Posts Tagged ‘veterans’

Is a Veterans Administration Benefit Right for You?

APRIL 30, 2012 VOLUME 19 NUMBER 17
We were reminded recently of the existence of a resource for elderly veterans and their surviving spouses — one that is too often overlooked, as it happens. We had yet another client who was unaware that she might qualify to receive a Veterans Administration pension benefit. We have written about veterans benefits before, but it always surprises us to note how often potential applicants are unaware of the benefits they are entitled to receive.

To qualify, the veteran must have served 90 days or more of active duty, including a single day during a war time period. War time periods include the second World War, the Korean Conflict, the Vietnam War, and Desert Storm, Desert Shield, and really any service in Afghanistan or Iraq from August, 1990 onward. The Department of Veterans Affairs helpfully maintains a list of the actual dates of “Periods of War” online.
The veteran must also have been honorably discharged (or at least, not dishonorably discharged) from his or her military service. Unlike other VA programs, there is no “service-connected” requirement for this particular benefit.

The benefit is available to veterans and their surviving spouse. If you are the surviving spouse, you must have been married to the veteran at the time of his or her death and can not have remarried since.  There is an asset test; to qualify, you may have family net worth of no more than $60,000 to $80,000, not counting the value of your home, car, and certain other items.

In calculating the amount of your pension benefit, the VA assesses your “countable monthly income.” Under this formula, any money you receive from Social Security reduces the amount of money you will receive from the VA.  Note, however, that you can reduce your “countable monthly income” by monthly unreimbursed medical expenses. These include such things as your Medicare premium, a dental insurance premium, a long term care insurance premium, prescription drugs, hearing aid costs, vision care costs, and expenses related to transportation to your doctor’s office.

Application forms are available at the Veterans Administration website, http://www.va.gov, or by calling 1-800-827-1000. The veteran’s application is form 21-256, widows use form 21-534, and the medical expense form is 8416.

The state of Arizona has created a department of Veterans Services to assist state residents in obtaining federal veterans benefits to which they may be entitled. A counselor will assist you in making the application. The Tucson office is located at 1661 N. Swan Road, Suite 128, Tucson, AZ 85712 and their telephone number is (520) 207-4960. You can also call the Phoenix office toll-free at 1-800-852-8387.

Wondering why no one has invited you to a free lunch to hear about this exciting benefit? VA rules state that anyone who assists you in completing this application can charge you no more than $10.00 for the service. That makes it hard to make a living explaining the benefit, unless your salary is paid by the federal or state government.

White House Conference on Aging (Cont’d)

APRIL 10, 1995 VOLUME 2, NUMBER 40

More proposals considered by Arizona delegates to the White House Conference on Aging (by topic area):

Health Care and Mental Health

  • Permit reimbursement for direct care provided by nurse practitioners and physician’s assistants, for home care, preventive care and wellness programs.
  • Reduce duplication and coordinate services, particularly for those who access special services such as Veteran’s programs, Indian Health Services and Medicaid.
  • Control prescription medication costs.
  • Avoid rationing of health care by caps on service reimbursement and cost-benefit analysis of the true value of high-cost medical procedures.
  • Use excess hospital capacity for alternative services, such as extended care and assisted living.
  • Share medical resources, particularly high-tech equipment.
  • Consider means-testing Medicare (though a strong minority voice opposed any discussion of such a step).
  • Expand health programs to include mental health services.
  • Promote greater patient involvement in medical decisions.
  • Deal more creatively with substance abuse and suicide among the elderly.
  • Encourage medical professionals to work in rural and under served populations.
  • Institute a single-payor national health program (though this one did not make it into the final report).

Long Term Care

  • Shift emphasis from long term care in medical institutions to home care.
  • Provide tax incentives for family caretakers.
  • Encourage innovation in state and local programs by granting federal program waivers.
  • Promote prevention practices, among both elderly and young.
  • Encourage seniors to volunteer in their communities, to help them stay vital and involved.
  • Develop a wellness check program for homebound seniors.
  • Provide loans and incentives for home repair and adaptation for the homebound elderly.
  • Increase recreational programs for the elderly.
  • Expand case management programs.
  • Provide respite care for family care givers.
  • Promote congregate housing alternatives to reduce care costs.
  • Promote family and community responsibility for the elderly.

These are just a few of the myriad of suggestions considered by Arizona delegates. Next issue, we will discuss “special populations” and “elder rights.”

Recent Court Cases

MARCH 13, 1995 VOLUME 2, NUMBER 36

Recent court decisions of interest to those dealing with the elderly:

Care Home Liable for Condition of Resident

Sylvia Kyro, a demented patient, was a resident at Country Home Care in the Reno, Nevada, area. After she had been at the home for about two years, she became bedridden. Four months later, in April, 1993, she was taken to an area hospital.

At the hospital, Ms. Kyro was found to be malnourished and suffering contractures of both legs. The contractures were determined to be the result of lack of movement and muscle degeneration from inadequate blood circulation.

At the time of admission hospital staff also found infected bedsores on Ms. Kyro’s hips, knees and elsewhere. The most serious sores were Stage IV–the most advanced categorization.

Ms. Kyro’s guardians sued the care home, alleging that the home should have taken steps to transfer Ms. Kyro to a higher level of care when she became bedridden. The guardians also alleged that the home failed to notify Ms. Kyro’s physician of her worsening condition, which would have been a violation of Nevada licensing regulations.

In November, 1994, Country Home Care settled the claims. The amount of the settlement: $410,704. Kyro v. Frederick d.b.a. Country Home Care, (Washoe County District Court, Nevada, November 10, 1994).

Veteran’s “Aid and Attendance” Reduces Medicaid

Roland Kreuger, a North Dakota nursing home resident, was a veteran. In 1992 the Veteran’s Administration increased his “aid and attendance” payment. Since his care was being subsidized by Medicaid, his “turnover” amount (the amount he had to contribute to his nursing home care each month) was increased by the same dollar amount, resulting in no net increase to Mr. Kreuger.

Mr. Kreuger attempted to transfer his aid and attendance increase to his wife rather than use it to pay a portion of his nursing care. His argument (which was successful in the North Dakota trial court): federal law expressly provides that aid and attendance is not “income” and therefore not available for calculation of the turnover amount.

The North Dakota Supreme Court, however, reversed the lower court holding. Since the aid and attendance allowance was intended to provide care for veterans, and since Medicaid does not provide similar care when other payors are liable to do so, aid and attendance is a third-party program legally liable for the care before Medicaid makes a contribution. Kreuger v. Richland County Social Services (North Dakota Supreme Court, December 20, 1994).

Arizona White House Conference on Aging

FEBRUARY 27, 1995 VOLUME 2, NUMBER 34

The Arizona White House Conference on Aging held in Phoenix last month dealt with issues facing the full White House Conference on Aging when it meets in May. Arizona’s delegation dealt with several issues expected to dominate the national aging agenda.

Long Term Care

Everyone knows that the proportion of elderly citizens is expected to grow dramatically in the next two decades. What many do not appreciate is that the greatest growth is projected for the “old old”; those over age 85. Currently one-quarter of all women (but only one-seventh of men) over age 85 live in nursing homes. Those who turn 65 in any given year have about a 40% chance of spending some portion of the rest of their lives in a nursing home. About 10% of those will spend five or more years there.

Another tremendous segment of the population requires long-term care, but receives care at home. About 70% of all long-term care of the elderly is provided solely by family and friends, without institutionalization.

For those who can be cared for at home, the cost of assistance may be prohibitive. Simply bringing an aide into the home three times a week for meal preparation and light housekeeping can easily cost in the range of about $600 per month. Since about 20% of Arizona’s elderly live at or near the federal poverty level, even such small assistance may be unaffordable.

For those placed in nursing homes in Arizona, the cost of care will typically vary from $30,000 to $40,000 per year. Many seniors expect Medicare to pay some portion of that cost; in fact, Medicare pays only about 3% of the total nursing home bill in this country. Private long-term care insurance (still a relative rarity) and Veteran’s benefits account for another percent or two each; the remaining portion of long-term care costs are paid roughly equally by Medicaid and patient’s private savings and income.

Although nursing homes care for less than one-fifth of those requiring long-term care, they are responsible for more than half of the cost of care. Seniors are reluctant to enter the nursing home, and much prefer to be cared for (and die) in their homes.

Cost effective alternatives to institutionalization exist, especially in urban areas. Adult day care, respite care, hospice and assisted housing programs can keep many nursing home candidates in less expensive settings and more comfortable. Unfortunately, such programs are too rare and are seldom funded by public dollars. Paradoxically, it becomes less expensive for most patients to move into the nursing home and qualify for Medicaid (ALTCS in Arizona) than to secure care at home or in a more home-like setting.

More AZ White House Conference on Aging

FEBRUARY 13, 1995 VOLUME 2, NUMBER 32

As mentioned in previous Elder Law Issues, the Arizona White House Conference on Aging held in Phoenix two weeks ago dealt with issues facing the full White House Conference on Aging when it meets in May. Arizona’s delegation dealt with several issues expected to dominate the national aging agenda.

Problems of “Special” Populations

Of course, elderly citizens may also belong to minority or disadvantaged groups. Of particular concern to the Arizona White House Conference on Aging were the specific problems encountered by four subgroups:

  • Ethnic and racial minorities
  • Physically disabled,
  • Developmentally disabled,
  • Homeless, and
  • Veterans

Approximately one-quarter of all citizens belongs to a minority ethnic group. Elderly minority group members may suffer from double (or even triple or quadruple) jeopardy. In addition to the problems shared by all elderly citizens, the ethnic elderly are less likely to be home owners, are more likely to have transportation problems, and may find language and cultural barriers to securing services.
Our increasingly mobile society may cause special problems for the ethnic elderly. Divorce rates, changes in family structures (including increased frequency of grandparent custody and visitation disputes) and elder abuse (including financial abuse) may work special emotional and financial hardships for ethnic minorities.

In Arizona, Native Americans face special problems. State and Federal disputes over responsibility for services has left an especially needy population vulnerable.

Older citizens with developmental disabilities may face many of the same problems. Their problems are compounded by the fact that the aging services network is unfamiliar with their needs, and is strained by the additional demands imposed by this special population.

Physical disabilities are increasingly common among the elderly. Among the most elderly (those 85 and older), 62% of women and 46% of men need help at home or are living in a nursing home. Physical barriers are even more limiting to the elderly physically disabled than to their younger counterparts.

Homelessness is increasingly common among the elderly. Particularly the elderly mentally ill, who in previous decades would have been housed in institutions, may now be displaced.

Veterans as a group are getting older, and medical programs and facilities designated for their care are not geared to meet their changing needs. Only 10% of qualified veterans use VA facilities, yet overcrowding and long waiting periods are endemic.

[Next issue: Financial Security Issues]

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