Page Reviewed / Updated - Jan. 2014
In producing this guide, it is not our intention to replicate the VA Guide to Long Term Care. The VA website does an excellent job of describing the programs and types of assistance available to elderly veterans. Instead our objective is to focus on veterans' options with regards to paying for care. The aim is to help veterans discover and understand the benefits available to them, to find financial assistance and to provide ideas that can reduce the costs associated with long term care, be that in a nursing home, in assisted living or at home.
Be aware that not all options are available to any one veteran. Some programs have eligibility criteria which specifically state that the recipient cannot be eligible to receive a different VA benefit. Also worth noting is that the sources of funding described here are not limited to those offered by the VA. Also included is assistance from non-profit organizations intended specifically to help veterans.
Within the category of residential care, there are many different living environments where veterans can receive the type of care they require. One might elect from the following based on their severity of need, the availability of services in their geographic area, the level and source of funding available and / or their personal preferences.
Community Nursing Homes are what most people think of when they hear the term "nursing home". This name is given to differentiate from nursing homes which are owned and operated by the VA. Community Nursing Homes are regular nursing homes under contract with the VA to provide services to veterans. The VA outsources nursing home care largely to provide veterans with a much broader range of locations in which they can receive care.
Payment for services received by veterans in Community Nursing Homes comes largely from VA Health Care (a.k.a. VHA). TRICARE for Life and CHAMPVA for Life, which work similar to Medicare supplemental insurance plans, will pay for short stays in nursing homes. An additional source of funds are veterans' pensions, specifically the Basic Pension and the Aid and Attendance Benefits although they are less frequently used for this purpose. Readers may also want to review our guide to paying for nursing home care which discusses a broader range of assistance not specific to veterans or our Medicaid vs. Veterans Pensions page.
Community Living Centers (CLCs) are nursing homes which are operated by the VA as opposed to Community Nursing Homes which are not. They provide much of the same services as regular nursing homes and are available to veterans both on a short and long term basis. The drawback of CLCs is that they are limited in number with fewer locations in comparison to regular nursing homes. A list of CLCs is available here.
For the vast majority of residents, payment for the CLC comes from VA Health Care. Some residents may be required to make a co-payment which comes out-of-pocket. TRICARE for Life and CHAMPVA for Life may pay co-payments for short term residents, although holders of these types of insurance are less likely to reside in CLCs.
Somewhat confusing in name, State Veterans Homes are nursing or long term care residences for veterans, however they are not run by the VA. State Veterans Homes are run by state governments. From a services perspective it is best to think of these are comparable to Community Living Centers or Community Nursing Homes.
Payment for State Veterans Homes can come from a variety of sources such as VA Health Care, Medicare, Medicaid and the Aid and Attendance Benefit. However eligibility is determined at the individual home level not on a nationwide basis and therefore it is difficult to provide an exhaustive list of funding options. A map of State Veterans Homes is available here, veterans interested should contact these residences directly to ask about funding sources.
Assisted living provides a community-like living environment with private or shared rooms and apartments. Residents have the choice of communal dining or preparing and eating meals in their apartments. Around the clock care is available to provide assistance to residents with their activities of daily living. The level of care provided is significantly less than is offered in nursing homes. Social and recreational activities are available throughout the day.
Understanding how veterans can pay for assisted living and the care services received therein is a little complicated. It is helpful to break the cost of assisted living into different components. Most assisted living communities will bill veterans for care services separately from room and from board costs. Most communities also permit residents to receive outside assistance with care services.
Although the VA does not directly pay for assisted living nor offer its own assisted living residences, there are several ways veterans can receive assistance from the VA to pay for assisted living. The most common way veterans pay for assisted living is using Aid and Attendance. This pension benefit is designed for veterans who require assistance with their activities of daily living and can be applied to whatever purpose the recipient desires and therefore towards assisted living rent, board or care services.
Another assistance option veterans have is Home and Community Based Services (HCBS). Veterans can receive these services in their homes or communities. Communities include assisted living residences. Therefore certain HCBS can be received by veterans living in assisted living communities, thereby reducing the fees they would otherwise be charged by the assisted living communities itself. For example, most assisted living communities offer primary care and assistance with the activities of daily living. They charge residents by the amount of each they require. Since outside professionals from Veterans HCBS can provide these services instead, the veteran can significantly reduce their monthly expenditures paid to the assisted living community.
There are also programs that help pay for assisted living that are not limited only to veterans. Read our guide to paying for assisted living here. For assistance finding affordable assisted living,click here.
Adult Foster Homes might best be envisioned as small versions of assisted living communities. Typically this type of residence care for a maximum of 4-6 individuals and provide many of the same types of services as larger assisted living residences though typically with fewer organized recreational activities. Adult Foster Homes are also less expensive.
The VA does not pay directly for Adult Foster Care, however assistance is available to indirectly cover the costs very much in the same way as described in Assisted Living section above.
Much like Adult Foster Homes are small versions of Assisted Living, Medical Foster Homes can be thought of as smaller, more personal nursing homes. The VA does not pay for the room and board charges associated with foster homes. However, through VD-HCBS' Homemaker and Primary Care programs, primary care, personal care and assistance with the activities of daily living can be paid for in Medical Foster Homes. Aid and Attendance pension benefits can also be applied towards the room and board cost of Medical Foster Homes.
In this section, in addition to home medical care, we have included other human-based, support services that help a veteran remain living at home.
Home Medical Care, for the most part, is provided by nurses, nursing assistants, therapists and nurse practitioners and to a much lesser extent by medical doctors. The focus of home medical care is on more health maintenance and providing assistance with the activities of daily living and less on diagnostic procedures.
Home Medical Care is considered a Home and Community Based Service and is provided to any veteran receiving Veterans Health Administration Medical Benefits. The cost of Home Medical Care or the co-payment amount is determined by the recipient's priority group. An alternative option is through Medicare, which covers Medical Home Care when medically necessary. In these cases, TRICARE for Life and CHAMPVA for Life will typically pay for the portion of the cost which Medicare does not cover.
Personal Care can best be described as non-medical assistance with the activities or the instrumental activities of daily living. Assistance performing activities such as bathing, maintaining personal hygiene and eating or in the preparation of meals is provided. There are large areas of overlap between Personal Care and Medical Home Care and often times Home Care professionals also provide Personal Care during their visits. However, Home Care professionals have higher levels of medical training and are therefore more costly to employ.
Personal Care at home can be paid for by several different sources of funds from within the VA. Similar to Home Medical Care, Personal Care is a covered VA Medical Benefit under HCBS and fees are determined according to Priority Group. In addition, one of three different veterans pensions can be used; the Basic Pension, Aid and Attendance or Housebound. TRICARE for Life and CHAMPVA for Life do not cover personal care provided in the home.
Elderly veterans and their spouses who live at home often require assistance with the maintenance and upkeep of their property. Activities such as yard work or simply changing a difficult to access light bulb may present challenges. The idea behind Chore Services is to provide assistance in these areas which are important to helping veterans maintain a safe and secure living environment but are outside the services provided by Home Medical or Personal Care professionals.
For the most part Chore Services are outside the scope of covered benefits by VA Health Care, although often times Personal Care or Home Care aides will provide minor assistance with tasks. However, there are other methods by which veterans can obtain more regular assistance. Under Veterans Directed Care within HCBS, veterans are given the flexibility to determine the range of services that are required to help them remain living in their homes. Hiring an individual to maintain the home and property as a safe environment certainly falls within the scope of services that are eligible.
Another option is non-military, non-profit assistance. An organization called Cleaning for Heroes coordinates cleaning services on a national level to help disabled and elderly veterans by providing free cleaning and minor home maintenance services.
Adult Day Care is offered in special centers that provide basic primary care services, assistance with the activities of daily living, meals, recreational and social activities. Typically these centers are open during normal business hours. Care and supervision are provided in a group environment making adult day care one of the most cost effective ways to care for elderly veterans that require near constant supervision. The VA offers Adult Day Care in many of its Medical Centers as do State Veterans Homes. However, veterans are not required to receive assistance in either of these locations, they are welcome to find other adult day care centers in their communities.
Adult Day Care is covered by VA Health Care for eligible individuals with a need. Fees are determined according to the veteran's Priority Group. Adult Day Care is also quite frequently paid for using VD-HCBS. Veteran's pensions, principally the Basic Pension or the Aid and Attendance Benefit allow the recipient to spend the benefit on whatever type of care they require and can therefore be used for Adult Day Care. CHAMPVA for Life and TRICARE for Life do not pay for adult day care.
Individuals caring for elderly veterans often need a break from their caregiving responsibilities. Respite Care is a formalized manner in which caregivers can achieve this goal. There are different ways in which caregivers can be relieved. Respite caregivers can come to a veteran's home or alternatively the veteran can be taken to a center that provides respite care. Often adult day care centers and state veterans homes also offer respite care sometimes even on an overnight basis.
VA Health Care offers qualified individuals up to 30 days per year of VA Respite Care. Co-payments may be required dependent on one's Priority Group. Also, under Veterans Directed Care as part of HCBS, a veteran can choose to allocate some of their budget on respite care services.
To assist veterans in aging in place, more is required than human based caregiving. It is important to enable veterans to live as independently as possible both for their own sense of self-reliance and because it is cost effective. To do so, often requires the purchase of durable medical equipment and that modifications be made to the home or place of residence to accommodate for the medical equipment and for their physical challenges.
Durable Medical Equipment, also called DME or Home Medical Equipment, refers to long lasting and reusable medical equipment that helps persons to function independently on a daily basis and to manage their activities of daily living. For example, standalone equipment such as wheelchairs, home hospital beds and walkers, as well as fixed items such as handrails and wheelchair ramps and finally smaller electronic items such as nebulizers, home blood testing kits and ventilators are all considered to be DME.
There are many assistance options to help veterans purchase DME. VA Health Care will provide assistance when it is determined the item is medically necessary and prescribed by a physician as will TRICARE and CHAMPVA. TRICARE for Life and CHAMPVA for Life will pay the DME co-payments that Medicare does not, this is typically 20% of the purchase cost of the item. Under VD-HCBS, veterans determine what medical equipment requirements they have and within a certain budget, are free to purchase whichever items they require. Veterans' pensions do not dictate how their assistance can be spent. This source of funding is also at the veterans' discretion. Finally there are the HISA, SHA and SAH grants which are primarily intended for home modifications but very often the lines between home modifications and DME are loosely defined. For example, wheelchair ramps and grab bars can be considered part of either category. A more complete review of medical equipment purchasing and veterans is available here.
Modifying one's home to account for a disability and the natural challenges associated with aging is a necessity to maintaining independence and maintaining a safe living environment. Home modifications can be as simple as changing knobs to levers on faucets or as complex as building a complete in-law apartment. Veterans in wheelchairs may need ramps, doorways to be widened and floor surfaces to be smoothed to allow easy passage. Bathrooms might require a complete re-build or simply the addition of grab bars in a shower.
Funding for veterans for making home modifications is a bit more difficult to obtain than for other types of care. This is perhaps because the line between home improvements which increase a home's value and modifications is somewhat undefined. However, funding and assistance are still available.
Veterans Directed Care allows a veteran to make their own decisions and therefore can be used for modifications, especially should those modifications lower the care costs they would otherwise incur. The Veteran's Homebound Pension does not restrict the recipient's right to allocate as they see fit for their care and therefore can be applied for this purpose. Certain veterans are also eligible for one of three grants specifically intended to pay for home modifications to account for their service-connected disabilities and for disabilities unrelated to their military service. These grants are the HISA, the SAH and the SHA Grants. Finally, there are non-profit organizations unassociated with the armed forces that provide assistance specifically for veterans. The national non-profit called Rebuilding Together has a program called Heroes at Home which offers help.
Assistance for veterans is not limited to just programs designed for veterans. There are many other options available for the general aging population. To search for other forms of assistance, use our Resource Locator Tool or browse for programs by area of need.
For families and veterans struggling financially to care for themselves, their spouses, parents or other loved ones, a very effective way to reduce care costs is to ask for a reduction. Home care providers and to a lesser extent, assisted living communities sometimes will provide discounted services for those who have served the country. We have partnered with two services that provide free assistance helping veterans to locate the most affordable, quality care in their geographic areas. Get help finding affordable care now.