Congregate Living Centers

[scudder]

My father-in-law is a widower living on his social security that has been diagnosed with and is being treated for Alzheimer’s.

He is living in a ‘congregate’ living facility in Minnesota that supplies meals, room cleaning, laundry, and a sleeping room but no medical assistance.  A home health care representative, paid for by the VA and personal insurance, provide weekly visits to fill his pill caddy and to check on his general health.  He can still function on his own (he drives locally) with the level of supervision provided by the congregate living facility and the home health care assistance, but is forgetful and cannot live alone.

My question is: “Does the expense of the congregate living facility qualify as a medical expense?’

[vetadmin]

I would think that this would fall into what the VA describes as 'Community Residential Care'.

*Community Residential Care*
**
    *Community Residential Care provides health care supervision to
    eligible veterans not in need of hospital or nursing home care but
    who, because of medical and/or psychosocial health conditions as
    determined through a statement of needed care, are not able to live
    independently and have no suitable family or significant others to
    provide the needed supervision and supportive care. The veteran must
    be capable of self-preservation with minimal assistance and exhibit
    socially acceptable behavior.*

Based on the info below from the VA's manual, I would say that the room and board could be counted as a deductible medical expense. I think this would fall under the 'custodial care' section. Hope this is of help to you.

If a beneficiary or dependent, or other person for whom medical expenses may be allowed, is maintained in a home, assisted-living facility, or other institution, because the individual needs to live in a protected environment, all unreimbursed fees paid to the institution for custodial care ("room-and-board") and medical or nursing care are deductible expenses, as long as

* a licensed physician certifies that the individual has a medical condition that makes such a level of care necessary, or
*VA has determined the individual is entitled to A&A or Housebound benefits as a beneficiary or the spouse of a veteran entitled to compensation at the 30-percent rate or higher.

If it is established that a disabled person in a governmental institution is participating in a program of therapy or rehabilitation supervised by a physician, or a physician has certified that the person has a medical condition that makes such a level of care necessary, allow the entire amount paid as a deductible expense.

A physician's statement specifically addresssing the issue of whether an individual who is not entitled to A&A or Housebound benefits needs to be in a protected environment must be of record, even if the individual's diagnosis is known.

Example:   Even if the evidence confirms that a veteran's spoouse has Alzheimer's disease, do not allow fees paid to the spouse's assisted-living facility unless a physician's statement is of record indicating that the spouse needs to live in a protected environment

[scudder]

Thanks Debbie,

The information you provided was right on target and today we received confirmation that my father-in-law was to receive A&A and that the congregate living center expenses would be allowed as medical expenses to offset income.

But, that brings up another problem.  The Medical Statement we supplied with our application stated that the claimant cannot leave home unassisted because the patient gets confused easily and could lose his way.  This statement was made by and signed by the examining doctor and supplied with the original application.

While the doctor's statement is true, dad still has a car and drives locally within his hometown of 1400 folks.  He is able to navigate within his home turf but does not venture out of town and stays within a half mile of the congregate living center.

Am I obligated to inform the VA that dad is driving locally against the doctors orders?

[vetadmin]

His still driving is going to be an issue, and quite honestly a hazzard to himself and to others.  This issue truthfully needs to be addressed.  I dealt with this same issue with my dad, who ended up having two accidents, both of which were his fault before he lost the battle of keeping the car.  I know it is their independence, but for safety reasons and for VA purposes, this needs to be dealt with.