1. + Benefit for Non service-related disabilities, available to veterans or their surviving spouses who qualify. © 2012 Companion Connection Senior Care. All rights reserved. Aid in Attendance

2. 2 + The “Aid and Attendance” Pension is a benefit for Non service-related disabilities, available to veterans or their surviving spouses who qualify. In order to qualify for the pension: The veteran needs to be over 65 years of age. The veteran must have served at least 90 days active duty in the military, with at least one day during wartime. The applicant must be at least 60% housebound (no longer driving) which will require certification by a licensed physician. The applicant must meet income and asset limits.

3. 3 + History Aid and Attendance is part of the VA's Improved Pension Program, which took effect on January 1, 1979, with the establishment of Public Law 95-588. The updated benefits program allows for increased payments to eligible veterans and their spouses, as well as the surviving spouses of deceased veterans. The other tiers of the Improved Pension Program are Basic and Housebound. Aid and Attendance offers the highest level of benefits, although eligibility is more restricted and requires extensive medical documentation.

4. 4 + A Personal Account: Stacey Reich-Benjamin, LCSW | At Home Companions I joined Companion Connection Senior in 2003 and opened my agency, At Home Companions, in early 2004. The Aid in Attendance Pension was introduced to me by CCSC in 2005. At that time the Aid and Attendance Pension was still relatively unknown within the home health care community. My knowledge of the pension opened doors to referral sources that would have normally been closed, in particular non-profit organizations. My application process for assisting the veterans has changed through the years. Veterans Salute (formally an option) Processing the applications independently Veterans Home Care (CCSC current partner)

5. 5 + Who is Eligible? Veterans and their spouses, surviving spouses Who fit into these criteria? Over the age of 65 The veteran has to have served 90 days in active duty, one day beginning and ending during wartime. The veteran must show medical need for the regular aid and attendance of another Must be 60% homebound and no longer driving The veteran/surviving spouse must meet the income and asset limits. The amount of monthly pension serves as a guideline for monthly income Veterans and their wife (husband) may be entitled to $2054.00 per month (20- 25 hours per week) A veteran living alone: $1732.00 per month (16 hours per week) A Surviving Spouse $1113.00 per month (10.5 hours per week)

6. 6 + How the Pension Works Aid in Attendance is technically a reimbursement for regular re-occurring, unreimbursed, medical expenses. To qualify for the pension you must be spending 105% of your monthly income on regular, reoccurring, unreimbursed, medical expenses. It is in this statement that LIES THE CATCH-22. Clearly an individual cannot pay 105% of their income on home care expenses when living expenses need to be considered. To make it possible for the veteran to take advantage of this pension; an application is filed, services are established, the client is invoiced for services rendered then expected to pay for services once the client receives the retroactive check from the VA.

7. 7 + Inquiry/Application Process First Contact: review with client and/or family representative eligibility requirements. Can be over the phone. Refer client to Veterans Home Care. Veterans Home Care makes home visit and completes application with client and family representative. Veterans Home Care processes the application and files with the VA. Veterans Home Care requests a “start of care” for home care services with predetermined hours per week, per month. Client receives on a monthly basis invoices for services rendered.

8. 8 + Inquiry/Application Process continued In approximately 6-8 months, the client receives a retroactive check for home care services rendered. Client is responsible to reimburse Veterans Home Care for past invoices. Client receives a check between 1 st and 3 rd of month to pay for last month of services, which is used to pay for Veteran Home Care services. In the interim, Veterans Home Care pays agency with 60-day terms. This becomes Guaranteed Income.

9. 9 + The Role of Veterans Home Care Once it is determined that a client is eligible, refer them to VHC. VHC then calls the client and confirms all the information. They will then explain where they fit in to the equation. VHC will make a home visit to the client to complete the required documents and have the patient sign the necessary documents. The family needs to provide the following The discharge record (DD214) The marriage license which includes a date and/or a death certificate for the veteran if it is for a surviving spouse, their current award letter from Social Security, proof of all other income and records of financial assets. Once the application is completed and the necessary documents are collected, VHC processes the application on their end and forwards it to the VA. Payment for services is retroactive to the first day of the next month after the application has been submitted to the VA.

10. 10 + The Role of Veterans Home Care continued Once the application has been forwarded to the VA, VHC then forwards a SOC with the information regarding the services required, hours, needs of the client, contact info etc. You then need to set up service in a way that meets the client’s needs but is also realistic. For example, a surviving spouse will only receive 10.5 hours a week. Try to break up those hours to make it realistic to appeal to a caregiver. Once service is set up, there needs to be a designated person in the office to track the veteran hours and keep them accurate. If there are unused hours try to make them up within 30 days. Set a rule to not provide service on Holidays. VHC does not reimburse for a holiday rate. A concern with working with VHC is, of course, about the money. You must agree to wait 60 days to get paid. The other concern is, will it be possible to ever raise your rates. I do not believe it has ever been done. For the most part, cases are long-term and worth the effort.

11. 11 + Marketing The value of working with VHC and assisting veterans and their spouses with assistance in applying for this pension is multifaceted. The genuine idea being that you will now be able to provide services to an entire client population that would not have been able to afford services. As a new or growing agency you will have a unique reason to visit referral sources that may not have recognized your value to their client population. In particular, non-profits who service a less privileged population. If you are a Medicare or Medicaid provider, you can qualify your Medicaid patients for the pension and just add the hours to an already established case. Aid and Attendance is not supposed to be seen as income and should therefore not affect your Medicaid patients, however, recently that is not such a clear cut answer so be sure to speak with your VHC rep and let them know that your client is receiving Medicaid. Your Medicare patients where the case would normally end after 30 days or so may be able to continue on with services.

12. 12 + Marketing continued Areas to Market Division of Senior Services - may be unaware of the benefit. County benefits - see if you can combine the two, i.e., Respite Program VA chapter - may or may not embrace you as you may be perceived as a threat to take advantage of seniors Sell yourself as an expert in the benefit, remember that you are also selling VHC. This is extremely important. You want the transition to be seamless and for them to automatically trust the rep you are referring to. The real financial relationship is between VHC and the client. The client must trust them in order to go forward.