The Wakeup Call

I remember the day vividly. My phone rang, and it was my mom. She couldn’t get out of bed and stand up without getting physically sick.  She was headed to the ER.  Her blood pressure was off the charts.  She was overwhelmed and exhausted from being the full-time caregiver for my dad, who had Alzheimer’s. It was clear we needed a change, and fast.

We decided that I would take over as my dad’s healthcare Power of Attorney (POA) with the understanding that I would make the decision to find and move him to a long-term care facility.

I had anticipated this moment and had done some research. I knew that if we wanted to place dad in a residential (assisted living) facility, we would have to pay out of pocket. I had been researching a VA benefit called Aid and Attendance that could help, but kept running into roadblocks. Now I had to figure them out.

In this blog post, I’ll walk you through some of the challenges I faced, how I overcame them, and what I learned along the way.

Challenge 1: Understanding the Difference Between VA Healthcare and VA Pension Benefits

One of the first hurdles came down to understanding the difference between VA healthcare and VA pension benefits. Veterans can enroll in VA healthcare and receive medical services through the VA. The benefits they receive depend on their disability rating and other factors. Financial need may influence the amount of benefits, but it isn’t necessarily a prerequisite.

VA pensions, on the other hand, are separate from the VA healthcare program and do not require enrollment in VA Healthcare. Aid and Attendance (A&A) and Housebound benefits are special add-ons to a VA pension, which is based on financial need. To qualify for A&A or Housebound benefits, a veteran must first qualify for a VA pension based on financial need, wartime service, and other factors. Then, they must also qualify for the A&A or Housebound add-on based on their care needs.

Challenge 2: Service Qualifications

The first major obstacle was that my dad didn’t have a copy of his discharge papers (form DD-214). A DD-214 is essential for applying for VA benefits. I had already tried calling multiple VA locations for help.  When I finally got someone to answer the phone, they couldn’t do much to help me.  They didn’t have my dad’s information in their system since he had never received VA benefits. They suggested I check with the county where he was discharged, but my dad couldn’t remember where that was due to his Alzheimer’s. So we were stuck.

I had already submitted a request for his service records through the national archives and had been waiting about a year and a half with no success. So I went back through every paper I could find for clues. Hidden in the small print of a commendation he had saved, I found the name of a nearby county. I called them, and they confirmed they had his records. I was able to get a copy the next day.

Initially, we thought he served from August 1960 to August 1963, which was outside the Vietnam War era as defined by the VA. However, I wasn’t sure if those dates were accurate.  Once I had his discharge papers, I was able to confirm that he served until September 1, 1964, which meant he served during the Vietnam War era and met the wartime requirement.  On to the next challenge!

Challenge 3: Financial Qualifications

Like Medicaid, the VA pension is based on financial need, and you can deduct qualifying medical expenses from your income when assessing eligibility. My dad’s income was above the allowable limits, but once he started incurring the expense of assisted living, I expected him to qualify. Many people are in this situation due to the high cost of assisted living.

The problem was that at the time we applied, he wasn’t in assisted living yet. You have to prove the financial need when you apply, which required us to already be incurring the cost of the assisted living facility. Even though he hadn’t moved in yet, we had to have a signed contract showing the committed room and board amount. The hard truth is that there isn’t much you can do about this one. I had to make the decision to move him without having the VA’s decision in hand. It was a leap of faith based on the research I had done.

Challenge 4: The Application Process

The first step in applying is to fill out and send in a form called the “intent to file.” This form saves your place in line and establishes the start date for your benefits. It’s about one page and straightforward, so it should be filed as quickly as possible while you work through the rest of the process.

The rest of the application involves forms and supporting documentation to prove service-related details, financial need, and medical need. It’s a tedious process, and it’s crucial to fill out the information completely and accurately and provide all the supporting paperwork like tax returns, bank statements, medical forms, etc. Even with no errors, the VA takes at least 3-4 months to review and make a ruling on a new Aid and Attendance application. Any mistakes or missing documentation will delay the process.

After about a month of hard work, we had all our information together and submitted it to the VA.

Challenge 5: The Expensive Waiting Period

The VA takes at least 3-4 months (if everything is filled out perfectly) to review and make a ruling on an application. Any information missing on the application or supporting documentation will delay the process more. 

During this time, the veteran must cover the full cost of care out of pocket. The good news is that if approved, the VA will retroactively pay the benefits back to the original “intent to file” date.

If the veteran has dementia, Alzheimer’s, or is otherwise ruled incompetent to manage their own benefits, they will also need to go through a second process to request a fiduciary to manage their benefits. This is typically an adult child or trusted friend. The fiduciary must be reviewed, interviewed and approved by the VA. Once approved, they must set up a separate account to manage the benefits and go through audits with the VA on how the money is spent.

The fiduciary appointment process can take another 3-4 months. If the veteran is due a retroactive payment, it won’t be paid until the fiduciary is established, although monthly benefits may still be paid in the meantime.  For us, this was a full 9 months after our intent to file, even though we had absolutely no errors or issues in the application forms we submitted.

Summary and Advice

Here are my key takeaways and advice for anyone navigating this process:

1. Get the Veteran’s Service Records Early: Obtain the DD-214 discharge papers in advance. Even if you don’t plan to request Aid and Attendance, these are still important to have readily available for any veteran.  If you don’t know where they are, call as many county offices as possible where the veteran might have filed their papers. You can also request them from the national database, but be prepared to wait about three years or more.
2. Research Facilities and Costs Ahead of Time: When the need arises, it is often urgent and stressful. Having information compiled ahead of time can be extremely helpful.
3. Save Up Money: It’s likely the veteran will need to cover the entire cost of care out of pocket for at least four months. If they require a fiduciary, they may not be reimbursed for benefits until 8-9 months into the process or longer. Unfortunately, if they or a loved one aren’t able to cover that initial cost, there aren’t many resources available to help them.
4. Use a Veteran Service Officer (VSO) or accredited agent: VSOs and VA accredited agents can help you through the application process to ensure everything is submitted correctly. Many VSO’s are overwhelmed.  If you don’t have luck at one place, try another until you find someone able to give you the help you need. VSOs and accredited agents can be found on this page on the va.gov website. Note that it is not legal to charge veterans for representing them in an initial claim. However, there are also companies that offer software or services to help veterans through the process for a fee even though this is technically not legal. The level of help from VSOs can vary, so some people find it worth the money to use a paid service if they have an urgent need, even though those companies should not be charging them.

In the end, if you prepare ahead of time and can take advantage of this benefit, it can make a huge difference. Aid and Attendance can be used for assisted living and significantly reduce the cost. Housebound benefits are very similar except they are meant for veterans that are still living and home, unable to leave their house, and need help with day to day tasks. 

For my father, Aid and Attendance covered about half the cost of room and board. Without it, we could have afforded assisted living for almost two years, but with it, we could afford it for over ten years. Having him in an assisted living facility made a huge difference in his physical, emotional, and mental well-being compared to a nursing home. 

My father is not alone; I know of many other veterans who have had many more options available to them for long-term care because of this wonderful benefit.

Navigating the Aid and Attendance benefit can be challenging, but with preparation and persistence, it can provide invaluable support for veterans and their families.

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What Next?

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Do you have experience with VA Aid and Attendance or Housebound benefits?  Share your insights with others in the comments below!

At Advocate Money Management, we offer free assistance to our active clients in helping them apply for VA benefits. We are also available to consult with adult children or others helping a veteran loved one apply for benefits.  Contact us for a free consultation today!