Government Program Pays Family Members for Taking Care of Mom and Dad

Looking for a way to help Mom and Dad pay for Home care or assisted living? Perhaps you are their caregiver. Wouldn't it be nice to receive some extra income to help you provide their care? There is financial help available for senior veterans and their spouses.

For veterans who served during a time of war or for their surviving spouses, the Veterans Aid & Attendance Pension will pay additional income to cover long term care costs. The great news about this program is that VA will allow veterans' households to include the annual cost of paying any person such as family members, friends or hired help for care when calculating the Pension benefit.

Pension can provide an additional monthly income of up to $1,949 a month for a couple, $1,644 a month for a single veteran or $1,056 a month for a single surviving spouse of a veteran. This money can be used to help pay the cost of home care, adult day services, assisted living or nursing home services.

In order to reduce income to meet the income test for pension, a rating for "aid and attendance" or "housebound" is crucial. Not only does the rating significantly increase the benefit amount but without a rating, room and board costs for assisted living are not deductible for purposes of reducing income. Only the much smaller assisted living medical costs are deductible.

For home care, non-medical costs are only deductible if the in-home attendant is licensed for healthcare in that state or if there is a rating. Since the non-medical costs for home care represent the bulk of all costs for long-term care at home, without a rating, those households with a non-licensed attendant would not qualify for the benefit. Examples of medical or nursing services at home would be help with activities of daily living such as dressing, bathing, toileting, ambulating, feeding, diapering and so on. Other services might include medication reminders or supervision necessary to provide a protective environment for the care recipient -- in the case of dementia or Alzheimer's.

A rating for aid and attendance is automatic if someone is a patient in a nursing home or that person is blind or so nearly blind as to need assistance.

It is our understanding that a non-licensed in-home attendant could be just about anyone receiving pay for providing services. This might be members of the family, friends, or someone hired to live in the home. Unfortunately, a spouse cannot be included in this list for reimbursable caregivers.

For a disabled person who has been rated, a family member will be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from a family member living in the household are legitimate. Such arrangements should be extensively documented and completely arm's-length.

The care arrangements and payment for home care must be made prior to application and there must be evidence that this care is needed on an ongoing and regular basis. We recommend a formal care contract and monthly invoice billing for services. Money must exchange hands and there must be evidence of this. All of this documentation must be provided as proof to VA when making application for the pension benefit. Costs for these services must be unreimbursed; meaning these costs are not paid by insurance, by contributions from the family or from other sources. Even though the family member being paid for services cannot reimburse the veteran household directly,the family may pay the bills for the veteran household. This indirect form of support is allowed.

There is an application form to be submitted, along with a doctor's report form, documentation of medical expenses and payment of home care services or facility fees. Other documentation includes original discharge papers, marriage records if applicable and a death certificate where applicable. An inventory of all sources of household income and all household cash equivalent assets is also required. Providing complete documentation with the initial application will expedite a rating and approval for pension payment.

For those who want to do it themselves, the National Care Planning Council provides help in their book “How to Apply for the Veterans Aid & Attendance Pension Benefit.” http://www.longtermcarelink.net/a16veterans_books.htm

This book provides, in detail, a description of application for the Pension Benefit and what information and documentation other than the application form should be submitted. All necessary forms are included in the book such as the application form and forms for medical expenses and other costs.

ElderLawAnswers.com review of this book states; “This is the book to get if you want an in-depth understanding of how veterans' benefits work, what options are available and how to apply. http://www.elderlawanswers.com/resources/article.asp?id=6209&section=5&state =

One purchaser of the “How to Apply” book emailed his successful experience.
“I purchased " How to Apply for the Veterans Aid & Attendance Benefit" earlier this year, and I wanted to let you know how much of a blessing this book was. I followed the instructions exactly as stated in the book. I used the forms provided (Forms 1-4). I made copies of everything. I submitted my dad's application on March 31, 2009. I received a response TODAY, May 2, 2009, that approves my father's application, and he will be receiving a substantial amount in benefits monthly, beginning April 1st. In addition, the VA sent additional forms for me to submit stating that my dad may be eligible to receive additional benefits for medical expenses incurred from March 31, 2008 to March 31, 2009. In essence, I had to submit no additional documentation, just the documentation you suggested in your book. I was approved in one month's time. NO DELAYS!!! Thank you for your wonderful book! I needed no consultants, no attorneys, no one and nothing but the advice contained within your book. I highly recommend this book to EVERYONE who is seeking to apply for this valuable benefit.”
To read more about the book and purchase your copy of the “How to Apply for the Veterans Aid & Attendance Pension Benefit” go to http://www.longtermcarelink.net/a16veterans_books.htm

Veterans Benefits Consultant
A veterans benefits consultant is an individual who helps veterans understand long term care benefits available through VA. This can include information on veterans health care, state veterans homes and veterans disability income benefits. Consultants place particular emphasis on Pension and Death Pension because these benefits are typically more useful for the elderly needing long term care. Pension is also known as "the aid and attendance benefit." Being a consultant is not a formal title but is merely a description of this person's function.

Consultants provide information about the aid and attendance benefit including what it is, who can qualify and what information and documentation are necessary in order to file a claim. A consultant does not participate in any way in the application process unless that consultant is an accredited attorney representing his or her client in proceedings before VA. Consultants who are accredited veterans service organization representatives can also assist claimants with the filing of a claim. For all other consultations, veteran households seeking help with filing a claim are directed to an appropriate veterans service organization or to a state or county veterans service officer or, where appropriate, they are encouraged to file a claim on their own.

Some consultants also help potential claimants realign their assets and complete important estate planning documents prior to making application.

Veterans Benefits Consultants are private practitioners or in some cases representatives of veterans service organizations and are not connected with the Department of Veterans Affairs. To find a consultant in your area go to http://www.longtermcarelink.net/ref_veterans_consultants.htm

Helping Your Older Parents Stay Happy and Healthy by Robert Stall MD, Geriatrician

If you're fortunate enough to have one or both parents still living, you may have noticed a role reversal taking place in your relationship. Remember the days when Mom shuttled you to the doctor whenever you were sick? Now, it may be you who's driving her to her medical appointments. Perhaps you've become even more involved in managing her healthcare needs – serving as her healthcare proxy, moving her into your home to care for her, or even having to select a nursing home for her to live in.
Whatever the case, it's natural to feel challenged – and, yes, intimidated – in the role you've undertaken. But if you stay positive and proactive, you'll be in a great position to advocate for your parents' optimal care. And, really, what better way is there to say "Thank You" for all they've done for you over the years?
The following six recommendations will help you understand what may be happening to your parents as they age – and what you can do to help.
1. Stay vigilant to sudden changes. Typically, sudden changes arise from sudden problems. Your elderly father who becomes confused one week but was alert and oriented the week before, or becomes unsteady walking and starts falling, is likely experiencing an acute problem – an infection, medication side effect, or perhaps, a heart attack or stroke.
If you pay attention to your parent's baseline health and behavior, you'll be alert to sudden, and subtle, fluctuations. Being attuned to what's “normal” for your parent is critical in advocating for his care. By informing his physician of these changes, you help ensure that he receives a proper diagnosis and timely treatment – especially important in acute conditions.
2. Investigate the source of gradual decline. Several years ago, I met an elderly woman living in a nursing home. Her family, assuming she had dementia, had moved her there after she had gradually stopped speaking.
After performing a brief procedure on her, I asked how she was doing. “I'm OK,” she replied.
A miracle? Not exactly. I'd removed bullet-sized pieces of wax from her ears. She'd stopped speaking because her ears were too plugged to hear.
A host of conditions can cause gradual decline. Before jumping to the conclusion – as many people do – that Alzheimer's disease is the culprit, recognize that your parent may be experiencing an altogether different problem: a vitamin B12 deficiency, an underactive thyroid, Parkinson's disease or depression, to name a few.
When discussing your parent's decline with her physician, make sure the two of you consider all the possibilities. To prepare for the appointment, make notes detailing how her decline has manifested itself – loss of appetite, a failing short-term memory and so forth – and how long you've noticed these changes. That way, you won't leave anything out. To help you, I've created a free checklist that either you or your parent can complete at seniorselfassessment.com – make sure you print or email the “Test Result Details” at the bottom of the page to analyze your responses and give you advice based on your answers.
3. Know thy parent's medicine cabinet. Familiarize yourself with the medications your parent takes: what each one is for and how often he takes them. Make sure you notify each doctor your parent visits of all the medicine he takes, including over-the-counter products. Ask what side effects you might observe from each medication and whether it's potentially dangerous if your parent takes them together. You also want to tell the doctor whether your parent drinks alcohol or caffeinated drinks and whether he smokes, as these substances can affect some medications' efficacy and safety. To recognize which medications might cause the symptoms your parent experiences, check out drugscanmakeyousick.com .
4. Discourage ageist attitudes. Simply put, ageism is prejudice against the elderly. It exists in many forms but can be particularly damaging to an older person's self-esteem when it assumes that all of her woes are age-related. Here are a couple of ways of expressing ageism to an elderly parent:
“What do you expect at your age?” “You're not getting any younger.”
If you're ever tempted to utter something similar, remind yourself that by chalking up everything that ails her to her age, you sell your parent short. If she's depressed, it may have nothing to do with the fact that she's 80 and everything to do with a biological predisposition to depression. And remember that right-knee pain in a 90 year-old can't be just from age if there's no problem with her left knee. (More about Dr. Stall and a more in-depth article on the attitude of society towards medical care for the elderly can be found at http://www.longtermcarelink.net/eldercare/medical_care_issues.htm )
5. Address not just symptoms—but emotions, too. There is disease and then there is “dis-ease” – that is, a lack of ease, security or well-being. “Dis-ease” can manifest itself as myriad emotions in an elderly person: fear, grief, boredom, embarrassment and sadness among them. The fact is, these emotions can be every bit as debilitating as disease.
Take the case of a parent who's incontinent. Too embarrassed to socialize, she cuts herself off from friends. Without companionship, she becomes lonely. Instead of allowing her to become a hermit, discuss with her doctor how to address the incontinence. Together, you can consider different solutions that will ease her embarrassment and reinvigorate her social life.
6. Strive to maximize your parent's quality of life. No matter our age, we all want to enjoy life to the fullest and have the capability to do the things we want to. Improving the enjoyment of life and a patient's functional ability are the cardinal goals of geriatric care. But you don't need a medical diploma on your wall to help your parent achieve either of those goals.
Being there to solve a problem or provide company are tremendously worthwhile services you can provide – no expertise required. Remember, as your parent gets older, his quality of life becomes more important to him than how much longer he lives. And he doesn't necessarily need medications or surgery to ensure that he's living the latter part of his life to the fullest.
If he enjoys books but has difficulty reading regular-sized type, check out sight-saving titles at the library. If he's grieving the loss of his best buddy, introduce him to new acquaintances at the senior center. If he's living in a nursing home, bring your kids there to share a meal with him.
Sometimes, it's the small gestures that have the most profound impact. As the child of an elderly parent, you are uniquely positioned to deliver these life-changing gifts.
Dr. Robert Stall is a geriatrician practicing in Tonawanda, New York and a clinical associate professor at the University of Buffalo's School of Medicine and Biomedical Sciences. He serves as medical director and attending physician at Beechwood Homes in Getzville and Blocher Homes in Williamsville. To learn more about senior care issues, visit his website at stallgeriatrics.com or call 716-213-4345. For information on a new program offering balance assessment and fall prevention tips, call 716-213-0772.