Planning Your Care in a Home Away from Home

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Planning Your Care in a Home Away from Home

What do any of us have in common with Jack Nicholson’s crusty healthcare tycoon character in the 2007 hit movie “The Bucket List?”  It might not be his extravagant around-the-world adventures romp, but like him, our “do it while we can” dream lists often originate from impending health care challenges that may require care outside our homes.  Most of us will avoid anticipating the need for caretaking and more likely, we’ll expect to be the caregiver.  Yet it is known that about 15% of U.S. citizens will need to use residential and nursing home care during their lifetime.  

Veterans of all ages, with and without combat experience, have a variety of community, state and federal alternatives to consider, some dedicated to serving only veterans.  In addition to extended skilled nursing care, it is common to need short-stay care after surgery or an acute illness.  Respite care, temporary relief for someone caring for you in your or their home, is becoming increasingly popular.

Go shopping and make firsthand comparisons.  Expect the best possible match for yourself through a shared decision process.  You and your admission coordinator will determine what care you need and can financially afford, available home services and fulfillment of admission criteria.  It will assuredly be less stressful for you and your caregiver if you tackle this when you are still your own spokesperson and not in the midst of a crisis.   What should you consider?  

Your Veteran Status.  Veteran status may or may not be a factor depending on your home of choice.   Each home and other agencies providing services and financial support publish their unique definition of “veteran.”  Some may give admission priority to wartime veterans or to service-connected disabled veterans.  Others may specify a “veteran” as someone with only one day of active duty military service for other than training, which opens doors for those who served active, Reserves and Guard duty.  Most require an honorable discharge from military service.  Veterans in Veterans Administration (VA)-certified homes may qualify for financial stipends.  It’s always best to contact the home of interest and talk directly with them about their admission criteria.  See sections below for more information.  

Desired Location.  Always visit a facility in advance of your final decision if possible.  If finances are a concern, you want to know if the home is VA certified or not.  See next section.  Can the facility that interests you meet you and your family’s location proximity preferences and emotional needs while accommodating your residential and/or health care requirements?  If not, does the facility offer visitation transportation or electronic family connections through Skype or other computer applications?  Your nearest VA Medical Center Geriatrics and Extended Care office can assist you in identifying facilities.  Your local area agency on aging and the National Association of State Veteran Homes are also dependable resources.

Veterans Administration (VA)-certified Homes.  The VA must formally recognize and certify a facility as a State Veterans Home, a Community Nursing Home or a Medical Foster Home.  VA-certified homes can apply for VA construction grants and their veteran residents can apply for VA financial stipends.  Your nearest VA Medical Center Geriatrics and Extended Care office usually maintains a list of these homes.  The VA does not manage State Veterans, Community Nursing or Medical Foster Homes, but they do inspect and approve them to ensure they continue to meet VA standards.  The VA does manage their Community Living Centers.  See Financial Obligations below.

 

Capacity for Required Care.  Your needs will be assessed as a part of the admissions process to ensure your home of choice can offer what you need and want.  Again, expect the best possible match through a shared decision making process.  If not satisfied, shop around if you can.     

 

Room Availability.  Facilities range in size and none share a common structural design.  Some states have more VA-certified home alternatives than others.  Always visit homes as far in advance as possible before making your final decision.  By federal law, facilities that participate in the VA construction grant program must serve at least 75% veterans and may serve, if space is available, up to 25% veteran widows, spouses, widowers, and Gold Star parents.  Homes with more private rooms have more admission flexibility and you are more likely to be admitted at or closer to the time of your need.

 

Coordination of Care.  It’s important to understand a home’s protocol for managing your in-home care, transferring you to other care facilities and accessing outside mobile health teams and telehealth.  If you want to be able to access outside care while at a home of choice, for instance VA services, its best to verify the availability and deliverability of these services from your local VA.

 

Length of Stay.  Veterans need short- and long-term care.  Short-term care might mean living at the home 24/7 or attending adult daycare programs.  Long-term stays can occur more than once and are not just end-of-life care focused.   Homes are diversifying their services to include out-patient physical, occupational and speech rehabilitation services.

 

Culture Compatibility.  You and your caregiver need to carefully identify what is most important to youperson- or staff-directed care, transparency and enforcement of resident rights, an all-veteran setting, ratio of male to female residents and residents to staff, institutional or social concepts and design, VA certification, food preparation, indoor and outdoor activities, volunteers associated with facility, ease of mobility on property, visiting hours, alternative communication opportunities with family and friends (Skype, e-mail, phone), resident safety and security measures, inspection results and any other priorities you or others identify.  

 

Financial Obligations.  Your care is not free and again, costs vary depending on a host of factors at VA-certified and other homes.  The Admission Coordinator or other staff helps you complete a financial assessment.  Ensure you clearly communicate your veteran status.  In FY2014, the daily VA stipend for veterans in VA-certified homes was $100.37 for nursing home care and $43.32 for residential care.  Service and non-service connected veterans may be entitled to additional monthly benefits such as VA Aid and Attendance.  Homes complete a VA provider agreement for 70-100% VA disability-rated veterans needing skilled nursing home care.   

 

Very few women veterans take advantage of these services.  There are several influential self- and industry-imposed factors limiting women veteran admissions.  The age-old stumbling blocks that we’re not old enough yet to worry about it, too busy, unsure of our veteran status, erroneous beliefs we have to have retired from the military or serve during a wartime period or in combat, and our inclination to give care not take care top the self-imposed list.  On the other hand, the residential and nursing home industry is lagging in its preparation to receive more women veterans at or closer to the time of their need.  The forecast is clear.  There are about two million women veterans today and the Veterans Administration (VA) expects their female patient load to double within the next decade. However, facility design benefitting from VA construction loans historically supported non-private rooms with shared bathrooms for a predominately male veteran population.  Admissions flexibility hindered by traditional architectural design, constrained future-year construction funding and advertising and marketing campaigns that do not inclusively target all veterans directly impact who will receive care at or closer to the time of their need.  If women are not clearly represented in brochures, TV ads and in radio biddings, they have not received an explicit invitation to these services…the doors are not wide open.  

 

Women still live longer and some outlive their children, on average earn significantly less lifetime wages, build less lucrative retirement plans if any, and not infrequently experience home, health and food insecurities at some point in their lives.  

 

Be your own best advocate and give yourself some peace of mind by understanding your veteran benefits.  Plan ahead, sooner than later, for care-taking and caregiving in a home away from home.

 

January 25, 2015

Updated: 4/08/2015

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