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Author Topic: ASSISTED LIVING FACILITY TELLING MY MOM SHE OWES $10,000  (Read 3700 times)
Vanessa Sunshine
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« on: September 14, 2011, 02:55:46 PM »

Aaargh. I've been on here several times and received a lot of help from you all.  My mother moved into a Holiday Retirement Assisted Living home. They told us before she moved in that their services were covered under A&A. My mom moved in in October 2010. I sent her paperwork into the VA and she was approved for A&A retroactive to November 2010, BUT, the VA called the manager at her Holiday home and the VA told me that their facilities do not qualify for A&A. This was strange as the Holiday facility had a table full of photos of retired military personal who were living there now and I was assuming were using their A&A benefit there. I talked to the local management and gave them a copy showing that she was indeed approved. I had someone from their corporate office call me and she referred me to one of the agencies that helps people get A&A. I sent this person my mother's application and her VA approval. Long story short I've contacted her several times and never really gotten much feedback on it...she did respond, but just to tell me how busy she was and she was working on it.  Also, during this time, apparently Holiday moved some 'special care' workers into their facility...way in the back. I called them and talked to an employee and asked if they knew what I need to do to get my mom's care covered under A&A. He didn't know and he never called me back. Early this week my mom received a letter from Holiday's corporate office saying she owed them over $10,000 and they wanted to get it resolved this month.  What this is is the difference between what they are making her pay ($1,700) and what they actually charge ($2,700) since they are waiting for their payment from the VA and they are assuming they are never going to get it now. I am so tired of fighting with them. I just need someone to tell me what I need to do so that my mom can get this benefit. She does not have a lot of money and her annual income is around $13,000. Her doctor wrote a letter for her VA application saying she cannot even take care of her own money. She is 81, but honestly it's like she's 101. She mentioned receiving this letter to her local mgmt at her Holiday facility and they told her that over 1,000 letters saying the same thing had gone out from their corporate office to other retirees living at Holiday and that their phones had not stopped ringing. I'm at my wit's end trying to get someone to tell me what I need to do.  Cry  Cry Should I just move her? How do I make sure she can write off the inflated rent at the next place she moves to so that she can receive this benefit. I'm even more aggravated with the VA. If they spent about 5 minutes with my mom they could see that she in incapable of living without assistance. Thanks for any advice!  Smiley
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Marp
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« Reply #1 on: September 15, 2011, 02:54:37 PM »

Did the VA say why the Assisted Living Facility doesn't qualify for VA benefits?

Knowing that would certainly help figure out the best next step for you.
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Marp
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« Reply #2 on: September 15, 2011, 03:06:06 PM »

I just went online and looked up Holiday Retirement Assisted Living Home on the Internet:  http://www.holidaytouch.com/

If this is the right one, it looks like they're communities are independent living communities that don't provide the types of services the VA Aid and Attendance benefit covers.  The Aid and Attendance benefit provides a benefit for people who need assistance with activities of daily living and, sometimes, protection from hazards of their environment (that's usually where Alzheimer's patients get the benefit).  From the website I found, Holiday Retirement Assisted Living doesn't provide those types of services. 

Maybe that's why the VA says that home doesn't qualify? 

Of course, I don't know if I found the right website.
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vetadmin
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« Reply #3 on: September 15, 2011, 04:21:26 PM »

This company has caused more problems than I care to count.

They are an "independent" community with no medical responders or on-site assistance.

Unless your mom has outside services coming in to be claimed as medical expenses, or her physician has written a letter that she needs to be in a modified enviornment, the VA is not going to allow the "rent" as a medical expense.

I would tell them they can "eat" the back payments as they knew their facility does not meet the criteria, and I would report them to the VA, the GOA, and would contact your local media.  These folks have taken gross advantage of so many and have facilities througout the country.  Many have skated by the first year, and then the VA sends out the annual EVR, and then comes back to the veteran or widow demanding all the pension be repaid as they in fact did not meet the criteria.

In the meantime, you may want to move your mom to a faciltiy that does provide the services that she is in need of that will be recognized by the VA.

I am serious about telling them upfront, they lied and were fraudulent in their representation of this pension, not to mention the financial group they are working with.
« Last Edit: February 06, 2012, 11:21:04 AM by vetadmin » Logged
chchch
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« Reply #4 on: November 14, 2011, 12:26:32 AM »

how was this resolved?  The same thing happened to my mom and Dad but Holiday wrote it off, but we were never told the reason was Holiday did not meet the requirements of a Assisted Living Facility for A&A.  We thought it was a paper work mess so refiled the claim.  Of course it took the VA another ten months to tell us that there was a problem and during that time we having been paying out of pocket hoping to be reimbursed. 
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gosborne
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« Reply #5 on: February 06, 2012, 10:20:33 AM »

As inh many places on the internet, there is a great deal of information that is erronous when it goes to anything related to the VA and especially the Non-Service Connected Pension; so, here is the straight story regarding why some (and I stress some) residents of Holiday communities fail to receive their Pension or an amount less that what they expected.

First of all, this issue has nothing whatsoever to do with Holiday or the services they provide.  Holiday provides instrumental activities of daily living, noteably Transportation to medical appointments, meal preparation, housekeeping and laundry.  They do not provide basic ADLs.  The issue is federal regulations and how the directives are being followed by the Pension Management Centers.

All the applicable regulations state is found in 38 C.F.R. 3.272(g), i.e. un-reimbursed medical expenses are deductible from gross income for Pension eligbility purposes.  The actual directives on what this means is found in the Compensation and Pension Manual (Rewrite) at V.iii.1.G.43. d.,h.,and m.

The VA has a necessarily broad and liberal definition of what constitutes medical services and its subset, nursing services. In V.iii.1.G.43.h., it clearly says that if a claimant or beneficiary is rated in need of the (continued) 
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gosborne
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« Reply #6 on: February 06, 2012, 10:29:09 AM »

continued... aid and attendance that all care expenses directly related to the care and well-being of the claimant is continued....a fully deductible medical expenses for VA purposes.

The problem is actually the Milwaukee and to some extent the Philadelphia PMCs.  The St. Paul PMC is correctly interpreting the directives and Pensions are routinely granted.  Milwaukee in particular takes the opposite view of the exact, same directive and says that so-called independent living facilities cannot provide nursing services, which, of course they do under the laws clear language!  In short, you have unequal treatment of claimants before the law.  If you live in the St. Paul area, great; if you live in the Milwaukee area, you're in trouble.  Same regulation.  Same directives.  Different interpretation.

We have made the VA General Counsel and the Pension and Fiduciary Service aware of this problem and steps are being taken to fix the issue as we speak.  Just don't blame Holiday.  Sure, they have made big mistakes with their outreach to Veterans, but this is not one of them.
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vetadmin
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« Reply #7 on: February 06, 2012, 11:39:27 AM »

Glenn,

I don't believe that you need to be on here defending Holiday since you work with them.

Given the number of contacts I receive weekly from folks who were informed they did not qualify and now owe 6 months rent, or just got the response from the EVR that they owe the VA all the money they were paid, that you are treading on thin ice here, and your defense would be better served elsewhere.

It is pretty telling when you have employees sharing insider information about how this pension is used at certain properties.  Since information is indeed freely available, one can come to their own conclusions on this matter as to how one conducts business.

http://blog.dlcharles.com/search.aspx?q=veterans&sc=tconcom&dt=a&al=

For further insights to this matter see this article and scroll down to the 2nd comment:
http://gwwood99.hubpages.com/hub/Elder-Abuse-Protection-and-Senior-Citizens
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