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Aid and Attendance for Assisted Living Facilities

VA Pension benefits can be extremely helpful in paying for an elder's assisted living facility (ALF). ALFs typically cost from $2,000 to $6,000 per month and VA Pension benefits can be up to $2,127/m for married veterans and up to $1,153/m for the surviving spouse of a wartime veteran. Pension benefits can be the difference between a good assisted living facility or a nursing home, among other possibilities.

Applying for and receiving VA Pension is not easy, of course. The VA itself is a very large bureaucracy and has many rules for getting help. VA Aid and Attendance is the highest level of pension awarded, so it is often our planning target for our elderly clients.  One key to getting Aid and Attendance is having recurring medical expenses. Pension benefits are only awarded for veterans/surviving spouses with high out of pocket medical expenses, which makes Pension perfect for assistance with the ALF. But just because your elder lives in an ALF it does not mean that benefits will be awarded to pay for this cost. 

Aid and Attendance and Activities of Daily Living

When looking for Aid and Attendance to pay for all of the ALF cost (including room and board), the applicant will need assistance with 2 of the 5 activities of daily living. Before 2012, VA staff were inconsistently awarding Aid and Attendance benefits across the country. In 2012, the VA wrote an opinion letter on awarding Aid and Attendance that was very helpful to those looking for help. The letter basically said that in order to have the entire assisted living monthly rent be counted as an unreimbursed medical expense, the applicant will need help with 2 of the 5 activities of daily living ("ADLs"). As defined in VA regulations, ADLs are basic self-care and includes:

  • bathing or showering;
  • dressing;
  • eating; 
  • getting in or out of bed or a chair; 
  • and using the toilet.

Accordingly, for pension purposes, the cost of room and board at a residential facility is an unreimbursed medical expense (UME) if the facility provides custodial care to the individual, or the individual's physician states in writing that the claimant must reside in that facility to separately contract for custodial care with a third-party provider. 

Other Requirements for VA Pension (including Aid and Attendance)

If the veteran or his/her surviving spouse is in assisted living and needs assistance with 2 of the 5 listed ADLs, the applicant will still need to make sure:

  • The veteran served 90 days of active duty, at lease one of which was in a war time
  • The veteran had a discharge that was other than dishonorable
  • The applicant has recurring unreimbursed medical expenses (such as the ALF cost or in-home care) 
  • The applicant's income is an issue for VA purposes, although income is offset by UMEs
  • The applicant's assets are below the threshold, which varies based upon age (starting at $80,000 in countable assets)

Points to Remember with VA Pension

The VA system and application process is very complex, so there are a few key points to remember when looking for help:

  • VA Pension is a great program to help pay for a veteran or his/her surviving spouse's assisted living or in-home care;
  • "Aid and Attendance" is the highest level of Pension awarded;
  • You may not need an attorney to help with Pension benefits if assets are low enough, but it never hurts to meet with an accredited elder law attorney to make sure everything is in order, including your durable power of attorney and advance directives;
  • Asset protection may be available with the right advice; and
  • Protecting assets to receive Pension early may interfere with protecting assets for Florida Medicaid purposes later, so great care must be taken in any planning.

If you are needing help for yourself or your aging loved one, we have more information on VA Pension Benefits to assist you. We also provide free monthly seminars on VA and Medicaid benefits for your further education.

 

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