What I feared happened, the VA is saying no to the Independent Living place Mom was moved to. Has this happened to you?

The medical eligibility requirements for Aid & Attendance, and the many misunderstandings that people have about the pension, were dramatized several years ago by the daughter of a World War II Veteran during a US Senate subcommittee hearing several.

The daughter testified how someone assured her mother and father they could get Aid & Attendance to pay rent at an Independent Living facility. Her 90 year old parents sold their house and moved to the independent living. Then her mother died, and the VA denied her father’s application for Aid & Attendance because he was healthy and did not need the Aid & Attendance level of care. The veteran did not understand the medical rules for Aid & Attendance when he decided to sell the house and move to the facility.

The veteran or surviving spouse must need assistance with activities of daily living. Proof of the need for attendance from a doctor’s evaluation of the veteran, or surviving spouse is required. It’s very important that the medical evidence be
reviewed by someone familiar with the VA. Even if the veteran or spouse does qualify, if the applicant’s medical needs are not explained properly, the VA case worker may deny the application.

The VA published a letter in 2012 that discusses Room and Board as a Deductible Unreimbursed Medical Expense:
http://masshealthhelp.com/pdf/2012_VA_letter.pdf

But without experienced assistance with the application process, the VA rules are difficult to understand.

Thank you for posting your mother's story. It will raise awareness, and may help other people avoid these serious difficulties that you are going through.

The only way you get VA aid is when the MD fills out the VA 2680 form showing the patient needs help with 2 or more ADL's. Independent Living is not the same as Assisted Living. You were relying on third hand information from a well-meaning friend, instead of a written plan from the IL facility? Does the work around include help with: feeding, cooking, bathing, blindness, medication, finances, walking or toileting? The MD has to sign the 2680 and the facility has to sign that they provide the services needed. We are working with a consultant, ERBC, and they are quite helpful.

The problem is the facility does not provide those services beyond providing meals in a dining room and cleaning service once a week. They call themselves AL but in reality operate as a more attentive IL. The workaround they recommend is a contract between mom and someone (me or the friend) that we are providing assistance with ADLs and that we are hiring the AL to assist. Then we (me or the friend) provide annual logs and receipts to the VA "proving" we've provided such services. It commits someone (me or the friend) to doing this indefinitely and we are not comfortable with this fuzzy workaround. Even the fact that Mom is legally blind might not be enough to qualify the facility.

Go with the backup plan. The last thing you want to do is knowingly commit fraud or put yourself in a position as her caregiver for these services. Aid and attendence is not for room and board or custodial care. You can always look for a place closer to you after the fact. Most AL facilities are for profit/private pay and some willl go to any unscrupulous lengths to keep beds full.

Wow that sounds like a rough situation. I used to work for a health insurance company and also for Patient Accounts at a pediatric hospital and I always heard the same story as you: "They told me it would be covered!" I always told the people I spoke to (in both jobs) never to rely on the provider for insurance advice because they are contracted/providers for so many different payors they really cannot keep information straight as far as benefits, network/contracted status etc. I am aware this post is probably not really helpful to you - I apologize. But since you posted your story, maybe your story and/or this post may help others. Hang in there.

At the time I posted this out of frustration. Now that we have moved Mom to the place that is approved, I am glad I posted so others will be aware.

The workaround that the first place recommended would also commit whoever signed an agreement to provide care and help with ADL to Mom (and then hire the facility) to paying taxes on income. Money would go from the VA to Mom, from Mom to the caregiver, from the caregiver to the IL place. The caregiver would be required to pay income tax on those payments. No one in the family can afford that.

It took us this long (2 months) to get the application submitted to the VA (gather documents, meet with VA rep) and all is in order accirding to our VA counselor. We expect an answer no earlier than December 2014. It could even be later. This is a long process.