In the last few weeks St. Louis and indeed the entire Midwest has experienced a great deal of confusion, agitation, and outright denials on the part of the VA concerning the VA aid and attendance benefit. Eldercare attorneys in the St. Louis area have been telling their clients that they have less than a 50% chance of getting the VA benefit if they live in independent living.
This can be a problem not only for families faced with high medical expenses, but frankly a problem for independent communities as well. Many excellent senior communities depend on this benefit as much as many families do.
We continue to advocate for families in Veteran First Communities. In this time of need we propose a multi-pronged approach to this problem that involves the families the physician and your community
But first a little background.
Beginning around the first the year, veterans benefit practitioners around the country started seeing denials of benefits from the Veterans Administration. With the following language use:
“Evidence shows that this facility does not provide any medical or nursing services to you and they are considered to be in independent living facility. VA does not consider meal preparations pull cords or transportation to medical or nursing services. We consider this fee is paid to landlord providing residency. Therefore, this is not countable medical expenses.”
Prior to this point the Veterans Administration has allowed the expense associated with an independent living community to be counted as part of the claimant's unreimbursed medical expenses. In fact, M21 – 1- MR provide clear support for this position:
M 21 – 1MR, part B, subpart II, Chapter 1, section G
V. Custodial care, including assisted living facilities.
If a beneficiary or dependent, or other person for whom medical expenses may be allowed, is maintained in the home, the assisted living facility, or other institution, because the individual needs to live in a protected environment, all unreimbursed fees paid to the institution for custodial care i.e., room and board and medical or nursing care are deductible expenses, as long as a licensed physician certifies that the individual has a medical condition the make such a level of care necessary.
Without a formal modification to their express language in M21 – 1MR, we fell that the Veterans Administration should not be denying claims were a doctor has stated that a senior veteran needs to live in an independent living community due to their medical condition.
Who Is Affected By These Changes?
Families: A little more leg work is required on the part of families. It's our job to guide them and to make sure that they can communicate effectively with physicians and caregivers. Families may need to make specific changes to the way they look at financing long-term care or independent living for their senior veteran. Planning has changed in light of recent events and we've taken steps to inform and equip them so that seniors can continue to live with grace and dignity.
Physicians: Our on staff physician works to educate family doctors in order to fully document and explain to the VA each particular situation. The VA's homebound rating must be explicit, instead of inferred from VA forms.
Community Directors: The new challenge of this situation requires community directors to fully disclose some features of their protected environment. Because you need to respect state laws concerning RCF-1 licensure, it’s likely that staff and administrators may need to be more sensitive in their speaking to both family members and representatives of the VA.