you've been denied

Discussion in 'Share Your Personal Experience' started by hanford9, Sep 20, 2013.

  1. hanford9

    hanford9 Newbie

    Thanks Debbie for all your work on this informative site.

    Mom 89 applied for AA 10/12 just rec word that she was denied. It appears that VA thinks she is living at a independant living center when in fact it(facility) has both AL and independant. Is it best to try and clarify,appeal or refile? Currently she receives meds,laundry ,cleaning,meals(some brought to her room if not well) rides to shopping and med. appointments. Mom cannot drive or walk 100 yards ,uses walker ,hearing aid ,diabetes , heart meds ,osteoporosis and need some help with getting a good bath. Her income covers the AL cost and her children are paying for medicine delivery service. We would like to get more things done as they will do more but at additional cost. Lucky mom told us to stay in school and we can help,for now. Any advice on how to proceed. Thank You all/
     
  2. vetadmin

    vetadmin Administrator Staff Member

    Something doesn't sound quite right here regarding her services as you have described them. It sounds more like an IL property. That may be part of the issue.

    First let me say you NEVER appeal the decision. You use VA form 21-4138 Statement in Support of Claim to provide additional information or clarification supporting the claim.

    Did the ALF complete the Statement of Occupancy correctly clearly showing she is on the "assisted" side? You need to clarify that if Mom is on the "assisted" side that she is receiving proper services for her limitations, and that she is NOT on the independent side of the property.

    Thanks for your kind words regarding my efforts, and hope you can get this straighten out soon.
     
  3. hanford9

    hanford9 Newbie

    Debbie,

    Thanks for your fast reply. My sister is handling most of the leg work and works full time. Is this available online, as I cannot find it and my sister who live close to my mom is away for several days. At the time, my mother is alert and asks about the money as she knows were paying. As vet myself I understand the frustration in dealing with the VA. Thanks again
     
  4. vetadmin

    vetadmin Administrator Staff Member

    You can get the 21-4138 on our home page located under A&A Forms. You can also try to find it on the VA's website.

    Statement of Occupancy is not a VA form, and the facility would have that.

    Thank you for your service to our country!
     
  5. hanford9

    hanford9 Newbie

    Thanks again,

    Have 21-4138 and I'll ask about the other. Tried to donate and paypal said it was recurring ? Will try later. Thank you
     
  6. vetadmin

    vetadmin Administrator Staff Member

    Hanford9,

    Greatly appreciate your effort to donate supporting our work here.

    There should have been an option for just a one time donation, but it may be easier for you to go to the www.VeteranAid.org site and make your donation through that link on our home page.

    Thank you!
     
  7. hanford9

    hanford9 Newbie

    Dedbbie,

    Called place where mom lives and they said she was in assisted living. Does the VA normally call and verify all the info we sent? It looks like we will add a new service to her arrangement (bathing assistance) and hope the VA reconsiders. Figured out the paypal issue. And again thank you
     
  8. vetadmin

    vetadmin Administrator Staff Member

    It is very common for the VA to call and verify the facility and services provided.

    Bathing assistance would already be part of services provided by an ALF, unless this property offers more of an ala-carte of services.
     
  9. hanford9

    hanford9 Newbie

    Good day,

    Yes everything is available as extras. Food, cleaning, transport and escort is included in charges. We pay extra for meds and they do occasional help for free(included in rent fee) . We are aware of new clarification on needing two adl's being done but we sent our forms in before Oct. 12,2012. Had we know, we would of had more services covered rather than my sister doing them. Their website details what is provided. Del Obispo Terrace .com. Again thanks for the info.
     
  10. vetadmin

    vetadmin Administrator Staff Member

    In looking at their site, it is easy to see why they appear to be more of an "independent" property.

    Have to say that there model is not standard for assisted living, and probably in large part why the VA made their decision.

    Yes, you will need to add services, but am a bit concerned that the VA will view having to pay for what is typically traditional services by a ALF, it may take some explain to get them to understand.
     
  11. hanford9

    hanford9 Newbie

    Just rec packet sent to VA and their denial from my sister. Wow I need to go to law school to understand some of the wording. We sent a 21-0779 that say's nursing home info. instead of a statement of occupancy. ?? Would this confuse them? Plus the letter from VA says medication management is not an ADL . They(VA) refer to a Facility Expense Statement that shows Del Obispo (where she stays does not provide nursing or medical services) which they do . We need to add services or count my sisters help as a paying activity that my mom pays for. The letter from the va says "we have denied your claim for dependency and indemnity compensation(DIC), death pension and accured benefits) is this right and are we still in the running? Wow the next page we have not evaluated your eligibility or AA . Then the next paragraph says we have denied facility cost for Del Obispo because they do not provide nursing or medical services. Am I confusing you or is this normal? I will try and call as soon as the budget is passed. I spent 30 years mil and civil service and understand most of the paper work but this is scary. Lastly my sister did not cross out nursing home and write in ALF . Can we address this with the 21-4138 form? Sorry for the long post but maybe it will enlighten someone else. Again Thank You
     
  12. vetadmin

    vetadmin Administrator Staff Member

    It would take a law degree to figure this one out.

    1st thing - Not sure why they processed the claim for DIC, when the application was for A&A. This is a common issue, and generally can be resolved by using VA form 21-4138 informing them that they processed the application for DIC instead of A&A.

    You do need a Statement of Occupancy from the facility and they need to list what services they are providing to your Mom. Medication management is an ADL, so their reply seems to be all over the board without landing on the right square.

    You can address the issue of her being in an ALF and not Nursing Home on the 21-4138.

    You also need to address the issue that they are claiming medical and nursing services are not being provided, which the Statement of Occupancy should help to clear up.
     
  13. hanford9

    hanford9 Newbie

    Debbie,

    Will keep trying as mom is getting more feeble(pain meds for back issues don't help with her mobility and they are starting to affect her memory). Thanks so much much for your quick reply. We are frustrated but determined.
     

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