Elder law attorneys from around the country with whom we communicate regularly are beginning to experience a change in the way that the Veterans Administration is reviewing applications for the Aid and Attendance Program. This program is a special pension that wartime veterans become entitled to receive when their income and assets fall within certain levels, and they have a medical need for help with Activities of Daily Assistance (ADLs). The change is related to how the reporting of help with ADLs is being interpreted by the VA.
In the fall, the VA announced its plan to scrutinize the ADL issue more thoroughly than previously had occurred, when it was assumed by the VA that, if a veteran resides in a facility that provides meals and other support services, then this requirement of needing ADL assistance was deemed to be satisfied. This was true in the past, whether the facility was licensed as a Personal Care Home or not, in which event the facility is generally known as an Independent Living facility. Although the VA scrutiny was thought to be mostly directed at Independent Living facilities, the level of scrutiny is also being applied to applications of veterans who reside in licensed Personal Care Homes.
The ADLs are transferring from a bed to a chair, bathing, dressing, feeding, toileting and continence. In addition, significant cognitive issues such as Alzheimer’s disease or other dementia related problems, as well as blindness, trigger a presumed need for ADL assistance. Within the long term care insurance industry, help with two of these activities is usually required to trigger the payment of benefits. It is still a bit vague as to what is now required by the VA, but clearly it is more than providing three meals a day within a safe environment.
Keystone Elder Law has begun to implement some new procedures to assist our clients and their care facilities to properly document a need in order to report it to the VA, whose forms are somewhat less than clear for some physicians to understand. We have seen physicians make reports in such a manner that it is clear that they do not understand the basic or essential ADLs, such as mentioned above, and Instrumental ADLs (IADLs). Instrumental ADLs include such things as managing money and shopping, which the VA is not concerned about.
The Aid and Attendance Program is becoming increasingly popular and, for this reason, applications are taking the VA longer to process. We have seen applications take as long as you 11 months to process. Because an VA application that is denied can result in a veteran losing out on nearly $25,000 per year, it is increasingly important to make sure that the application is as solid as possible at the time of the initial submission. Once the application has been approved, however, benefits are awarded retroactively from the date of application.
We encourage veterans or care providers to contact our office if you have more questions about this subject.