In order to be eligible for Aid & Attendance benefits the claimant must have limited income. In processing an application the VA allows “unreimbursed medical expenses” or UME’s to be deducted from the applicant’s gross monthly income. Examples of UME’s that are typically deducted from an applicant’s income are medicare premiums, private insurance premiums, cost of care-givers in the home, and assisted-living facility costs. Monthly costs at an assisted-living facility are often very high. Assisted-living facility residents almost automatically satisfy the income portion of the Aid & Attendance eligibility analysis. An applicant still must show that the assisted-living costs are “medical”. This is typically done by describing in the application packet that the applicant requires assistance with certain activities of daily living which are provided to him/her by the facility. Historically there has been a long list of activities of daily living (ADL’s) that the VA would accept for this purpose including monitoring by caregivers multiple times a day, a medic alert system with 24 hour on-site emergency response, assistance with bathing, assistance with dressing, assistance with using the restroom, assistance with feeding, food preparation, medication management, and assistance with laundry/housekeeping.
On October 26, 2012 the VA sent out a letter to their adjudicators which supposedly clarified which type of facility costs could be allowed as UME’s for Aid & Attendance applicants. The letter is confusing and it has been interpreted differently but here is how it is being applied. Acceptable activities of daily living are “basic self-care” and include:
– Assistance with bathing or showering
– Assistance with dressing
– Assistance with eating
– Assistance getting in or out of bed or a chair
– Assistance using the toilet.
In order for the costs of any facility, independent or assisted-living, to be allowed as a UME the applicant must show that they require a “protective environment” and assistance with at least two of the specific ADL’s listed above. There are many seniors who require supervision, assistance with medication, food preparation, etc…who do not require assistance with the ADL’s identified as “basic self-care” above. This will greatly reduce the number of applicants whose assisted-living or independent-living costs can be deducted from their income as UME’s. Accordingly, this will greatly reduce the number of Veterans and widows of Veterans who can access the Aid & Attendance benefit to pay for their care.