State veterans homes fill an important need for veterans with low income and veterans who desire to spend their last years with “comrades” from former active-duty. The predominant service offered is nursing home care. VA nursing homes must be licensed for their particular state and conform to skilled or intermediate nursing services offered in private sector nursing homes in that state. State homes may also offer assisted living or domiciliary care which is a form of supported independent living.
Every state has at least one veterans home and some states like Oklahoma have six or seven of them. There is a great demand for the services of these homes but lack of federal and state funding has created a backlog of well over 130 homes that are waiting to be built.
Unlike private sector nursing homes where the family can walk in the front door and possibly that same day make arrangements for a bed for their loved one, state veterans homes have an application process that could take a number of weeks or months. Many state homes have waiting lists especially for their Alzheimer’s long term care units.
No facilities are entirely free to any veteran with an income. The veteran must pay his or her share of the cost. In some state the veterans contribution rates are set and if there’s not enough income the family may have to make up the difference. Federal legislation, effective 2007, also allows the federal government to substantially subsidize the cost of veterans with service-connected disabilities in state veterans homes.
THE APPEAL OF LIVING IN A STATE VETERANS HOME
We believe most veterans or their families seek out residency in a state veterans nursing home because they believe this service is one more VA entitlement that should be available to them. But there is also a similar entitlement available to anyone in most private sector nursing homes–facilities that may be geographically closer to the family than the nearest veterans home. This is Medicaid. Veterans seeking long term care from VA programs generally don’t have the funds for private pay in a people in a private sector Medicaid certified facility. Most families who are seeking help for their loved ones, who are veterans, generally look to VA first before considering Medicaid. Or they are simply not aware of Medicaid. In many cases, Medicaid may be the better choice.
Aside from seeking long term care because of an expectation of entitlement are there any other reasons that veterans would prefer a state home? We ask this question of ourselves because we have noticed that in some states veterans homes are in distant rural areas. The fact that some of these homes are hundreds of miles from urban areas where the majority of veterans would tend to live, made us wonder why some veterans would move long distances to reside in these facilities.
To answer this question we contacted a number of rural state veterans homes on the phone and asked them why a veteran or his or her family would seek out their services as opposed to seeking services in a closer non-veterans facility under Medicaid. Almost unanimously the answer we got was that some veterans like the idea of sharing their living arrangement with other veterans. The facilities almost always referred to this as “camaraderie”– a band of brothers.
Statistically, private sector nursing homes are mostly populated by older women who are generally in poor health. Some men may not feel comfortable in an environment where the activities and the social atmosphere are centered on women. In contrast, veterans homes are almost exclusively populated by men. In addition, based on our observation, we suspect the population of state homes is younger and healthier than that of private sector facilities.
These demographics would suggest that activities and social atmosphere revolve around the needs of men not women. A younger, healthier population would also suggest veterans homes would offer more opportunity in the form of transportation or scheduled outings for the residents to be out in the community. One veterans home reported to us that they regularly scheduled fishing trips and outings to sporting events for their residents. These would be unheard of activities for the typical private nursing home.
The second most common reason reported to us why veterans seek out state homes is for financial reasons. In many states the cost of the home is subsidized for veterans who meet an income test. The vet’s income is considered sufficient to cover the cost. These veterans may own a home or other assets that they wish to protect from Medicaid and leave tot their family. The state veterans home will allow them to give these assets to the family without penalty. Medicaid would require a spend down of those assets or impose a penalty for gifting.
Another reason related to finances may be there are no available Medicaid beds in the veteran’s area. The veteran may be paying out of pocket ofr a nursing facility but have his name on a waiting list for a State Home where the out-of-pocket cost would be much less. When his name comes up he will move to the State home.
A financial incentive for the veteran is that all state veterans homes will apply for the pension benefit for those residents who are eligible. Federal law prohibits VA from paying any more than $90 a month to single veterans who are eligible for Medicaid in a non-veteran nursing home. State veterans homes are exempt from this rule and the single veteran can keep the entire pension amount although most of it will have to apply to the cost of care. For those state veterans homes that also accept Medicaid, pension represents additional disposable income.
Medicaid is not allowed to apply the aid and attendance allowance from pension towards the cost of care but must let the veteran retain that money. The fortunate veteran who has this additional #300-$500 a month can use this money for additional personal needs. One veterans home that has this dual arrangement with Medicaid and Va pension reports that the veterans receiving this benefit, pool the money with other veterans in the facility and it helps pay for dinner tickets, theatre tickets, expensive outings and other amenities that would not normally be available to private sector nursing home residents.
PER DIEM RATES
The Veterans Administration pays the state veterans homes an annually adjusted rate per day for each veteran in the home. This is called the per diem. In most states the per diem falls we short of this goal.
The per diem program and construction subsidies mean that State veterans homes can charge less money for their services than private facilities. Some states have a set rate, as an example, $1400/mo, and they may be relying on the pension benefit with aid and attendance plus the per diem to cover their actual costs. Other states may charge a percentage of the veterans income but be relying on other subsidies to cover the rest of the cost.
Most of the states with income-determined rates are selective about the veterans they accept. These states may rely on a variety of private and public sources to help fund the cost of care.
States without set rate subsidies may charge 50% to 70% of the rate of private facilities based on private or semi private room occupancy and if the veteran does not have enough income, these homes accept Medicaid or Medicare to make up the difference. In these state the veterans homes are Medicaid and possibly Medicare certified.
Some state facilities offer assisted living or domiciliary care in addition to nursing care. Some states even build facilities devoted entirely for domiciliary. According to the Veterans Administration the definition of domiciliary care is as follows: “To provide the least intensive level of VA inpatient care for ambulatory veterans disabled by age or illness who are not in need of more acute hospitalization and who do not need the skilled nursing services provided in nursing homes. To rehabilitate the veteran in anticipation of his/her return to the community in a self-sustaining and independent or semi-independent living situation, or to assist the veteran to reach his/her optimal level of functioning in a protective environment.”
A domiciliary is a living arrangement similar to assisted living without substantial assistance, but is not intended as a permanent residence. Domiciliary rooms in veterans medical centers are designed around this concept and are used for rehabilitation recovery from surgery or accident, alcohol abuse, drug abuse, mental illness or depression.
The domiciliary concept does not work well in a state veterans home setting and in the context domiciliary is simply another name for assisted living without the assistance. This represents a form of independent retirement living with a little more support where the veteran can stay as long as he or she needs to. A far as state veterans homes go you should think of domiciliary as a substitute for supported independent living retirement.
Many state veterans facilities have set aside a wing for Alzheimer’s patients. In some states this is the most popular service sought by veterans or their families and waiting lists could require a number of years before a bed opens up. A small number of facilities offer adult day care.