State Veterans Homes
May 1, 2018 | by the National Care Planning Council
Available to Most Veterans but Not Always Free of Cost
State Veterans Homes fill an important need for veterans with low income and veterans who desire to spend their last years with "comrades" from former active-duty. The predominant service offered is nursing home care. VA nursing homes must be licensed for their particular state and conform with skilled or intermediate nursing services offered in private sector nursing homes in that state. State Homes may also offer assisted living or domiciliary care which is a form of supported independent living.
Every state has at least one veterans home and some states like Florida and Texas have a large number of them. There is great demand for the services of these homes, but lack of federal and state funding has created a backlog of well over 70 major renovations to existing homes and approximately 22 new homes that are waiting to be built.
Unlike private sector nursing homes where the family can walk in the front door and possibly that same day make arrangements for a bed for their loved one, State Veterans Homes have an application process that could take a number of weeks or months. Many State Homes have waiting lists especially for their Alzheimer's long term care units.
No facilities are entirely free to any veteran with an income unless the veteran is also receiving Disability Compensation at a certain disability rating. The veteran must pay his or her share of the cost. In some states the veterans contribution rates are set and if there's not enough income the family may have to make up the difference. Federal legislation also allows the federal government to substantially subsidize the cost of veterans with service-connected disabilities in State Veterans Homes.
Type of Care Provided
Some state facilities offer assisted living or domiciliary care in addition to nursing care. Some states even build facilities devoted entirely for domiciliary. According to the Veterans Administration the definition of domiciliary care is as follows: "To provide the least intensive level of VA inpatient care for ambulatory veterans disabled by age or illness who are not in need of more acute hospitalization and who do not need the skilled nursing services provided in nursing homes. To rehabilitate the veteran in anticipation of his/her return to the community in a self-sustaining and independent or semi-independent living situation, or to assist the veteran to reach his/her optimal level of functioning in a protective environment."
A domiciliary is a living arrangement similar to assisted living without substantial assistance but is not intended as a permanent residence. Domiciliary rooms in veterans medical centers are designed around this concept and are used for rehabilitation recovery from surgery or accident, alcohol abuse, drug abuse, mental illness or depression.
The domiciliary concept does not work well in a State Veterans Home setting and in that context domiciliary is simply another name for assisted living without the assistance. This represents a form of independent retirement living with a little more support where the veteran can stay as long as he or she needs to. As far as State Veterans Homes go you should think of domiciliary as a substitute for supported independent retirement living.
Many state veterans facilities have set aside a wing for Alzheimer's patients. In some states this is the most popular service sought by veterans or their families and waiting lists could require a many months before a bed opens up. A small number of facilities offer adult day care.
It appears that in most of the states, facilities are overseen by state employees through their State veterans departments. Some state veterans departments may contract with third-party administrators to staff their programs.
Eligibility and Application Requirements for State Veterans Homes
From state to state, facilities vary in their rules for eligible veterans. And even in the same state it is common, where there is more than one state home, for some homes to have very stringent eligibility rules and others to be more lenient. These differing rules are probably based on the demand for care and the available beds in that particular geographic area.
Some homes require the veteran to be totally disabled and unable to earn an income. Some evaluate on the basis of medical need or age. Some evaluate entirely on income -- meaning applicants above a certain level will not be accepted. Some accept only former active-duty veterans, while others accept all who were in the military whether active duty or reserve. Still others accept only veterans who served during a period of war. Some homes accept the spouses or surviving spouses of veterans and some will accept the parents of veterans but restrict that to the parents of veterans who died while in service (Gold Star parents).
Federal regulations allow that 25% of the bed occupants at any one time may be veteran-related family members, i.e., spouses, surviving spouses, and/or Gold Star parents who are not entitled to payment of VA aid.
Domicile residency requirements vary from state to state. The most stringent seems to be a three-year prior residency in the state whereas other homes may only require 90 days of residency. All states require an application process to get into a home. Typically a committee or board will approve or disapprove each application. Many states have waiting lists for beds.
The Monthly Per Diem Program
The State Veterans Homes Per Diem Program provides per diem payments to State Veterans Homes for the care of eligible veterans only. For fiscal year 2017 the Department of Veterans Affairs provides $106.10 per day for each veteran who is in a State Veterans Nursing Home. If the home provides adult day care, the Per Diem is $84.52 a day. For domiciliary care, $45.79 a day. This monthly support reduces the out-of-pocket cost for a veteran in a state home. Per diem is provided for the care of veterans irrespective of whether the veteran has wartime or peacetime service.
