VA Connecticut Healthcare System

Statement on rest home payments

October 24, 2013

VA deeply regrets that we are unable to continue to cover the costs for veterans to reside in rest home level of care facilities.  VA Connecticut Healthcare System social workers will work closely with each patient, family and conservator impacted by this change to ensure appropriate residential relocations for these patients.

Options for the veterans impacted by this decision include:
• If eligible, relocating to a skilled VA contracted nursing home at VA expense;
• Remaining at their current facility at their own expense;
• Relocating to another residential facility, a family residence or other preferred option that best meets the veteran’s needs, at the veteran’s expense. 

VA discovered in late January 2013 that it had been placing veterans in rest home level of care facilities since 2001. Rest Home level of care is not authorized under the options available to VA medical centers for placement of veterans in need of full time nursing care.  Only skilled nursing care facilities are authorized for these types of placements.  This placement discrepancy was discovered during an audit and impacts three area rest homes. 

While the veteran residents have specific benefits as a result of their military service, VA does not have the authority to pay for veterans to be in a residential level of care in rest homes or in assisted living facilities per regulations.

A process known as Equitable Relief was requested from the Department of Veterans Affairs on behalf of these patients, their families and the rest homes.  Equitable relief ensures that the government will not attempt to recover any unauthorized payments made on behalf of these patients.  The equitable relief approval process took longer than anticipated but protects these patients, their families and the rest homes from financial liability.

Key Facts
• VA Connecticut Healthcare System will work closely with each patient impacted by this change to obtain appropriate residential placement.  Placement may be at VA expense, depending on the types of VA benefits each patient is eligible to receive.
• This issue has been under review since January and is completely unrelated to the government shutdown.
• These patients were originally placed in the rest homes because they had exhausted their abilities to remain in their homes while receiving home care and other community-based services.
o While remaining at home was no longer an option, at the time of placement - these patients did not yet require a skilled nursing facility.
• VA Connecticut began notifying patients on Oct. 11, 2013.  Payments made on behalf of these patients to the rest homes are scheduled to cease on Dec. 31, 2013.
• VA  has no authorization to pay for care at rest homes or assisted living facilities based on regulation - 38, U.S.C. 1730.
• VA requested and was granted equitable relief from the Department of Veterans Affairs which ensures that the veterans, their families and the rest home will not have to repay the government for payments made on behalf of the veterans.

 Key Definitions*
• Residential  Care Home – An institution having facilities and all necessary personnel to furnish food, shelter and laundry for two or more persons unrelated to the proprietor and in addition, providing services of a personal nature which do not require the training or skills of a licensed nurse.  Additional services of a personal nature may include assistance with bathing, help with dressing, preparation of special diets and supervision over medications which are self- administered.
• Rest Home with Nursing Supervision – An institution having facilities and all necessary personnel to provide, in addition to personal care required in a residential care home, nursing supervision under medical direction 24-hours per day.
• Nursing Home – A long term institution having facilities and all necessary personnel to provide skilled nursing care under medical supervision and direction to carry out simple, non-surgical treatment and dietary procedures for chronic disease or convalescent stages or acute diseases or injuries.
*Public Health Code of the State of Connecticut, Section 19-13D1(b)