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Old 04-20-2015, 02:00 PM   #41
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Can you elaborate on what ability to pay entails? I'm particularly interested in what it practically means for a married couple where the disabled veteran is likely to require some type of care (in home or SNF) and is likely to predecease his spouse by at least a decade. If the veteran requires say 5-7 year of LTC while his spouse is healthy and living in the community, are they going to have to drain their personal retirement accounts first before the military kicks in for his care? This could very well leave the surviving spouse with 10+ years to live with no assets.

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Originally Posted by razztazz View Post
Another weird confluence. This past week I have been researching this exact thing. LTC (nursing home and in some cases Assisted living arrangements) are available via the state run Veteran's Homes formerly known as "The Old Soldier's Home".

Yes, cost is based on ability to pay. You cannot be turned away except for not meeting state residency or medical requirements. They are not The "VA" they are State run entities and different rules apply in each state.

I found out I am eligible for a slot in one of Nebraska's four Veteran's Homes and also in the one big centralized one in the State of Iowa.

My hang up with this is if I ever end up in a group living arrangement
for veterans in my old age they will be the same azzholes I had to live in the barracks with in my young age!
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Old 04-20-2015, 02:02 PM   #42
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I'm not sure, but I believe that the care would be priced according to financial need.

That's a heck of a question for my next eBook, though-- thanks for asking it. I'm going to have to research what the VA would do, and for which veterans, and from what care contractors, and how much it'd cost.

At this point even the VA is preferable to John Hancock.
Good luck on that project, I think it is a huge can of worms and rules vary from state to state. Since my DH is a disabled vet, please let us know here if you do any posts or updates about this on your blog..Thanks!
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Old 04-20-2015, 02:02 PM   #43
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Originally Posted by Marita40 View Post
I remain conflicted about LTC.
I feel your pain.

I've posted previously that we purchased LTC policies for each of us when we were in our early 50's. Six month waiting period, 5% annual inflation adjustment, three years of coverage with an initial premium of just under $600/yr for each of us. The premium went unchanged for 14 years before we were hit with a 50% increase last year. We now pay $875/yr each for coverage that has grown to $208/day from an initial $100/day.

I'm sure we have not seen the last of the increases nor the opportunity to be conflicted.
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Old 04-20-2015, 06:09 PM   #44
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Can you elaborate on what ability to pay entails? I'm particularly interested in what it practically means for a married couple where the disabled veteran is likely to require some type of care (in home or SNF) and is likely to predecease his spouse by at least a decade. If the veteran requires say 5-7 year of LTC while his spouse is healthy and living in the community, are they going to have to drain their personal retirement accounts first before the military kicks in for his care? This could very well leave the surviving spouse with 10+ years to live with no assets.
I haven't looked into the nitty gritty yet and as he post after yours says the rules vary state to state.
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Old 04-20-2015, 06:42 PM   #45
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The Genworth policy my mom has lists these six criteria for payment:
BATHING- Washing oneself by sponge bath;or in either a tub or shower, including the task of getting into or out of the tub or shower
DRESSING- Putting on and taking off all items of clothing and any necessary braces, fasteners or artificial limbs.
TRANSFERRING- Moving into or out of a bed chair or wheelchair.
TOILETING- Getting to and from the toilet, getting on and off the toilet and performing associated personal hygeine.
CONTINENCE- Ability to maintain control of bowel or bladder function, the ability to performm associated personal hygeine.
EATING- Feeding oneself by getting food into the body from a receptacle (such as a plate, cup or table) or by a feeding tube or interveneously.

She needs to be deficient on 2 of the 6. On good days she can pass all of them, but she's freaking 95 years old and just shouldn't be living by herself or with a lot of checking on, at least.

She just survived a house fire and pneumonia. She's finally going into assisted living and I hope , since we all know corporations are people too, they will be understanding (after she has paid them $100k over 20 years). She will have her interview in a couple of weeks- will report.
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Old 04-20-2015, 08:03 PM   #46
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Wow, went through some of this VA stuff for my dad.

First of all, did you know about the "Aid and Attendance" benefit? We were pretty enthusiastic about this. Dad served in WWII and is eligible, even though he is not an army pensioner.

But alas, the benefit really isn't that much (can't remember exactly, but a few thousand a month), not enough to pay his LTC. It kind of seemed useless, to be honest, but I think it could work for some folks in assisted living. Dad had a 10% war disability too, and this payment would be deducted for the AA payment.

Second, all the VA LTC benefits have ability to pay in them. They also have some priority scheme. Dad would not be at the front with his (non government) pension and only 10% disability.

The application is thick. I suggest anyone considering it dig deep. You can find information out there. Also, I spoke with some finance folks at dad's home and they had indications of what it takes to get VA benefits. Assets (aside from home) need to be in the $100k or less range. Over that, and you probably will be denied. However, sometimes it takes months (1/2 year or more) go through the app, so people apply ahead and watch their assets drain during the application wait. NOTE: do not take my 100k number as firm gospel. The "real" number floats and is based on location, monthly income, etc., etc. It is just an estimate based on what I heard from finance people who were willing to talk. Very few people want to give any indication of what this number is.

What I basically found was that there are all sorts of tricks people do to hide assets, hide pensions, etc., etc. I was unwilling to do any of that and we continued our self-pay.

The process is so complex, there is a whole shady industry built around it. Supposedly, nobody can charge you for advice, but they "have ways."

As for straight VA nursing care, it was similar. But as I said, Dad was going to be at a lower priority since he was not a full military pensioner. And there were need requirements similar to the AA plan, so again, we didn't bother.

Let me summarize what I felt about this... The VA nursing or aid benefits are just a bit above Medicaid from a financial eligibility standpoint. I didn't visit a VA home. I would hope, though, that the standard of care was better. Despite what you may hear out there, Dad and us kids loved the VA. They treated him well -- even saved his life twice. Our only problem was it would take 3 months or more for many appointment lead times. I'd hope their care facilities were as good... but I don't know.
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Old 04-20-2015, 09:01 PM   #47
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For varying definitions of "care", yes.

Paying for Long Term Care - Geriatrics and Extended Care
The question is is the disability service connected and the percent of disability. If high then the answer is likley yes. If low you get into the means tested realm. High is 70% here is a link to an article with more info:
https://www.caring.com/articles/va-nursing-home
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Old 04-21-2015, 08:27 AM   #48
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The question is is the disability service connected and the percent of disability. If high then the answer is likley yes. If low you get into the means tested realm. High is 70% here is a link to an article with more info:
https://www.caring.com/articles/va-nursing-home
In this case the disability is high (I believe it's 90 or 100%) and service related -- related to Agent Orange exposure, which I believe may have some additional entitlements (at least the presumption of disability without having to prove as much).

Based on this, it seems this applies (Paying for Long Term Care - Geriatrics and Extended Care

Special Monthly Compensation
If you receive VA compensation for a service-connected disability, you may be eligible to receive additional monthly monetary benefits if you ALSO:
Require significant help with your personal care needs by another person because of your disability, or
Are bedridden because of your disability
You can use your Special Monthly Compensation payments to help pay for services that you need.


SMC rates: Special Monthly Compensation (SMC) Rate Table - Effective 12/1/14 - Compensation
Looks like from around $3,500/mo to $5,000/mo, depending on rank and status.


There is also the Aid & Attendance that someone else mentioned.

What I can't find is if these are means tested. Again, the primary concern is what about a community spouse who is depending on traditional retirement assets to live off of.
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Old 04-21-2015, 08:29 AM   #49
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The question is is the disability service connected and the percent of disability. If high then the answer is likley yes. If low you get into the means tested realm. High is 70% here is a link to an article with more info:
https://www.caring.com/articles/va-nursing-home
Exactly! Which is why dad at 10% was back of the line.

If you do fall into means testing, I gave some of the rough guidelines. YMMV.
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Old 04-21-2015, 09:07 AM   #50
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We have a friend who recently bought LTC for himself. $6K/year premium, he is early 60s. Couldn't buy it at all for his DW, also early 60s, but would have been happy to pay $6K/year for her as well.

We ourselves have LTC that we bought for both DW and myself in our mid 30s. We're now 57 and while the coverage cost, with Hancock, has increased by 75%, it is about $2K/year for both of us. Very good coverage as well, but I expect the cost to double every 7-8 years. We're going to hang on to it. DW's mom spent 15 years in a wheelchair due to multiple strokes. Her dad took care of her mom all that time. I have relatives on my side with early dementia.

We think this will protect each other should something go wrong with the other spouse.
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Old 04-21-2015, 09:14 AM   #51
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This link brings you to the latest "Senior Living Guide" from the Chicago Tribune, last sunday.
It IS an advertisement provided by dozens and dozens of facilities , but more importantly it has a broad overview for alternative living for seniors.
The part that I found interesting was that each of the different alternatives gives a price range for that particular type of care.
As much as I thought I knew about senior living, the different links opened my eyes to things I haven't considered.
The pages are directed to Ilinois residents, but the information is general in nature.
Illinois has its' own websites that delineate the state assistance for different levels of income and medicaid eligibility. Most states will also have this type of homepage for legal and financial matters.
Note... click the main headings for access to the information pages.

Senior Housing Guide - Chicago Tribune
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Old 04-21-2015, 09:15 AM   #52
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Based upon this web site: VA Health Care: Cost and Co-payments | Military.com it appears that significant service connected disabilities remove any means testing for getting the benefit. (Which only makes sense since the disability was due to military service). It appears the means testing is primarily for those with low disability percentages
The following from the web site discusses VA means testing
"Certain nonservice-connected and 0% noncompensable service-connected veterans are required to fill out the financial worksheet, which we refer to as the "Means Test." A means test is a gathering of financial information by which VA determines your priority group for enrollment, and whether or not you are required to make copayments for the service you receive. The means test is based on prior year income and net worth."
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