A VA adjudicator called the facility and asked if the facility provided “medical care” to the vet, and the facility said “No”.

A veteran was denied the full amount of his Aid and Attendance because he lived in the “independent living” wing of an assisted living facility.  The VA approved his A&A for his pharmaceutical cost but did not approve of the rent paid to the independent living, because the VA adjudicator called the facility and asked if the facility provided “medical care” to the vet, and the facility said “No”. 

You must, if you are a veteran or a family member acting as agent, filing for aid and attendance, inform the facility that ABSOLUTELY NOBODY from the facility has permission to speak to the VA.  If a VA rep calls, he/she should be referred back to the agent of record.

Basically, they’re two categories of services, both of which can result in an award for A & A.  One, medical skilled care, e.g. wound care, respirator care, trach care, therapy, etc.  The other, nursing services, which an assisted living usually provides; e.g. help with medications, ADL's, protective environment, etc.  If the independent wing of an assisted living facility is providing a "protective environment" and the doctor's 21-2680 states the need for this "protective environment" is provided by such a facility, then the claimant should be rated A & A and all associated fees should be allowed.

Consequently, if you state your claim correctly, have all your necessary documentation, and don’t allow any parties to talk to the VA adjudicator, you may not have been denied.

To increase your monthly income, please contact us about a FREE HANDBOOK about VA Benefits, written by David Wingate, an accredited VA Attorney, of Senior Life Care Planning, LLC, go to info@seniorlcp.com or if you require additional information about VA Benefits, visit our Senior LCP's Website.

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  1. Rita says:

    This is very timely information and equally important for senior service providers to be aware of. Can you clarify which of the two categories of service is not required to be provided by licensed healthcare professionals? The categories the VA provides are confusing for many people as one is “medical skilled care” and the other “nursing services”. Many people are confused thinking in terms of care that only a licensed nurse provides.

  2. If you require nursing home skilled care, you should send the physician’s report and complete the VA nursing home form. Medical skilled care is usually provided at the nursing home.
    If you are in an assisted living facility, require “activities of daily living” care, bathing, dressing, medication management,etc. you should send a physician’s report, and a letter from the assisted living facility, stating the “nursing services” they are providing to the client. The VA does not have a form for assisted living facilities, but we modify the nursing home form and adapt it for ALF’s.However, some ALF’s will not sign the VA form as it is called a nursing home form, and they don’t want to get into trouble with the state regulators etc.
    The issue is, client at an ALF, but living independently, i.e. not requiring any help with your activities of daily living then, technically, if you are at the ALF not for your health, but you don’t want to shovel snow, their for socialization, meals, etc., then A and A will not be available, as the ALF cost is not deductible,except for any medications, doctor’s visits etc.
    If you are at home, using home care help for activities of daily living, and have a doctor’s report stating that you need such help then this is “nursing services” and is allowable as a deduction.

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