On this Page: 1. State Veteran Benefit Finder 2. Pre-Need Eligibility for National Cemetery Burial 3. PDBR Review of Disability Claims Continues 4. Compensation and Pension Examinations and Their Role in a VA Benefits Case 5. Your VA Benefits Eligibility Matrix 6. Understanding What It Means to Be Rated 100% Disabled 7. PTSD Coach Mobile App 8. Sensorineural Aids; Hearing Aids and Glasses 9. Arm Forces Medical Facilities closing to veterans 10. VA Veteran Money 11.Other Compensations That A Veteran Must Know 12. VA telehealth 13. VA Caregiver Tip Sheet During Pandemic 14. Your Guide to VA Appeals 15. Financial Assistance as result of VA action 16. Women Veterans and VA Healthcare Benefits 17. Fiduciary Accounting Submission Tool (FAST) 18. Benefits for spouses, dependents, and survivors 19. Adapt Your Car with VA 20. Free Entrance toNational Parks forVeterans and Survivors 21. 2021 Veterans disability compensation rates 22. The Veteran Appeals Improvement and Modernization Act of 2017 became law on August 23, 2017 (Pub L. 115-55). It is also known as the Appeals Modernization Act. 23. Federal tools to help maximize GI Bill education benefits 24. VA COVID 19 vaccine availability 25. Support for Caregivers 26. Changes in Travel Pay Reimbursements 27. Burial Expenses Reimbursed 28. Memory Care Resources for Veterans
1. State Veteran Benefit Finder
The Center for a New American Security (CNAS) created the “State-Level Benefits Finder for Veterans,” which is a new online tool catalogue that displays benefits offered by each state across the U.S. according to CNAS. There is a total of 1,814 unique benefits which exist across the 50 states and the District of Columbia. However, there is significant variation across states in terms of available benefits, who is eligible to access them, and their value. For more information or to locate benefits that may pertain to you here in California and the rest of the states see below link.
State Benefits Finder: <https://www.cnas.org/publications/reports/state-veteran-benefit-finder?utm_medium=email&utm_campaign=MVS%20Report%20State-Level%20Benefits%20for%20Veterans&utm_content=MVS%20Report%20State-Level%20Benefits%20for%20Veterans+CID_deaf0a4502668c4aa2c448e8d0609b55&utm_source=Campaign%20Monitor&utm_term=Veteran%20Benefit%20Finder
2. Pre-Need Eligibility for National Cemetery Burial or Memorialization
Requesting Burial in a National Cemetery To apply for pre-need determination, veterans should complete and submit a VA Form 40-10007 - Application for Pre-Need Determination of Eligibility for Burial in a VA National Cemetery, along with copies of supporting documentation, such as a DD Form 214. The documents should be sent to the VA National Cemetery Scheduling Office at: toll-free fax at 855-840-8299; email to [email protected]; or mail to the National Cemetery Scheduling Office, P.O. Box 510543, St. Louis, MO 63151.
Applicants may indicate a preference for a VA national cemetery on the application form, but a pre-need determination of eligibility does not guarantee burial in a specific VA national cemetery or a specific gravesite. VA assigns gravesites in cemeteries with available space once death has occurred and the burial is scheduled.
What to Expect After Applying VA will review pre-need burial applications and provide written notice of a determination of eligibility (a decision letter). VA will save the information electronically for future reference and to expedite processing burial claims at the time of need.
You should save a copy of all documents submitted and the decision letter received. It is also a good idea to communicate with one’s loved ones or estate planners where the documents are, and about the preference to be buried in a VA national cemetery.
At the time of need, the next-of-kin, funeral home or other representative responsible for making final arrangements should contact the National Cemetery Scheduling Office at 800-535-1117 to request burial.
If the veteran didn't complete a "pre-need determination" request prior to death, survivors or funeral directors can request burial in a National Cemetery by faxing eligibility documentation to 866-900-6417 or scanning and emailing the information to [email protected], survivors or funeral directors can also call the VA at 800-535-1117.
Eligibility for Burial in a National Cemetery Veterans and armed forces members who die on active duty are eligible for burial in one of VA's 135 national cemeteries. An eligible veteran must have been discharged or separated from active duty under conditions other than dishonorable and have completed the required period of service. A U.S. citizen who served in the armed forces of a government allied with the United States in a war also may be eligible. Spouses and dependent, minor children of eligible veterans and of armed forces members also may be buried in a national cemetery.
A surviving spouse of an eligible veteran who married a nonveteran prior to Oct. 31, 1990, and whose remarriage was terminated by death or divorce prior to or on that date is eligible for burial in a national cemetery. A surviving spouse of an eligible veteran who married a nonveteran prior to Oct. 31, 1990, and whose remarriage was still intact on or after that date, however, is not eligible for burial in a national cemetery. A surviving spouse who marries a nonveteran after Oct. 31, 1990, is not eligible for burial in a national cemetery. Note: For all the below benefits, see a Service Officer prior to applying.
The following benefits are available to Veterans and their families: VA provides for a final resting place for eligible Veterans, spouses, and their eligible dependents, as well as a headstone or marker, a flag to drape the casket and a Presidential Memorial Certificate.
Memorial or Burial Flags: A United States flag is provided, at no cost, to drape the casket or accompany the urn of a deceased Veteran who served honorably in the U. S. Armed Forces. U.S. Post Offices are the primary issuing point for burial flags. Each family of a decedent is entitled to one flag.
Government Headstones or Markers: VA can provide a single headstone, columbarium niche cover, or a flat marker for a Veteran’s final resting place (private, state or national cemeteries).
Cemetery Medallions: VA can provide a medallion for use on a headstone or other memorial in a private cemetery to signify a decedent’s status as veteran. Multiple sizes are available.
Presidential Memorial Certificates: VA can provide a Presidential Memorial Certificate (PMC) to the family of the deceased Veteran. A PMC is an engraved paper certificate signed by the current President.
Burial Benefits and Burial Automatic Payments:
Burial benefits are paid to a spouse, designated family member, or executor to partially offset the cost of burial expenses, plot costs, and transportation costs for a Veteran’s remains.
These benefits are paid at different rates based on whether the Veteran’s death was service connected or non-service connected.
If the Veteran was receiving VA benefits prior to their passing and had a spouse of record, these benefits will usually be paid automatically to that spouse. However, additional funds may be paid, or payment made to another party, if an application is completed. Additional benefits, including a plot or interment allowance and transportation allowance, may also be payable.
Veterans Month of Death Benefits: If a Veteran who is receiving VA compensation or pension benefits passes away, their last month of benefits can be paid to their surviving spouse. This payment is usually automatic, but if it is not received, it can be claimed via a phone call to 1-800-827-1000, or through your County Veterans Service Officer (CVSO).
3. PDBR Review of Disability Claims Continues The Physical Disability Board of Review was created in the FY2008 Defense Authorization Act (NDAA) that reassess the accuracy and fairness of combined disability ratings of 20 percent or less for service members who were separated from service, rather than medically retired because of medical conditions.
In order to be eligible for a PDBR review, service members must have been medically separated between Sept. 11, 2001, and Dec. 31, 2009, with a combined disability rating of 20 percent or less and found ineligible for retirement. Currently only 19,000 of the more than 71,000 eligible have requested a review of their claim. The Physical Disability Board of Review claims that more than half of the reviewed claims have been upgraded to a disability rating of 30 percent or more.
The review panel is authorized to recommend an increase in a disability rating, uphold the previous finding or issue a disability rating when the previous board did not assign one. The board, however, is NOT able to recommend a lower rating. Eligible veterans can request a board review by submitting a Department of Defense Form 294, Application for Review of Physical Disability Separation from the Armed Forces of the United States.
This form is online at; <https://health.mil/Military-Health-Topics/Conditions-and-Treatments/Physical-Disability/Disability-Evaluation/Physical-Disability-Board-of-Review/PDBR-Application-Process
Veterans requesting a review must mail their completed and signed DD Form 294 to SAF/MRBR, 550 C St. W., Suite 41, Randolph Air Force Base, Texas 78150-4743. Applicants may submit statements, briefs, medical records or affidavits supporting their application.
For more information about the PDBR; <https://health.mil/Military-Health-Topics/Conditions-and-Treatments/Physical-Disability/Disability-Evaluation/Physical-Disability-Board-of-Review
4. COMPENSATION AND PENSION EXAMINATIONS AND THEIR ROLE IN A VA BENEFITS CASE
As a Service Officer I am often asked about why the VA does an examination even though you have provided medical evidence from your "Civilian Primary Care Doctor". So I thought I would provide you with the reasons...Bud
WHAT IS A C&P EXAM? A Compensation and Pension (C&P) exam, is a medical examination of a veteran’s disability, performed by a VA healthcare provider, or a VA contracted provider. VA uses C&P exams to gather more evidence on a veteran’s claimed condition before issuing a decision and assigning a rating. Most commonly, C&P exams are used to: 1) confirm or deny service connection, and/or 2) establish the severity of a veteran’s disability.
Before the exam, the examiner will review your entire claims file, which contains previously submitted evidence and medical treatment records. The exam itself usually only lasts about 15-20 minutes, but can range anywhere from 5 minutes to several hours.
WHEN WILL YOU ATTEND A C&P EXAM? A C&P exam is typically the first step in the VA disability claims process after a claim has been filed. Namely, VA has a “duty to assist” veterans in obtaining evidence to support their claims. Since medical evidence is crucial to a veteran’s disability case, C&P exams are provided by VA at no cost to the veteran. After applying for service-connected compensation, VA will send a notice either informing you that an exam has been scheduled, or indicating that you will need to schedule one. If an exam is already scheduled for you, VA will provide the date, time, and location that it will take place. If you are responsible for scheduling the exam, you must respond promptly by reaching out to the Compensation and Pension Department at the VA in order to do so. Either way, it is very important to attend a C&P exam once it is scheduled. If you do not attend, your claim will likely get denied.
WHAT WILL HAPPEN DURING THE C&P EXAM? During the C&P exam, the examiners will ask questions about your disability and how it affects aspects of daily functioning. VA examiners might complete a Disability Benefits Questionnaire (DBQ) as well. Each DBQ is drafted to correspond with a specific condition, and is formatted for examiners to “check a box” next to descriptions that most accurately depict the disability in question. It is important for you to be honest about your symptoms so that they can be properly documented.
HOW DOES VA USE C&P EXAMS? After the exam, the examiner will write up a report that includes a review of the exam’s findings, any clinical test results, and any medical literature used by the examiner to determine etiology – the cause or origin of a disease or condition. If the examiner is trying to confirm or deny service connection, he or she will write up a medical opinion that states whether it is “at least as likely as not” (a 50% chance) that your disability was incurred in or aggravated by service. The C&P exam is then added to your claims file as part of the evidence VA will use to make a decision.
CAN YOU GET A COPY OF YOUR C&P EXAM? You have the right to request and obtain a copy of your C&P exams by contacting the VA medical center where the exam was conducted, or your VA Regional Office. VA decision makers often place significant weight on C&P exams when deciding claims. Therefore, it is important for you to review the exam to determine if the results are favorable. Furthermore, you can ensure that the exam was filled out completely and thoroughly, reflecting the most accurate information possible.
WHAT IF YOU DISAGREE WITH YOUR C&P EXAM RESULTS? If you disagree with your C&P exam results, consider disputing or countering the examiner’s report by doing the following:
1. Gather “buddy statements”; Buddy statements are written statements from people who know you, your symptoms, and how your disability affects your life. Your “buddies” might include your spouse, children, other relatives, fellow veterans from your unit, co-workers, etc.
2. Request a hearing with the Board of Veterans’ Appeals; DO NOT ATTEMPT THIS ALONE. ALWAYS USE EITHER THE COUNTY VSO OR A MILITARY ORGANIZATION VSO SUCH AS THE AMERICAN LEGION.
Attending a hearing allows you and your attorney to point out the specific problems with your C&P exam and present evidence that may counter or weaken the exam results. If a Veterans Law Judge feels as though your C&P exam is lacking the adequate amount of information required to make an informed decision, they will remand, or send back your case to the Regional Office with specific instructions for additional development. The Regional Office will then order a new C&P exam, and you will have to repeat this process. After the proceeding, the transcript of your BVA hearing is added to your claims file.
3. Have your doctor complete a DBQ; In theory, the DBQ allows you to submit a medical exam performed by a private physician who knows the history of your disability and can spend more than 15 minutes with you. However, there are several downfalls that make the DBQ option potentially less effective. For example, the DBQ form your doctor would complete is different than the evaluation guidelines for C&P exams. Specifically, the DBQ forms do not ask your doctor to provide descriptions or rationales for any symptoms listed or conclusions drawn during the exam. This often leads VA adjudicators to give DBQs less weight in making a decision on your claim. Therefore, if you choose to pursue this option, let your doctor know that they should support their answers with a written explanation even if the form does not require it.
COMMON PROBLEMS WITH C&P EXAMS: It is beneficial to gather information about your C&P exam in order to highlight the exam’s weaknesses. For example, there are several common issues that come up in C&P exam reports that may be helpful to your case.
1. The examiner was not qualified to examine your disability; Unfortunately, it is not uncommon that C&P exams are performed by non-physicians. You may be evaluated by a nurse, a nurse practitioner, a physician’s assistant, or internist rather than a licensed doctor. Some veterans have even been assigned a physician whose specialty is unrelated to their disability. If this is the case, you can make a strong argument that the exam results should not be considered valid. The name of your examiner will appear on your copy of the exam report. By searching the internet, you will likely be able to find your examiner’s level of training, specialty, and perhaps even their CV or resume.
2. The examiner provides irrelevant or outdated medical research as rationale; On C&P exams where service connection or etiology are being established, the VA examiner is required to reference medical research that supports his or her medical opinion. Take a look at the medical literature they list on the report. If the evidence referenced was published more than five or ten years ago, this could help you case. Or, if the evidence referenced is regarding a different type of disability or does not discuss a connection between the type of in-service event or injury you experienced and your current disability, you should address this.
3. The examiner ignores favorable medical information; Examiners must provide a rationale for any medical opinions they provide. If in the report, the examiner lists only medical treatment records or medical research that do not support your claim, an argument can be made that they ignored more favorable information. For example, if you are claiming a back condition, an examiner might cite two doctor’s appointments in which you said your back pain was the worst pain you ever felt you have ever felt and you couldn’t walk for more than 2 blocks.
4. The examiner misreports what you said or suggests you are “malingering”; Does the exam report match what you said in-person? The examiner may have misstated or misinterpreted what you said. It could also be possible that you did not understand the examiner’s question. For example, if an examiner asks if you experience “radiculopathy” without explaining that it means “numbness and tingling”, you may have unintentionally answered incorrectly. Additionally, an examiner might suggest that you are “malingering”, meaning you are exaggerating or faking your symptoms. An assumption like this could undermine the C&P exam report and even other parts of your claims file, so it’s important to address this as well. Buddy statements are particularly effective in this case if your “buddy” has witnessed your symptoms and can provide specific examples of how they affect your life.
5. Your VA Benefits Eligibility Matrix
Folks, Take a look at the eligibility matrix below to see what benefits you are eligible for based on your disability rating and keep it on your record file for future reference:
Rating of 0% - 20%:
Certification of Eligibility for home loan guaranty.
Home loan guaranty fee exemption.
VA Priority medical treatment card.
Vocational Rehabilitation and Counseling under Title 38 USC Chapter 31 (must be at least 10%).
Service Disabled Veterans Insurance (Maximum of $10,000 coverage) must file within 2 years from the date of new service connection.
10-point Civil Service preference (10 points added to Civil Service test score).
Clothing allowance for veterans who use or wear a prosthetic or orthopedic appliance (artificial limb, braces, wheelchair) or use prescribed medications for skin condition, which tend to wear, tear or soil clothing.
Temporary total evaluation (100%) based on hospitalization for a service connected disability in excess of 21 days; or surgical treatment for a service connected disability necessitating at least 1 month of convalescence or immobilization by cast, without surgery of more major joints.
Rating of 30%:
Additional allowance for dependent (spouse, child(ren), step child(ren), helpless child(ren), full-time students between the ages of 18 and 23 and parent(s).
Additional allowances for a spouse who is a patient in a nursing home or helpless or blind or so nearly helpless or blind as to require the regular aid and attendance of another person.
Rating of 40%:
Automobile grant and/or special adaptive equipment for an automobile provided there is loss or permanent loss of use of one or both feet , loss or permanent loss of one or both hands or permanent impaired vision in both eyes with central visual acuity of 20/200 or less in better eye.
Special adaptive equipment may also be applied for if there is ankylosis of one or both knees or one or both hips.
Rating of 50%:
VA Medical outpatient treatment for any condition except dental.
Preventative health care services.
Hospital care and medical services in non-VA facilities under an authorized fee basis agreement.
Rating of 60% - 80%: Increased compensation (100%) based on Individual Unemployability (IU) (applies to veterans who are unable to obtain or maintain substantially gainful employment due to service connected disability).
Rating of 100%:
Dental treatment.
Department of Defense Commissary privileges.
Veteran’s employment preference for spouse.
Waiver of National Service Life Insurance premiums.
National Service Life Insurance total disability income provisions.
Specially adapted housing for veterans who have loss or permanent loss of use of both lower extremities or the loss of blindness in both eyes having light perception only plus loss of use of one lower extremity or the loss or permanent loss of use of one lower extremity with loss or permanent loss of use of one upper extremity or the loss or permanent loss of use of one extremity together with an organic disease which affects the functions of balance and propulsion as to preclude locomotion without the aid of braces, crutches, canes or wheelchair.
Special home adaptation grant (for veterans who don’t qualify for Specially Adapted Housing) may be applied for if the veteran is permanently and totally disabled due to blindness in both eyes with visual acuity of 5/200 or less or loss or permanent loss of use of both hands.
Rating of 100% (Permanent and Total): In Addition to the Above:
Civilian Health and Medical Program for Dependents and Survivors (CHAMPVA).
Survivors and dependents education assistance under Title 38 USC Chapter 35.
Non Service Connected Pension Benefits:
10 point veteran preference in Federal hiring
Health care enrollment (subject to income requirements)
Travel allowance for scheduled appointments for care at a VA medical facility or VA authorized health care facility
Burial and plot allowance
Non-Service Connected Pension with Aid & Attendance or Housebound Benefits:
10 point veteran preference in Federal hiring
Health care enrollment (subject to income requirements)
Travel allowance for scheduled appointments for care at a VA medical facility or VA authorized health care facility
Free hearing aids
Free eye glasses
Burial and plot allowance
Aid & Attendance for spouse (only if spouse meets certain criteria)
Medal of Honor Recipient Benefits:
Medal of Honor Pension
VA administers a pension benefit of $1,329.58/month to recipients of the Medal of Honor. This entitlement is not based on income level or need.
Former Prisoner of War Benefits:
No cost health care and prescription medications
No cost dental care
Service Connected Disability with Anatomical Losses or Impairment - Benefits:
Special Monthly Compensation
Specially Adapted Housing/Special Home Adaptation Grant
Veterans Mortgage Life Insurance
Automotive Grant/Automobile Adaptive Equipment
Home Improvement Specially Adapted grant
Veteran Who Is Recovering From Surgery Benefits: Temporary monetary compensation at the 100 percent rate
Veteran With Joint Immobilized By Cast Without Surgery - Benefits: Temporary monetary compensation at the 100 percent rate
Veteran Hospitalized 21 Days or More For Service Connected Disability - Benefits: Temporary monetary compensation at the 100 percent rate
Veteran Who Served In Vietnam or Korean DMZ and Has Biological Child With A Birth Defect – Benefits:
Monthly monetary compensation
VA Health Care
Vocational training for child
Spouse or Dependent Child of a Veteran Who Died From Disability Related to Military Service – Benefits:
Dependency and Indemnity Compensation (subject to income limitations for dependent child)
Dependents Educational Assistance
Special restorative training
Home Loan Guaranty benefit (surviving spouse only)
6. Understanding What It Means to Be Rated 100% Disabled
Unfortunately, many of us are often confused about the VA's 100 percent disability ratings and whether or not we are allowed to secure gainful employment if rated at 100 percent. While sometimes confusing , let’s take a look at the four types of 100 percent disability ratings......Bud 1. Combined. When a veteran's service-connected disabilities are combined to reach 100 percent, he/she is allowed to work full time or part time. For example, if a veteran is rated 70% for PTSD, and 30% for IBS, the two disabilities equal 100% (sometimes – see rating table), and the veteran is allowed to hold a full time or part time job. 2. TDIU or IU. Total Disability/Individual Unemployability. This is a specific type of claim made by a veteran, requesting that he/she be paid at the 100 percent rate even though his/her disabilities do not combine to reach 100%. The request is often made because the veteran is unable to maintain "gainful employment" because his/her service-connected disabilities prevent him/her from doing so. The basic eligibility to file for Individual Unemployability (IU) is that the veteran has one disability rated at 60 percent or one at 40 percent and enough other disabilities that result in a combined rating of 70 percent or more. The one disability at 40 percent criteria can be a combined rating of related disabilities. Meeting the basic criteria is not a guarantee that the veteran will be awarded 100 percent under IU criteria. The medical evidence must show that the veteran is unable to work in both a physical and sedentary job setting. A veteran not meeting the percentage criteria may still be awarded IU if the disabilities present a unique barrier to gainful employment. If a veteran is granted 100 percent under IU he is prohibited from working full-time, because in filing the claim for IU the veteran is stating he/she is unable to work because of his/her service-connected disabilities. However, receiving IU does not necessarily prevent a veteran from all employment circumstances. The veteran can work in a part-time "marginal" employment position and earn up to a certain amount annually, but not allowed to surpass a certain amount. 3. Temporary 100 percent rating. If a veteran is hospitalized 21 days or longer or had surgery for a service-connected disability that requires at least a 30-day convalescence period, the VA will pay at the 100 percent rate for the duration of the hospital stay or the convalescence period. For example, if a veteran has a total hip replacement for a service-connected hip disability, the VA will pay 100 percent compensation for up to 13 months, the standard recovery period for a replacement of a major joint. The duration of 100 percent temporary disability for any other type of surgery will depend on what the doctor reports as the recovery period. 4. Permanent and Total (P&T Rating). A 100 percent "permanent and total" rating is when the VA acknowledges that the service-connected conditions have no likelihood of improvement and the veteran will remain at 100 percent permanently with no future examinations. The P&T rating provides additional benefits, such as Chapter 35 education benefits for dependents, among others. Veterans sometimes make the mistake of requesting a P&T rating simply because they want education benefits for their dependents. The one caveat that veterans need to keep in mind is that when P&T is requested, all of their service-connected disabilities will be re-evaluated. If improvement is noted during the subsequent examinations, a reduction from 100 percent can possibly be proposed. Because many veterans are service-connected for conditions that VA says have a "likelihood of improvement," most ratings are not considered permanent and are subject to future review. The only time veterans can't work a full-time position, that is considered a gainfully-employed job is if they were awarded 100 percent disability through a claim for IU. Additionally, a 100 percent rating under either IU or combined ratings may or may not be rated as permanent and total. A temporary 100 percent rating is just that: temporary due to being hospitalized or recovering from surgery on a service-connected condition.
7. PTSD Coach Mobile App
New PTSD Coach Mobile App Released: VA has released PTSD Coach, its first mobile app that features tools to help you manage stress symptoms, information about post-traumatic stress disorder and treatments that work, improved graphics to help track your progress, and new ways to personalize your app with the ability to turn on or off daily quotes and the distress meter. The PTSD Coach app is available for download at Google Play for Android users and iTunes for iPhone users.
Did you know veterans who are enrolled in the Department of Veterans Affairs (VA) health care system may be eligible to receive free hearing aids, glasses or contact lenses? These “sensorineural aids” are provided at no charge to veterans who are determined to need the devices, even if the veteran is not “service-connected” for hearing or vision impairment.
Such services are considered part of the preventative care package for all veterans enrolled in VA health care system who meet certain eligibility criteria.
For some veterans, there may be a $50 co-pay depending on the veteran’s enrollment priority group status. This are groups 2 through 8. There is no co-pay for the devices or the batteries, nor are there any charges for visits for the purpose of adjusting, repairing or modifying hearing aids and/or glasses.
To make an appointment, please call: For Glasses - Mission Valley Optometry, 1st Floor, Room 1169 - (619) 400-5000 or For Glasses, Contact Lenses, Hearing Aids - La Jolla VA Hospital, Atrium Clinic, 2nd Floor, Room 2A126 - (858) 552-8585
9. Arm Forces Medical Facilities closing to veterans
Folks, there are four Arm Forces Medical Facilities closing to veterans throughout the state. Here are the two affecting us
Facilities closing to non-active duty patients include:
Marine Corps Air Station Miramar, California, Rancho Bernardo clinic
San Onofre Marine Corps Base, California, San Onofre Health Clinic
10. VA Veteran Money
Comrades, did you know these VA programs will pay you and your surviving spouse in all matters financial? As you explore these programs, keep in mind, it may be in your best interest to see a Veteran Service Officer should you elect in pursuing any of these programs.
Hidden VA Money:
Any veteran who is a senior citizen or his/her surviving dependents may be eligible to receive over $2,000 per month ($24,000 per year) in tax free income. The payments include annual cost of living increases.
A veteran can easily qualify for a VA Pension even if his annual income exceeds the limits set by the VA. For this program, a veteran may need a highly qualified VA attorney to help.
Recurring, non-reimbursed medical expenses of a veteran and the surviving spouse are deductible from gross income. Veteran family members can be paid as caregivers, which is also a tax deductible expense.
If a veteran resides in an Assisted Living Facility the entire amount paid for the service is a deductible expense.
Veterans 65 years-old or older, are presumed to be disabled. It does not have to be proven.
There are many federal VA nursing homes, and private nursing homes with a federal VA Contract who will admit veterans for care even if the veteran does not meet the service connected disability requirements.
Veterans who are 100% service-connected IU may be eligible for an additional monthly entitlement of $62.50/mo. for catastrophic injury.
Catastrophic injury; Based on a VA clinical decision, Veterans are considered to be Catastrophically Disabled when they have a severely disabling injury, disorder or disease that permanently compromises their ability to carry out the activities of daily living. The disability must be of such a degree that the Veteran requires personal or mechanical assistance to leave home or bed, or require constant supervision to avoid physical harm to themselves or others.
Veterans determined Catastrophically Disabled are placed into Priority Group 4 unless eligible for a higher Priority Group placement based on other eligibility criteria such as being a compensable service-connected Veteran, a former Prisoner of War, or a Medal of Honor or Purple Heart recipient.
A Catastrophically Disabled determination may be authorized when a VA clinician determines that
there is sufficient medical documentation without further evaluation. Veterans may also request
a Catastrophically Disabled evaluation by contacting the Enrollment Coordinator at their local VA
health care facility. It is VA policy to provide a Catastrophically Disabled Veteran an evaluation within
30 days of the request. There is no charge for this examination.
DMAVA and the department of education jointly launched a program on October 5, 2002 to honor world war two era veterans who left school to join the military and have never received a high school diploma.
Veteran family members can be paid as caregivers, which is also a tax deductible expense.
If a veteran resides in an Assisted Living Facility the entire amount paid for the service is a deductible expense.
If the veteran is deceased and the surviving spouse is applying for low income pension, the spouse can be of ANY age and does NOT have to be disabled.
Reports indicate that a pension with aid and attendance is easier to obtain then Household Benefits.
A veteran who is healthy but has a spouse who is disabled, may be eligible for Improved Pension (Low Income Pension).
In order to receive service-connected disability rating a veteran’s disability does not have to be related to combat.
A VA rating of 70% or higher will allow a veteran-claimant to reside in a federal VA nursing home, at no charge. Other stipulations may arise resulting in minimal fees.
When a veteran is rated at 100% disability or if rated as individual unemployability (IU), the veteran will receive the highest rating and the highest pay. Additionally, if a veteran is in need of additional aid of another person to help with activities of daily living (walking, bathing, dressing, toileting, etc.) there is an added supplemental compensation called “aid and attendance”.
11.Other Compensations That A Veteran Must Know
If a veteran has a service-connected rating of 60% - 90% that causes unemployability, the veteran may be eligible for compensation at 100%.
If a veteran is hospitalized for 21 days or more, or inconvalescent care for one month or more for service-connected disabilities, the veteran will be compensated at 100% during the time period.
Any veteran rated 10% or more for a service-connected disability is eligible to receive training from Vocational Rehabilitation Training program.
Any veteran rated 10% or more for service-connected disabilities may have the Home Loan fee waived.
If your service-connected disabilities are disabling to the point you are unable to hold down steady, gainful employment, you may apply for total disability. To apply, visit your VSO or nearest VA office and complete VA Form 21-8940, which is the Veteran’s Application for Increased Compensation Based on Unemployability.
Compensation payments are exempt from claims made by creditors. With certain exceptions, compensation payments are not assignable and are not subject to attachment, levy or seizure except as to claims of the United States government.
12. VA telehealth The Veterans Health Administration is heavily encouraging veterans to call their local medical center before they visit the facility and consider using VA telehealth. The VA's telehealth providers can evaluate patient's symptoms to make a diagnosis and provide comprehensive care from a telephone. For more information on VA telehealth, go online:
VA telehealth; <https://telehealth.va.gov/type/home
13. VA Caregiver Tip Sheet During Pandemic
VA released a tip sheet: https://www.caregiver.va.gov/pdfs/CSP-Caregiving-During-COVID-19-Tip-Sheet-3Apr2020.pdf on “Caregiver Support Program Information for Caregivers During COVID-19.” During this time of social distancing, the tip sheet provides reminders of how to prepare: create a back-up plan, protect yourself, protect others, monitor yourself and the veteran for symptoms, and be aware of the additional caregiver support program resources. Remain connected with family, friends, clergy, and other caregivers through the phone, text message, video chat, or email. Maintain self-care and remember to refuel throughout the day, it can help prevent caregiver burnout.
Caregiver Support Program Website contains tips, tools, videos and links to resources for caregivers of Veterans of all eras. The link is: www.caregiver.va.gov.
San Diego Caregiver Support Coordinator (CSC)
VA San Diego Healthcare System 3350 La Jolla Village Dr. San Diego, CA 92161
Phone Number for Caregiver Support Coordinators: 858-642-1215
14. Your Guide to VA Appeals The Appeals Modernization Act helps Veterans who disagree with VA's decision on their compensation claims. View the new Quick Start Guide; <https://www.va.gov/decision-reviews-guide.pdf to learn about the three review lane options: supplemental claim, higher-level review, or direct appeal to the Board of Veterans’ Appeals.
15. Financial Assistance as result of VA action
VA Can Assist Veterans Resolve Community Care Debts: VA’s Office of Community Care (OCC) contact center can help veterans fix issues with credit reports or debt collection actions that are the result of an authorized VA community care claim. Once a veteran contacts VA’s OCC contact center, with their information regarding debt collection, staff will work one-on-one with the veteran to research and resolve collection-specific issues. Contact VA Office of Community Care; https://www.va.gov/COMMUNITYCARE/about_us/contacts.asp
16. Women Veterans and VA Healthcare Benefits
Women veterans are the fastest growing veteran group. A wide variety of VA healthcare benefits are available to eligible women veterans. To learn how to get started with Women Veterans Health Services. Go to; <https://www.va.gov/women-veterans-health-services-quick-start-guide.pdf to get the "Women Veteran Health Services Quick Guide". Additionally you can access the Women Veterans Call Center and receive assistance with further information through their:
VA's fiduciary program (https://www.benefits.va.gov/fiduciary/index.asp) protects Veterans and other beneficiaries who, due to injury, disease, or age, are unable to manage their financial affairs. Learn how the Fiduciary Accounting Submission Tool (FAST) makes the accounting process easier for Fiduciaries.
18. Benefits for spouses, dependents, and survivors
Health care; <https://www.va.gov/health-care/family-caregiver-benefits/ Find out if you may qualify for health care through our CHAMPVA program, the Department of Defense's TRICARE program, or one of our programs related to a Veteran's service-connected disability. If you already have health care through VA, learn how to manage your health and benefits. For spouse, dependent child, surviving spouse, surviving child
Education and training; <https://www.va.gov/education/survivor-dependent-benefits/ Find out if you may be eligible for help paying for school or job training through our Survivors' and Dependents' Education Assistance Program (also called Chapter 35) or the Marine Gunnery Sergeant John David Fry Scholarship. And learn about how a Veteran may transfer their unused Post-9/11 GI Bill benefits to you. For spouse, dependent child, surviving spouse, surviving child
Home loan programs or financial counseling; <https://www.va.gov/housing-assistance/home-loans/surviving-spouse/ Apply for a Certificate of Eligibility (COE) for VA home loan programs to buy, build, repair, or refinance a home. Or, if you're having trouble making mortgage payments on a VA-backed loan, get help to avoid foreclosure and keep your house. For surviving spouse
Life insurance options, claims, and beneficiary assistance; <https://www.va.gov/life-insurance/ Learn how to apply for Family Servicemembers' Group Life Insurance (FSGLI) coverage, explore other coverage options, and manage an existing policy. If you're the beneficiary of a Veteran's or service member's policy, find out how to get free financial advice and will preparation services. For spouse, dependent child, surviving spouse, surviving child
Pre-need eligibility determination for burial in a VA national cemetery; <https://www.va.gov/life-insurance/ Apply in advance for eligiblity to be buried in a VA national cemetery. This can help you plan ahead to make the burial process easier for your family in their time of need. For spouse, dependent child, surviving spouse, surviving child
Burial benefits and memorial items; <https://www.va.gov/burials-memorials/ Get step-by-step guidance on how to plan a burial in a VA national cemetery, or in a state or tribal government Veterans cemetery. You can also apply for help paying for burial costs, request memorial items, and learn about bereavement (grief) counseling and transition support. For surviving spouse, surviving child, surviving parent
Survivors Pension (Contact Your Post Service Officer); <https://www.va.gov/pension/survivors-pension/ If you're the surviving spouse or child of a Veteran with wartime service, find out if you're eligible for monthly pension benefits. For surviving spouse, surviving child
Compensation for surviving spouse and dependents (DIC) (Contact Your Post Service Officer); <https://www.va.gov/disability/dependency-indemnity-compensation/ If you’re the surviving spouse, child, or parent of a service member who died in the line of duty, or the survivor of a Veteran who died from a service-related injury or illness, find out how to apply for this tax-free monetary benefit. For surviving spouse, surviving child, surviving parent
19. Adapt Your Car with VA https://www.va.gov/disability/eligibility/special-claims/automobile-allowance-adaptive-equipment/ If you have a service-related disability that prevents you from driving, VA can help you buy a specially adapted vehicle or adapt an existing vehicle to make it drivable for you! Learn how to apply for automobile allowance and adaptive equipment grants.
20. Free Entranceto National Parks forVeterans and Survivors
Starting Veterans Day 2020, all veterans and Gold Star Families became eligible for free access to more than 2,000 federal recreation areas, including national parks, wildlife refuges, and forests. In addition to receiving access to National Parks, the Bureau of Land Management, Bureau of Reclamation, the U.S. Fish and Wildlife Service, the U.S. Forest Service, and the U.S. Army Corps of Engineers have indefinitely waived entrance or standard amenity fees for veterans and Gold Star Families.
Please visit the National Parks Service website; <https://www.nps.gov/planyourvisit/veterans-and-gold-star-families-free-access.htm for more information about how to access this new benefit. 21. 2021 Veterans disability compensation rates
Starting Dec. 1, all compensation benefit rates will increase by 1.3%. VA is required by law to match the percentage of cost-of-living adjustments made to Social Security benefits. These adjustments help to make sure that the purchasing power of your benefits keeps up with inflation.
View 2021 Veterans disability compensation rates. Use our compensation benefits rate tables to find your monthly payment amount. We base your monthly payment amount on your disability rating and details about your dependent family members.
22. The Veteran Appeals Improvement and Modernization Act of 2017 became law on August 23, 2017 (Pub L. 115-55). It is also known as the Appeals Modernization Act.
The new law: • Modernizes the current claims and appeals process • Includes three review options for disagreements with decisions • Requires improved notification of VA decisions • Provides earlier claim resolution • Ensures you receive the earliest effective date possible
What are the new options for review?
You have three options for review:
Option 1: Higher-level Review Your claim is reviewed by a more senior claims adjudicator and involves: • A higher-level de novo review (new look) of the decision 1. No submission of new evidence allowed • The possibility of overturning the decision based on: 2. A difference of opinion 3. A clear and unmistakable error
The reviewer, who identifies or learns of a duty to assist error, can return the claim to the regional office for correction. You or the VSO can request an informal phone call to identify specific issues.
Option 2: A Supplemental Claim Lane You can submit or identify new and relevant evidence to support your claim. Your VSO will provide assistance in developing the evidence.
Option 3: Appeal Lane for Appeals to the Board • This option allows you to appeal directly to the Board of Veterans’ Appeals. You can choose between three options: 1. Direct review: You have no new evidence and do not want a hearing. 2. Evidence submission: You have new evidence, but do not want a hearing. 3. Hearing: You have new evidence and want to testify before a Veterans Law Judge.
Note: A Lawyer dealing with appeals is highly recommended before going before a Veterans Law Judge/US Court of Appeals for Veterans Claims.
23. Federal tools to help maximize GI Bill education benefits
Like any military mission, transitioning to civilian life takes research, planning and the right tools. One of the most powerful tools you can use is the GI Bill ®. Since the Post-9/11 GI Bill was implemented in 2009, VBA has provided more than $111 billion in educational benefits to 2.2 million Veterans and their family members.
As part of National Veterans and Military Families month, VA teamed up with the Department of Education (ED) and the Consumer Financial Protection Bureau (CFPB) to highlight some of the federal tools available to help service members, Veterans and military families pick the right program and make a sound plan to pay for it.
Find more information on our joint podcast; <https://www.consumerfinance.gov/consumer-tools/educator-tools/students/financial-intuition.
It is important that you do your own research before using your GI Bill benefits, as some schools have defrauded Veterans by falsely promoting educational benefits and using deceptive marketing tactics to target service members, Veterans and military families. In addition, though many schools offer similar majors, some may have better reputations that make their graduates more desirable in the job market. To maximize the career and financial payoff from your education benefits, you should find answers to questions like: * Which schools offer the best programs for my career track? * Where does my desired company or industry recruit from? * What if my GI Bill doesn’t cover my whole tuition? * How do I spot deceptive or fraudulent schools?
Where do I start? If you are asking these questions, then you are in the right place and on the right track. Check out these featured tools to get the process started.
Step 1: Before you apply, use the GI Bill Comparison Tool The GI Bill Comparison Tool; <https://www.va.gov/gi-bill-comparison-tool/, provides key information for calculating your benefits. It provides a breakdown of tuition and fees, housing allowance and book stipend. This will be critical in your planning process for your family and finances.
It lists other important factors to consider, too, such as school accreditation and Yellow Ribbon Program; <https://www.va.gov/education/about-gi-bill-benefits/post-9-11/yellow-ribbon-program/, availability. The Yellow Ribbon program helps you pay for higher out-of-state, private school, or graduate school tuition that the Post-9/11 GI Bill does not cover. It also lists the number of students that received VA education benefits in the last calendar year.
This tool also offers insights on potentially cautionary information from student feedback about the school submitted to the VA through the GI Bill Feedback system; <https://www.va.gov/education/submit-school-feedback/introduction. Check out VA’s “Know Before You Go” video; <https://www.youtube.com/watch?v=Z1ttkv9oRI4 to get advice from other Veterans based on their experience using the GI Bill.
Step 2: Considering a State University, private college, or community college? Check out The College Scorecard The U.S. Department of Education’s College Scorecard website; <https://collegescorecard.ed.gov/, helps prospective students make informed postsecondary education choices. There are plenty of options to consider but finding the school that fits your goals and aspirations is critical to your success. Make your own college wish list and compare your options with The College Scorecard’s comprehensive data on colleges and universities, including costs, outcomes and more.
Key data elements featured on the College Scorecard include: * Cost: Average annual cost for federal financial aid recipients, which is the tuition, living costs, books and fees minus the average grants and scholarships, as well as average cost by family income. * Completion and retention: Graduation rate and the proportion of students who return after their first year. * Debt: Typical cumulative federal debt of graduating borrowers by field of study and typical monthly payment. * Earnings: Typical annual earnings of former students one year after graduation by field of study.
Step 3. GI Bill ✔️ College(s) Applied ✔️… Now how do you navigate financial aid and make a plan to pay for school? Once you have received financial aid offers, you can evaluate them with the CFPB’s webtool, Your financial path to graduation (Grad Path). Grad Path guides you through information that will help you answer questions like, “Can I afford the loans I’ll need to finish my program?” and “Is this school worth it for me?”
Here are a few ways Grad Path can help you navigate paying for college: * Break down the financial aid offer. Grad Path explains jargon in plain language. For each type of funding, it points out money saving strategies as well as potential pitfalls. As you examine each funding source (including the GI Bill, Military Tuition Assistance, and other programs like Yellow Ribbon), you will see your running total of uncovered costs. Look at the whole picture. Students often overlook expenses, miss funding options, and forget to consider the total cost of a multiyear program. Grad Path provides detailed guidance about costs and resources, plus projections about total debt, and earnings at graduation to help you determine whether you can afford a particular program – now and in the long run. * Decide whether the school is financially right for you. Understanding how a school fits into your academic goals and future job opportunities is just as important as planning how to finance your education. This tool provides key statistics to consider when determining whether a program is likely to pay off on the investment of your time, work, and money, including your service member education benefits.
24. VA COVID 19 vaccine availability
***COVID 19 vaccine is by appointment only and for enrolled VA patients.
As supplies allow, contacts to VA patients are coming out via letter or phone calls and vets will be asked to call 858-642-3810 to schedule a primary and secondary appointment within 24-28 days.
Patients should follow mitigation practices (masking, distancing, hand washing, necessary trip) before and after the vaccine following CDC guidelines as the Pandemic is not yet resolved.
25. Support for Caregivers
Caregivers play an important role in the health and well-being of Veterans. The Caregiver Support Program offers training, educational resources, and multiple tools to help you succeed. Eligible Veterans of all eras may benefit from these services, under the Program of General Caregiver Support Services. Call toll free 1-855-260-3274 or go to to learn more:
As part of the VA MISSION Act, the VA is working to increase access to the Program of Comprehensive Assistance for Family Caregivers (PCAFC), which is now only available to eligible Veterans injured in the line of duty on or after September 11, 2001.
26. Changes in Travel Pay Reimbursements
The Department of Veteran Affairs (VA) changed processes for veterans to receive pay for their travels to and from appointments for medical conditions.
These changes started on January 1, 2021, in which some veterans may have a more difficult time filing for travel reimbursements. The VA has moved everything to an online format, therefore, all veterans who want to be reimbursed for their travel expenses now have to go to a special VA website and set up an account. Each time a veteran travels to an appointment, he will have to log into the website to create a travel claim for each appointment they have attended before they can be reimbursed.
To set up an account; <https://eauth.va.gov/accessva/
27. Burial Expenses Reimbursed
Did you know VA will pay burial allowances up to $2,000 if the veteran’s death is service-connected? In such cases, the person who bore the veteran’s burial expenses may claim reimbursement form VA.
VA Expense Form; <https://www.vba.va.gov/pubs/forms/VBA-21P-530-ARE.pdf
In some cases, VA will pay the cost of transporting the remains of a veteran whose death was service-connected to the nearest National Cemetery with available gravesites. There is no time limit for filing reimbursement claims in service-connected cases.
Burial Allowance Did you know VA will pay $300 burial and funeral allowances for veterans who, at the time of death, were entitled to receive pension or compensation or would have been entitled if they were not receiving military retirement pay? Eligibility also may be established when death occurs in a VA facility, a VA-contracted nursing home or State Veterans nursing home. In cases in which the veteran’s death was not service-connected, claims must be filed within two years after burial or cremation.
28.Memory Care Resources for Veterans Receiving an Alzheimer’s diagnosis can be devastating for both seniors and their loved ones. And while the news itself can be overwhelming, getting the right diagnosis is also the first step in receiving the right care. From therapies to medications, new and innovative treatments are being developed all the time to improve the quality of life of those living with memory impairment. Understanding the disease and getting the right treatment as soon as possible is the best way to ensure that patients lead the best lives possible. Table of Contents
Stages of Dementia Dementia is the general term used to describe memory loss and the deterioration of cognitive abilities, and Alzheimer’s disease is the most common cause of dementia among older adults. In America, 1 in 9 adults over the age of 64 has the disease and that number rises to 1 in 3 once adults reach age 85. Alzheimer’s is a progressive disease where the symptoms develop slowly and gradually get worse over time, eventually becoming severe enough to interfere with common everyday tasks. Medical professionals often discuss dementia in stages. These stages refer to how far dementia has progressed and which symptoms one can expect to experience. Having these clearly defined stages helps caregivers understand where their loved one stands with the disease and allows them to better determine the right course of treatment. Generally, dementia is defined in three stages – early, middle, and late. Early Stages Patients in the early stages of dementia have difficulty concentrating, trouble remembering recent events or recently learned information, may have trouble managing their finances, and find it hard to travel alone to new places. Patients will also begin having a hard time socializing and may become withdrawn or refrain from doing activities they once enjoyed. Despite some of the symptoms still being mild, a physician will be able to diagnose dementia in the early stages. Middle Stages Patients in the middle stages of dementia will start having major memory lapses. In addition to forgetting recent events, people in this stage will often begin to forget vital pieces of information like their home address, their phones number, and even the names of close friends and family. At this point, many patients will need some help completing daily living activities such as preparing meals, dressing, and bathing. As patients reach the late-middle stages their ability to speak declines and incontinence often becomes a problem. Noticeable personality changes and emotional problems are also common as many patients become anxious and agitated and may even experience delusions. Late Stages As patients enter the late stages of dementia, they often lose the ability to speak and communicate. These patients will require help with even the most basic activities like eating and using the bathroom. They also often lose their psychomotor skills like the ability to walk. Depending on the stage of dementia, the course of treatment for each patient will vary. Managing Dementia
The amount of care that a person with dementia requires will vary by the stage of the disease. Unfortunately, there is no cure for dementia, but there are some treatments available that have been shown to improve brain function and slow the disease. Medications Depending on the patient and stage of the disease, doctors may prescribe one of several medications to improve brain function and slow symptoms. Medications are generally most effective in the early and middle stages of dementia and can help reduce symptoms, improve a patient’s overall quality of life. Medications commonly used to treat dementia include:
Cholinesterase inhibitors
Memantine
CBD
In other cases, medication might be prescribed to treat other conditions that are common with dementia. Many patients will struggle with insomnia, depression, anxiety, and psychosis over the course of the disease and medications that eliminate or minimize those symptoms can help patients live a more fulfilling and comfortable life. Some of these medications include:
Anxiolytics – used to relieve anxiety and agitation
Antidepressants – help improve both mood and function
Antipsychotics – used to treat psychosis and minimize hallucinations
Hypnotics – help patients fall asleep and stay asleep throughout the night
Therapies and Alternative Medicine Along with prescriptions, many patients find that natural medicines and various therapies are able to ease the symptoms of dementia and slow the progression of the disease. Diet A diet rich with leafy green vegetables, cruciferous vegetables, and fish has been shown to have a positive impact on dementia symptoms. Foods like these are high in antioxidants and can help to protect cells from damage. Exercise Even light physical activity like regular walks and gardening have been shown to promote brain health. While there isn’t yet evidence that proves exercise slows the progression of dementia, it has been shown to help ease symptoms like anxiety, depression, and insomnia. Brain Exercises Studies have suggested that puzzles and brain training games like crossword puzzles and Sudoku may help slow the progression of dementia. Regularly reading books, playing board games, using a brain training app, and playing card games are other enjoyable brain exercises. Therapy Different forms of therapy have been shown to ease the symptoms of dementia patients and help improve their quality of life. For example, art and music therapy allow patients to experience something they enjoy and stimulate their mind while also serving as valuable social interaction. Alternative Medicine Many doctors now suggest alternative medicines such as acupuncture and massage therapy in addition to medication and traditional treatment. Massage therapy stimulates blood flow and acupuncture can help improve energy. Therapies like this can help ease symptoms and help release physical pain and tension. Memory Care for Veterans When we think of the sacrifices that veterans make, we often think of time, life, or obvious physical injuries. Sometimes the sacrifices are more subtle, however. Veterans who served in combat zones experience both Traumatic Brain Injuries (TBIs) and Post Traumatic Stress Disorder (PTSD) at higher rates than the general population because of their exposure to hazards like explosions as well as other forms of violence and trauma. Recent research is finding that veterans who experience TBIs and PTSD are at risk for cognitive problems later in life. In one 2010 study, for example, researchers found that veterans with PTSD were twice as likely as their veteran peers without PTSD to develop dementia. A different study conducted in 2019 by some of the same researchers found that veterans with even “mild” TBIs were at a twofold increased risk of developing dementia. As veterans who served in conflicts from World War II to the Gulf War and beyond reach mature ages, many of them are experiencing Alzheimer’s or other forms of dementia. Some may be able to trace their illness to TBIs or PTSD that they experienced as a result of combat. Many veterans who served during peacetime have to deal with dementia diagnoses as well simply due to genetic predisposition or other factors. Whatever the cause of the disease, these veterans and their families are faced with the task of paying for the increasing costs of care associated with dementia. Veterans Affairs (VA) provides a variety of programs that can help with veteran memory care needs, but the options can be overwhelming for those unfamiliar with the VA system. To help veterans and their families, we’ve created a guide to walk you through the basics of dementia and memory care. In this guide, you’ll explore several ways that the VA can help you afford memory care services, and you’ll find answers to some of the most frequently asked questions about memory care. The Basics of Dementia and Alzheimer's Disease Dementia is a general term referring to cognitive decline that interferes with a person’s ability to reason, remember, make choices, and complete normal daily activities. If you are a caregiver of a veteran, having some basic knowledge of dementia can help you understand the challenges the person you care for may be facing and can help you communicate more effectively with doctors. Types of Dementia Alzheimer’s is the most common kind of dementia for veterans and for the general public, but it’s not the only one. Below you’ll find quick explanations of the different kinds of dementia and their causes, symptoms, and progressions. Alzheimer’s Disease Between 60% and 80% of dementia cases are caused by Alzheimer’s disease, according to the CDC. It typically affects those 65 and older, though there is a rarer, early-onset version of the disease that can affect those as young as 30. The hallmark of Alzheimer’s is abnormal plaques and tangles that build up in brain tissue, as well as a loss of neurons. Small instances of memory loss, confusion, and mood changes are often the first signs, and symptoms become progressively worse over time. Lewy Body Dementia This type of dementia is caused by abnormal deposits of the protein alpha-synuclein in the brain. These deposits are referred to as “Lewy bodies,” and they are separate from but can occur alongside the tangles and plaques associated with Alzheimer’s. Lewy bodies also occur in Parkinson’s disease, and there are Parkinson’s and non-Parkinson’s versions of this dementia. Muscle tremors and stiffness, along with hallucinations and fluctuations in recall, attention, and energy are common in Lewy Body dementia. Vascular Dementia Vascular dementia occurs when blood flow to the brain has been hindered by a condition or event, such as narrowed blood vessels, a stroke, or a brain hemorrhage. In the case of vascular dementia caused by a stroke, dementia can worsen dramatically if other strokes occur. This is in contrast to the gradual decline typically experienced by those with Alzheimer’s disease. Symptoms can vary depending on the exact region of the brain affected. Uncontrolled diabetes and poor cardiovascular health are both risk factors for vascular dementia. Frontotemporal Dementia This term refers to a wide range of disorders of the brain in which tissue damage occurs in the regions behind the forehead or by the ears. Amyotrophic lateral sclerosis (ALS), also known as Lou Gehrig’s disease, is just one well-known example of this kind of dementia. Diagnosis of one of the frontotemporal dementias tends to occur when a patient is between 40 and 60, which is significantly earlier than the average Alzheimer’s diagnosis. The earliest signs are usually related to muscle function, and memory problems may show much later than in other forms of dementia. Mixed Dementia Often times, a patient can suffer from multiple forms of dementia. Because one form of dementia’s symptoms may be more pronounced at first, medical professionals and family members alike can initially miss the fact that the patient has mixed dementia. An example of this could be a patient in the early stages of Alzheimer’s who has suffered a ministroke that went undetected. Because the patient was already having trouble recalling things and was experiencing mild depression, this sudden increase in confusion and his trouble with making decisions may at first seem like the natural next step in Alzheimer’s rather than evidence of a new condition. “Reversible” Dementia Sometimes what at first appears to be Alzheimer’s or another form of dementia may actually be a temporary and treatable deficiency, a problem with medication interactions, an addiction to illicit drugs or alcohol, or a hormonal imbalance, especially of the thyroid. It could also be a brain tumor that is treatable but is interfering with brain function. These conditions are very different than the above dementias because they can be reversed with a prescription, procedure, or even a lifestyle change in some cases. Problems like these are often referred to as reversible dementias. The questions doctors ask and the tests they run are often designed to rule out some of these conditions during the diagnostic process. Signs of Dementia Not every dementia presents with the same symptoms, and the list of possible symptoms associated with dementia is quite long. Below you’ll find the most common symptoms, though the list is by no means exhaustive. Common symptoms:
Trouble recalling recent events
Confusion and trouble making decisions
Hallucinations and delusions
Getting lost in familiar settings, including while driving
Changes in sleep habits
Reduced attention to personal care and grooming
Trouble finding the right word or name, or general trouble with communication
Fear, anxiety, or depression
Aggression and anger
Inappropriate speech or actions that indicate a loss of inhibitions
Loss of independence in daily tasks
Shuffling or difficulty with walking
Staring spells
Many of these symptoms can occur on their own from time to time in perfectly healthy people, and the veteran in your life being occasionally forgetful or moody doesn’t necessarily indicate that they have dementia. However, a doctor is the most qualified person to evaluate what changes in mood, memory, communication, or behavior mean in a senior. It’s a good idea to schedule regular health checkups with a VA or community doctor and to discuss any symptoms even if they seem mild. Stages of Dementia Stages of dementia vary dramatically depending on the kind of dementia. However, most forms of dementia have an early, middle, and late-stage, with only a few mild symptoms appearing in the early stage, more in the middle stage, and many and severe symptoms in the late stage that lead to a total loss of independence until the end of life. Since Alzheimer’s Disease is the most common form of dementia, we’ve provided a more detailed explanation of its stages below. This progression varies by patient and often occurs over a four-to-eight-year time period, though it can last longer. Early Stage In the mild early stage, a person can often still drive, work, and care for her or himself reasonably well. It may become apparent that the person is losing things, forgetting new names, or having difficulty with planning ahead or with work and social activities. It may be difficult for family members to tell if some of the forgetfulness is normal or a symptom of brain changes, and a doctor should be consulted. The person experiencing the symptoms will probably be aware of them and troubled by them. A doctor may prescribe various forms of therapy or medication. Middle Stage In this stage, symptoms become more obvious but are still considered moderate. This stage can last for years. The patient will need support or frequent reminders for many daily activities such as personal grooming, selecting clothes, and using the restroom. Confusion, wandering, changes in sleep, and forgetfulness about personal history is likely, and mood swings or delusions and hallucinations are also common. Late Stage In the late stage of Alzheimer’s, symptoms are so severe that the patient is reliant on caregivers for virtually every facet of daily life, even including walking. Muscle control will decline, the patient will be less active or even immobile and will be prone to secondary health problems like pneumonia and other infections. The patient may appear totally unaware of his or her surroundings and will rarely attempt to communicate. Late-stage care will always include around the clock assistance, which is often referred to as memory care. Overlapping Stages The stages of Alzheimer’s and other forms of dementia aren’t clear cut. It might be difficult to say precisely which stage a patient is in. However, the main point of the stages is that the disease becomes progressively worse, affecting more and more daily functions as time passes. For more information on the stages of Alzheimer’s, you may want to explore this helpful article from the Alzheimer’s Association. Alzheimer’s and Dementia Treatment and Memory Care Benefits of Alzheimers and Dementia Treatment Most forms of dementia are currently considered progressive and incurable, although advances in medicine may change that in the future. Just because we don’t have a cure now doesn’t mean that a veteran experiencing dementia doesn’t benefit from treatment, however. On the contrary, doctors and therapists have developed an array of treatment techniques that can make a dementia patient’s life better. Patients can benefit from medications, therapies, activities, and assistance that range from in-home help to full-time memory care in a medical facility. Proper treatment, including memory care, can:
Slow the worsening of symptoms
Improve the happiness and health of the patient
Reduce the risk of injury for patients and caregivers
Alleviate caregiver stress
Elements of Dementia Treatment Below we’ve outlined some key elements of dementia treatment so that you can know what to expect as you and your loved one learn more about their condition. Diagnosis A medical evaluation for the purpose of diagnosis can take many different forms, but will probably include all of the following:
A general physical exam and inquiry into overall health and habits
Conversation with the patient and oral, written, or physical tests to gauge cognitive function and reflexes
A conversation with the patient’s caregiver or spouse about their observations
In many cases, a doctor may order one or more of the following:
Blood or other lab tests to rule out deficiencies or hormonal imbalances that are reversible
CT or MRI scans to check for evidence of strokes, internal bleeding, or tumors
PET scans to confirm the presence of Alzheimer’s-related protein deposits or to evaluate brain activity
Be aware that problems with memory and moods aren’t always evidence of incurable dementia. Poor nutrition, lack of sleep, depression, anxiety, thyroid problems, or tumors, and a variety of other conditions occasionally interfere with memory and manifest similar symptoms to those of other dementias. Early diagnosis is important in part because a professional will be able to distinguish between dementia and other conditions. Medication Once a senior has been diagnosed with Alzheimer’s or with another form of dementia, a doctor may prescribe medication to manage symptoms. Not every patient will take the same medication for the same symptoms, and doctors may decide that medication is not helpful in some cases. Commonly prescribed medications for dementia patients include:
Cholinesterase inhibitors: These drugs alter brain chemistry in order to boost the levels of key chemicals involved in memory. Cholinesterase inhibitors are commonly prescribed to patients suffering from Alzheimer’s, Lewy Body dementia, or Parkinson’s disease.
Memantine: This drug improves memory and daily function in some Alzheimer’s patients. It works by blocking certain chemical receptors and altering the way the brain handles glutamate.
Selective serotonin reuptake inhibitors (SSRIs): Dementia patients often experience depression and anxiety in addition to memory problems. These mood disorders can be a response to the diagnosis of dementia and fear for the future, and they can also be a symptom of changes within the brain caused by dementia. Selective serotonin reuptake inhibitors (SSRIs) can be used effectively to improve a patient’s quality of life and to ease mood swings.
Antipsychotics: With some forms of dementia, including Alzheimer’s, hallucinations are common. Doctors sometimes prescribe antipsychotic drugs to reduce or eliminate hallucinations that are distressing to the patient. This kind of medication poses some risks to elderly patients and is generally used with caution and increased supervision.
Some of these medications can trigger serious or unpleasant side effects or interact with other medications that a senior takes. It’s crucial that caregivers pay attention to how medication is affecting their loved ones. It’s also important to return to follow up visits on whatever schedule the doctor suggests for monitoring the effect medications are having on the patient’s dementia. Therapy and Activities Physical therapy, occupational therapy, and even music and art therapy can all be tools for improving the safety and happiness of patients with Alzheimer’s or other dementias. Activities that include social elements that are stimulating without being overwhelming are often recommended because they can improve the patient’s sense of well being and level of activity. Patients that don’t participate in stimulating activities may decline more quickly than those that do. Therapy can be useful for family caregivers, too. Therapy of various kinds can teach caregivers important coping skills and communication techniques so they don’t become burnt out. Support groups for Alzheimer’s caregivers are also often available in local communities. Assistance and Memory Care Patients in the middle and late stages of Alzheimer’s or other forms of dementia need full-time assistance either from a family member, a nurse, or other trained professionals. The level of assistance needed varies quite a bit, but it generally starts as the need for someone to mind the patient and help them with activities of daily living such as cooking and taking medication, and then progresses to more medical and labor-intensive needs as the condition worsens. The provision of assistance for dementia patients, especially around the clock assistance in a secure medical facility, is often referred to as “memory care.” Memory Care Settings There are multiple types of locations where veterans can receive memory care: including at home and in a residential facility. More specifics are provided below.
In-home care: Many families opt for in-home memory care, especially in the middle stage of Alzheimer’s disease. Family members often serve as paid or unpaid caregivers, but they may also rely on non-medical trained aides from a community aide program during certain hours, especially to help with bathing and other difficult tasks. Many families also utilize “respite care” in which a paid caregiver takes over for a period of hours, days, or even weeks so that a family caregiver can go out of town or take a much-needed break.
Blended adult daycare and in-home care: Adult daycares exist to provide secure medical or non-medical memory care and assistance while caregivers work. Adult daycare can be cost-effective and enable the adult child of a veteran with dementia to make a living while looking after and providing a home for the parent at night and on days off. This is an ideal setup for those who can’t be full-time caregivers but who still want to be very involved in the dementia patient’s daily life. Adult daycares typically provide transportation and meals.
Assisted Living: Privately owned assisted living facilities often have a memory care wing within the building. These wings will have private or semi-private rooms for the patients. A memory care unit within an assisted living facility will offer all of the meals and other services typically offered within the assisted living facility, with the addition of 24/7 supervision provided by trained staff. Many locations include alarmed doors to prevent dangerous wandering. The cost of care in these units will always be higher than the cost of living within regular areas of the same assisted living community.
Nursing Homes: Nursing homes frequently provide memory care in special units or separate floors. Patients can receive 24/7 care from staff who are specially trained to handle dementia needs. Staff-to-resident ratios in nursing homes are regulated by state laws and could be even lower than one-to-ten, depending on location. Memory care units have secure perimeters so forgetful patients cannot wander off and put themselves in danger. These units are ideal for patients who need constant supervision along with skilled nursing care.
Medical Foster Homes: Medical foster homes are local households that contract with the VA to provide full-time care equivalent to that provided in nursing homes .These homes are licensed and inspected regularly, and they may house veterans alongside non-veterans. Medical foster homes are staffed 24/7, and they typically have about six adults in them at a time. Caregivers live within the home. These homes typically receive funds from families rather than directly from government sources like the VA.
VA Programs for Memory Care Overview of VA Memory Care Options Program Type Of Benefit Care Provider Eligibility Cost To Patient Availability Homemaker and Home Health Aide Care In-home caregiving. Trained non-medical personnel. Veterans who need help with ADL. Possible copays. Available in most communities.
Veteran Directed Home Based Care (VD-HCBS) Funding for in-home caregiving, adult daycare, supplies, or other needs. Any home-based caregiver the family chooses. Veterans who need help with three or more ADL (in most cases) Possible copays. Not available in all communities.
Aid and Attendance Allowance Additional pension funds for caregiving needs. In-home caregivers, medical foster homes, assisted living, or other providers the veteran chooses. Eligibility for the regular VA pension plus clinical need for help with ADL. No cost unless needs exceed pension amount. Available to anyone who meets eligibility requirements.
Community Nursing Homes 24/7 residential care with skilled nursing/ memory care. Private-sector providers that employ skilled nursing professionals. Determined by service-connected disability status, level of disability, and income. Possible copays. Available in many communities.
VA Community Living Centers Home-like 24/7 residential care skilled nursing/ memory care. Skilled nursing providers employed by the VA. Determined by service-connected disability status, level of disability, and income. Possible copays. Approximately 100 locations throughout the United States.
State Veterans Nursing Homes 24/7 care with skilled nursing, domiciliary care, and often adult daycare and memory care. Skilled nursing in state-run, VA-approved centers. Determined by each state, spouses sometimes eligible for admission. Varies by state and sometimes partially covered the VA. Over 50 locations, with at least one in each state and one in Puerto Rico.
*ADL stands for Activities of Daily Living, which include bathing, eating, cooking, and many other tasks necessary for normal daily life. Program Eligibility Veterans who qualify for VA Healthcare have access to a wide variety of help with the treatment of dementia. Whether the veteran in your life needs to see a doctor, to get an in-home aide, or to move to a 24-hour memory care unit, the VA should be able to provide some funding or support that is based on the veteran’s income and priority level within the VA Healthcare system. Often times, the VA allows a veteran to use multiple programs at once. Funding and care options may be especially plentiful for veterans whose dementia can be linked to their service record since that will put them in a higher priority category. If the veteran in your life has dementia and also has a record of TBI or PTSD that is connected to his or her service, their dementia could be considered a service-connected disability by the VA. If they were exposed to Agent Orange during the Vietnam War and are experiencing Lewy Body Dementia, which is linked to Parkinson’s Disease, their condition may also be considered at least partially service-connected. It’s always best to enquire if you’re not sure, as rules surrounding dementia care have changed in the last few years. Even if there’s no obvious connection between dementia and the veteran’s time in service, he or she may still be eligible for some VA Healthcare or pension benefits. Below you’ll find some quick explanations of the VA programs covered in the above table, as well as explanations of some other programs you may find helpful although they don’t meet extensive memory care needs. If you want to learn more about priority groups and VA Healthcare and pension eligibility, we’ll cover that in more detail in Steps to Obtaining Memory Care through the VA. Waitlists If you’re considering placing the veteran you care for in a residential setting such as a nursing home, assisted living facility, or medical foster care, be aware that some locations have waitlists. If you find that the veteran will not able to transfer right away due to a waitlist, you may still be able to get help from the VA with finding temporary in-home care solutions in the meantime. VA Programs That Are Most Helpful for Memory Care Needs Homemaker and Home Health Aide Care In many cases, if the VA assesses that a veteran suffering from dementia needs help with three or more activities of daily living (ADL), they may pay for a community aid agency to send a trained aide to your home. This aide will be trained to help with activities of daily living but will not be able to provide skilled nursing. Typical tasks an aide helps with:
Moving around within the home
Going to appointments
Eating
Using the bathroom
Bathing
Getting dressed
Personal grooming
Aides from the Homemaker and Home Health Aide Care program will be supervised by a registered nurse who will initially make a plan for the veteran’s daily living needs but will not visit on a regular basis. Aides can visit multiple times a week or just once a week, depending on need. Those without service-related disabilities will usually pay a copay for these services, but all enrolled veterans are eligible as long as they meet clinical need requirements. Availability for this program is fairly wide, but there still may be some areas without it. Veteran Directed Home Based Care (VD-HCBS) Veteran Directed Home Based Care (also called VD-HCBS or just Veteran Directed Care) is an alternative approach to memory care and other healthcare needs that give the veteran and/or caregiver control. In this program, those in need of care sit down with a VA social worker or case manager to set a care budget based on actual needs. Supplies and the need for assistance, including aides, respite care, or even adult daycare, are all part of the budget. The patient has the freedom to select a capable family member to be their paid caregiver, if desired. Once a budget is approved, any care provider who’s been included in the budget will be paid directly by the VA. Caregivers who purchase supplies included in the budget will be reimbursed from the budget. This program gives incredible freedom to vets and their loved ones who are dealing with a dementia diagnosis. Receiving these funds gives families the power to make choices that truly suit their needs. This program is not available in all communities, so you will need to check someone from your nearest VA facility to determine if Veteran Directed Care is available to your family. Aid and Attendance Benefit Rather than a direct medical program, this benefit includes payments of extra pension funds based on need. If a healthcare team confirms that the veteran’s dementia makes it necessary for them to have aid and attendance to complete activities of daily living such as dressing, bathing, and cooking, then the monthly Aid and Attendance benefit (A&A) may be awarded. Funds provided by this pension benefit can be used for a range of services. They might be used to pay for rent in an assisted living facility with a memory care unit, for care in a nursing home, medical foster home, or adult daycare, or for an aid who will come to the veteran’s own home. Restrictions may apply, and those who receive this benefit should always consult a VA social worker to make sure you are using funding appropriately. Pension rates are determined using complex math that involves service history, income, dependents, spouses, medical expenses, assets, and disabilities. Some veterans with a regular VA pension plus the A&A or housebound benefit can receive over $22,000 each year from the VA. Rates are highly specific to the individual, however, and not everyone can qualify. Another benefit that is separate from but often brought up alongside the A&A benefit is the Housebound Allowance. You will see this benefit mentioned in the link we’ve provided for the A&A benefit. The Housebound Allowance is also additional pension funding that those who already receive the general pension may qualify for. It’s important to note that Veterans cannot receive A&A and Housebound benefits simultaneously; the VA will determine which is the better fit. But if a medical care team can document that a veteran is unable to leave their home, the housebound benefit can be awarded at the same time as the VA pension. Community Nursing Homes Community nursing homes are residential medical facilities that include, at a minimum, 24-hour skilled nursing care for minor things like wound care or help with IV medication, occupational and physical therapy for those who need it, and access to social services. Many nursing homes also include their own memory care services, often in distinct units of the facility. Nursing homes may also offer hospice and palliative care, forms of care for the terminally ill that focus on comfort and pain relief rather than on improvement of the underlying condition. The VA covers the cost of some community nursing home care at facilities that it approves, for those with a clinical need. VA officials routinely visit community nursing locations to verify that facilities are meeting VA care standards. Not all community nursing homes have room for new patients, and a patient may experience a wait time even if they are technically approved for admission. VA Community Living Centers VA Community Living Centers used to be called VA Nursing Homes. These community centers provide residential care to veterans at a similar level to that provided by community nursing homes, but they provide it in a more home-like atmosphere. These homes often allow residents to decorate their rooms and keep pets, and they host a variety of stimulating activities for veterans to enjoy. There are approximately 100 VA Community Living Centers across the nation. Usually, to qualify for long term care at one of these facilities, a veteran needs to have a disability that is deemed to be 60% or 70% caused by a service-related injury. Although scientific evidence suggests that Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD) make dementia more likely in service members, such a high service-related rating for dementia may be difficult to obtain unless there is significant documentation. You’ll need to consult with a VA caseworker about your options. These homes may be most likely to accept veterans who have other major service-related physical disability or condition along with dementia. State Veterans Nursing Homes After the Civil War, individual states set up nursing homes to meet the enormous need for rehabilitation and long-term care that disabled or homeless veterans from that conflict faced. Many of these state nursing homes are still operating today, now serving veterans of modern conflicts, and they are now called State Veterans Nursing Homes. In terms of care provided, these facilities are similar to community nursing homes. They offer nursing home care, adult daycare, and domiciliary care. Domiciliary care is simply providing a place to stay for homeless veterans on a temporary or long-term basis. State veterans nursing homes are operated by the states they are located in, but VA officials visit and certify them yearly. It’s possible for a facility to lose its status as a state veteran’s nursing home if it stops meeting VA care standards. There are state veterans nursing homes in all 50 states, and some states have multiple locations. There’s also a state veteran’s nursing home in Puerto Rico, but not in other U.S. territories. Other VA Assistance That Can Benefit Veterans with Dementia
In addition to the above resources that are very directly tied to memory care, there are several VA programs that can help veterans with dementia although they do not directly meet memory care needs. Home Improvements and Structural Alterations (HISA) This grant can provide significant funding to cover home accessibility improvement costs for disabled veterans. With this grant, a veteran who struggles with mobility issues may be able to install a ramp, a roll-in shower, alter a driveway, lower kitchen or bathroom counters for accessibility, and more. Further eligibility details, videos, and forms related to HISA grants are available in the above link. If the veteran you care for is in a wheelchair or otherwise has significant disabilities, she or he can be granted up to $6,800. The upper limit of $6,800 is only available to those with conditions that VA considers at least 50% service-connected. Those with disabilities that are not service-connected may still be able to receive up to $2,000 for some home accessibility alterations. Home-Based Primary Care In some cases, the veteran’s VA healthcare team decides that the veteran’s doctors, pharmacists, therapists, psychologists, and nurses should visit the veteran in his or her own home. Home-based primary care is usually used in cases where leaving the home simply results in more mental or physical risks and challenges than benefits. Eligibility is determined by caseworkers based on service-connected disability and financial factors, and copays for those eligible may apply. Home-based primary care is not a source of 24/7 aide or help with ADL, but it can be used in coordination with other VA memory care programs to give a veteran the care they need. Skilled Home Health Care Skilled home health care is available to veterans who live far from VA centers and have a clinical need to receive case management, occupational therapy, physical therapy, speech therapy, skilled nursing, wound care, or IV antibiotics at home. Skilled home health care is provided through local community companies that contract with the VA. It isn’t available in all locations, and the veteran can be charged a copay. Skilled home health care services are most likely to be provided by a nurse as opposed to a doctor. Telehealth Telehealth, also known as remote monitoring care, refers to a broad range of services that utilize technology to connect a patient at home to a healthcare team. With telehealth, the veteran regularly uses home medical equipment to measure blood pressure, blood sugar, pulse, weight, blood oxygen levels, and more. Using cell phones, cellular modems, and phone lines, the veteran securely sends that information to a VA hospital, and a care coordinator passes the information to a physician or nurse if anything seems unusual. Telehealth can help those receiving care at home to catch health risks early when they are most treatable. Telehealth can help caregivers provide the best care possible to veterans, enabling them to receive care at home as long as possible. This service is available to all enrolled VA healthcare members who have a clinical need for it, though services can vary by location. Most services provided through telehealth do not include copays. Palliative Care Teams and Hospice Palliative care is any care focused on comfort and relief of suffering and symptoms. Hospice care is palliative care that’s provided in the last six months of life. Neither of these is, strictly speaking, memory care services, but they are often used when dementia has progressed to such a degree that the patient is immobile. Palliative care and hospice include services aimed at meeting medical, social, spiritual, and psychological needs. These services are already included in many programs provided to veterans both at home and in residential settings. For example, if a veteran is in a memory care unit of a VA state nursing home, a family member of the veteran may just need to meet with a social worker at the nursing home in order for the veteran to begin receiving hospice or palliative care. Each situation will be a little different, and when it’s time family can always contact the veteran’s social worker with questions about palliative care or hospice. Copays are never charged for hospice, but they may be charged for palliative care. Respite Care Because it’s not long-term care, we haven’t included respite care in our memory care table. However, respite care can be extremely helpful to families that are providing memory care at home for a veteran. Respite care is when a temporary caregiver steps in to give family members a break. Through its respite care program, VA Healthcare can pay for the following services:
Six hour time periods in which a person comes to the veterans home to temporarily care for the veteran
Six hour time periods in which a veteran visits an adult daycare
A nursing home respite care stay in which a veteran stays at a nursing home for up to 30 days per year while if family is out of town
Respite care can be a regular part of a care plan, or it can be a rarely-used service that comes in handy during stressful times. Obtaining Memory Care through the VA Step 1: Determine the Veteran’s General Eligibility for VA Benefits If you are caring for a veteran and want to help them take advantage of VA assistance for their memory care needs, then your first step should be to inquire about their eligibility and enrollment status for both VA healthcare and VA pensions. Chances are good that most elderly veterans are already signed up for the benefits they qualify for, but sometimes veterans may not realize they are eligible. Healthcare eligibility If the veteran you care for is not already enrolled in VA Healthcare, you can check her or his eligibility for enrollment in this VA healthcare eligibility article. This article includes helpful explanations of VA Priority Groups. All veterans receive a priority designation of 1 to 8 based on wartime or combat service dates, service-related disability ratings, and income, among other factors. The lower the number of priority group veterans receive, the higher their priority for enrollment and care. Those with higher priority numbers may be denied coverage or charged a copay for some services. The VA’s budget for care changes year to year based on congressional approval. Priority groups allow the VA to serve those in the most need or with the most service-connected disabilities when congressional funding is low. If you determine that the veteran you care for is probably eligible for care but is not signed up for it, you can visit the VA website to see a detailed list of documents needed and steps to take. VA Healthcare applications are usually processed within a week. Pension eligibility Many veterans who qualify for VA healthcare don’t qualify for a VA pension. To qualify for a pension, a veteran must meet several requirements, including having served at least one day during a wartime period. Official wartime period dates can be viewed here. For more information on pension eligibility, you can explore the VA Pension website. If the veteran has never applied for a pension or has applied and been denied in the past, applying late in life may still be worth it. For veterans who just don’t have the financial means to pay for full-time memory care, pensions can provide the funds needed to dramatically improve their quality of life. Veterans who already receive a regular pension may also be eligible for additional pension allowances because of their need for help with activities of daily living like cooking and bathing, or because they are housebound. Step 2: Utilize Diagnostic Services from the VA Once you’re established general eligibility for VA Healthcare, you’ll need to have your loved one’s suspected or diagnosed dementia evaluated by a VA doctor. This locator tool can help you find the phone number for the nearest VA location and ask to set up an appointment. Important things to know about visiting a VA doctor for dementia concerns:
The VA selects a and doctor for the veteran
Veterans in some priority groups pay copays
The VA can help withto an appointment in some cases
The VA may bill to cover some of the care they provide, and this billing method could eliminate some of the copays
If appointment wait times or distance are prohibitive, you may seek approval to receive for the veteran
A first visit may include tests or a general physical as well as discussion of dementia
Keep in mind that receiving an official diagnosis of Alzheimer’s or other forms of dementia may be an emotional experience for both you as the caregivers and for the veteran you care for. Ask your VA or community care provider about resources for coping, and plan to reread any provided pamphlets later to go over information you may have missed during the appointment. Step 3: Utilize Medical Shared Decision Making Resources After diagnosis, medical shared decision making can help you decide your next steps for treatment. Medical shared decision making refers to the process in which patients, their loved ones, and their care team all come together to make healthcare decisions. With many options for memory care both at home, in the community, and in VA centers, it’s important that everyone involved has a chance to voice their concerns and preferences with the medical team. Shared Decision Making for Veterans The following worksheets, Shared Decision Making Worksheet for Veterans, might be useful for veterans in the early stages of dementia. You can read this worksheet with the veteran and write down their answers for them if they prefer that. However, sometimes a veteran experiencing dementia will be unaware of their own lapses in memory or will be emotionally unable to cope with facing changes brought on by dementia. In such a case, this worksheet may not be as helpful. Its utility will depend largely on the veteran’s current state of mind, health, and desire to communicate. Self-Assessment for Caregivers Regardless of whether the veteran is able to complete the above worksheet, you as a caregiver can still use the Caregiver Self Assessment PDF, also provided by the VA. After completing this worksheet, you can use the included contact information to reach out to a VA social worker. Discussing your results with a social worker can help you to decide if you need more support or resources to prevent you getting burnt out in you important caregiver role. After completing one or both of the above PDF worksheets, you may want to bring them to the next appointment the veteran has with his or her VA doctor. Step 4: Apply for Appropriate VA Assistance Looking into VA resources that can help with long term memory care needs can be a confusing experience. There are many paths to memory care, and your best option depends on a combination of personal preferences, caregiver abilities, financial position, and clinical need. Your care team will probably suggest a program or service they think is suitable for the veteran, but you can also ask about the services listed below. Keep in mind that eligibility or admission for most of the programs below is heavily tied to the veteran’s priority group. You may not be able to determine eligibility for a program until you speak directly with a VA caseworker or Veterans Service Officer. The following three options provide funding or help for at-home care options:
Other VA resources to look into: The following options don’t provide full-time memory care, but they can all be a piece of the full care puzzle for patients with dementia.
Skilled Home Healthcare or Home-Based Primary Care: Visits from doctors, therapists, pharmacists, and nurses to meet medical and nursing needs for those who have a clinical need not leave their homes for care.
Respite Care: Access to temporary caregivers at home, in an adult daycare, or in a nursing home so that primary caregivers can run errands, take breaks, or even take much-needed vacations.
Telehealth: Remote health monitoring through at-home medical devices that can be transmitted to VA medical staff. Care coordinators can review health data and determine if it needs to be passed along to a doctor for immediate attention.
Palliative Care and Hospice: Palliative care and hospice care boh focus on managing pain and symptoms, but hospice is for the last six months of life. Both kinds of care are frequently available through various VA programs.
HISA Grants: HISA Grants aren’t for healthcare at all, but they provide funding for home alterations that are necessary to accommodate a disability. This may be helpful in cases where a veteran with dementia is also struggling with other physical disabilities.
Full explanations of all of the above options are included directly below our “Overview of VA Memory Care Options” table. If you haven’t already viewed that table and the material below, you may want to do so now. You’ll find information on eligibility and the services that are available. Step 5: Plan to Be Flexible About Care One of the most important qualities a caregiver can have is flexibility. This is especially true for families who decide to provide care in-home with the help of support programs from the VA. It’s important to be willing to change a care plan if it’s no longer working. Developments that may require you to change a home memory care plan:
The caregiver’s cognitive or physical health declines, limiting their strength or mobility
The veteran develops secondary mobility or health problems that make home care more difficult or impossible
The veteran develops a habit of wandering and cannot be confined in the home
The caregiver no longer gets enough sleep because of the veteran’s dementia-related altered sleep habits
The veteran becomes too aggressive and hostile for the caregiver to safely interact with when alone
The caregiver begins to feel overworked, isolated, unsafe, depressed, or anxious
Even with help from the Aid and Attendance pension, the Homemaker and Home Health Aide Program, or VD-HCBS, the conditions listed above could make providing care at home unrealistic, depending on the exact circumstances. To truly provide the best care possible, plan to check in with yourself periodically, looking at your needs and the veteran’s needs. Discuss any new difficulties and concerns with other family members or the veteran’s social worker, actively seeking out objective opinions on how the home memory care you’re providing is working. Ultimately, one of the most loving things you can do for a veteran with dementia is to connect them to the care that’s best for them. If at some point that means moving them to a quality residential facility funded by the VA, you can feel good about that choice. Paying for Memory Care and Alzheimer’s Care The Cost of Memory Care Many seniors want to know what memory care would cost them if they were to pay out of pocket. It’s a difficult question to answer because memory care can take so many different forms, from paid and unpaid in-home caregivers, to adult daycare, to secure memory care wings in assisted living or nursing home settings. National surveys can give us an idea of the true cost of memory care, though each situation will be different. A 2015 study funded by the National Institutes of Health (NIH) found that caregiver’s yearly out-of-pocket spending to care for patients with dementia in the last five years of life was $61,522. This yearly out of pocket cost is almost twice the cost of out of pocket spending for patients who had cancer or heart disease. For the most part, the out of pocket costs in this survey reflect what caregivers paid after insurances such as Medicare had paid for some services. Out of pocket costs are even higher for those with no health coverage. Another comprehensive national survey, in this case conducted by Genworth in 2019, provides insight into the costs of various kinds of memory care. The figures below are the median national costs presented in annual figures: Homemaker services: $51,480 Home health aides: $52,624 Adult medical daycare: $19,500 Assisted living memory care: $48,612 Nursing home memory care: $90,155-$102,200 Additionally, the cost of having a skilled nurse come to your home to care for a dementia patient costs $87.50 per visit, according to the 2019 national median. The above figures give only a snapshot of possible costs. Actual costs can vary tremendously depending on factors like location and the severity of dementia symptoms. Nevertheless, even this brief snapshot shows that dementia is an incredibly expensive condition to treat. How to Get Financial Assistance Outside of the VA If you find that the veteran you care for does not qualify for VA Healthcare or pensions, or if VA resources are not plentiful in your area, you do still have other options for help with expenses. You may be surprised to learn that Medicare does not cover long term care, so you’ll need to look beyond at some of the options below. TRICARE Many veterans who don’t qualify for VA Healthcare do qualify for and use TRICARE, insurance that’s made for veterans and their families. TRICARE does not cover long-term care costs at all, but it can still help you with the costs of doctor visits, medications, and skilled nursing. It won’t provide all the funding needed, but it can be part of the solution. TRICARE may work in combination with Medicare. PACE State Medicaid Programs called Programs of All-Inclusive Care for the Elderly (PACE) can provide dementia care through a network of contractors within your community. The point of PACE programs is to enable seniors to stay at home instead of going into a nursing home or other institutions. PACE covers therapy, prescription drugs, adult daycare, and many other medical and caregiving services that dementia patients typically need. Those with Medicaid have no premiums for the long-term care portion of PACE, and those with Medicare but not Medicaid will need to pay some monthly premiums. Federal Long Term Care Insurance Program (FLTCIP) Long term care insurance is designed to cover the extensive, long term costs of care associated with conditions like Alzheimer’s Disease. This kind of insurance is available through private companies, but the Federally provided version is available to Federal and U.S. Postal Service employees and active and retired members of the uniformed services. It’s also available to close family members like spouses, unlike VA Healthcare. This program is administered by Long Term Care Partners, LLC in partnership with the US government. You can explore the program in full through the FLTCIP website. Frequently Asked Questions 1. How do I know if I or a loved one might have Alzheimer’s? Diagnosing Alzheimer’s isn’t something that you can do on your own, but you can look out for symptoms. The list of possible Alzheimer’s symptoms is quite long, but some to look out for include:
Forgetfulness
Confusion
Changes in moods
Changes in sleep patterns
Getting lost in familiar places
Hallucinations
Aggressiveness
Uncharacteristic inappropriate behavior
If you see some of these signs, it may be time to consult a doctor. Many of these behaviors occur sometimes in healthy people who are just tired or having a bad day, but if you’re seeing multiple symptoms or consistent and worsening symptoms, don’t wait to see how much worse they get. A doctor will be able to evaluate the patient’s symptoms while also ruling out other possible causes such as hormonal imbalances or nutritional deficiencies that are causing cognitive problems. 2. How much does Alzheimer’s care cost? Alzheimer’s care costs vary widely depending on what kind of setting the family chooses to provide care to the patient in. Estimates for the cost of in-home care often are cited as $43,000 per year, while the cost of memory care in a nursing home setting can cost over $100,000 a year in many cases. The good news for veterans is that with VA Healthcare, many veterans pay just modest copays for services, rather than bearing the full cost of care. 3. Who should I contact for more information about benefits? If you have any questions about whether or not you qualify for VA Healthcare, you can call 877-222-8387, Monday through Friday, 8:00 a.m. to 8:00 p.m. If you’re already enrolled in VA Healthcare but have a question about eligibility for a specific health service, however, you’ll want to contact a local a local VA location and get connected with a VA social worker. If you need to find out about your eligibility for a VA pension, you can visit a VA regional office, or you can call an office using the provided regional contact information in the VA Regional Office Locator Tool. If you find you are eligible for a general pension, you also may be eligible for the Aid & Attendance (A&A) or Housebound pension allowances. 4. How do I apply for benefits? To apply for VA Healthcare benefits, you’ll need to visit the VA’s website and/or work with your local/state Veterans Service Officer. The application process will require you to have on hand some personal information, including:
A recent tax return
The veteran’s social security (SS) number, as well as the SS numbers of any of the veteran’s dependents
Account numbers for Medicare, Medicaid, TRICARE, or any other form of insurance the veteran already has
Once you have the information you need, you can apply online, over the phone 877-222-8387, Monday through Friday, 8:00 a.m. to 8:00 p.m. or even by mail at Health Eligibility Center, 2957 Clairmont Rd., Suite 200, Atlanta, GA 30329. To apply for pension benefits, you should follow this link. You’ll need to have on hand the following for your pension application:
SS number
Military history
Financial information for the veteran and dependents
Work history
Bank account information for direct deposit
Medical information
5. How long does it take to get approved for benefits? Approval for VA benefits depends on what exactly you’re applying for. To discover your general eligibility for VA Healthcare, you’ll need to wait about a week after you’ve submitted all required paperwork. If you’re trying to get approval for a pension or a grant, your wait time could be significantly longer, but the VA does not provide an exact time frame. After you are enrolled in VA Healthcare, you may need to fill out additional applications for various services you want to use. With some services, you’ll need to sit down with social workers and draw up a budget in which you are asking the VA to provide funding for specific purposes. This is true of the Veteran Directed Care program. The application process can be lengthy, and you’ll want to ask your VA social worker for an estimated wait time at the time that you apply. 6. What support is available for family and caregivers? Caregivers and family members of veterans with dementia often experience financial strain and mental or health struggles because they are investing so much time, energy, and money in helping their loved ones. To recognize the often overlooked role that caregivers play, VA services include a helpline for caregivers: 1-855-260-3274. Those who call can receive advice and information on available services, and they can also talk about their frustrations if they need a sympathetic ear. Local VA offices also have professionals called Caregiver Support Coordinators that caregivers can consult with. If you want to get in touch with a local caregiver support coordinator, start by using this locator tool. If you’re looking for caregiver resources specifically related to health, the VA provides a page that has links to many different caregiver resources. As a family member of a veteran, it’s possible that you’ll qualify for TRICARE insurance or CHAMPVA cost-sharing so that you can get quality care for your own health needs. More Memory Care Resources for Veterans If you still want to learn more about Alzheimer’s and dementia, or if you’re looking for more resources to support you as a caregiver, you’ll find the following government and nonprofit websites helpful. Resource Contact Information Important Features VA Caregiver Support (855) 260-3274 Helpful articles and videos for caregivers, a toll-free helpline, and a caregiver coordinator locator tool.
VA Beneficiary Travel Points of contact for different regions Detailed information on how to access free transportation services from the VA, including forms and cost information.
Caregivers Video Series 801-582-1565 ext. 2770 Links to informational videos for caregivers of veterans with dementia. Visitors to the website are encouraged to use the provided contact information to ask questions, give feedback, or request a DVD copy of videos.
Alzheimer’s Association (800) 272-3900 for a 24/7 helpline General information on Alzheimer’s, numerous caregiver resources, financial information, links to support groups for caregivers, opportunities to volunteer, advocate, and fundraise for the cause, and more.
The National Alliance for Caregiving (202) 918-1013 Guidebooks, links to research on caregiving, advocacy information, and links to many government and nonprofit websites that can provide caregiver help in the “Resources” tab.