Veterans Eligibility for VA Nursing Home Care

The Department of Veterans Affairs (VA) provides both short-term and long-term care in nursing homes for veterans who are unable to care for themselves due to disability or age. Eligibility for VA assisted living benefits varies depending on how much care the veteran needs and the types of nursing homes available. In some cases, the VA may pay for in-home care of the veteran.

Who Qualifies for VA Assisted Living?

Priority is given to veterans who have a highly-rated service-connected disability. The VA is required to provide nursing home care to any veteran who:

• needs nursing home care as a result of a service-connected disability
• has a combined disability rating of 70% or more
• has a disability rating of at least 60% and is deemed unemployable, or
• has been rated permanently and totally disabled.

After the above groups are taken care of, other veterans needing nursing care will be provided with these services if the resources are available.

Types of VA Nursing Homes

The VA offers several kinds of assisted living arrangements, depending on the needs of the qualified veteran.

Community Living Centers

Community Living Centers (CLCs)—formerly known as Nursing Home Care Units—are VA nursing homes that help veterans with activities of daily living and can also provide skilled nursing and medical care. CLCs are typically located within a VA Medical Center, but can also be in a separate building.

There are over 100 CLCs nationwide. You can find a list of all the CLCs, including the ones closest to you, here.

Community Nursing Homes

Community Nursing Homes aren't VA nursing homes, but the VA contracts with them to help veterans meet their daily needs. The VA only pays for Community Nursing Home care for veterans who are eligible based on criteria involving their income and service-connected disability rating. Veterans who don't meet these criteria may still benefit from Community Nursing Home service, but will need to use their own resources to pay.

Community Nursing Home availability can be limited for veterans with ratings less than 70% and for veterans who don't need care due to a service-connected disability.

State Veterans Homes

State Veterans Homes are nursing homes for veterans approved by the VA and run by each state. The VA can sometimes pay for part of the care a veteran gets at state Veterans Home.

Each state establishes its own admissions and eligibility criteria. For example, some State Veterans Homes may admit spouses and parents of veterans, while others may only admit veterans themselves. You can view the Directory of State Veterans Homes to find the contact information for the location closest to you and ask about the eligibility criteria specific to your state.

In-Home Care

In some cases, veterans may be eligible for in-home care as an alternative to a nursing home. Homemaker and Home Health Aide Care can be helpful for veterans who are isolated or whose usual caregiver is overburdened. The VA can contract with a Home Health Care to support veterans in their homes, assisting them with daily tasks and self-care.

The VA may pay for some or all of a veterans' in-home care costs, depending on the veterans' service-connected disability rating.

Veterans' Eligibility for CLCs, Nursing Homes, and In-Home Care

As mentioned above, priority for nursing home care is given to veterans with high service-connected disability ratings. Eligibility can also be determined by several other factors, depending on the type of care the veteran is seeking.

Requirements for Care at a CLC

Veterans who seek care at a CLC must meet the following requirements::

• they're enrolled in the VA Health Care System
• they are "medically and psychiatrically stable"
• they can provide documentation specifying whether short or long-term care is needed, an estimation of how long the stay will be, and when discharge will occur, and
• they can show priority (service-connected status) for a stay in a CLC.

However, meeting the above criteria doesn't automatically ensure admission. CLCs make decisions about whether to admit a veteran based on the following factors:

• the availability of services in the CLC
• what sort of care the veteran needs, and
• whether the CLC can competently provide the type of care the veteran needs.

To request care in a CLC, a veteran's physician will typically submit VA Form 10-10172, Community Care Provider-Request for Service (RFS). Veterans who aren't exempt from co-pays must complete Form 10-10EC, Application for Extended Care Services.

Requirements for Community Nursing Home Care

Any veteran who needs Community Nursing Home Care for a service-connected disability or is receiving VA home health care after discharge from a VA hospital is eligible for direct admission. To be admitted, all that is required is for a VA physician or authorized private physician to determine that nursing home care is needed. Veterans with a service-connected disability rating of 70% or more should also be eligible.

Other veterans are eligible to be transferred into a Community Nursing Home if the VA determines the care is needed and:

• the veteran is in a VA hospital, nursing home, domiciliary, or has been receiving VA outpatient care, or
• the veteran is an active member of the Armed Forces who was in a DOD hospital, needs nursing care, and will be an eligible veteran upon discharge.

Veterans who aren't in the priority groups are usually limited to six months of community nursing home care. Those in the priority groups can technically get unlimited free nursing home care, but (unfortunately) may receive shorter stays due to a lack of funding and resources to accommodate them. Many vets can extend their stay by relying on payments from Medicare and Medicaid.

Similar to applying for CLC care, a veteran's doctor, social worker, or nurse will apply for community nursing home care using VA Form 10-10172. If you're interested in finding a community nursing home, the VA provides a helpful tool to search for VA nursing homes in your area..

State Veterans Homes and Per Diem Aid

Depending on the state, veterans may be eligible for free admission to a state veterans home. In cases where the veteran isn't eligible for free nursing care at a state facility, the VA can help cover some of the expenses for a veteran's care through what is known as "per diem aid." To qualify for this financial support, the home must meet certain VA standards for nursing care. However, it's important to note that the VA won't cover more than half of the total cost of the veteran's care.

State homes provide hospital care, nursing home care, domiciliary care, and sometimes adult day care. To receive per diem aid, veterans must meet VA long-term care eligibility requirements for the type of care they need. The VA will pay per diem aid for a veteran's care indefinitely.

States usually have their own residency requirements, in addition to the VA's requirements to live in a veterans home. The State Nursing Home will apply for VA aid for a veteran's care by submitting VA Form 10-10EC, Application for Extended Care Services.

VA In-Home Care

Homemakers and Home Health Aides enable veterans to continue living independently in their own homes, regardless of age. All enrolled veterans are eligible for Homemaker Home Health Aide Care if they're also eligible for community nursing home care and meet the clinical criteria for the service.

Whether or not the VA will pay for in-home care depends on the veteran's service-connected disability rating. Some veterans with lower percentage ratings may be charged a co-pay for in-home care.

The veteran's doctor, social worker, or nurse will apply for in-home care using Form 10-10172.

More Resources for Nursing Home Veterans

It's always a good idea to contact your VA social worker or case manager to find out how to get into a veterans nursing home and determine which nursing home benefits the VA will cover in your case.

It's important to note that under 38 CFR § 5503, a veteran who begins to receive nursing home care will have his or her monthly pension payment reduced to $90 if:

• the veteran has no dependents
• the veteran is living in a Medicaid approved nursing facility, and
• the nursing home care is paid for by Medicaid.

For more information on when the VA can help pay spouses of disabled veterans who provide in-home care, ask your social worker about the VA Aid and Attendance benefits.