Medical Expenses and Assisted Living

Discussion in 'Expenses' started by Cpg66, Mar 5, 2015.

  1. Cpg66

    Cpg66 Newbie

    My question as it relates to A&A and the application process is how do I show need when my 90yo dad has just started requiring extra assistance. He has advanced COPD and Congestive Heart Failure. He recently concluded a 12 day hospital stay in ICU and 24 days in rehab center. Thankfully he is home with mom now and has had 2 weeks of Medicare paid for nursing visits (2xweek) and PT and OT and we have also paid for private home care of about 2 hours a day. He and my mom are about to go into assisted living (within 2 weeks) at a cost of $6,500 per month (not an expensive place either). They currently bring in $3,000 month (ss, small pension, small Va service disability compensation of $599 is included in that total monthly earnings). My 3 brothers and I are going to pay for shortfall but can not sustain for very long without a VA benefit.
    If they haven't moved into assisted living yet how do we show need? Thanks so much!
  2. vetadmin

    vetadmin Administrator Staff Member

    You will need to wait until they are in the facility to make application and actually incurring the expense. You cannot make application based on anticipated expenses, and the hospital/rehab stays do not count as they are not reoccurring expenses.

    For the family paying the short fall, you want to keep that separate so that it does not appear they have resources they don't. Do not put the money in their account. Pay separate to the facility so that you have a record of payment.

    Dad will loose his $599.00 disability once approved for A&A as he cannot draw both "compensation" and "pension".

    Highly suggest you make sure you are sending in a Fully Developed Claim so that there will be less for the VA to push back on, and you can get the award in the least amount of time.

    Good luck with the process, and be sure to use the site and forums to help ensure your success.
  3. Cpg66

    Cpg66 Newbie

    Thank you for your reply. It was my gut feeling that you confirmed about waiting as the small charges for home care incurred so far just didn't seem to paint the full picture as to their needs. Also, the Medicare paid nurse visit on surface look like no cost but that ends soon. With the statement of occupancy from the assisted living and list of services we are going to be paying certainly seemed a stronger and obvious case for need.

    However, I am extremely concerned about the VA implemented changes you wrote about in your open letter to the VA. Specifically the doing away with the retroactive payment from the date of application. I don't expect you to reply as you have many questions you are answering but I am trying to figure out if the retroactive payments go away for application received AFTER the 24th and those received prior to will still receive the retroactive payments?, they certainly don't make it easy.
  4. vetadmin

    vetadmin Administrator Staff Member

    That goes to "informal claims" so it will not impact your parent's application, but no, they don't make it easy.
  5. Cpg66

    Cpg66 Newbie

    Thank you so much for your assistance. My brothers and I will make sure to contribute to your site so that you may continue to help others as you have helped us with your site.
  6. vetadmin

    vetadmin Administrator Staff Member

    Thank you Chris, and I certainly appreciate the support!

  7. Cathy

    Cathy Newbie

    VetAdmin- I just(last week) moved Mom into Assisted Living. I plan to apply for A&A . What is this about not paying retroactive to date of application /'informal claim'(what is an informal claim versus ?)? I tried reading thru the official VA link but could not locate that verbiage ? I just want to know if I need to go into warp speed before 3/34 on this application? Thanks so much !
  8. vetadmin

    vetadmin Administrator Staff Member


    You can file an "informal claim" to start the effective date on the application, so in the event the pension is awarded, it would go back to the date of the informal claim.

    You do not need to hit the warp button. Just gather all the documents and send off a complete (Fully Developed Claim) with all supporting documentations.
  9. Cathy

    Cathy Newbie

    Thank you very much.
    A few other questions...
    For Assisted Living, Aside from the Physician's Statement form(21-2680) what other form/forms do they need ?:
    would they need the 'nursing home form' even if it's assisted living?
    and I also seem to have acquired a form "care provider certification of services FV13" along my research journey ?
    I just want to be sure I send what is required and of course not what isn't.

    Also, the Fully Developed path kind of scares me a bit - I don't want to be dumped into another pile because something is missing. I also am confused by the form--is my mother applying for Death Benefits or DIC or both ? (This is just plain old standard A&A-no one has been getting any compensation).
    On the other hand, Is the standard path 21-534 considered an informal claim ? (which I obviously want to avoid).
    Again, thank you so much !
  10. vetadmin

    vetadmin Administrator Staff Member

    Send the nursing home form, and a Statement of Occupancy from the facility.

    21-0845 Approved 3rd Party and no on the FV13.

    Your Mom is applying for "Death Benefits" not DIC.

    Go the the site, read through the list, print off all the forms under the "Forms" tab, and you will be ok. Do not leave one single blank on the application. If it doesn't apply, put N/A.
  11. Cathy

    Cathy Newbie

    Question 16 on the 21-534EZ is asking "What are you claiming?" ( check all that apply):
    1.DIC (we know it isn't that)
    2.Death Pension(yes, per reply)
    3. Accrued Benefits (does that get checked?)

    They do not have a box to check for survivor A&A should that get written in as well ?

    Thanks ! After this I'll get to work....
  12. vetadmin

    vetadmin Administrator Staff Member

    Mark "Death Pension", and Good Luck!

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