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I am really confused. My mother is in AL and is receiving A&A. I've been researching for the last 7 months on how I could move her home so I can take care of her. I had our attorney draft a Personal Care Agreement, did all the right things thinking she would not lose the benefit. I just emailed a contact at the local VA and she advised me that my mother would lose the benefit if I did this. Is this correct?? I thought that if it was proven that she needed the help, the VA benefit could be used to pay for a child to take care of the recipient. Can someone that knows what they're talking about please answer my question? Thanks!

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Emma Sue - No, my mom isn't the veteran.
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mally1, I apologize if I contributed to your being overwhelmed and eyes crossing. It does get a bit complicated. The important thing to get from the discussion and resolution of Jazzermom's question is that the Veterans Administration's Aid and Attendance Pension (A&A) can be used to pay family members for at least some of the in-home personal care they provide to veterans or their spouses via a personal services agreement (PCA). And, as Jazzermom was eventually assured by the VA, the care provided does not have to be medical in nature as it can also be personal care such as bathing, toileting, ambulating, feeding, diapering, etc., but it does have to be via a PCA based on documented personal care needs and at reasonable hourly rates, etc.

The PCA should be in place and money already paid by the veteran to the caregiver before applying for A&A (or supplementing an application to include a new PCA). The application can be complicated and the VA's approval can take many months, but A&A is a valuable resource that should not be overlooked, e.g. as a WWII widower, my dad gets $1,830 per month to help pay his memory care bill and that amount could have been paid to me when I was caring for him in my home if I had chosen to do that. Upon approval, the VA will make a large lump sum payment for costs incurred retroactive to the first month after the application was received.
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Good grief! I tried to follow this thread and now am totally overwhelmed and my eyes are crossed...
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Jazzermom, that's good news that your VA A&A and Personal Care Agreement problem is resolved. The following website might help other in-home caregivers of veterans and/or their spouses learn about the possibility of receiving A&A financial assistance: www.veteransaidbenefit.org/aid_and_attendance_pay_family_home_care.htm
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Guests - I'm not providing medical care. I am providing medication management. Everything the AL does, I'll be doing - but more. AL just provides 3 meals per day, laundry service once per week, clean sheets once per week, 1 shower per week and medication management. That's it. She had another stroke in March and I had to twist their arms to at least help her get dressed in the mornings. Been a hassle. I'd rather just take care of her myself. I had her for 10 years until my first husband died and I had to place her somewhere. Anyway, thanks everyone.
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I received more clarification after I emailed pension services officer. I told her that I plan on setting up a dba and paying taxes on all income. She then said. "Yes, they will consider you as an aide and use what she pays you also as medical, that's no problem at all. Just need a statement and proof of payment."

I've been self-employed before and so I know how to file quarterly returns, etc. and planned to keep good records, a caregiver log, etc. The agreement is comprehensive and lays out everything. It's actually an agreement atty. uses to protect Medicaid eligibility. So, I think I'll be ok. Thanks everyone for getting back to me.
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My understanding with A&A is that the Vet or spouses medical costs are over and above their income. Like prescriptions being high, the cost of aides when living home. My Mother was in an AL when I applied. I filled out all the paperwork with the help of the VA rep. I had everything he needed. Moms monthly income was 1700, The AL was almost 5k. I got a letter telling me she made over the 13K allowed. What! Who could live on 13K Mom was just about making it on 20K before the AL. I chose not to appeal since she was going on Medicaid, You can't have both.
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Jazzermom, was your Personal Care Agreement (PCA) documented by your mother's doctor as being necessary for her health based on an activities of daily living (ADL) assessment? If not, get that done and provide it to the VA.  In my dad's case, his VA doctor and the VA hospital's social workers were very helpful. I assume that your attorney who drafted your contract was careful to list your caregiving duties, used normal caregiving hourly rates, the number of hours you would provide, etc. It's my understanding that whatever the PCA equates to in dollars per month will be deducted from your mom's income and that net income is what the VA will use to determine A&A eligibility. If all that's already been done, then contact one of the organizations that advocate for veterans, e.g. your state's veterans affairs agency, etc.

I'm sure the VA is faced with a lot of problems with PCAs due to a lot of families trying to game the system, so it has to do due diligence. In my several A&A experiences for my dad, both the federal VA and my state's veterans affairs agency were overall very good, but not without some hiccups. However, I did not have or need a personal care agreement, so my, so my experience is somewhat limited.
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Jazz, are you providing MEDICAL care? that's the sticky part for a homebound person getting A&A. The 2018 limits for homebound is $16,089 annual, or $1,340.75 per month. So at $1,400 per month, your mother is over the initial A&A limit for a homebound person not living in a facility. Did the VA person know that you were preparing a Caregiver's Agreement and planned to declare the income on your tax return? yes, it is all very tricky and you have to be aware of all the rules - like with Medicaid planning, tax preparation to properly report income and asset transfers, or insurance filings with property damage.
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Jazz - the insurance policies, how small?, like under 2k in face value?
Do they have any cash value or ability to do a life settlement?
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ML - I’ll stand by my statement. My take is that if an elder law attorney knows that a client is a veteran and this attorney is inexperienced or unknowning on VA eligibility rules then the atty has a responsibility to inform you as a client and they seek a consultation with an atty or law firm who has that experience. Or they have a huge errors & omissions policy to cover this. If attorney puts themselves out there as knowledgeable and they are not, they need to be called out on it.

Every state’s Bar association has a system for consumers/ clients to do this.
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Is your mother the veteran?
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She has no other assets except 2 small life insurance policies.
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Without A&A Mom's income is $1,409.08 per month. So if she's living with me, then she'll be disqualified? I thought I could be part of her "unreimbursed medical expense?" With her A&A, she has just enough to pay for her AL room and board and not much left over. This is crazy.
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Igloo572, that really isn’t fair to say an attorney is or isn’t worth a flip if they don’t know specifics on VA rules. Many are not familiar with the VA, which is the worst bureaucracy ever in history! You must literally have a VA certified attorney to deal with them, as I have found out myself. Families must get familiar with VA rules or risk situations such as the above.
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A&A now has a income & asset threshold (like what Medicaid has). In the past VA A&A did NOT do this. Lots of vets with sizable nest-eggs could draw A&A. In theory they could afford private pay totally for care on their own without A&A. VA redid eligibility to make it more in line to make it more “at need”. Changed about a year or so ago.

I’d bet that why the VA rep said this to you regarding what will happen IF mom moves out of the AL (that has a set verified room & board costs), is cause her income/assets once living at home will take her over the income/assets threshold to be eligible for A&A. If I had to guess..... average AL is 4k-5k a mo, average A&Ais $1700 a mo, so maybe your mom has maybe 3k a mo income??? If so, It’s too much $ to be “at need” if she’s living with family.

Your attorney - if worth a flip - should have known about the specific $ amount figures  for “at need” aspects for VA.
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