Denied :-( HELP!

[wtfindley]

My 86 year old father is a WWII and Korean war vet.  He and my mother are currently residing in an ALF.  They are at level one which includes medication monitoring (they count their medicines once a week to make sure they are not overmedicating I guess), provide them with meals and transportation and take their blood pressure and weight once a week.  My father just received a denial of benefits.  The care expense statement asks if medical services are provided for this patient.  The director said that what they are receiving is not considered medical so she checked that box as no. Due to this the VA said they would not consider the cost of assisted living against their countable income.  My mother has dementia and can barely walk from the bedroom to the living room.  My father is a little better but also has some memory problems and difficulty walking.  They definitely could not live independently.  Should we just bump them up to level two care and reapply?  Or should we write out a detailed statement of the care they are receiving for the ALF administrator to sign and reapply?  If they count the ALF their countable income will be negative.  Thanks in advance for your advice. 
                                                                                                            Frustrated in OKC

[vetadmin]

Do a 21-4138 "Statement in support of Claim, and have the administrator write a letter attesting to their physical limitations and challenges and the "assistance" that is provided to them by the facility.  The Physician's statement should have listed their challenges.

Keep in mind that the Veteran has to meet the qualification of "needing assistance" in order for the spouse to benefit unless widowed.  Sounds like mom is possibly in more need than dad.

[jpez]

The definition of 'medical' is different for the VA.
The asl director is trying to cover her lic.
THe items that she is providing ARE in fact concidered Medical by the VA.
But try to focus on the NEEDS described in the doc form 21-2680.
If your folks need 'med management' which is why the blood presure is being taken....that really is medical.

[AngelaManz]

Remember too that the VA also will count the cost if one or both spouses needs a "protective environment." The director can state that due to mom and dad's cognitive and physical impairments, they are being provided a protective environment and that will help.  Also use the Statement in Support of Claim to explain their individual needs and how the community is meeting those needs. 

[jpez]

Let me throw this out.......

Witfindly, was that care expense form 4 pages?
The form that i use has examples of 'medical expenses" under the line.

If it is the same form, then I would think the better approach is to have the Director retract her statement and acknopwlegle that by Va standards she is providing "medical care"

your thoughts?

[wtfindley]

No, the form was only 2 pages.  Is there another form I can use?