Books for Long Term Care Planning
Find books provided by the National Care Planning Council to help families prepare & recognize the need for long term care planning and to help implement that planning.
Long Term Care for Veterans
Medicare Long Term Care Coverage
Medicaid Long Term Care
Community Aging Services and Long Term Care
Long Term Care for Veterans Find a Veterans Benefits Consultant
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 (2009) a day 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 in service, non-disabling 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. Click here to learn more about this benefit
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 un-reimbursed 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 $7,000 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 similar forms (VA Forms, click here). Generally the Pension benefit is more applicable for applications associated with little or no service connected disabilities. Pension is especially useful when significant costs for home care, assisted living or nursing home care are present.
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 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, a single veteran with no dependent children is entitled to an MAPR (Maximum Allowable Pension Rate) of $12,867 without aid and attendance and $21,447 with aid and attendance. In comparison, a surviving spouse is entitled to an MAPR of $8,629 without aid and attendance and $13,794 with aid and attendance.
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.
Medicare Long Term Care Coverage
Medicare coverage is not intended to provide long term care services longer than a few months. Coverage is limited to rehabilitation from an illness, a hospital stay or an injury. Medicare will not cover chronic, ongoing long term care needs.
Nursing Home Care Traditional Medicare will pay for 20 days in a skilled nursing care facility at full cost and up to an additional 80 days after an out-of-pocket co-payment of $124 per day. Private Medicare supplement insurance pays the co-payments of $124 per day if a person carries this insurance and the right policy form. However, Medicare often stops paying before reaching the full 100 days. When Medicare stops, so does the supplement coverage.
Medicare Advantage plans typically require out-of-pocket co-payments for the first week or more of nursing home coverage before the plan takes over. This is just the opposite from traditional Medicare which pays the first 20 days at no cost. Advantage plans also tend to limit the number of days of allowable nursing home care when compared with traditional Medicare.
Home Care Medicare will provide limited home care services for people who are homebound and needing rehabilitation from an operation, an accident or an illness. Care is usually limited to 2 to 4 hours a day and generally will not last longer than two months.
Medicare Advantage plans are reported to be limiting severely the length of time allowed for home care as compared with traditional Medicare.
Hospice Care Traditional Medicare and Medicare Advantage plans provide hospice care at home or in a facility for individuals who are not expected to live longer than six months.
Medicaid Long Term Care
Medicaid will provide nursing home care for seniors age 65 and older and for certain other low income, disabled Medicaid recipients regardless of age. In recent years, state Medicaid programs have also been providing home care services and some coverage for assisted living. These alternative or "waiver" programs for community services, other than nursing homes, are typically administered by the local area agencies on aging in each state. Once eligible, a beneficiary is also covered for health care by Medicaid.
Federal rules require having less than $2,000 in assets and an income that will not cover the cost of long term care services before Medicaid will start paying the difference between the income and the cost of services.
Married couples are allowed to retain a certain level of income and assets for the spouse remaining at home to avoid impoverishing that spouse. The healthy spouse is also allowed to keep the home and an automobile. Neither of these assets will disqualify the spouse needing Medicaid assistance. In most states, a single Medicaid beneficiary will not be disqualified by retaining the home, even though it may not be occupied.
Any assets that have been gifted five years or less prior to applying for Medicaid will result in a denial of benefits until a penalty period – calculated from the amount of the gift – is met.
Specialists and attorneys who understand Medicaid law can often help families retain assets or income that might normally have to be given up in order to qualify for Medicaid. These specialists will also provide strategies to decrease or eliminate taxes associated with Medicaid transfers or inheritances.
Community Aging Services and Long Term Care
There are many private, religious and government organizations across the country that provide supportive services for older people. Many of these services center around helping people stay in their homes and avoid having to go to live in an institution or perhaps move in with family. Because of the emphasis on helping people remain independent, many community aging programs could be viewed as long term care programs. In fact it's probably just a matter of semantics; long term care and community aging services are just two sides of the same coin. Community aging programs might include:
- Meals served in community centers or delivered to the home
- Community Senior Center activities and training
- Transportation and shopping services for people who can't drive or leave their homes
- Home repairs, snow shoveling, telephone support, caregiver support, care management, legal services, energy and weatherization services, housing subsidies, home health care, counseling and much more
- Adult day care
- Protection from abuse
- Help with health insurance and government entitlement programs
Private support groups might be the Red Cross, women's auxiliaries or foundations. Many religious communities support activities for their elderly members as well as nonmembers. Both private and religious groups often provide services for free to people with little income and few assets. They may, however, charge people for services who have adequate income or assets. Many of these groups may also operate nursing homes and assisted living facilities.
Senior centers are often the focal point for all aging services in a community. Experts or contact people are housed in senior centers and can provide many services in the center itself or refer out to other organizations that can help. The community-served meals or congregate meals in senior centers are a means for attracting older people into the centers. Seniors can then be exposed to the many services that are available.
Government support for aging services comes from the Older Americans Act, passed in 1965. This act, over the years, has produced a large network of care providers and local government managers called Area Agencies on Aging. This network also includes federal agencies, state agencies as well as local area agencies and is called the "national aging network".
Although area agencies on aging currently do not track and direct people to non-government services, in the future, the Government intends on being the single source coordinator of all aging services in the community. Therefore, if you're looking for any services in the community, public or private, you should contact your area agency on aging first.
We have compiled a list of all 655 area agencies on aging in the United States . Click here for the state list of area agencies on aging.