What are VA Nursing Homes?
The Department of Veterans Affairs (VA) offers nursing home care for veterans via three settings within the VA health care system: Community Living Centers, Community Nursing Homes & State Veterans Homes.
Community Living Centers (CLC)
Community living centers are VA owned and operated nursing homes that are located within a wing of, or near, a VA medical center. CLC’s offer a home-like environment for short-term (generally for rehabilitation), and in some cases, long-term care. Assistance is available 24-hours / day and includes skilled nursing care, medical care, rehabilitative care, assistance with activities of daily living (i.e., bathing, dressing, mobility, eating), and social work services. Dementia care (specialized care for persons with Alzheimer’s disease or a related dementia), mental health care, end-of-life care planning, and hospice care may also be available services in CLCs. The exact services offered are community living center-specific.
To see community living centers by location, click here. At the time of this writing, there are approximately 130 CLCs nationwide, and none within Alaska, Rhode Island, or Utah.
Community Nursing Homes
Community nursing homes are not VA nursing homes. Instead, they are nursing homes that contract with the VA to provide care for veterans who meet VA eligibility for such care. When one thinks of VA long-term nursing care, it is Community nursing homes that generally come to mind, as opposed to community living centers, which are more suited for short-term rehabilitative care. In addition to 24-hour skilled nursing care, community nursing homes provide therapies (occupational, physical, and speech), and social work services. Short-term rehabilitative services, specialized dementia care / Alzheimer’s care, and hospice / palliative care might also be available.
There is significant overlap of nursing homes that contract with the VA and with Medicaid.
State Veterans Homes
State veterans homes are state owned and managed, but certified by the VA (with annual surveys to ensure they continue to meet VA standards). The VA pays these homes a per diem (a specified daily rate) for providing care for veterans who meet the eligibility criteria. These homes provide short-term and long-term skilled nursing home care, which may include memory care for veterans with cognitive deficits due to Alzheimer’s disease or a related dementia. In addition to nursing home care, state veterans homes may offer adult day health care and domiciliary care (which provides a supportive independent living environment and can be thought of similarly to assisted living). In addition to veterans, some state veterans homes will admit non-veteran spouses and gold star parents (parents whose child was killed in action), but will not fund any of the cost.
State veterans homes are found in all 50 states and Puerto Rico. However, some states have just a single home in the entire state, while other states have multiple homes. For example, both Indiana and Maryland have 1 home, New York has 5, Florida has 7, and California and Texas each have 8. There is no requirement that says veterans can only reside in state veterans homes in their home state. Veterans should consider homes out of state, especially if they reside near state borders. A list of state veterans’ homes by location can be found here.
Medicaid Nursing Homes vs. VA Nursing Homes
Medicaid nursing homes, which also called Medicaid nursing facilities, are Medicaid-certified nursing homes. These nursing homes provide rehabilitative care, skilled nursing care, medical services / supplies, assistance with activities of daily living (i.e., bathing, grooming, dressing, mobility, transitioning, and eating), and social / recreational activities.
Not all nursing homes are Medicaid-certified, and even if one meets the eligibility criteria for nursing home Medicaid, Medicaid will not pay for care in a facility that is not Medicaid-certified. In Medicaid-certified nursing homes, generally a select number of beds are set aside for Medicaid-funded residents. These nursing homes are usually also Medicare-certified, meaning they accept Medicare-funded residents. (Medicare will only pay for short-term nursing home care). Some beds are also allocated for private pay residents.
While VA nursing homes are meant for veterans, Medicaid nursing homes accept anyone who qualifies for Medicaid-funded nursing home care, including veterans. Furthermore, some state veterans homes are also Medicaid-certified, which mean Veterans can live in a VA nursing home and Medicaid will help fund it.
VA Nursing Homes Eligibility Criteria
For all types of VA skilled nursing home care, Veterans must be eligible (and enrolled) in the VA health care benefit system, also called the standard medical benefits package, via the Veterans Health Administration (VHA). Eligibility requirements are as follows:
– Must not have been dishonorably discharged
– Must have actively served in the military, air, or naval service
– Must have served 24-months continuously or the full active duty period in which one was called IF enlisted after Sept. 7, 1980, or became active duty after Oct. 16, 1981. This minimum active duty criteria is not applicable for veterans who actively served before Sept. 7, 1980, or were discharged due to a disability that resulted from, or was worsened, by active duty, or had an early-out or hardship discharge.
– National Guard or Reserves members (current and former) must have served active duty per a federal order and served the entire period as ordered. Active duty status for training only does not count.
Once enrolled in VA health care, a Veteran’s service-connected disability status, disability rating, and income are considered to determine eligibility for skilled nursing home care. (For a disability rating, a percentage is assigned to one’s service-connected condition. The higher the percentage, the more severe the condition.) Nursing home care must be provided to veterans who have:
– A service-connected disability that necessitates nursing home care
– A service-connected disability with a 70% or greater rating
– A service-connected disability with a minimum 60% rating and determined unemployable or rated permanently and totally disabled
The exact eligibility criteria tends to differ based on the state in which a veteran resides, the type of nursing facility (community living center, community nursing home, and state veterans homes), and even the specific nursing home. However, generally speaking, for VA nursing home admittance, Veterans must be mentally and medically stable, and have a functional need for nursing home care, often demonstrated by the inability to independently complete one’s activities of daily living (i.e., bathing, dressing, toiletry, mobility, transitioning, eating). Furthermore, such care often needs to be deemed necessary by a medical provider. A co-pay for nursing home care might be required, but this is Veteran-specific, and is based on one’s particular circumstances.
VA Nursing Homes Admissions Process / Wait-Lists
Remember, Veterans must be enrolled in the VA health care system in order to receive VA nursing home care. To apply for VA health care, veterans must complete an Application for Health Benefits (VA Form 10-10EZ). This can be done via mail, in person at one’s local VA medical center, over the phone at 877-222-8387, or online. Generally, it takes less than one week for approval or denial of one’s application.
To apply for VA nursing home care, one should contact their VA social worker or call 877-222-8387. The forms required vary based on the nursing home program for which a veteran is applying. For example, for community nursing homes, the Geriatrics and Extended Care (GEC) Referral (VA Form 10-0415) must be completed, and for state veterans homes, the State Home Program Application for Veteran Care Medical Certification (VA Form 10-10SH) is required for the per diem program.
Some veterans may have a co-payment for nursing home services. This is determined, as well as the amount of co-pay (if applicable), during the application process by submitting an Application for Extended Care Benefits (VAF 10-10EC).
As the availability of VA nursing homes within a state, and beds within the facilities, are limited, there may be a waitlist for admission. This is particularly true for veterans who require Alzheimer’s care in a memory care unit. The wait for an available bed varies, but could be week, months, or even years. Veterans dually eligible for VA health care and Medicaid may find shorter or no wait periods with a Medicaid nursing home.
Medicaid Nursing Home Alternative
For some veterans, a Medicaid nursing home might be a good alternative to a VA nursing home. Some reasons are as follows:
1) Nursing home Medicaid is an entitlement, which means applicants who qualify for such care are guaranteed Medicaid-funded nursing home care. There is no waitlist, which unfortunately, isn’t always the case with VA nursing homes. In fact, waitlists for VA nursing homes are fairly common and can be quite long.
2) The availability of VA nursing homes are limited, which means there might not be one in a veteran’s geographic region.
3) For persons who qualify for Medicaid funded nursing home care, Medicaid will cover 100% of the cost. Many veterans are required to pay a co-payment for VA nursing home care. However, based on a veteran’s circumstances, Medicaid may cover the required VA co-payment.
4) While nursing home Medicaid does consider an applicant’s monthly income and countable assets in the eligibility process, one does not need to be impoverished to be eligible. In fact, even if one is over Medicaid’s income and asset limits, there are a variety of planning strategies to help one meet the financial criteria, and hence, become nursing home Medicaid eligible. Via Medicaid planning, a professional Medicaid planner can assist Veterans in restructuring finances to meet the eligibility criteria. Find a Medicaid planner.
To learn more about Medicaid-funded nursing home care, including eligibility criteria, click here.