How to even get started

Discussion in 'General Discussion' started by PNWMandala, May 31, 2013.

  1. PNWMandala

    PNWMandala Newbie

    I live in Oregon, and my two sisters live in other states, one in Arizona where my mom lives, so we're having a heyday trying to coordinate things since I discovered this program.

    My Mom is 91 and appears eligible for this program. We are thrilled but cautious about that. She has macular degeneration, neuropathy and a severe hearing loss. Very hard to walk and needs lots of help with ADLs. Can't leave house without someone taking her. Only reason she still lives on her own is because one of us is a nurse and is running her place like a 1 person nursing home, and is overburdened. Now we are gathering paperwork like mad. . . .leading me to (feeling overwhelmed as the point person, but at the moment needing to) ask a couple of questions:

    -Does it make sense for us to file the 1 page informal claim while we're plotting/paperwork gathering? If approved, will the VA make it retro to that date, rather than the full application date?

    -As she is a WWII vet in her own right, but living on her own (sister nurse is 2 miles away and on constant call, so not really, but not compensated either), we are looking for homebound A& A care. Do we have to specify which pension we're applying for, or does the VA decide that?

    --She has several doctors, and I think we'll have to get the retinologist's records to her PCP so he can do a physical evaluation, because her vision loss is key, and PCP will need those records to say anything about her vision. But the VA will still want releases of information for all of her doctors anyway? So I have to send each of them a release?

    Thank you all so much for whatever you can share. This has really been a journey already for us, just talking about it, and wondering why nobody knew about it, and whether she's been eligible for the VA pension all of these years. ???
  2. vetadmin

    vetadmin Administrator Staff Member


    Yes, you can file the "informal claim" as that does start the clock on the effective date. You have up to 1 year to submit the completed application.

    The bigger issue that you have is that this pension is means tested, and is intended to help offset the "costs" of care. Since she is not paying anyone for that, it will be hard to demonstrate a financial need for the pension.

    If you elect to make application, it would be best to have her PCP get the records from other Drs and have him complete the Physician's Evaluation. Most Drs do require a release to share information with other Drs.
  3. PNWMandala

    PNWMandala Newbie

    Well, I wonder if that means-tested issue is a stopper that cannot be gotten around, given the following. . . she does pay for yard help/handyman because she really cannot do anything. That person retrieves mail, waters plants, changes light bulbs, lifts anything over about 5# for her. She has a cleaning lady who does everything except simple dusting because she has such limited mobility in all ways. Would these portions of services count I wonder?

    My mother has mild dementia and clinical depression at this point, it has changed noticably in the last 6 months. We feel she is at a turning point with a downward trajectory.

    My sister manages her meds, takes her to dr appts, takes her shopping, does many routine hygiene needs she can no longer do herself. manages her finances. One other person takes her to church and occasionally out to lunch. A couple of other relatives watch out for her when the others are gone. The problem also is, my sister is aging, and due to health issues can no longer do what she does, which would be supported by medical documentation as well. Does anyone know if this comes into play?

    Her income is $2000/month, from federal, non-military pension and also SS. She owns her small home, has few financial assets.

    I am wondering if she is excluded from the A & A pension, if applying for the VA pension would be an option? Or is a better option right at the start?
    Thank you for anything you have experienced or know that could be helpful to us as we are sorting all of this out.
  4. vetadmin

    vetadmin Administrator Staff Member

    It's not that she is excluded from the pension, but the services you listed do no qualify as medical expenses and would not be allowable. That means that she would be over income to financially qualify with no medical expenses to offset her annual income. By not paying anyone to do the things your sister does, she cannot demonstrate a financial need for the pension to pay for her care.
  5. PNWMandala

    PNWMandala Newbie

    Well, that is very troubling to hear that she would not qualify because she shows no medical needs. My sister does many ADLs for her, consistently, for years. I understood that this program could provide income for in home use for these services.

    I read more on the forum, and found a similar question by another, and the response (to the unpaid caregiving) was this:

    "Based on what you have said, your mom does have a medical need for assistance--you are just providing it without charging her. In order to qualify for the benefit, a doctor must also sign a form indicating that she has a medical need for this assistance.

    Once you have know you have the military service dates covered, as well as the medical need satisfied, the next issue is financial need. To qualify for the a full award, her countable income must be zero or negative on a monthly basis.

    Here is some information that may be helpful. You first must determine if your mom may outlive her your case, I would contact a local home health agency and find out what they would charge to provide the same help that you are donating to your mom....this would be a good place to get the idea of its value."
    So I am confused whether that is a valid approach or not? My mom has less than a year's salary (for her) for total assets. If she were paying fair market rate all these years her assets would have been gone long ago. She will outlive them, I believe, as she is in decline but not a sudden one (so far). Her doctor would readily attest to her need for ADL help. Is there some help or clarification anyone can offer on this issue? Thank you very much.
  6. vetadmin

    vetadmin Administrator Staff Member

    I'm sorry, but without any expenses for care, how would she qualify for this pension? This pension is intended to offset the costs of care, so that veterans or their widows do not do without care or substandard care. Your Mom would be "eligible" for the "Basic" level of the pension IF income was less than $697 a month as there is no requirement for assistance with daily activities for the "Basic" level of this pension.

    It is not uncommon for family members to take care of a loved one and not charge for it, and as in the post you reference, there was no expenses, and yes, there is a requirement for her doctor to complete the evaluation form which has to indicate her physical state and diagnosis of any frailties - limitations.
  7. suse

    suse Jr. Member

    If your mother were able to pay your sister or you or any caregiver zeroing out her monthly income & include any medical expenses (including any medical insurance she is paying) I believe she would then qualify. If you use the "countable income" form on this website you will see if she would then qualify. Also, it is not an all or nothing formula. However to get the full amount it is about zeroing out income. It is a catch need the $ to pay for the caregiver & can't qualify unless you are paying a caregiver. There has to be proof that a caregiver has been paid, as w/ canceled checks & followed up w/ a 1099 at end of year.

    Debbie, please correct me if I am wrong.

  8. PNWMandala

    PNWMandala Newbie

    Hello Debbie and Suse,

    Thank you both very much for comments. As you can see, we are just getting started, and even after having read everything I can find many times, it is confusing to sort out and apply to our situation.

    So, I went to the screening site, which was helpful because it made me see categories of her expenses I had not thought of with the countable income form. Expensive hearing aid, ongoing medical transport costs, med & rx copays, insurance premiums (knew those 2 counted), etc. Still I doubt her income will be 0.

    Question: What I now cannot find--does it exist?--is something indicating that she might get SOMETHING from either the BASIC, HOUSEBOUND, or A& A pension, as it isn't all or nothing, right?

    Another question: We have been screening/looking for assisted care for her in her slow decline. When we get someone in the next month/two, we still won't show that as annual expense, it'll be a new monthly expense. ---Are we applying too soon?--- If we get anything, it would help a lot. But her need will really rise in this next year. Thanks to anyone who has any thoughts or experience on this once more.
  9. vetadmin

    vetadmin Administrator Staff Member

    All 3 levels have income means test. It's only Basic that does not require assistance with daily living. She makes too much to get Basic, and until her income basically zeros out at the end of the month, she is not going to hit the threshold. The VA does award partial awards, but again she has to have the expenses to get that.

    The other issue here is her age. The VA is not going to be as generous in allowances for a 91-yr old as they would and 85 year-old based on anticipated lifetime, they will feel she is close to her end of time from actuary tables. You can file the informal to start the effective date, which gives you the year, and if and when things change where she is paying for care and assistance, then her expenses would be different, and at that time submit the application.

    You need to be prepared that the VA will rule her mentally incompetent due to the dementia, and they do not recognize POA.
  10. suse

    suse Jr. Member

    A question to ask yourself. With the income your mother does have, is she in a position to pay someone now for her, your sister or outside help. If so, that is what will help qualify her. Sometimes they don't count meds, etc. initially but let you expense it out after qualifying. Debbie, please weigh in on the following: Family members can assist w/ home payments, utilities etc but can not deposit any financial assistance in her account. Doing so could free up her being able to pay a caregiver. Again, caregivers have to be paid w/ check, receive a 1099 at end of year, & file that income w/ IRS.

  11. vetadmin

    vetadmin Administrator Staff Member

    You do not want to deposit money into her account as it will raise a flag as to the source of the income, and make it appear she has other sources of income.

    Family members are better off paying the "household" expenses and let Mom write the check to the caregiver so that it is clear she is paying for her care and coming up short at the end of the month after paying for "care" not the electric bill, food, water etc.
  12. PNWMandala

    PNWMandala Newbie

    OK for now, I think, I've got a lot to look into.

    The caregiver has to receive a 1099 and pay taxes (be an employee). . . we can pay for groceries, pay the light bill directly, etc but no deposits to account. My sister/nurse does have the POA for Mom, not sure how that interacts w/VA if dementia increases, but I'll look into that.

    We will be filing informally, and will get a caregiver in to start relieving my sister and creating a financial deficit :( as well, that has been artificially staunched for about 5 years now. We'll submit a formal application in the next few months.

    Thanks so much. I'll keep checking in here and reading.
  13. suse

    suse Jr. Member

    Since your mother has dementia, as does my husband, the VA will want to appoint a fiduciary but that would be handled after approval. The VA does not recognize POA. Your or your sister could request to be fiduciary but do not address this issue now. Once you have proof of payments to a caregiver and are in a position to apply do so. Search this forum to get more info on the fiduciary situation. Also keep in mind you can start the process even before sending the application in & instructions for that is here too. For example, I sent in the "informal claim" in June of 2012 & then sent the actual application in October of 2012, since caregiver expenses started in September of 2012.

  14. vetadmin

    vetadmin Administrator Staff Member

    Thanks for jumping in Suse!
  15. suse

    suse Jr. Member

    You're very welcome. After all the help I have received here from you & others "jumping in", I feel a responsibility to share what I have gleaned from you & others. I will try to remember to add a disclaimer on anything I share that you are the ultimate authority & feel a comfort in knowing you read every post.

    When I was working on my vet's application it gave me great comfort to read of other's success in this process. I read new posts every is still a lifeline for me.

  16. vetadmin

    vetadmin Administrator Staff Member

    Make me smile Suse, and again thanks for staying on and helping others through their process. :)
  17. caa

    caa Newbie

    I am filling out the 21-4138 form to get started. Debbie states "You should include the following statement on Form 21-4138 in the space allotted:

    Please accept this correspondence as my informal claim for non service-connected pension with 'Aid & Attendance' benefit ("for a surviving spouse" or "for a veteran"--list only one), as provided by the following regulation:

    38 CFR 3.155 Informal Claims" then it goes on to list a, b, c, do I need to type a, b , c with all that informtion on the form?

    Thanks so much,
  18. vetadmin

    vetadmin Administrator Staff Member

    Yes, and good luck with the process. Be sure to mail Return Receipt and to the right pension center for the applicant's state.
  19. caa

    caa Newbie

    Thank you, another question:

    My dad is in very bad health, copd, incontenience (bladder and bowel) Swollen and infected legs. Still living in home and I am trying to take care of him , so he does not pay for help yet. Although he needs it. Doctor is evaluating him now. He will prob need to have daily in home care or assisted living. My question is regarding income and if he qualifies. He receives soc security. 1600. per month, he pays 181.60 for aarp supplimental health ins. 25.00 perscriptions. He rents housing so the rest of his money goes for housing, utilities, food, medication and his extras (beer and cigarettes) which uses up all his funds.
    Based on that info, is it worth me sending in the 21-4138 to get started.
  20. sewandsing

    sewandsing Newbie

    I came to this topic because this is where I am. My 90 year old mother is a WWII veteran of the Navy - WAVEs. She (like many on this board) has numerous physical issues related to crippling rheumatoid arthritis that make her unable to care for herself. Long story short, she recently had surgery for a fractured femur and is now in rehab; while in rehab, the intermittent confusion that she had displayed at home became a much bigger issue, and after evaluation, we were told that she has advanced dementia, requiring 24/7 care. She's still in rehab - today - but after rehab, we - my sister (who has been her primary caregiver with whom my mother has lived for the past several years), brother, and I - expect her to be transferred to assisted living with memory care.

    I considered applying for A&A about a year ago, but she wasn't using "enough of her resources for her medical care" to qualify at that time. There is no doubt that she will qualify for now - in assisted living, she will go through all her minimal resources (~$30K with only SS income) in less than a year - but I have some questions:
    1. I noted a comment that suggested that a 90 year old might receive less consideration for this benefit, because presumably she is "at the actuarial end of her life." I would like to think that she would get it, but should this be a concern?
    2. I have seen the eBenefit area of the VA website where one may apply for the benefit electronically. Is this advisable or should we go ahead and use snail mail with certified mail/return receipt to verify that they got the claim?
    3. My mother was divorced either some time before or shortly after she joined the military. We do not have marriage or divorce papers for that marriage. Is that going to be a problem? Is this something I need to be working on?
    4. I live in VA (Chesterfield County, to be exact, Debbie!); my mother and siblings live in TN. Is it true that she has to sign these papers, even if she might later be declared "incompetent?" My sister is the one who would most likely be named her that a process that should begin even as we begin this journey now?

    At this point, I intend to at least start the process with the informal claim...if I can figure out how to do it. I have located the form, but I'm not sure I've located the specific language that needs to go on it. I'll keep looking, but any help you can provide would be much appreciated.

Share This Page