Spousal impoverishment under VA healthcare/assisted living. Any advice?

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I'm in a very stressful situation right now and I'd appreciate any advice you could offer.

I'm the wife of a 100% T&P SC Vietnam-era vet who also receives A&A SMC. My husband is currently hospitalized at a VA hospital because he needs 24/7 supervision at home due to his dementia (also, service-connected). I have been taking care of my husband for the 3 years and have not been able to find employment because of that. Thus, our only family income is his VA disability compensation and SS retirement pay.

My husband's VA primary care doctor decided that my husband could not longer be at home without 24/7 assistance and refused to refill his prescriptions. His doctor told me to take him to the ER at a VA hospital for a psych-neuro evaluation and placement. My husband is still at the hospital awaiting placement. I contacted our local VARO and the informed me that the VHA should pay for his placement because his dementia is service-connected and he's 100%T&P disabled. However, the hospital staff insists on my husband not meeting the requirements for skilled nursing level of care which the VA would normally pay for. Instead, they're pressuring me into discharging him from the hospital and paying for a very expensive assisted living facility with memory care out of pocket using his VA disability compensation which is our only source of income. The hospital is threatening me with financial abuse allegations and neglect, an APS investigation and a VA fiduciary investigation, simply
because I'm trying to explore other options for placement and protect our income. My husband has been deemed incompetent and unable to make his own medical decisions and manage his own financial affairs by the hospital staff. I'm his DPOA.

Unfortunately, if I pay for my husband's assisted living facility, I will lose our apartment and will have to go to a shelter. Is there any way to protect myself in this situation against this pressure from the VA hospistal staff? Are they right in their refusal to cover his assisted living needs (refusing from SNF level of care) despite the fact that my husband 's VA disability pay is our only source of income? Do you think it is time to file for apportionment to protect my part of this income since my husband is incompetent and needs to be placed? I'm getting a lot of pressure and threats from the hospital and no assistance with regards to asset protection/financial planning in this tough situation. My husband is also ineligible for Medicaid/SSI to help defray assisted living costs.

I'd appreciate any advice!

Answers 1 to 8 of 8
Expert Answer
152 helpful answers
An advocate in your city or town could help you sort out the confusion the discharge planners are having with your husband's level of care. The primary care doctor's recommendation for a neuropsychologist evaluation is an excellent first step. If your husband gets a thorough examination that documents the deficits you describe, an elder law attorney or veterans benefits attorney could begin the process of convincing the VA providers to provide the needed level of care and resources. Use your state or county bar association to find a local attorney who specializes in veterans benefits and elder law. Your state may also have a veterans agent assigned to advocate for residents of your city or town.
Call your congressman and your senator. Go to your nearest branch of the Vietnam Veterans and ask for help. Who said he is ineligible for Medicaid? This does not sound right either.
You need some legal or estate planning help ASAP - and maybe an appeal letter from the doctor who feels he cannot return home and is not even willing to write Rxs that would enable him to do so, to indicate that he does indeed qualify for skilled care or memory care. There is something called a Miller Trust where excess monies are put into an account for care and you can then qualify for Medicaid and protection against spousal impoverishment - but the regs and details of those vary from state to state. I don't get why the hospital thinks they can treat you this way instead of trying to help make arrangements - maybe some admin has gotten greedy and/or isn't meeting budget. And I suspect APS would not get it either and would end up helping you instead of founding a report.
Thank you for your advice, vstefans! I've heard of Miller Trusts before but will definitely need to seek legal help in that area.
I agree that there may be internal budget regulations involved and they just want to get rid of my husband ASAP and use all of our family income toward his placement. I'm getting calls from social work supervisor threatening me with all sorts of neglect/abuse investigations if I don't place my husband immediately.
Thanks for your words of support!
Thanks for your advice! Something I've been meaning to do.
He's ineligible for Medicaid Long Term Care because of the income cap. Also, MediCaid doesn't cover assisted living facilities (except for AL waiver program), it only covers skilled nursing care and his doctors are saying he's not at this level of care.
Mapriam, check your PMs.
Yeah, if the VA is not helping, and you can;t get legal or congressperson help immediately, try getting with your local DHS and get some idea of the lay of the land - it sounds like you have to hustle now, and at least get him "Medicaid Pending" status if possible. It's true you are supposed to use a person's disability income for their care, but to ask you to immediately lose all your income and maybe even your home seems a bit much.
I think the idea of getting an elected official involved is a good one; you might do some quick research to see if any of your congresspeople or senators are veterans and contact them. They might be able to pull some strings, as it seems as though you're really getting hassled by the VA.

I do hope you can find some help; this kind of harassment is inexcusable; I can't help thinking though that they people who are harassing you are taking their orders from someone higher.

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