorable discharge or general discharge.
• You can choose where you want to live as long as it is a credible facility or community/ Home care company.
• You may not qualify if you are on state assistance (Medicaid or another subsidized program due to your low income).

If you qualify, a Veteran is eligible for up to $1,554 per month, while a surviving spouse is eligible for up to $998 per month (2008 rates). A couple is eligible for up to $1,842 per month. Increase each year for cost of living.

Advocacy groups to help Veterans and/or their spouses obtain these benefits are popping up all over the country. I do not endorse any specific group, but it is imperative that you know there is no cost to you to use an advocacy group. If a company tries to charge you, they are scamming you. These companies work with financial planners to refer Veterans who are above the income limit to reorganize assets to then qualify for the benefit. The income the group receives from the financial planning company allows them to advocate at no charge to the Veterans who do fall within the guidelines. Realize that it could take from 4-6 months to start receiving the benefit, but the payment will be retroactive to the filing date. Some advocacy group’s work with companies that will provide the funds to you before the benefit is paid to be reimbursed when benefits begin.

Visiting Angels offers a brochure on this benefit at www.visitingangels.com under Brochure Library

In the midst of health care reform, it is crucial to contact your representatives and demand an increase in long term care benefits for seniors. Seniors and families are in crisis trying to figure out how to pay for care, especially when they want to stay home and receive homecare. Others are forced into nursing homes after they’ve exhausted finances or were low income to begin with because Medicaid will pay for a nursing home, but not homecare. Many times these seniors are not even given a choice of nursing homes, but are admitted to the first nursing home that has a Medicaid bed available. This is NOT how the senior citizens in this country should be treated. Most have paid into this system their whole lives, and will find themselves with no choice in care or where they will call home. I invite you to go to UTube and look up elder abuse. There you will find some of the most appalling videos on elder abuse in nursing homes. These horribly abused seniors are typically ones who have no choice in care, and no one to advocate for them on their behalf. This is a travesty in this country that we can put to an end with us all standing together for Long Term Care reform. Please join me and the Visiting Angels Organization to help our seniors stay in their homes.