Has anyone dealt with VA benefits? My GM has severe dementia to the point where she is constantly trying to escape, screaming for help, pooping all over herself and doesn’t realize it. She talks to people who aren’t there and so on. Her husband served in ww2 and recently passed. The VA has dropped her care hours to two hours a day. They are telling my husband she doesn’t qualify for anything else and Medicaid isn’t doing anything. None of this seems right or adds up to me. Is there anyone out there that can give me a little guidance with the situation? Any answers would be greatly appreciated.
So they can have whatever $ their State has for PNA $ plus VA $90, so benefit from both but it’s a very narrow use of that $90 as they are in a NH on Medicaid so Medicaid rules on $ & spending matter, so no gifting. State Medicaid does not count VA stipend as “income” and does not require VA stipend to be included in the NH copay; but $ can become an “asset”, so they / their POA do have to be mindful not to have their PNA account at the NH (if it gets the stipend) &/or their bank account to go over 2K asset maximum as it would be for most States a LTC Medicaid eligibility issue. There has been more than 1 tale of surprise posted on this forum from a family member who found their elders PNA NH account almost zeroed out as NH ordered durable medical equipment item billed to resident to get their PNA balance reduced. NH allowed to do this as per admissions contract. OR POA found they had to do an annual LTC Medicaid renewal with submission of bank statements and hit with Medicaid eligibility issues as elder ended months over $2,000 banking balance. If they are getting VA $90 a mo stipend plus Medicaid PNA $, they can hit asset max a lot quicker. Elder or their POA need to be sure to spend $ regularly as allowed under Medicaid rules. It’s hard to imagine that family allows $ to build up but it happens.
For some States in the South, PNA is low, like $40. Not realistically enough to pay for on site barber/beauty shoppe visits + clothing + toiletries replacement. Not enough $ if the NH charges for in room cable or phone. It’s only a couple of States that have PNA over $100 a month, most are $50/$60 a month. A $90 VA stipend $ a mo would make a huge difference to veterans & their spouse’s in an nonVA NH and their families for buying incidentals not provided by Medicaid. But it’s not the same as Aid & Attendance payment of $1,432 or more a month to add to the elders SS & retirement monies to pay towards their AL bill or inhome healthcare or copay at a PACE day program. Things like these imo are really great use of A&A $, it’s a real benefit.
Neither VA A&A or VA stipend will cover the custodial room and board costs at a nonVA skilled nursing facility that Medicaid LTC program does & why ultimately it’s the Medicaid LTC program that matters once the elder gets to NH “at need” point for their care.
I am going to mention one thing about Patriot Angels. Yes, they charge a vet/family a fee to do an Aid & Attendance application. I’m going to say for the record that is 100% illegal to do. They can charge for an appeal, but not the original application. VA.gov states this clearly. I’m just putting that out there.
In my professional opinion, it seems like your grandma may need more around-the-clock care than she’s currently able to receive. It sounds as though Medicaid planning may be the most appropriate action right now, as, if she needs skilled care, Medicaid would need to kick in to pay, and I easily see skilled facility costs go to $15k per month, depending on the type of care needed. If you have specific questions about the VA benefits, let me know and I’d be happy to connect.
It is likely time to consider placement and all that goes along with that.
The POA if one exists is responsible to get control of this already rolling ball. If there is not a POA, the VA Social Worker may be able to guide you to the easiest way for the person most willing / able to get temporary guardianship. There will need to be assets assessment and assets management, and then placement for care.
If grandmother isn't competent she cannot confer POA on someone if that wasn't done already, so guardianship would be the only option.
You need one person in charge. If that's your hubby I am sorry for it, but one day at a time. It is like detective work. I hope you'll update us as you go.
These are 2 very different paths & important to find out which it is. If it’s the former, then you kinda are stuck and will have to do whatever to get your elders chart built up to show “at need” for skilled nursing needed & probably get them hospitalized so they can enter a SNF that path. If it’s the latter, you likely will need to look further out to find a MC that does take waivers and has a bed available or placed on their list.
Fwiw Under federal law, Medicaid is required to provide (pay for) LTC for those “at need” medically & financially for skilled nursing care. Which at the time (the 1960’s) meant care in a NH. Medicaid is a joint federal & states with $ % based on your States demographic so why census mucho importante. Over time states have been able to file for waivers to the $ stream to have a % of $ “waived” to go to other programs that serve the same demographic. Like right now the cute girl in town for waivers is PACE, the day program for those who otherwise qualify for NH placement. So some States are heavily moving $ from NH into PACE as it’s deemed cost effective. My State (Louisiana) has been quietly doing this via PACE for about 6 years with its health services partner organization, Catholic Charities Healthcare Division. Other States file for “waivers” to have some $ shifted from NH to instead pay for MC and some even for AL as the costs are so much lower than a NH. The MC/ AL facilities can decide if they want to participate in the waiver program but if they do they have to do it for a fixed period. Usually it’s 5-7 years and for 5-10% of their beds. So if a facility can easily fill beds via private pay, they have no need to ever participate in a waiver. But there could be a facility in an adjacent county or a more challenging location in a big city that does take the waiver. All why it’s important to find out just what the waiver situation is for your state is based on.
Remember if waiting list, please put their names on more than one list and keep in mind the chances are your elders name will move up a lot faster than you ever anticipated.
Get a case manager involved either thru her PCP or community senior services in your area.
Call 911 and have her transported to ER. When at ER, discuss the situation with hospital/ ER case manager and, seek placement options for her. Safety and biohazard issues concerns are described in your writing. Address these and her decline, level of care needs with the hospital staff.
Call APS, inform them of the physical, emotional dynamics in the home. Seek APS support to obtain care for her that will provide safety and address all her needs.
Inform APS, her Physician, and/ or hospital professionals that you,family cannot provide the level of care she needs in the home.
Take care of yourself.....
The VA drowned me with paperwork and nit-picked everything except for my father's service records, which is only a small part of the paperwork.
They don't tell you this, but you've got one year from the time you notify them that you're applying to get an approval, and the odds of that are about zero if you're doing it on your own.
So I decided that it was either accept the rejection of benefits or pay a third party to help me.
Someone on this forum mentioned using Patriot Angels. I've hired them and it's been very efficient and smooth. There is a one-time fee and they take care of putting everything together and submitting it it to the VA.
But COGs have always had a Council on Aging sector and over time, the Area (Council) on Aging in some states have become really big to the point they have their own free standing buildings and staff even tho’ technically under the COG. Like Houston is HGAC for its COG, but its AoA is now huge, HUGE, like 4 full building offices scattered in 3 counties plus outreach staffers with each of the co. Health departments in the 13 county H-GACofGovernment. COGs tend to run below the radar, till someone doesn’t get their way on a development, a certificate of need or other federally mandated paperwork.
But I digress….. if I was in a avg size town, I’d try the Area on Aging office for my region as a starting point. A few States are a single AoA. Now if was in a big city (close to M & M+) and they had an active Jewish Family Service program, I’d go there as JFS tend to have really good outreach elder programs & some do needs assessment referrals. Like Dallas’ JFS does in house needs assessments with cost based on sliding scale; their elder program is quite amazing. The “needs assessment”, to me, is so THE key to the starting point on all this nowadays. You as a family member cannot DIY and subjectively determine what your elders placement/ needs are. Ya need that outsider document. You don’t want to spend hours researching AL when it’s actually MC placement required. Or thinking that In-home health will provide for 32 hrs a week only to find that needs assessment has it at 18 hrs a week on IHHS.
Area (Council) on Aging is your tax dollars at work. Use them!
When it comes to Medicaid LTC and Aids and attendance, you can't have both an Medicaid pays the most. From my understanding, both are Federal benefits so you have one or the other.
Fro Igloos post, I think you may need to have GM re-evaluated by the VA. If she is turned down, then you apply for Medicaid in home or even LTC.
It’s a math problem to determine which is better based on financials and what degree of assets the grandparents had and IF anything hinky happened with them for a lookback. I don’t think VA does the deep dive into lookback like Medicaid.
Sometimes VA A&A is really good if it’s AL and she has a spend down to do to eventually be impoverished enough for Medicaid; as the A&A$ combined with her SS monthly income plus asset spend down might pay for months & months of AL. So it s..t…r…e…t…c…h..e..s the $ out lots longer as AL is so much cheaper.
Gran needs her own “VA needs assessment” done that is current.
It sounds like that does not exist and her VA benefits were based on her recently deceased spouse. She got accessory hours as a spouse. & whatever benefits she was getting was based on his care plan which no longer exists since he’s dead. Now VA may require it to be done by their own VA team (tends to be a SW/social worker & a RN that specializes in gerontology), so contact VA to find out clearly what has to, HAS TO, happen to have her evaluated to have her own benefits reset by the VA for her own IHHS aka in-home-health-services.
On not getting any traction from Medicaid, this makes sense because she is probably on VA for health care providers & health insurance and getting her involved with any Medicaid filings would throw a wrench into her healthcare & insurance. Plus Medicaid tends not to provide for other ancillary services IF there is another provider who can pay for services instead and as VA shows up for her late spouse, Medicaid knows gran can file for VA’s Aid & Attendance program. She doesn’t need to file Medicaid community based IHHS as she can go VA A&A route. My suggestion is someone in the family needs to get with VA A&A asap to have the assessment scheduled & file whatever paperwork filed to get gran into her own A&A.
Please, please, pls be aware that VA - as hold true for State Medicaid programs- will look hard at the needs assessment as to feasibility on providing “in home” care healthcare via VA Aid & Attendance. If gran is assessed to be beyond a certain threshold for care…. like she actually needs to be under 24/7 observation or close to 24/7 for her own safety because of point of her dementia or her other diseases or disabilities….. neither VA (or State Medicaid IHHS) will pay for more round the clock in home (except for very unusual circumstances) but instead the needs assessment will show elder best placed into LTC custodial care in a NH or a MC. So watch what you wish for in # of hours provided.
Yeah, it’s a lot to take in. VA is not in my wheelhouse. But Medicaid kinda is and it is a huge, beyond huge set of different programs too. Some will have zero copay but others will require gran to basically have a copay of almost all her monthly income to be enrolled. So if grans income is being used to keep household afloat in any %, that $ may not be be there. This often comes as a total surprise to families. Also be aware that if grandpa or grandma gave anyone in the family anything of value past few years and she ends up filing for LTC Medicaid program as she needs to move into a LTC Medicaid bed at a NH or a MC facility, she will have to provide for by & large is past 5 years of her & her late husband’s financials. The “gifting” could pose eligibility issues. The date of the start of the lookback on financials will be based on the date the Medicaid application is filed. State will X check database for asset transfer (home, land, auto). It’s very much worthwhile for whomever is POA to go through the grand’s financials to see if anything’s amiss ahead of any application filing. Often “gifting” or “lending” was done that others in the family were unaware of.
WHERE DO WE SEND THEM. I know when to suggest an attorney, a doc, a specialist, a LSW, a pyschologist. I have no idea how to answer queries for our OPs about "Where can I get help! I don't even know what forms to fill out".
I am just wondering, and have been for a long time.
call your county office of aged and disabilities, they may give you guidance
there should be copies of the forms that were filled out to obtain the VA benefits. There is a phone number in the beginning of the packet you could call for clarification. Or ask county office of aged and disabilities if they have the number to the county VA office ( not the VA)
Frankly, I would call 911 and get her admitted to the hospital if she is hallucinating and escaping from the house. She may have a UTI or other infection.
Once admitted, refuse to take her home and get her placed.
Do you or husband hold POA for her? Have you applied for long term care Medicaid?