[Rose76]

I'm trying to help my friend get set up with some home care, so that he can remain home and not have to go into a nursing home. He is an elderly Vet whose primary care is from the VAMC. (disabilities are not service connected.) His income and assets are very sparse, and I believe he would qualify for Medicaid, if he went into a long-term care facility. He would like to stay home for as long as he can. (Currently, he does have Medicare available, but not Medicaid.)

I thought the VA would more or less arrange this, but that doesn't seem to be quite the case. It seems that I'm going to have to find out what his options for home care are. Even the Social Worker at the VA seemed to not be the greatest source of info. Lots of his neighbors (with similar level of disability) in the senior apt. complex where he lives have home care aides coming and going, so I think he should be eligible for something similar.

Anyone have any experience navigating this?

Also: I'm thinking he might benefit, a lot, from a motorized scooter or wheelchair. Anyone know how a person goes about getting that, either through Medicaid or the VA?

He has no family nearby to help with this. I tell him that if we don't get on this stuff soon, he might find himself forced into a nursing home. He's had a few falls. I was shocked to see that there seems to be waiting lists for some of the benefits, e.g. non-institutional Medicaid.

Thanks for any feedback anyone has.

I think that's a great thing you're doing Rose. I really hope you can help him avoid having to go into a nursing home. Medicaid is a state program and I believe just about everything about it varies by state. It might help to know his age and the state he lives in. I'm surprised the SW at the VA can't be more help. He/she should be know the answers or be willing to find out.

[Rose76]

The SW told me that she thought his income would be too high for medicaid. Last night, on line, I saw something that indicated that his income would have to be a good deal higher before it would be too high. She was nice, but I've found, in the past, that he's gotten bad direction from them at the VA. When he needed appropriate senior housing, they said that could take over a year to find. (They recommended a VA nursing home.) On my own, I was able to find low-income, handicapped accessible, senior housing for him in less than 2 months. (He's done great there for years.) I've learned not to trust anything I'm told about how "hard" it is to find something.

Back then, at a team care conference, the SW was busy in a corner typing up stuff about another patient. I requested that we delay the start of the meeting, until she could grace us with her presence. Sorry to sound sour, but experience has done that to me. It seems that marginalized members of society are apt to remain exactly that without strong advocacy by some caring friend. (Excuse my vent.)

I guess things will surely vary by state. Any info would give me an idea of trends. I think VA practices might be more standardized across the nation.

SW has referred this to a nurse, who is supposed to contact us. I'm wondering what to expect. I read somewhere that the patient has to need assistance in at least 3 activities of daily living. He tends to say he can manage just fine with anything they ask about. Not true. I'm trying to coach him not to disqualify himself by sounding overly independent. People who've been through the vetting process often understand this issue.

[~Christina]

He is lucky to have your help Rose

I use to do home health care... The biggest issues they are looking for are

(non RN issues)

Does he need assistance Bathing?
Is he able to wash and dry his own clothing?
Is he able to fix meals for himself?
Can he keep his residence clean and clutter free (decreases fall risk)

He needs to answer these with a NO !

Do he have safety bars in the bathroom? ( decreases fall risk)

RN issues

Is he capable to taking any medication correctly and on time?
In regards to a fall .. A RN can contact his Doctor and request he
be evaluated by a Physical Therapist. they will also see if a scooter is needed
Do he have any wounds?
Is he diabetic?

These are just a few "common" questions that will help determine what he qualifies
for ..

Men really don't like to amit they are having trouble .. but .. If he doesnt he would get any help that he DESERVES!

Hope this helps and dealing with the VA .. Ugh ! You just have to keep calling and calling ... The VA "assumes" people will not push for what they deserve and just go pay for it themselves ... So be pushy .

Good luck

[TerryL]

Hey Rose, have you tried contacting your local Medicaid office? or your State Dept of Human Services or Dept of Health?

I know your friend wants to stay at home and his condition doesn't sound that bad yet but just in case..my state has an adult foster home program for nursing level of care clients. It is a Medicaid-subsidized program. It keeps people out of institutions and the clients get to stay in a home-like environment. It's not everyone's cup of tea and it might not even be available in your state, but just thought I would share it as an option.

[Perna]

Don't know if this will help?

Home Based Primary Care for Senior Veterans - Geriatrics and Extended Care

It looks to me like you probably cannot have both and/or if he can get Medicaid, his VA benefits will be reduced proportionally, etc.

Moving Vets Off Medicaid and Onto VA

[Rose76]

Christina, Thanks. He tends to say he is fine with all ADL's, and he is not. On a lot of these issues, he is kind of on the cusp . . . sort of managing, but really needing supervision. It seems the VA does hang back and can leave you in the lurch, if you do not "push."

Terry, I checked on the Medicaid, and it sounds like applying for that would be one way to go. If I'm reading right, we do need to go to Dept of Human services for that. I'm wondering if that, or the VA, would be better. Maybe there would be no harm in applying for both.

Perna, Thank you, those are very relevant articles.

[Perna]

Rose! Looks like there might be a special additional little-known VA pension that can be applied for for what you are looking to get for him:

Veterans Administration Aid & Attendance Special Pension Information by VeteranAid.org

[Rose76]

Somehow I didn't see the last post above until now. Thanks Perna. It sounds relevant to his situation.

[Rose76]

Originally Posted by Perna

Rose! Looks like there might be a special additional little-known VA pension that can be applied for for what you are looking to get for him:

Veterans Administration Aid & Attendance Special Pension Information by VeteranAid.org

Well, great news. I have been contacted by a company with a contract with the VA to assist veterans to apply for a "pension" that is available to meet the cost of getting assistance in the home. It results in the veteran getting a payment of over $1700/month to use to pay the home care agency. It provides for about 70 hours of in-home assistance.

This is sounding to me like what is described in the link provided above by Perna. I would have thought the phone call was a hoax, if not for the description in that link. This could make a huge difference in my friend's life. It is very hard to believe that it is true. But it seems that it is. I am flabbergasted that this is not more known about. (Apparently, the social worker at the VA didn't know about this. But, then, I've found VA social workers to be less than real helpful. Sorry to say.)

Thank you, Perna.

[yellowted]

it sounds like the American equivelant to the UKs Direct payment scheme which i use to pay for my Personal care assistant who helps me get up/dressed, personal care like bathing and continence care, she also helps with cleaning the house, washing clothes, shopping, caring for my pets and taking me out to live my life. a great scheme when it works!

[Perna]

Aid and Attendance Housebound - Pension

Hmm. Looks like it's right on the VA's own page too, doesn't need an outside agency to apply for but maybe it's like your SSDI, Rose, and better/faster with an agency? Odd the VA social worker wouldn't know about it.

[Rose76]

Thanks for the link above. That does sound like what my we are looking at through this agency. I think there are, like, 3 levels of benefit. To me it's very confusing. I do feel I wouldn't have made this much progress without the agency. Here is their web site:

Veterans Care Coordination | Seniors who served yesterday, benefit today

It seems a shame that a private company has to make money off of my friend getting a benefit, in order for my friend to get it. I'm sure it's not absolutely necessary, but, if it gets him what he needs, without taking from his benefit, I'm okay with it.

It was actually the home care agency that contacted the agency above. Here is the link for the home care agency:

Addus HealthCare

I think it's very odd that the VA social worker hasn't answered, or returned, any calls made over the past 2 weeks by either me or my friend's daughter. She told me to call her if we did not hear from a nurse soon. We didn't.

The support person at my friends HUD complex called the home care agency. They got the ball rolling by coming out and meeting him. Then they called the agency above that does the paperwork. This just occurred to me: Maybe the home care agency pays something to "Veterans Care Coordination." I'm going to ask them: just how do they get paid?

Ultimately, everyone is getting paid by the American public. Doesn't this all seem a rather round-a-bout wasteful way to get things done?

[Rose76]

It turns out that the home care agency is the party that pays the "Veterans Care Coordination" agency for their efforts to get the benefit from the VA.

When I see how impossible it is to deal with the VA directly, I can believe that "VCC" earns what it gets. It is, indeed, very analogous to using a law firm to get Social Security Disability Income. The "VCC" person, who has briefed me extensively on the phone (The company is located in Missouri.), knows all the information that I had hoped the VA social worker would know.

The VA social worker said she doubted my friend would be eligible for anything because she sort of thought that a veteran's income had to be below $12,000/year to qualify. She was fuzzy about everything. There are 3 "tiers" of benefits available through the "Improved Veteran's Pension" benefit. One of those levels does, indeed, require that annual income be slightly less than $12,000. My friend qualifies for the most advanced level, which allows for a higher income.

I would never have figured that out on my own.

Another requirement is that the Veteran has to already be getting an expensive amount of home care before the VA will approve his application. This is where the 2nd role of "VCC" comes in. They will actually underwrite the loan that will pay the home care agency, while the application is pending. When approved, my friend will receive retroactive payments from the VA of over $1700/month for every month that he has been receiving home care. He must agree that he will use those funds to reimburse "VCC" for the outlays they have made to Addus Homecare. (Again, somewhat analogous to the contract with a law firm that helps you get SSDI.)

VCC has an office full of people who hound everyone who is needed to contribute documentation necessary for getting the application for pension benefit approved. And a hound is what you need. You would think that the medical part of the VA could just nicely pass along the needed info to the benefits part of the VA. But no. That's not how they do things . . . as I've found out pounded my head against a brick wall at the VAMC for weeks now. VCC told me that families have spent as long as 18 months trying to get the different parts of the VA to collaborate. Meanwhile, they spend out of pocket for home care help.

Plus, VCC knows exactly how all the paperwork needs to be filled out. They review everything and make sure everyone fills everything out correctly. They will talk me through the 25 page form that I have to help my friend fill out. They will pester the doctors whose input is needed. I know how reluctant doctors can be to fill stuff out.

I have a lot of paperwork to wade through, but I think this will be worth it. I feel less depressed now. Once my friend has some home care that will help him with shopping, laundry, meal prep., housekeeping, etc., then maybe I can focus on so much that I need to do for me.

[Perna]

I think all big Government agencies like VA, IRS, etc. are complicated these days; that's Congress's fault rather than theirs often as Congress passes the laws and paperwork they have to follow and they never make sense. We have to pay all these paper pushers and there are never enough for the complexity of the problems; look at the people who don't pay their taxes/get behind and have to get former IRS agents/lawyers involved to help sort things out. I remember when I was taking the H&R Block course to be one of their tax preparers that's one of the first things they tell you, "It doesn't make sense, it was created over the years by a zillion Congresses just throwing stuff at the wall. . ." We already know the Country's budget doesn't work and these big agencies (Postal Service and Social Security, included; we know Congress has messed them up too) aren't in that much better shape. Our whole infrastructure, never mind just the roads and bridges :-) is in horrible shape.

[Rose76]

It's hard not to believe that the social infrastructure couldn't stand some streamlining.

I am trying to complete the paperwork for my friend today. It's a lot of work. Hopefully, it goes through okay. Then he will start getting some help on June 1rst.

[Rose76]

Well, the plot thickens.

The Pension for Aid and Attendance is considered non-taxable income by the IRS. Unfortunately, it is treated as ordinary income by HUD in my state. That means that, with the extra $1700 per month that the pension would provide (all to be disbursed for home care,) my friends rent would go way up. He has section 8 assistance. His rent would more than double, practically gobbling up almost all of his small social security check.

The company called Vetercans' Care Coordination insisted this wouldn't be the case. I did some deep checking. It is the case. Now they admit it too. So my friend doesn't want the benefit, and I understand his position.

Meanwhile, through the VAMC, he has been deemed eligible for some home care that does not involve this benefit, so that is what I am helping him pursue. His medicare will, supposedly, pay for it. It is taking quite a while to get set up.

We recently talked to a social worker who also believed that the Pension for Aid and Attendance would work out ideally. He did not understand the implications for HUD housing and was surprised when I told him.

It seems, according to one of my contacts, that HUD is interpreting this benefit differently, depending on what state you live in. VCC said they have lawyers who are fighting for a consistent interpretation across the country. Something's really wrong with this picture.

[Perna]

Oh, Rose, what a mess. Unfortunately I don't think the lawyers will win in this case since housing is a state's-rights sort of oversight, the State will always know "better" what it needs and be able to apply its rules for its citizens and have discretion on what to tax for itself. The housing doesn't move across state lines :-) so. . . The HUD is just the money giver and overall rule maker but can't mess with the state's right to tax. It's kind of like the SSI money and policies and why they are different state-to-state; SSDI is Federal/Social Security so they can't mess with it but SSI is state-run.

I hope the VAMC home care works out.

[Rose76]

Actually, states can, and do, kind of mess with SSDI. The first decision to grant SSDI - or not - is made by the local Disability Determination Service, which IS a state agency. They are contracted by the Federal Govt. (by the SSA) to provide that service and make that judgement. When I was applying for SSDI, my doctor warned me that the state where I lived was much harder to convince of disability than, say, California. As I think you know, there are web sites listing the relative leniency - or lack thereof - of various states. I guess something comparable is going on with HUD.

I don't think that the state's taxing authority has too much to do with either of these benefits (Social Security, or Section 8 subsidy.) Each state knows that it has many more citizens wanting a benefit than there are dollars to go around to provide them all with the benefit. So the state's interest, I would suspect, is in trying to make sure that the benefit goes to those most appropriate to get the benefit. (The state has no reason to turn down any Federal dollars. It does have good reasons to want to influence who, among its citizens, will be the ones to get those dollars.)

My understanding is that none of the 50 states are trying to tax the Pension for Aid and Attendance. Here is a link to support that:
Is the aid & attendance pension taxable?

[Perna]

Social Security comes directly from the US Government and is based on one's work history; we pay into Social Security, we don't pay into supplemental housing allowances :-) With Section 8, HUD gives the State money and the state divides it up; they have some overall rules and get X amount because the Feds knows/has decided the State's share of all the Fed money for housing is X but then things get interesting because there's the "poor" but not disabled and the disabled but who aren't on Social Security (or get VA or Military benefits), etc. and they all may need housing assistance.

States may want money from anyone who they are giving it to, any "income" at all, so I can see that some states might consider "their" HUD-based allowance income but not be able to touch someone else's (VA's) similar program; it's not under their control. I think it is kind of like how most states subtract out of your total income a matching amount when you get food stamps under SSI? They control SSI monies the same way they control HUD monies (and hence, since SSI has the same disability tests as for SSDI and they are in charge of the tests, some states are "harder" to pass).

It's all a very complicated racket run by Government employees so very red tape and confusion bound but getting States to agree with "each other" (to do things the same) is next to impossible :-)

[Rose76]

Perna, you say above that the federal government gives each state "X" amount of money, which is what the feds have decided to be that state's share of the HUD money. Where did you get that from?

Many states have tried to get federal aid granted in the form of "block grants" that the individual state can then disburse as they see fit. There are good arguments for doing things that way . . . as well as some sound arguments for not doing things that way. This is an on-going debate, which is far from resolved. Currently, it is not totally (or even largely) left up to any state to decide how HUD money is going to be disbursed. It might be your belief that it should be done that way, and you might have a real good argument for that, but it simply is not how the system does work - at this time.

HUD operates a number of different programs. There may, indeed, be programs that involve some block grants to local authorities. In fact, here is an example of one: The Community Development Block Grant program.

That program I've just described is one small part of where HUD money goes. It really has nothing to do with my friend's situation. The "project-based section 8 assistance" that my friend gets is money that goes from the federal government to the owner of the property on which he lives. That money doesn't first go to the State, which then decides how the money should be disbursed.

I've been informed by the property management where my friend lives that the upcoming change in HUD administration will involve the setting up of regional HUD offices that will not even be set up according to state boundaries. She said that, eventually, our area in New Mexico will be administered out of Denver, CO. So the disbursement of HUD funding is much less under the control of individual states than you seem to believe.

One HUD program is the Section 8 Voucher program (not what my friend is under.) A renter who is granted a Voucher can move to any state in the Union and use it wherever he/she goes. That renter could conceivably live in a different state every year, using the same voucher. He/she just has to find a local landlord who will accept the voucher. The landlord must then have his property inspected by local HUD authorities. Do all local HUD authorities march in lock-step? Surely they don't. That leads to inconsistencies. But the inconsistencies do not come out of states' differing tax policies.

[Rose76]

Originally Posted by Perna

Social Security comes directly from the US Government and is based on one's work history; we pay into Social Security, we don't pay into supplemental housing allowances :-) With Section 8, HUD gives the State money and the state divides it up; they have some overall rules and get X amount because the Feds knows/has decided the State's share of all the Fed money for housing is X but then things get interesting because there's the "poor" but not disabled and the disabled but who aren't on Social Security (or get VA or Military benefits), etc. and they all may need housing assistance.

States may want money from anyone who they are giving it to, any "income" at all, so I can see that some states might consider "their" HUD-based allowance income but not be able to touch someone else's (VA's) similar program; it's not under their control. I think it is kind of like how most states subtract out of your total income a matching amount when you get food stamps under SSI? They control SSI monies the same way they control HUD monies (and hence, since SSI has the same disability tests as for SSDI and they are in charge of the tests, some states are "harder" to pass).

It's all a very complicated racket run by Government employees so very red tape and confusion bound but getting States to agree with "each other" (to do things the same) is next to impossible :-)

We don't pay into Food Stamps, in the way that we pay into Social Security, but that doesn't give states any control over who gets Federal Food Stamps and in what amount. (Many states do add their own money to the federal program and provide an enhanced benefit to citizens. Basically, if you qualify for the federal food stamps, then you automatically get the state food stamps.)

Actually, what I've just said is not 100% true, and that could be the source of a lot of confusion. In order to get food stamps, you go to your local office of Income Support. That is a state agency. This state agency does decide whether, or not, you are eligible for food stamps. However, they don't get to make their own rules. They simply apply the criteria as they are instructed to do by the federal government.

Money goes further in some parts of the country than in others. For instance, an income that would have you living in the Subway system in NYC would get you a pretty nice apartment in southern Missouri. So the Federal gov't doesn't say how much food stamp benefit goes with what level of income. Neither does the State! The federal government says that you qualify for food stamps based on how your income compares to the income levels in the area where you live. (e.g. how far below the median income are you?) The federal government gives the states formulas to use. The states just plug in the numbers to the formulas. The states do not get to create the formulas.

The states do not "control SSI monies." If you live in NYC, you do not get a bigger SSI check than if you live in southern Missouri. Neither the State of New York, nor the State of Missouri, decides what your SSI check is going to be. If you are 65 years old and sufficiently poor, you will get approved for SSI, regardless of which state you live in. The amount of your SSI check will be the same, regardless of which state you live in. However, most states have their own income support programs, which add to the amount of your SSI check, based on conditions in each individual state. West Virginia and Mississippi are two states that do not do this. When a state adds to your benefit, it is not increasing your SSI check. It is giving you an additional income benefit independent of your SSI. The states control the monies that they give out, if they chose to give any money out. The states do not control how much money the federal government gives to anyone receiving SSI.

Here's where I think the confusion comes from. If you are not yet 65 years old, and you believe that you are too disabled to work, then whether or not you get SSDI, or SSI, initially depends on a judgement made by the local Disability Determination Service, which is a state agency. That DDS agency doesn't get to decide what the rules are for determining disability. They simply apply the rules set by the federal government. However, applying rules is not an exact science. The DDS in one state might tend to look at things different from the DDS in another state. Two DDS examiners in the exact same office might look at things differently. That is why the initial judgement can be so easily challenged. If you get denied by the DDS in your local area, you can appeal. The Administrative Law Judge that you end up going before (if you have to take it that far) is a federal employee and works for the Social Security Administration, not for any particular state.

[Perna]

Thanks, Rose, for all that clarification. Yes, I was thinking of the states adding various amounts of money and services to SSI. I should not have used the word "control". SSDI can only be gotten if one has worked a certain period of time. That comes from the Social Security taxes whereas SSI comes from general Treasury funds/taxes. A few people can get both SSDI and SSI but the limit for income for SSI is only $2,000/$3,000 a year and I think most people's Social Security checks would be more than that if they had been working the 10-20 years or so they have to have been to qualify for Social Security.

If you get SSI, you also may be able to get help from your state or county. For example, you may be able to get Medicaid, food or other social services. Call your local social services department or public welfare office for information about the services available in your community.

From: http://www.ssa.gov/pubs/EN-05-11000.pdf

It is so very confusing. Really interesting tables of how many people are getting the various benefits:

Monthly Statistical Snapshot, May 2013