Senior Housing & Senior Living Options for Veterans

One of the advantages of having served your country is the availability of special ex-military senior living options. While many veterans choose to live in civilian settings, there are communities that cater to Veterans, sometimes exclusively. There are essentially three types of senior living for veterans:

1. Veterans Affairs (VA) senior living communities.
2. Military-only retirement communities.
3. Senior living communities popular with the military because of their proximity to bases.

Let's explore these senior housing options for Veterans in more detail.

VA Senior Housing Options for Veterans

Community Nursing Homes are places for Veterans to live and receive skilled nursing care 24/7. The VA contracts with nursing homes across the country to care for Veterans. Other services include occupational and physical therapy, access to social services, short-term rehab, and Dementia / Alzheimer's care. The “VA will pay for Community Nursing Home care if you meet eligibility criteria involving your service connected status, level of disability, and income.” Community Living Centers (VA Nursing Home) provide nursing home care to Veterans of all ages. These facilities are designed to feel more like “homes”. Residents can decorate their rooms and are allowed pets. Their mission “is to restore each Veteran to his or her highest level of well-being. It is also to prevent declines in health and to provide comfort at the end of life.” Eligibility is “based on clinical need and setting availability.” The VA pays for care “if you meet certain eligibility criteria involving your service connected status, level of disability and income.” You must enroll in the VA health system and be medically and psychiatrically stable. State Veterans Homes provide nursing home and adult day care for “veterans disabled by age, disease, or otherwise who by reason of such disability are incapable of earning a living.” State governments own and operate these facilities. However, the VA does survey the facilities yearly to ensure they meet their standards. Eligibility is “based on clinical need and setting availability. Each State establishes eligibility and admission criteria for its homes.” State Veterans Homes are located in all 50 states including Puerto Rico. Costs vary by state and facility. Costs are lower than non-VA-funded nursing homes. Medical Foster Homes are private homes where Veterans (and non-veterans) receive 24/7 nursing care in a small, private home. The VA approves and inspects these homes. The VA does not pay for your stays. Medical Foster Homes charge between $1,500 and $3,500 a month based on your income and the level of care you need.

The VA and Senior Living

The support arm of the government for our 22 million military veterans is the U.S. Department of Veterans Affairs (VA). The VA is charged with administering benefits such as:

• Disability compensation
• Pensions
• Survivors' benefits
• Burial benefits
• Education
• Health care
• Rehabilitation
• Education and training
• Insurance
• Home loans
• Burial benefits
• Other senior care benefits

Since you may be researching on behalf of a family member, we'll start out with some basics. Then we'll show you some of the different types of VA facilities.

Who Qualifies as a Veteran?

According to Veterans Affairs, a veteran is anyone who “served in the active military, naval, or air service and who was discharged or released under conditions other than dishonorable,” National Guard members and Reservists may also qualify if “they were called to active duty (other than for training only) by a Federal order and completed the full period for which they were called or ordered to active duty.”

Others Eligible for Veterans Benefits

In addition to the above, these individuals may qualify for VA benefits:

• Veteran's dependent
• Surviving spouse, child or parent of a deceased Veteran

VA Pension

This is a benefit paid to wartime vets with limited or no income who are 65 and older, or if under 65, who are permanently or totally disabled. Generally, the eligibility requirements are as follows:

• Discharged from service under conditions other than dishonorable
• Served at least 90 days of active service 1 day of which was during time of war
• Countable family income is below the yearly limit
• The age requirements are stipulated above

Senior Living and Care Options for Veterans

Here is broad overview of some of the options veterans have for living and care. You can learn more about these options from the VA's Office of Geriatrics and Extended Care. Note that some of these options are covered in limited ways by the VA.

• Community Nursing Homes are places for Veterans to live and receive skilled nursing care 24/7. The VA contracts with nursing homes across the country to care for Veterans.
• Community Living Centers (VA Nursing Home) are facilities that provide nursing home level care to Veterans of all ages. They are designed to resemble a home as much as possible, allowing residents to decorate their rooms and to bring in pets to live or visit.
• State Veterans Homes are facilities that provide nursing home and adult day care. State governments own and operate these facilities, not the VA. The VA does, however, survey the facilities yearly to ensure they meet their standards.
• Medical Foster Homes are private homes where Veterans (and non-veterans) receive 24/7 nursing care in a small, private home. The VA approves and inspects these homes.
• Adult Family Homes are homes that rent rooms and provide assistance with activities of daily living (ADLs) 24/7. The VA does not pay the rent but may cover nurse visits to the home. Adult Family Homes are usually less expensive than assisted living facilities.
• Assisted Living Facilities are places where you have the option of shared or private apartments, meals in a shared dining room, and a trained caregiver to provide assistance 24/7. The VA does not cover rent at these facilities but they “may pay for some of the extra services the Veteran may need.”
• Homemaker or Home Health Aides provide in-home help with medication management, household management (pay bills, run errands, housekeeping, etc.). The VA contracts with agencies to provide these services as an alternative to nursing homes. You must be enrolled in the VA's health care system to receive benefits.
• Home Based Primary Care provides VA physician supervision of a health care team within a Veteran's home. This is for individuals who need skilled services, case management and assistance.
• Palliative Care is care and treatment for the physical, emotional and psychological symptoms that can occur during a serious illness. It does not require a Veteran to have a terminal illness. You must be enrolled in the VA's health care system to receive benefits.
• Respite Care provides skilled care to Veteran, relieving their family caregiver of their normal care duties for a period of time ranging from four hours to several weeks. Respite Care can include case management and assistance. You must be enrolled in the VA's health care system to receive benefits.
• Hospice care is comfort-based care for Veterans with a terminal condition (6 months or less to live). You must be enrolled in the VA's health care system to receive benefits.

VA Benefits

As a nation, we owe our veterans a great deal, and thanks to the G.I. Bill, signed by then-President Franklin D. Roosevelt in 1944, servicemen and women returning from the battlefields of Europe and the Pacific were offered services and grants ranging from educational grants to first time home loans. As we age, first home buyer programs do not meet the housing and care needs of older veterans. However, the Veteran’s Administration has programs in place to provide these services.

Specially Adapted Housing Grants

For veterans with permanent and total service-connected disabilities, the Specially Adapted Housing (SAH) Grant is an ideal way to help restore mobility and independence to a senior who served his country. Specifically, the SAH can be used to help adapt the living space of a veteran to create a barrier free environment in the following circumstances:

• Construct specially adapted homes on land to be acquired by the veteran.
• Build a home on land already owned for specially adapted housing.
• Make the home suitable through remodeling to achieve specially adapted housing.
• Apply a grant against an unpaid mortgage balance on property already owned and adapted if acquired without previous VA assistance.

Whether you suffer from loss of limbs, blindness, or the need for ambulatory help with braces, crutches, canes, or wheelchairs, Specially Adapted Housing assistance is available for needy service members. If you would rather purchase a turn-key home that is already adapted to providing enhanced mobility for you or the disabled veteran, you might prefer a Special Housing Adaptation Grant.

Special Housing Adaptation Grant

When a home is owned by an eligible individual or their family member, veterans suffering from service connected disabilities can receive a Special Housing Adaptation (SHA) Grant. These create a barrier free existence for eligible service members. Under the program, those with severe burns, respiratory, blindness, or loss of hands are eligible for help in the following situations:

• Purchase a home that has already been adapted to help those with disabilities.
• Adapt a home currently owned and occupied by veteran or family member will continue to live.
• Adapt a home that the veteran or family member intends to purchase for the veteran to live.

As mentioned, we owe our veterans everything, and the combined power of the SHA and SAH programs are designed to help those who were dedicated enough to serve and now need help as a result of that service. When it is time to make that transition from fully mobile to wheelchair bound, the last thing a veteran or their family should worry about is the cost of a remodel.

A Brief History of the VA

The concept of helping Veterans dates back to 1636 and Plymouth Rock. The Pilgrims passed a law that “disabled soldiers would be supported by the colony.” As the collection of colonies raced towards independence, the 1776 Continental Congress created the future nation’s first pension law. This law granted half pay for life “in cases of loss of limb or other serious disability.” The 1818 Service Pension Law gave Revolutionary War Veterans a fixed pension for life regardless of whether they were disabled or not. Officers received $20 monthly while enlisted men received $8. The country continued to evolve for its Veterans when Congress created the General Pension Act of 1862. This provided not only disability payments but also benefits for widows, children and dependent relatives. It also covered military service in time of peace. The National Cemetery System was also established in 1862. In his second inaugural address in the waning days of the Civil War, President Lincoln urged Congress “to care for him who shall have borne the battle and for his widow, and his orphan.” This later became the VA's motto. Throughout the next 70 or so years, various government agencies were created to assist Veterans, particularly in vocational training and rehabilitation for those back from the trenches of WWI. In 1930, the Congress under President Hoover created the Veteran's Administration, consolidating the “previously independent Veterans' Bureau, the Bureau of Pensions and the National Homes for Disabled Volunteer Soldiers.” The Veteran's Administration was responsible for war veterans' medical services; disability compensation; life insurance; bonus certificates; Army and Navy pensions; and civilian employees retirement payments. Congress created the Servicemen's Readjustment Act aka The GI Bill, in 1944. This bill greatly expanded Veterans benefits providing four years of education or training; guaranteed home, farm and business loans with no down payment; and unemployment compensation. In 1989, President Reagan signed legislation to elevate the VA to Cabinet status, thus changing the agency from the Veterans Administration to the Department of Veterans Affairs.

Veterans Facts

As of 2012, there were some 22 million U.S. Veterans:

• Army 9.4 million
• Navy 4.8 million
• Air Force 3.9 million
• Marines 2.3 million
• Non-Defense 211,000
• Reserves 933,000

Future Veterans

These are the projected totals for U.S. Veterans by 2035 as computed by Veterans Affairs.

• Army 5.5 million
• Navy 3.2 million
• Air Force 2.5 million
• Marines 1.8 million
• Non-Defense 233,000
• Reserves 915,000

Surprisingly, only about 8 million Veterans use the services of the VA such as healthcare.

VA Facilities Across the U.S.

• 807 VA Community-Based Outpatient Clinics
• 288 VA Vet Centers
• 152 VA Hospitals
• 131 VA National Cemeteries
• 56 Veterans Benefits Administration Regional Offices

VA Benefits and Health Care Use

One of the more surprising aspects of those who served is how few use the benefits they are entitled to. Only 8.3 million of the more than 22 million are enrolled in the VA Health Care System. Here is how the other services are used:

• Life Insurance Policies 7.1 million
• VA Disability 3.3 million
• VA Home Loans 1.5 million
• VA Education 900,000
• VA Pension 300,000
• Vocational Rehab 60,000

The VA's 21st Century Makeover

Today's VA has come kicking and screaming into the 21^st century. They've had to. The VA was in need of a major makeover, especially with the number of Veterans returning from the Middle East. The following are the VA's 16 initiatives:

1. Eliminating Veteran homelessness
2. Enabling 21^st century benefits delivery and services
3. Automating GI Bill benefits
4. Creating Virtual Lifetime Electronic Record
5. Improving Veterans' mental health
6. Building Veterans relationship management capability to enable convenient, seamless interactions
7. Designing a Veteran-centric health care model to help Veterans navigate the health care delivery system and receive coordinated care
8. Enhancing the Veteran experience and access to health care
9. Ensuring preparedness to meet emergent national needs
10. Developing capabilities and enabling systems to drive performance and outcomes
11. Establishing strong VA management infrastructure and integrated operating model
12. Transforming human capital management
13. Performing research and development to enhance the long-term health and well-being of Veterans
14. Optimizing the utilization of VA's Capital portfolio by implementing and executing the Strategic Capital Investment Planning (SCIP) process
15. Improving the quality of health care while reducing cost
16. Transforming health care delivery through health informatics

Non-VA Federal Retirement Homes

The Armed Forces Retirement Home(s) (AFRH) is an independent federal agency run as a Continuing Care Retirement Community with locations in Washington D.C. and Gulfport, MS. The AFRHs are open to all branches of the military. Though they are run like a corporation, the AFRH is subject to the authority and control of the Secretary of Defense. To live there, you must meet certain eligibility requirements. For example, you must be able to live independently at the time of admission. However, if “increased health care is needed after being admitted, assisted living and long term care are available at both campuses.” Some of the amenities include three daily meals, 24-hour fitness facilities, on-site pharmacy, full service bar, and more.

Veterans Senior Housing

If you want to enjoy your senior years in the company of other veterans, consider a military retirement community. These communities are similar to any other senior living arrangement only they are either exclusively for retired military or are a mixture of civilian and military. Certain levels of Federal employees (GS) also qualify for some communities. Examples of Qualified Veteran Branches

• U.S. Army
• U.S. Air Force
• U.S. Navy
• U.S. Marine Corps
• U.S. Coast Guard
• U.S. Public Health
• Foreign Service
• NOAA
• FBI
• CIA

What Differentiates Senior Living for Veterans?

The biggest difference is the shared experiences of its residents whether it's one combat vet reminiscing with another or a former Navy wife recalling their travels and life on base. This kind of camaraderie can only be found in the service.

• Private companies
• Other differences may include a community's close proximity to a military base with its hospitals, golfing, commissary, PX, etc.
• Military organization meetings
• lose proximity to a national cemetery

Paying for Veterans Senior Housing

Are you or your loved one leaving valuable VA benefits on the table? As a Veteran, you may qualify for money that can help pay the cost of a senior living community, such as assisted living and nursing home care and even in-home care. These benefits include VA pension, Aid and Attendance Program, and the Housebound benefit. Other qualifying recipients of these benefits include Veteran spouses, and surviving spouses.

VA Pension

A pension is paid to wartime Veterans with limited or no income, who are 65 or older, or under 65 and are permanently and totally disabled. Others who may qualify include senior Veterans who are nursing home patients or who are receiving Social Security disability payments. You must meet these additional eligibility requirements:

1. You must have been discharged under conditions other than dishonorable. AND
2. Served at least 90 days of active military service and “at least 1 day was during a war time period.” AND
3. Your income for VA purposes must be below the maximum annual pension rate as set by Congress.

In addition to the above requirements, your yearly income must be less than $12,256 with spouse or child or $16,051 with one dependent. You can find out about other income deductions (e.g. medical expenses) on the VA's website. Unremarried spouses and unmarried children who meet age, income and/or disability requirements may be eligible for Survivors' (Death) Pension. Veterans who are more seriously disabled may qualify for either Aid and Attendance or Housebound benefits. You cannot receive the Aid and Attendance benefit and the Housebound benefit at the same time.

Aid and Attendance

This is a benefit paid in addition to a VA pension and can help offset the cost of assisted living, nursing homes and other senior living options. Even if your income is above the minimum required for VA pension, you may still qualify for Aid and Attendance if you have large medical expenses such as nursing home or assisted living costs. Here are the basic eligibility requirements:

• The Veteran had to serve at least 90 days of active military duty and at least one day or service during wartime.
• The Veteran's discharge conditions must be anything other than dishonorable.
• The Veteran or spouse require assistance with activities of daily living (ADLs) such as dressing, bathing, feeding, etc.; need help with prosthetic devices. OR
• You are bedridden and your disabilities require that you remain in bed apart from any prescribed course of convalescence or treatment. OR
• You are a nursing home patient with mental or physical incapacity. OR
• Your visual acuity is 5/200 or less in both eyes, or “concentric contraction of the visual field to 5 degrees or less.”

If these requirements are met, VA determines the eligibility benefit by adjusting for un-reimbursed medical expenses (home health care, nursing home care, assisted living, et al) from your total household income. “If the remaining income amount falls below the annual income threshold for the Aid and Attendance benefit, VA pays the difference between the claimant's household income and the Aid and Attendance threshold.” Here are the income thresholds:

• Less than $20,447 without dependents
• $24,239 with one dependent
• Surviving spouse (no dependents) income must be $13,138
• Spouse of a living Veteran $16,056

The survivor may not receive Aid and Attendance benefits and Housebound benefits at the same time.

Housebound Benefit

The Housebound benefit is a payment in addition to basic pension for those who are receiving care in-home or in the home of a family member. But you first must establish eligibility for the basic VA pension. Housebound benefits are based on a higher income limit than a VA pension. So even if income ineligible for a pension, a Veteran could qualify for Housebound benefits. Veterans may be eligible for the Housebound benefits if:

1. 1. The Veteran has a single permanent disability evaluated as 100-percent disabling AND due to such disability, he/she is permanently and substantially confined to his/her immediate premises, OR,
   2. The Veteran has a single permanent disability evaluated as 100-percent disabling AND, another disability, or disabilities evaluated as 60 percent or more disabling.

In addition, your income must be less than $14,978 without dependents or $18,773 with dependents.

Applying for Aid and Attendance and Housebound Benefits

Contact your VA regional office. This should be the same office where you applied for pension benefits. You can also apply online using the VA’s VONAPP (Veterans On Line Application) website. Form 21-526, is the Veteran's Application for Compensation and/or Pension. Be prepared to show proof of health care needs with a detailed physician's report. The needs addressed should be those outlined above under the requirements for Aid and Attendance and Housebound benefits. This includes “how well the individual gets around, where the individual goes, and what he or she is able to do during a typical day.” The VA's Form 21-2680 can be used for this. Also, have your medical expenses ready to show the VA. This can include cost of home health care, assisted living, or nursing homes.