How to get my grandmother-in-law more benefits?

I would call Hospice now.

Rebecca, on getting both Medicaid and VA benefits, I don’t think VA $90 a month stipend can be viewed similar to VA Aid & Attendance benefit. Aid & Attendance is real $$$ & the vet / their spouse can self direct how & who gets paid (in-home care, adult day program, AL). The $90 stipend is - to me - more along the lines of Medicaid’s PNA aka the Personal Needs Allowance $ that each State LTC Medicaid program allows an individual living in a NH to keep each month to spend on themselves on items not covered by Medicaid. The stipend is really more an allowance.
So they can have whatever $ their State has for PNA $ plus VA $90, so benefit from both but it’s a very narrow use of that $90 as they are in a NH on Medicaid so Medicaid rules on $ & spending matter, so no gifting. State Medicaid does not count VA stipend as “income” and does not require VA stipend to be included in the NH copay; but $ can become an “asset”, so they / their POA do have to be mindful not to have their PNA account at the NH (if it gets the stipend) &/or their bank account to go over 2K asset maximum as it would be for most States a LTC Medicaid eligibility issue. There has been more than 1 tale of surprise posted on this forum from a family member who found their elders PNA NH account almost zeroed out as NH ordered durable medical equipment item billed to resident to get their PNA balance reduced. NH allowed to do this as per admissions contract. OR POA found they had to do an annual LTC Medicaid renewal with submission of bank statements and hit with Medicaid eligibility issues as elder ended months over $2,000 banking balance. If they are getting VA $90 a mo stipend plus Medicaid PNA $, they can hit asset max a lot quicker. Elder or their POA need to be sure to spend $ regularly as allowed under Medicaid rules. It’s hard to imagine that family allows $ to build up but it happens.

For some States in the South, PNA is low, like $40. Not realistically enough to pay for on site barber/beauty shoppe visits + clothing + toiletries replacement. Not enough $ if the NH charges for in room cable or phone. It’s only a couple of States that have PNA over $100 a month, most are $50/$60 a month. A $90 VA stipend $ a mo would make a huge difference to veterans & their spouse’s in an nonVA NH and their families for buying incidentals not provided by Medicaid. But it’s not the same as Aid & Attendance payment of $1,432 or more a month to add to the elders SS & retirement monies to pay towards their AL bill or inhome healthcare or copay at a PACE day program. Things like these imo are really great use of A&A $, it’s a real benefit.
Neither VA A&A or VA stipend will cover the custodial room and board costs at a nonVA skilled nursing facility that Medicaid LTC program does & why ultimately it’s the Medicaid LTC program that matters once the elder gets to NH “at need” point for their care.

Jj0327: Perhaps you can contact your grandmother in law's COA (Council on Aging) in her locality, who will have on staff a social worker. Start there.

Hi Jj0327, I read through all of the posts here, and you are getting some mis-information. Not only am I a retired vet, I’m clinical and am a geriatric care manager. I’ve done over 4,000 Aid & Attendance applications. Some bits and pieces mentioned are true, others are based on the senior’s situation. Now, the facts: someone mentioned one cannot get Medicaid and A&A both. This is not true. Every state is different. For example, in Florida, a qualified vet/spouse is allowed both, unless they go to a skilled nursing facility, then they lose all but a $90 stipend from the VA. Every.single.claim I’ve done over the years is different. One thing you mentioned - your grandma is getting hours of care from the VA. Homebound hours is only allowed to the veteran themselves, not spouses. That makes me think your grandfather may have been 100% service-connected, giving your grandma rare care from the VA, unless she herself was a vet as well. If she’s not a vet and he was 100% service-connected, she should be allowed the death benefit, which could be more than the $1432 of Aid & Attendance. Was he service-connected? Also, to get Aid & Attendance, your grandma has to show she is spending 105% (yes that’s correct) of her monthly income to qualify for the full award. There are a ton of moving pieces when trying to qualify. No two people’s situations are the same. She is allowed to own 1 house and 1 car and allowed no more than $150,000 in liquid assets. There is a 3-year VA lookback and a 5-year Medicaid lookback.

I am going to mention one thing about Patriot Angels. Yes, they charge a vet/family a fee to do an Aid & Attendance application. I’m going to say for the record that is 100% illegal to do. They can charge for an appeal, but not the original application. VA.gov states this clearly. I’m just putting that out there.

In my professional opinion, it seems like your grandma may need more around-the-clock care than she’s currently able to receive. It sounds as though Medicaid planning may be the most appropriate action right now, as, if she needs skilled care, Medicaid would need to kick in to pay, and I easily see skilled facility costs go to $15k per month, depending on the type of care needed. If you have specific questions about the VA benefits, let me know and I’d be happy to connect.

That is not true. Take his dd 214 and her income to a service officer. Tell them that you want to sign her up for aid and attendance. That is 2230 a month for her care. Also she would be able to too see the VA Dr's. And get all of her medicine from the VA. I run a VA home I deal with this all the time. Any other questions please call me

You will have, since VA is already involved, a case number. Ask to speak to a VA social worker or care coordinator, nurse manager involved in her case. Do know that what your husband has already learned may be the truth. There is often not a lot of options for in home care and help.

It is likely time to consider placement and all that goes along with that.
The POA if one exists is responsible to get control of this already rolling ball. If there is not a POA, the VA Social Worker may be able to guide you to the easiest way for the person most willing / able to get temporary guardianship. There will need to be assets assessment and assets management, and then placement for care.
If grandmother isn't competent she cannot confer POA on someone if that wasn't done already, so guardianship would be the only option.

You need one person in charge. If that's your hubby I am sorry for it, but one day at a time. It is like detective work. I hope you'll update us as you go.

call your county area of aging dept,

Schedule an appointment with your local VA office. My mother receives $1432 per month with Aid & Attendance. Yes, it was a process but after 9 months, she was finally approved and will receive retro payment since the date of application. We chose Aid & Attendance because mom will need memory care soon and our area facilities do not accept Medicaid for memory care. We felt something is better than nothing. Good luck!

Some considerations:

Get a case manager involved either thru her PCP or community senior services in your area.

Call 911 and have her transported to ER. When at ER, discuss the situation with hospital/ ER case manager and, seek placement options for her. Safety and biohazard issues concerns are described in your writing. Address these and her decline, level of care needs with the hospital staff.

Call APS, inform them of the physical, emotional dynamics in the home. Seek APS support to obtain care for her that will provide safety and address all her needs.

Inform APS, her Physician, and/ or hospital professionals that you,family cannot provide the level of care she needs in the home.

Take care of yourself.....

Read all the above advice regarding the VA. I've seen many TV ads because the VA does not appreciate our military who served in our country enough benefits. Screw the stingy VA and stop all their benefits! Grandmother should receive only Medicaid benefits for her care.

I spent a year dealing with the frustration of applying to the VA for Aid & Attendance for my mother. My father fought in both WWII and Korea.

The VA drowned me with paperwork and nit-picked everything except for my father's service records, which is only a small part of the paperwork.

They don't tell you this, but you've got one year from the time you notify them that you're applying to get an approval, and the odds of that are about zero if you're doing it on your own.

So I decided that it was either accept the rejection of benefits or pay a third party to help me.

Someone on this forum mentioned using Patriot Angels. I've hired them and it's been very efficient and smooth. There is a one-time fee and they take care of putting everything together and submitting it it to the VA.

Alva, I’m biased towards using AoA aka Area on Aging as a starting point. Every State has them. They are within your COG aka Council of Governments which are regional entities that get state / federal / local & oodles of grant $ and are divided into Areas of interest, like aging, planning, etc. The COGs do work that involve crossing jurisdictional lines. The classic COG staff work are transportation related stuff.

But COGs have always had a Council on Aging sector and over time, the Area (Council) on Aging in some states have become really big to the point they have their own free standing buildings and staff even tho’ technically under the COG. Like Houston is HGAC for its COG, but its AoA is now huge, HUGE, like 4 full building offices scattered in 3 counties plus outreach staffers with each of the co. Health departments in the 13 county H-GACofGovernment. COGs tend to run below the radar, till someone doesn’t get their way on a development, a certificate of need or other federally mandated paperwork.

But I digress….. if I was in a avg size town, I’d try the Area on Aging office for my region as a starting point. A few States are a single AoA. Now if was in a big city (close to M & M+) and they had an active Jewish Family Service program, I’d go there as JFS tend to have really good outreach elder programs & some do needs assessment referrals. Like Dallas’ JFS does in house needs assessments with cost based on sliding scale; their elder program is quite amazing. The “needs assessment”, to me, is so THE key to the starting point on all this nowadays. You as a family member cannot DIY and subjectively determine what your elders placement/ needs are. Ya need that outsider document. You don’t want to spend hours researching AL when it’s actually MC placement required. Or thinking that In-home health will provide for 32 hrs a week only to find that needs assessment has it at 18 hrs a week on IHHS.

Area (Council) on Aging is your tax dollars at work. Use them!

When it comes to Medicaid for health, in home care and long term care you go to your County Social Service office. IMO, a lawyer is only needed if like me, the selling of a house or the splitting of assets.

When it comes to Medicaid LTC and Aids and attendance, you can't have both an Medicaid pays the most. From my understanding, both are Federal benefits so you have one or the other.

Fro Igloos post, I think you may need to have GM re-evaluated by the VA. If she is turned down, then you apply for Medicaid in home or even LTC.

Grandpa died = his VA stops. Her’s was ancillary to his.
Gran needs her own “VA needs assessment” done that is current.

It sounds like that does not exist and her VA benefits were based on her recently deceased spouse. She got accessory hours as a spouse. & whatever benefits she was getting was based on his care plan which no longer exists since he’s dead. Now VA may require it to be done by their own VA team (tends to be a SW/social worker & a RN that specializes in gerontology), so contact VA to find out clearly what has to, HAS TO, happen to have her evaluated to have her own benefits reset by the VA for her own IHHS aka in-home-health-services.

On not getting any traction from Medicaid, this makes sense because she is probably on VA for health care providers & health insurance and getting her involved with any Medicaid filings would throw a wrench into her healthcare & insurance. Plus Medicaid tends not to provide for other ancillary services IF there is another provider who can pay for services instead and as VA shows up for her late spouse, Medicaid knows gran can file for VA’s Aid & Attendance program. She doesn’t need to file Medicaid community based IHHS as she can go VA A&A route. My suggestion is someone in the family needs to get with VA A&A asap to have the assessment scheduled & file whatever paperwork filed to get gran into her own A&A.

Please, please, pls be aware that VA - as hold true for State Medicaid programs- will look hard at the needs assessment as to feasibility on providing “in home” care healthcare via VA Aid & Attendance. If gran is assessed to be beyond a certain threshold for care…. like she actually needs to be under 24/7 observation or close to 24/7 for her own safety because of point of her dementia or her other diseases or disabilities….. neither VA (or State Medicaid IHHS) will pay for more round the clock in home (except for very unusual circumstances) but instead the needs assessment will show elder best placed into LTC custodial care in a NH or a MC. So watch what you wish for in # of hours provided.

Yeah, it’s a lot to take in. VA is not in my wheelhouse. But Medicaid kinda is and it is a huge, beyond huge set of different programs too. Some will have zero copay but others will require gran to basically have a copay of almost all her monthly income to be enrolled. So if grans income is being used to keep household afloat in any %, that $ may not be be there. This often comes as a total surprise to families. Also be aware that if grandpa or grandma gave anyone in the family anything of value past few years and she ends up filing for LTC Medicaid program as she needs to move into a LTC Medicaid bed at a NH or a MC facility, she will have to provide for by & large is past 5 years of her & her late husband’s financials. The “gifting” could pose eligibility issues. The date of the start of the lookback on financials will be based on the date the Medicaid application is filed. State will X check database for asset transfer (home, land, auto). It’s very much worthwhile for whomever is POA to go through the grand’s financials to see if anything’s amiss ahead of any application filing. Often “gifting” or “lending” was done that others in the family were unaware of.

Agree with advise below..

call your county office of aged and disabilities, they may give you guidance

there should be copies of the forms that were filled out to obtain the VA benefits. There is a phone number in the beginning of the packet you could call for clarification. Or ask county office of aged and disabilities if they have the number to the county VA office ( not the VA)

I agree she should be checked for a UTI. If she goes to the hospital, ask to talk to the social worker there. If no one is her PoA then the county can find placement forr her to go directly into a facility since she would be an "unsafe discharge". Don't pick her up and take her home. Stress that you can't take care of her and keep using the phrase "unsafe discharge". The hospital will exert a lot of pressure on you to take her and may even promise to help you care for her at home, but this isn't true (been there, done that). The county will become her guardian and take care of her needs and manage her affairs going forward.

HAve you considered consulting an Elder Law attorney?

Frankly, I would call 911 and get her admitted to the hospital if she is hallucinating and escaping from the house. She may have a UTI or other infection.

Once admitted, refuse to take her home and get her placed.

Do you or husband hold POA for her? Have you applied for long term care Medicaid?