Veterans, home health care and technology

Mountain Empire Legal firm logoThe Department of Veterans Affairs (VA) has become an unlikely and innovative pioneer in the quest to provide cost-effective, quality home health care for veterans. Although the agency has long been mired in controversies surrounding its programs, particularly arbitrary caregiver dismissals, the home health services sector of the VA has long been touted as an overall success story. As Thomas Edes, director of comprehensive geriatrics and palliative care programs for the VA puts it “We’re working in this environment of challenging budget constraints, and at the same time, we’re a very mission-driven organization. Put those together and what happens? That really pushes us to innovate.”

This innovation has seen home-based primary care for veterans quadruple since 2000, and all VA medical centers throughout the US now have a palliative care program as well. The VA Medical Foster Home program care has expanded from a pilot to a national program, recognized in at least 45 states and providing veterans housing as well as in-home care. These success stories are great news for veterans and a must for the Veterans Administration in part because the median age of a veteran is now 64 and the US aging veteran population is growing even faster than the senior civilian population.

It is not just the “new-comer” seniors straining the VA health care system. Nationwide the 85 plus population is on track to increase 70% from 2000 to 2020 according to the US Department of Health and Human Services. The overall unsustainability of the US health care system has forced the hand of the VA, and there is no more cost-effective way than through subsidized, at home family and community-centered health care and technology to meet veterans’ care needs.

The Official Blog of the U.S. Department of Veterans Affairs reports that Telehealth is revolutionizing veteran care and providing high-quality treatment for them. The VA Video on Demand is delivering convenient, accessible health care particularly to those 24 plus percent of veterans who live in rural and remote access locations. Telehealth is also important for those veterans who are disabled. Although a veteran might live in a city they might be unable to get themselves to a medical center for an appointment.

Assisted living technologies for veterans include assistive mobility equipment – an ever-expanding category including wheelchairs, all-terrain vehicles, exoskeletons and in-home ceiling track mobility systems. Each of these continue to be refined and specialized to meet the individual veteran’s needs. The Veterans Administration awards grants to develop technology to assist veterans and service members in modifying their homes. Adapted computer access and electronic aids to daily living and environment control units (personal assistants) provide customized interactive abilities for veterans.

Electronic cognitive devices help veterans who struggle with activities of daily living (ADL). These devices include personal digital assistants (PDAs), smartphones, pocket personal computers (pocket PCs) and other handheld devices, global positioning systems (GPS), reminder watches, pagers with reminder features, and digital voice recorders. The use of these devices helps a veteran stay on schedule with medications as well as stay connected with family, friends, and their medical monitoring community. Those veterans with Post Traumatic Stress Disorder (PTSD) are further helped with their ADLs when robots with artificial intelligence (AI) are introduced into their environment. These AI “tech bots” are capable of reading human facial expressions and can identify when a veteran is feeling particularly stressed, isolated, angry, or depressed. The robot can upload the information to the veteran’s caregivers thus alerting them to the need for human intervention. Wearable sensors can also alert a caregiver or medical professional when vital signs are outside of a normal, healthy range.

The VA will provide a payment to disabled veterans toward the purchase of a car or other transportation and additionally will pay for adaptive equipment, repair, reinstallation or replacement of necessary equipment due to disability. If a veteran has lost the use of at least one foot, hand, or has a permanent impairment to their vision or severe burn injuries or immobile joints that their limit mobility, the VA will help to fund the adaptation of the vehicle to make it fully operational to the veteran.

While the latest technology brings benefits to all seniors opting to age in place, the veteran community is especially helped. Many veterans would like the luxury of aging without combat or noncombat injury so inherent to military service. Some of the aging in place obstacles they must overcome are extreme, commensurate with the injuries (psychological and physical) they have endured. Navigating the benefits that are available to a senior veteran is complicated if you are not well versed in the process. Getting enrolled in the correct program and receiving benefits can also be a lengthy process, so it is best to seek help before wasting valuable time.

If you have questions or would like to discuss your particular situation, please don’t hesitate to contact us.

The VAs Pension Program Can Help Struggling Veterans and Surviving Families

Elder veterans and disabled former service members can fall on hard times if they are no longer able to work and generate income. Thankfully, the U.S. Department of Veterans Affairs provides a safety net for them, and their families, in the form of a veterans pension.

A veterans pension is a tax-free, monetary benefit payable to low-income wartime vets. In most cases, a veteran will need to have at least 90 days of active duty service to qualify, with at least one day during a wartime period. If they entered active duty after September 1980, then they’re generally required to have served at least 24 months or the full period they were called or ordered to active duty, with at least one day during a wartime period.

In addition to these service requirements, qualifying veterans must meet one of the following criteria:

  • Age 65 or older
  • Totally and permanently disabled
  • A patient in a nursing home receiving skilled nursing care
  • Receiving Social Security Disability Insurance
  • Receiving Supplemental Security Income

The VA also offers a Survivors Pension benefit, or sometimes called a Death Pension. This is another tax-free monetary benefit that is payable to low-income, un-remarried surviving spouses or unmarried children of a deceased veteran with wartime service. The basic military service requirements generally match those of the standard VA pension.

In both cases, a veteran’s annual family income must be less than the legal amount set by Congress. If eligible, calculating an individual pension benefit can be complicated, but it involves 12 monthly payments of the difference between a veterans annual income and the congressionally mandated income limit.

The VA also issued new pension regulations on October 18, 2018, which include the following:

  • Require a clear net-worth limit for income and assets for veterans to qualify.
  • Establish a 36-month look-back period to review asset transfers at less than fair market value that reduce net worth and create pension entitlement.
  • Establish up to a five-year penalty period to be calculated based on the portion of the covered assets that would have made net worth excessive.
  • Update medical expense definitions for consistency with VA internal guidelines.

Pension and Surviving Pension benefits are tremendously important for those who served and now may be in need. If you’re not sure how to proceed, do not wait to ask us your questions! We are your local community law firm ready to help you answer your questions on this and any of your elder law challenges you are facing.

Financial Benefits for Veterans and their Survivors


If you are a veteran, or if you are caring for one, it is essential to understand the many veterans’ benefits programs available through the Department of Veterans Affairs (VA). Often, financial support is available to a veterans spouse or their survivors as well as the veteran themselves. Even if there has never been a claim made for veteran benefits before based on a veteran’s current age, physical condition, or low income they may now qualify for financial help.

Even if you or the veteran you are caring for qualify for Medicare there can be advantages to choosing VA care for healthcare coverage. For example, Medicare does not cover physical exams and other preventative care, dental care, long-term in-home care or long-term nursing home residential care. The costs of VA co-pays and deductibles are generally lower than Medicare, and that includes prescription drugs. Some veterans can qualify for both Medicare and VA health coverage which can in some circumstances be extended to family members as well.

Many financial benefits available through the VA are offered through “service-connected disabilities.” These disabilities can include physical, mental, or emotional conditions which limit or preclude a veteran from performing various everyday activities deemed normal. A veteran does not have to have become disabled while in the military to qualify for these benefits. Service-connected disabilities can begin during military service and only start to show as the veteran ages. The vital point to understand is the disabling condition was caused during or aggravated by the veteran’s military service.

The condition that becomes disabling later in life can make a veteran eligible for a monthly disability compensation payment. When the VA reviews an applicant’s request for compensation, it will assign a rating to the disabling condition beginning at 10 percent or more. The rating is in 10 percent increments. The lowest rating at 10 percent in 2018 pays $117 per month while the highest rating at 100 percent pays $2,527 a month. Veterans who are housebound or require “aid and attendance” (regular in-home care) can receive an even higher monthly amount. Older veterans with a 30 percent or higher rating can have their spouse qualify for additional monthly benefits as well.

The VA can also help veterans with service-connected disabilities by supplying loans or grants to modify a home, whether it is the veteran’s home or the home of a family member where the veteran lives, through the Specially Adapted Housing (SAH) grants program. Special car modifications are available through a similar program. The VA also offers several types of loans and loan guarantees to aid veterans in the purchase of or refinancing of a home, townhome, or condominium.

If a veteran (65 or older) has a low income, has had 90 or more active days of military service, and at least one of those days during a period of war (World War II, Korean War, Vietnam War and the Persian Gulf War) they qualify for a VA pension even if the veteran was not in combat. If a wartime veteran or a surviving spouse requires care on a regular basis, the amount paid can be over $2,000 per month in tax-free income. However, there are specific financial and medical requirements for this benefit. The rules for qualifying for a VA pension benefit are changing on October 18, 2018, so if you or someone you know is a wartime Veteran or the surviving spouse of a wartime Veteran, contact us right away to see if you could qualify for this important benefit before the qualification rules tighten.

Applying for, or assisting a veteran in the application process for VA benefits can help them improve their quality of life or benefit their survivors. While there are toll-free numbers and websites to inform claimants, the procedures are complicated and can be confusing. We would be happy to talk to you about your situation and help you understand your options. Please don’t hesitate to contact us with any questions.

Veterans Affairs Nationwide Ranking Nursing Homes

In an unprecedented move furthering transparency within the Department of Veterans Affairs (VA) it has released the internal rankings of 133 VA nursing homes nationwide. The 5-star ranking system helps veterans and their families to locate the best facility possible in their area. The posted performance ratings are slated to be updated annually and includes: the names of the nursing homes associated to the VA system, one to five star ratings for quality of environment, care, and staff based on unannounced on-site surveys at each facility from which an over all-star ranking is assessed for each facility based on the criteria scores.

The mandate for more transparency regarding veteran care began with other internal statistics that are now publically published including:

The VA is the first hospital system nationwide to publish these statistics. “Now that VA has made a commitment to reporting accurate quality and comparative data on its nursing homes, we are pleased to begin adding that important information to our transparency portfolio for the benefit of Veterans in making their health care choices,” said Acting VA Secretary Peter O’Rourke.

Of the 133 nursing homes ranked, 34 earned an overall 5-star ranking. 73 nursing care facilities experienced no relevant change in quality. One nursing home dropped from a 5 to a 4-star ranking but still retains a reputation for quality VA care. The acting VA Secretary is determined to use best practices to lift the 11 worst scoring; one star rated nursing homes to viability and overall drive improvements across the VA nursing home system.

The ranking system used within the VA system was designed to allow valuable comparisons to the already existing 5-star ranking system by the Centers for Medicare (CMS), a federal agency within the Department of Health and Human Services. The VA nursing home interactive map helps you identify your best options. Then you can compare those options against Nursing Home Compare searches.

Overall the data shows that the VA nursing home system ranks very close to private sector nursing homes, even though the VA nursing homes on average cares for sicker patients than those in private care facilities. Of the 15,487 nursing homes ranked by CMS, almost 29 percent had 5-star rankings, compared to about 26 percent of VA nursing homes. However, the VA had only an 8 percent one-star ranking compared to 13 percent for CMS ranked private care facilities. It should be noted that because the VA does not turn away eligible veterans and they typically come with more complex medical conditions it is more difficult for the VA nursing home system to achieve higher rankings. Of course, these are just statistics, and while they help with the overview of options, this is a veteran’s story of care; it’s a story about people who served this country.

VA nursing home patients tend to have more numerous and challenging medical conditions than their private sector counterpart’s patients. Residents in a VA nursing home have conditions rarely seen in private nursing homes including higher incidents of prostate obstruction, spinal cord injury, mental illness, homelessness, PTSD, and combat injury. While a private sector facility can selectively admit patients, the VA will not refuse service to an eligible veteran no matter their condition.

Transparency of VA nursing home care and ranking systems that allow comparison to private care facilities can significantly help you or a veteran you love get the proper nursing home care required. There is a lot of information to understand how your specific military service record ranks you within the VA health care system in general and then explicitly applying those conditions to an adequately ranked nursing facility. If we can be of assistance, please don’t hesitate to reach out.

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