Homebound vs. Asstd Living

Discussion in 'General Discussion' started by dw999, Oct 3, 2015.

  1. dw999

    dw999 Newbie


    Question 1:

    Is it risky to go the route of: Do the Care At-Home: claim at-home medical expenses (vs veteran being admitted into an Asstd Living Facility) when attempting to obtain the VA A&A approval?


    • LPN giving help has a state-home-care license, but LPN prefers to work as an independent contractor (in lieu of under agency). (We hear that is a tricky approval.)
    • Relative 1 does the bathing help.
    • Those items (bathing, LPN help with meds, medical device help) appear to be the 2 ADLs
    • Relative 2 takes veteran to and from VA facility
    • Relatives 3 & 4 help cook and clean...but that's not an ADL
    • None of relatives are a spouse.
    • Friend 1 shops, pays the bills, does paperwork and research - not an ADL

    Eventually, we can see that 24/7 assistance will be required: $1,788 is not enough for that!

    So...this begs Question #2 -- Does switching gears mid-stream (from At-home care to Asstd Living care) delay the VA processing of the A&A claim? The move from at-home to Asstd Living might likely happen long before the VA comes up with an approval....especially since we are guessing the incompetancy letter thing will rise it's ugly head.

    Question #3:

    This is a flip of the other question #2:

    If we go ahead and apply for A&A using at-home care, and somehow get approved right away (via FDC), would that possibly actually expedite the process for the day the veteran has to move to Asstd Living --if he should decline? (I assume we would just submit the VA form 21-4138 to inform VA of the increased expenses, etc.) (We had a home-health-care org indicate that switching gears slows the process....but it seemed that they were looking for only really-clean claims that they know would be approved...and they said they wouldn't take a vet who wouldn't use their services for at least 6 months; if we thought the decline would happen < 6 mos, they wouldn't even take the case...thus my suspicions.)

    Thank you!
  2. vetadmin

    vetadmin Administrator Staff Member


    It doesn't matter that several family members are involved, but it would be best if only one was paid, otherwise it would be an accounting nightmare for VA purposes.

    If you bring in home care, then you make the file with what that expense is.

    A fully developed claim (FDC) if done correctly will get process pretty quickly. If the competency issue comes up and requires a Fiduciary to be appointed, only the funds that are held for the length of time of processing will be delayed. The monthly pension amount awarded would start the following month of award.

    It would be best if you move into the ALF to wait until the decision is made on the application, and then use the 21-4138 to inform the VA of their new residence, and if there is an increase in costs of care. You would also want to include a Statement of Occupancy from the facility that would show the date of move in, monthly expense and services provided.
  3. Rboyer

    Rboyer Newbie

    I had my mother at home and she was receiving less than the full amount monthly. About three months ago we moved her to an assisted living facility and the costs rose greatly so we submitted paperwork along with a cover letter requesting an increase in her monthly benefit. After three months all we have received is a letter from the va stating they received our request and they would contact us if they need further information, but it would take time because they are busy and many before us. In the mean time I must pay her additional costs out of pocket. My wife and I are also retired so we have a limited income, but this seems to make no matter to them. Why can't they get their jobs done?
  4. vetadmin

    vetadmin Administrator Staff Member

    #1 thing you need to do is keep records of what you are paying out of your personal money to cover the shortfall. Do not put money into her bank account for the convenience of writing one check.

    #2 Given that she is already in the system and approved for the benefit, it is unacceptable that you are 3 months out waiting for the adjustment to her award. Call her Senator's office tomorrow, and ask them to make an inquiry to the the status of her application. Stress that this is a "financial hardship" for you to be paying the difference for her to get the care she needs.

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