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The Veterans Administration has contracts with nursing homes that have agreed to participate in the benefits healthcare program. Therefore, the VA will not cover any nursing home care that is provided outside of its benefit network participation. It is, therefore, prudent for veterans and/or their families to get more information about Long Term Care (LTC) from their closest Veterans Administration center. General information about healthcare benefits for the veteran is also available.
An entire bundle of long term care programs are outlined and explained in the VA healthcare benefits guide. Among these programs are the following:
- Adult Day Care
- Geriatric Evaluation
- Respite Care
- Domiciliary Care
- Nursing Home Care
- Acute Care
Guidelines for Nursing Home Care
There are firm guidelines that must be met before nursing home care is approved and provided. Some of the specific qualifications include: the veteran must demonstrate the need for such care, be actively seeking these services and require the services for the treatment of a service-connected disability.
Some degree of nursing home service may also be approved for the veteran with a 60% service-connected disability AND who cannot pursue gainful employment. A veteran who is rated with a 60% service-connected disability, yet is permanently and totally disabled, would be eligible for nursing home care.
Finally, if the veteran is in need of nursing home care for an illness that is not service-connected, it would be granted to those who have a service-connected rating of 70% or higher. Any care that is approved by the VA must be provided in a VA facility or a contracted nursing home.
Veteran Admission Requirements
Nursing home care will not be provided unless a heavy dose of paperwork is submitted for review! A veteran with a 0% service-connected status can apply for long term care in a VA facility – and may be approved – but could amass some hefty co-payment commitments. The veteran who is compensated for a service-connected disability would be exempt from co-payments for the long term care.
The VA does have qualifiers for admission to a nursing home care unit. It is important for the veteran to be stable both medically and mentally. The guidelines in the VHA Directive 2005-061 (paragraph 3) must be followed. That directive includes:
- Documentation of the needed service
- An estimate of the length of time that nursing care would be needed
- Expected date of discharge
- Determination of the veteran’s priority status
- Special attention will be paid to the veteran experiencing difficulty with community care placement
- Enrollment in the VA healthcare program
Veteran Administration services are provided within the medical centers sprinkled liberally across the 50 United States and Puerto Rico.
Each program is expected to impart compassionate care in a multi-faceted setting to veterans who have enough impairment to require the level of service and skill that a VA nursing home offers. The care provided ranges from chronic conditions to issues of rehabilitation, respite, intravenous therapy to end-of-life comfort and care.
Nursing Home Care Settings
The Department of Veteran Affairs maintains three unique settings for the eligible veterans who need various levels of skilled care.
Veteran State Homes are managed by each state and partly funded by the VA
Community Nursing Homes are under contract to the VA who maintains a list of approved facilities and offers the veteran an opportunity to request a VA contract to cover a nursing home that is not on the list.
Nursing Home Care Units are skilled facilities that are located within a VA medical center or facility and offers care for service-connected disabilities or those with service-connected disabilities rated at 70% or more.
Depending on the situation, a veteran may need to meet certain income levels to qualify for VA-paid care. Other veterans may be required to pay a percentage of income as their share of the cost of care.
Intake and Discharge Notes
The VA will discharge a veteran when it is determined that care in a nursing home is no longer needed or continuing care can be given at home or in a private nursing home closer to the family.
Extended Care Services are given to veterans with a service-connected condition and a 70% or higher disability rating. Veterans in this group have mandatory eligibility for indefinite and unlimited care to address their health issues through the extended care services offered to them.