VA Disability and How to Qualify for Nursing Home Coverage

Around 18 million individuals, or around 7% of the U.S. adult population, have served in the army. 

Each of these veterans, whether on active duty, guard, or reserve, who are at least sixty-five years old or have a service-induced disability with little to no income, could potentially qualify for VA benefits. Most veterans do qualify for healthcare benefits, but this is subject to disability and other factors. 

If you or someone you know is looking to file a claim for VA benefits, there are likely, some questions on your mind.

For one, do VA benefits include nursing home care for veterans? If they do, who is eligible for these benefits? How do you apply or what do you do if your application falls through?

Do VA Benefits Include Nursing Home Care for Veterans?

The short answer is – yes, it does include nursing home care for veterans. 

The Department of Veteran Affairs, or the VA, makes provisions for veterans whose conditions aren’t severe enough to warrant hospital care, but who are still unable to take care of themselves due to their age or disability. 

However, to qualify for nursing home care, you must meet a specific set of criteria. Furthermore, you may be able to opt for long-term care or short-term care depending on your needs and which of the two you are eligible for. 

This brings us to our next question. Who is eligible for nursing home care?

Veterans Eligible for Nursing Home Care

Want to sign up for long-term or short-term home care through VA benefits? You may be eligible for nursing home care if you meet the following criteria put forth by the VA. 

1. You should have a service-related disability
2. This disability rating must be at 70 percent or higher, according to unemployment criteria, or alternatively, you must establish that you require specific services for ongoing care or treatment
3. An authorized physician must determine that the need for such care exists

Additionally, they may consider other factors like income and insurance coverage while evaluating your eligibility. Do keep in mind that you should already have signed up for health benefits to qualify.

Priority Groups for Home Care

However, the VA also has a set of groups for whom the VA must provide home care on priority. This group includes:

• Anyone requiring nursing home care due to a service-related disability
• Those whose combined disability rating adds up to 70 percent or more
• Those with a disability rating of 60 percent, due to which they are regarded as unemployable, or alternatively, as permanently disabled 

This group of people will be considered a “priority group” in the eyes of the VA while considering nursing home care. This means that their needs will take priority over the needs of others. However, when everyone under this priority group receives the care they require, other candidates will be provided for, if the VA has enough resources to support them.

Types of Home Care Available

Those who are eligible have access to various types of home care provided by the VA. These include Community Living Centres or CLC, Contract Nursing Home Care, and State Veterans Homes. 

Here is a more detailed description of what each of these types includes and their eligibility criteria. 

Community Living Centres

Community Living Centres (CLC) are generally located within VA medical centers. Currently, there are more than one hundred and thirty operative CLCs in the United States of America. 

Some may remember them by their former name as Nursing Home Care Units or VA Nursing Homes. Sometimes they can also be in a separate building within the vicinity of the medical center. 

These centers are designed to look and feel like real homes. They allow veterans the freedom to keep their own animals, and the liberty to personalize their own rooms. If you live in a CLC, you will be entitled to:

• All day, 24-hour nursing care
• Mental health-focused care and treatment
• Respite care
• Restorative care
• Access to social work services
• Palliative care
• Geriatric management and care

and more. 

Additionally, there will also be special provisions available to veterans with dementia, Alzheimer’s, or other cognitive impairments. 

Here one of our VA disability lawyers talks about how SMC (Special Monthly Compensation) works to help you get more money for extra expenses related to your disabling condition every month.

How Do You Get Into a CLC as a Veteran?

Admission is generally not guaranteed unless you fall within the specified priority group. Additionally, to be eligible for care under a CLC, you must:

• Be enrolled within the health care system
• Be deemed medically and psychiatrically stable
• Provide in writing your requirements for short or long term care

The VA may consider other factors like the nature of your condition and the availability of services within the CLC. 

Veterans who do not have a service-related disability that is rated at 10 percent or higher, and who receive an income that exceeds the pension rate set by the VA, must also make a co-pay. However, those who do have a disability rating of 10 percent or more will receive full payment for the services at the Community Living Center. 

Find a CLC near you by downloading this complete list of VA CLCs by state.

Supplied by va.gov/Geriatrics and Extended Care

Contract Nursing Home Care

Contract nursing homes refer to private nursing homes. These are generally reserved for veterans with severe disabilities who require short-term care ranging from thirty days to six months. 

If you are a veteran who requires contract nursing home care for a disability with a connection to service or are currently receiving home health care post-discharge, you would be eligible for direct admission to a contract nursing home near you. 

To prove this, a physician must be able to establish that you do in fact require nursing home care. However, a veteran with a disability rating of 70 percent or higher would also be eligible.

However, the VA may determine that you require contract nursing home care, in which case you would also be eligible, provided that you are currently in a VA hospital or are on the receiving end of hospital care. Additionally, you could also qualify if you are an active member of the Armed Forces who is in need of nursing care and would qualify as a disabled veteran on the day of discharge. 

Do keep in mind that the VA will only pay for veterans who are in contracted nursing homes that participate in the VA’s programs. 

State Veterans Homes

State veteran homes are those that are run by the state but receive approval from the Department of Veteran Affairs. These receive support through the VA, commonly referred to as “per diem aid”. 

Within these homes, the VA will pay up to half the cost of care for veterans. These homes provide a range of services including hospital care, nursing home care, domiciliary care, adult daycare, and more. However, your care will depend on which of these you are eligible to receive. 

However, in addition to the VA’s requirements, you may also have to meet special state requirements for admission into a state veteran’s home. 

Long-Term Care

In addition to the three types of nursing home care available to you, you might also be eligible for long-term care provided by the VA. Long-term care covers a wide range of services that help veterans manage daily tasks, or cope with disability or illness. 

They are provided for extended periods of time and can be offered in a variety of settings including your residence, communities, nursing homes, and more. However, eligibility for long-term care will be evaluated on a case-by-case basis. 

Some factors that could impact your eligibility include financial needs, service-connected disabilities, the extent of your disability, insurance coverage, and more. 

Some of these long-term care services include medical foster homes, adult family homes, adult day health care, veteran assisted living facilities, respite care, hospice care, palliative care, tele-healthcare, veteran-directed care, and home-based primary care. These services are either directly offered by the VA, but the VA also collaborates with other community-based agencies. 

Those veterans who are eligible for compensation due to a service-connected disability are exempt from paying long-term copayments. However, those who are considered non-compensable and zero percent veterans may be required to pay long-term copayments as specified by the Department of Veterans Affairs. 

Cost and Financing

Any veteran who is eligible for, and consequently receives nursing home care, could have their monthly pension reduced. However, this won’t happen in all cases. 

For those veterans who have no dependents, who are living within Medicaid-approved nursing facilities, and whose nursing homes are paid for by Medicaid, monthly pensions will be reduced to $90. 

However, in the case of long-term care, if you are receiving additional compensation for a service-connected disability, you could even be eligible for additional benefits if you are in urgent need of care from another person, or are bedridden. 

The VA does not cover all services provided through the home care system. Do be sure to check for what is included and what isn’t before going through any decisions. You may also be able to seek financial assistance with these services through private insurance companies such as Medicaid or Medicare. You should especially ask these questions if you aren’t going into a veteran nursing home.

This firm has been excellent at obtaining my disability claim. I now am 100% service connected. No complaints. Thanks to Woods and Woods. I will recommend them for anyone trying to obtain service connected disability.

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How to Apply for Home Care

If you haven’t already applied for VA health care, it is imperative that you get started on that process before you apply for home care facilities. We don’t help with that specifically at Woods and Woods, but a lot of the documentation we get together to win your VA disability case is the same documentation you’ll need to get into a VA nursing home.

Some documents you may require during the process include:

• Your most recent tax returns
• Your own social security numbers
• Social security numbers of your financial dependents
• Account numbers and information regarding any ongoing healthcare or insurance plans

You can apply over the phone, through the mail, in person, or through a third party. 

Once you’ve enrolled for VA benefits, you should then enroll yourself in a primary health care clinic. Here you will be required to get an evaluation done for whether or not you need nursing home care. 

After approval, if you do meet the eligibility criteria for home care, you may then apply to a Community Living Center, a Contract Nursing Home, or a State Veterans Home near you. There may be other options for assisted living for veterans in your area.

To apply for CLC care, your physician must submit an application that requests care for you within a Community Living Center. Depending on whether or not you are exempt from co-pays, you will have to fill out an additional form, namely VA Form 10-10EC. 

To apply for a contract nursing home, your application must be made by your doctor, a social worker, or a nurse through the right form. VA benefits do not extend to private nursing homes that do not participate in their programs. Your local RO may also know about nursing homes for veterans in your region.

To apply for long-term care, you must have an enrollment with VA health care. This means you must have applied to VA health care and received health care through a VA facility. However, note that simply receiving financial compensation through the VA does not directly qualify you for enrollment within the system. 

Get Started on Your VA Disability Claim Today

If you feel like you meet the criteria to qualify for home care for veterans, as offered by the VA, it is time to get started on your application. 

Not sure where to begin? Have you been denied before and want to make an appeal?  

At Woods and Woods, The Veterans Firm, we help you through every step of the way to ensure that you have the best possible chance of getting approved by the VA. We’ve helped thousands of veterans with their disability appeals.

Call us today to discuss your VA disability appeal. The call is free and we won’t charge you a single fee unless we win your case. You can look for a VA disability attorney near you or call us and join the thousands of veterans living off of VA disability thanks to Woods and Woods.

Talk to Us About Your Claim: (812) 426-7200