LTC Bullet: Vets "Confined to Quarters" by VA

Thursday, July 30, 2009


LTC Comment: No more 4-day passes; Vets confined to nursing homes 353 days per year. Details after the ***news.***


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LTC Comment: One of the most common and least credible excuses for failing to plan responsibly for long-term care is this one:

"I'm a vet. A grateful nation and the Veterans Administration will take care of me."

Big mistake. So big, in fact, that we created a special section in the Center for Long-Term Care Reform's website that lists "Reasons Why Veterans Should Not Depend on VA Benefits for Long-Term Care." That section has 27 entries already and we're adding another one today. (Available to Center members with user names and passwords. Need yours? Contact Damon at 206-283-7036 or

Here's the latest. "As the U.S. Veterans Affairs Department claims to be moving away from institutionalization, a new federal rule is keeping residents of veterans nursing homes more confined. Instead of unlimited four-day passes throughout the year, residents now are allowed only 12 days a year away from the nursing homes, the Tulsa World has learned." That's the lead. For the whole article, titled "Veterans nursing homes limit leave," click here.

In a nutshell: before the rule change, vets could get unlimited 96-hour passes away from their nursing homes to visit friends and family. The VA (Department of Veterans Affairs) would pay for their time away in order to ensure their beds would be available when they return. But . . .

"As of May 29, resident veterans may only take leave 12 calendar days per year. The VA won't pay to hold their beds any longer than that," according to Roy Griffith, head of the national liaison committee for the National Association of State Veterans Homes.

VA bureaucrats in Washington, DC said they are being "fiscally responsible. . . . The state is entirely free to permit longer absences at the state's discretion and expense, but VA will not continue to pay for an empty bed beyond the 12-day limit. Bed hold regulations are necessary to preclude paying for an empty space . . . The new VA regulations are consistent with Medicaid and more liberal than many states. . .."

Oh great! The VA's bed hold policy is as good as Medicaid? How reassuring is that?

Here's why bed hold policies are so important. If the VA or Medicaid won't pay to hold your bed when you're away to visit loved ones or hospitalized, where do you go when you need to return but the nursing home has given your bed to a paying customer?

This problem is especially serious for Medicaid recipients. Many state Medicaid programs don't pay for bed holds, including Rhode Island where I interviewed state officials recently. So, imagine yourself in this situation:

You didn't plan to save, invest or insure for long-term care. Now you have Alzheimer's Disease and your adult children are caring for you AND for your money (their inheritance). You're mentally out of the picture, but life goes on and everyone wants you to receive quality long-term care.

So your adult children's attorney assures them "Don't worry about the horror stories you've heard concerning Medicaid nursing homes. We'll get your Mom or Dad into one of the nice places where the staff don't even know who's on Medicaid and who's private pay. Here's our little secret. When we shift the folks' life savings to you, we'll hold back enough cash to pay for six months to a year of care. Nursing homes are so desperate for private payers at half again as much as Medicaid pays that they'll roll out the red carpet. Once your parents are in, however, the facility can't kick them out when the 'key money' runs out and we flip the switch shifting them to Medicaid."

Such a deal! You get an early inheritance, Mom and Dad get high-quality long-term care, the attorney pulls down a big fee and everyone lives happily ever after. Not!

Here's the flaw. If Medicaid won't hold your bed when you have a short-term absence for acute care, as frequently happens for nursing home residents, you're stuck if the nursing home can fill your bed with a much-higher-paying Medicare or private-pay resident. Watch out for those far-sighted people who planned ahead and bought private long-term care insurance. They're your biggest enemy because their ability to pay privately guarantees them the first and best access to all levels of long-term care.

When financial crises hit, expensive bed hold policies are among the first benefits public LTC payers jettison to save money. It's true for Medicaid. And now it's true for veterans' LTC benefits too.

So next time your prospect says, "I'm a vet. A grateful nation and the Veterans Administration will take care of me," tell him or her "Don't count on it." Loan them your user name and password and send them to "The Zone" for 28 "Reasons Why Veterans Should Not Depend on VA Benefits for Long-Term Care."

[Note: Special thanks to long-time friend and Center supporter Jason Goetze, a leading national expert on long-term care insurance and Medicaid issues, for tipping us to the DVA's new bed hold policy.]