VA Benefits For Spouse Pay For Nursing Care

VA Benefits Help Pay For Nursing Home Assisted Living Expenses

One of the difficult parts of aging is watching your parents age ahead of you. At some point you may find yourself making difficult decisions for them or urging them to think about the choices they may need to make for themselves. When you begin to notice a parent finding it difficult to care for themselves due to age or declining health, it can be incredibly hard to take the first step – talking to your parent about moving into a situation where there are skilled care givers that can help when needed.

After making the decision to move to an assisted living facility due to her declining health and her fear of being alone, my mother’s next difficult task was to find a way to pay for the facility. Averaging $5,000 a month in our part of the country, assisted living facilities offer private or semi private apartments where the residents have meals prepared for them, light housekeeping, laundry services and if needed, management of prescription medications.

During the initial interview, the facility’s director suggested my mother should apply for Aid and Attendance benefits from the VA based upon her husband’s military service. She strongly urged my mother to apply immediately as the process was known to take four to six months. With a little bit of research on my part, I found all the information I needed to get started with one very important first step that I found out about only by accident in a random forum.

Apply For VA Benefits

Step One

File Initial Statement In Support Of Claim – VA Form 21-4138

This form serves notice to the VA that you are filing a claim. The date the VA receives this form is the official application date. When benefits are awarded, they are effective as of this date.

Information Needed for VA Form 21-4138 : The Veteran’s full name and social security number

In the body of the form I wrote:

“Please accept this correspondence as my informal claim for non service connected pension with Aid and Attendance benefit for a surviving spouse, as provided by the following regulation: 38 CFR 3.155 Informal Claims

Surviving Spouse: My Mother’s Name

Residing at: My Mother’s Address”

The person (my mother) signs and dates the form including address and phone number. This form is mailed to the appropriate address for your area. Find your local VA office here.

Step Two

Gather all your information:

  • Death certificate for the Veteran
  • Separation or Discharge papers for the Veteran
  • Marriage certificate for Veteran and surviving spouse
  • Bank statements
  • Income statements (pension, insurance, etc.)
  • Current year social security income statement
  • List of all medical bills and medical expenses including care giver expenses
  • Nursing home or assisted living facility bills
  • Nursing home or assisted living facility contract

Step Three

Gather all your forms:

  • Form 21-534 Application for Dependency & Indemnity Compensation Death Pension & Accrued Benefits by a Surviving Spouse or Child
  • Form 21-8416 Medical Expense Report
  • Form 21-0518-1 Improved Pension Eligibility Verification Report
  • Form 21-0779 Request for Nursing Home Information in Connection With Claim for Aid and Attendance – Note: This form also applies to assisted living facilities
  • Form 21-2680 Provider Care Report
  • Form 21-2680 Doctors Statement of Examination for Housebound Status or Permanent Need for Regular Aid and Attendance

All VA forms can be found here.

Step Four

Take your time. Fill out all the forms, leave nothing blank. Every form has instructions included. Read the instructions and fill out the forms completely. Put it all in a folder and walk away for a day or two. After you let your mind clear, go back and re-read the instructions. Re-visit the forms and double check your work. Unlike the IRS where they will immediately notify you of your mistakes, the VA can take as long as three months just to let you know you did not dot an I or cross a T.

When you are sure you have filled out the forms in their entirety, make copies of everything – all certificates, statements – everything! Do not send any originals to the VA! Include a cover letter. Here is a sample of my mother’s letter:

To Whom It May Concern:

Please accept this correspondence as my claim for Aid and Attendance benefit for a surviving spouse – VA Form 21-534 filed by <name>, a surviving widow of <name>, a deceased Navy Veteran who served in World War II .

Due to my advanced age, and rapidly declining health, I respectfully request an expedited review of my request for benefits.

My application is enclosed along with the following documentation:

  • Initial Statement In Support of Claim, dated <date>
  • Copy of Death Certificate for <name>
  • Copy of Notice of Separation from U.S. Naval Service for <name>
  • Copy of Marriage Certificate for <name> to <name>
  • Form 21-2680 Doctor’s Statement of Examination for Housebound Status or Permanent Need for Regular Aid and Attendance
  • Copies of current bank statements and interest paid to date
  • Copy of 2013 Social Security Income Statement
  • Copy of statement from Metropolitan Long Term Care indicating award of benefits
  • Copy of most recent income statement from Metropolitan Long Term Care benefits
  • Copy of year to date billing statements from Assisted Living Facility
  • Provider Care Report from Assisted Living Facility
  • Additional Sheet for Section XI – Item 40a – Statement of prescription medication co-pay costs in addition to non-prescription medications and supplies used on consistent and recurring basis.

Thank you for your consideration of my application.

I hand delivered the package to our local office for my mother as the instructions indicated the original separation papers were required. I have the original papers but I was not willing to put them in the mail to the VA as they are fragile from age and I also did not want to risk losing them. I told the registration clerk of my concern and he told me copies were acceptable and that I should NEVER send an original of anything to the VA office.

How to Handle VA Rejection of Benefits

Three months later I received a letter of rejection from the VA as, based upon the medical report from the assisted living facility (which was now six months old) my mother only needed help with one ADL (activity of daily living) and the VA required two or more for them to consider the cost of her assisted living charges as a valid medical expense. Knowing my mother needed help with more than two ADL’s I quickly had all the forms re-done with the assistance of her doctor and mailed back to the VA within two weeks.

IMPORTANT TO NOTE: If you do not receive a letter from the VA acknowledging the receipt of your correspondence, then they never received it.

By the time April came and went and I did not receive an acknowledgement of our appeal request, I took the only other step I could think of – I contacted my Congressman’s office. Done. Within a month by working closely with the VA specialist at my Congressman’s office, my mother was awarded the monthly benefit she needs to help with the cost of her medical care.

Not only was the VA specialist able to get the attention of the VA office but he also advised me on the correct forms and made sure I had all information filled in correctly. It was a little more than a year from start to finish but my mother’s benefit payment was retroactive to the day I sent the first form, the Initial Statement in Support of Claim (Form 21-4138). It’s short and only requires names and social security numbers – send it now!

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