Medical Foster Homes for Veterans – New alternate to nursing home care for veterans

Geriatrics and Extended Care

 

Medical Foster Homes
What is a Medical Foster Home?

Medical Foster Homes are private homes in which a trained caregiver provides 
services to a few individuals. Some, but not all, residents are Veterans. A Medical
Foster Home can serve as an alternative to a nursing home. It may be appropriate
for Veterans who require nursing home care but prefer a non-institutional setting
 with fewer residents.

Medical Foster Homes are private residences where the caregiver and relief
caregivers provide care and supervision 24 hours a day, 7 days a week. This
caregiver can help the Veteran carry out activities of daily living, such as
bathing and getting dressed. VA ensures that the caregiver is well trained to
provide VA planned care. While living in a Medical Foster Home, Veterans
receive Home Based Primary Care.

VA Medical Centers with Medical Foster Home programs

This list includes the VA Medical Centers currently operating a Medical Foster
Home program. However, many facilities are in various stages of development
of their own programs. Please reach out to your VA social worker to inquire
about when a Medical Foster Home will be available at your local facility.

Medical Foster Home in the News

Southern Living: Foster Families for Veterans Keep America’s Heroes in the
Homes They Deserve

People Magazine: Indiana Family of Eight Fosters Three Veterans Who Are
Disabled: ‘We’re One Big Family Now’

Are you interested in becoming a Medical Foster Home?

If you are interested in becoming a Medical Foster Home (MFH) Caregiver,
review the Medical Foster Home Checklist for more information, then reach
out to your local MFH Coordinator.

Medical Foster Home in Greenville, Indiana

Three war heroes, two parents and six kids
live together in Greenville, Indiana as part
of the Medical Foster Home Program.

VETERAN DIRECTED CARE PROGRAM - KEEPS VETS AT HOME INSTEAD OF NURSING HOMES

This program uses VA funds to help any elderly or disabled Vet remain home with loved ones instead of needing nursing home care.

by Wes Carter

WHAT? VA PROGRAM PAYS TO HELP VETERANS AVOID NURSING HOMES AND LIVE INDEPENDENTLY!

REQUIREMENTS: ONLY A NEED AND AN HONORABLE DISCHARGE

INTRODUCTION

In Colorado, this terrific program is currently available to Veterans living in these counties: City and County of Denver, Adams, Lane, Larimer, Arapahoe, Clear Creek, Douglas, Gilpin and Jefferson, Boulder, Washington, and the City and County of Broomfield.

Veterans Health Administration launched Veteran Directed Care (VDC) to help Veterans with disabilities of all ages and their families pay for needed services in their own homes and communities. VDC is an exciting and comprehensive VA program, open to all veterans in those counties, regardless of service-connection.

VDC delivers home and community-based long-term service and support, giving Veterans more choices and control over nearly all types of care they receive in their homes and communities. This program combines the hands-on experience and skills of local medical and service providers with the VA’s extensive resources to provide additional opportunities to avoid nursing home placement and stay independent in your own home

Under the VDC Program, Veterans (or their caregivers) manage their own flexible VA-provided spending budgets, hire and supervise their own workers, including family or friends, and purchase what’s needed to live independently. The key point again: VA gives the Veteran a budget to pay for this!

Thousands of Veterans have already signed up with VDC, including the elderly, and younger, severely injured Veterans of Operation Iraqi Freedom, Operation Enduring Freedom and Operation New Dawn. The keys to this program are an Honorable Discharge, the need for it, and availability of VDC where you live. There is no financial test, no need for a VA disability rating, and there’s no impact on any Social Security or other disability program.

A Veteran in the VDC Program is supported by: a VA program coordinator to oversee quality, satisfaction and service delivery; a person-centered counselor from an Area Agency on Aging, Aging & Disability Resource Center or Center for Independent Living to assist in finding and/or training workers caring for the Veteran’s needs.

ENROLLED VETERANS:

• Receive a comprehensive assessment and care planning assistance

• Decide for themselves, or with a participant representative, what mix of goods and services will best meet their needs

• Manage a flexible, individual budget. Funds are provided by VA and used by the veteran to pay for services and supplies to remain independent in the community.

• Hire and supervise their own workers, including family or friends

• Get financial management and support services available if needed

• Use traditional service providers, or an overall contractor or palliative care provider, if desired, to coordinate care

TARGETED VETERANS IN VDC

All Veterans enrolled in the Eastern Colorado VA Health Care System are eligible to participate in the VDC program when the Veteran is “in need of nursing home care” and interested in self-directed care. The determination of whether a Veteran is “in need of nursing home care” is made by the VAMC.

The VDC Program is targeted to Veterans whose home care needs exceed the average number of hours generally available through the Homemaker/Home Health Aide (H/HHA) Program. (If the need is more modest than VA  requirements and if the Veteran is service-connected, ask about this homemaker support.)

IS VDC FOR YOU?

Do you want the control and flexibility to live more independently by choosing how and when you purchase your goods or services? Can you be responsible for recruiting, hiring, and dismissing your workers and services providers? If so, the VDC Program might be for you! If you know another vet who might benefit, pass the word!

Recognition for Colorado Legislators Who Sponsored Gold Star Spouses Amendment

 On Wednesday the United Veterans of Colorado met with legislators who sponsored last years' constitutional amendment adding Gold Star Spouses to the property tax exemption. We're grateful for their outstanding leadership, especially from Representative Cathy Kipp!

Colorado LSC initial cost estimate of $4.5 million for HB 23-1002 (TDIU) was inaccurate

Colorado LSC initial $4.5 million estimate for HCR23-1002 (TDIU) was inaccurate
(see revised budget impact from LSC correction below, based on this analysis)

The Cost for HCR23-1003 Total Disability for Individual Unemployability (TDIU) Property Tax Exemption

Background:

1. TDIU is regulatory, not statutory. The key section of the US regulation reads:

“Total disability ratings for compensation may be assigned, where the schedular rating is less than total, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. Provided that, if there is only one such disability, this disability shall be ratable at 60% or more, and that, if there are two or more disabilities, there shall be at least one disability ratable at 40% or more, and sufficient additional disability to bring the combined rating to 70% or more.” (38 CFR § 4.16a.)

2. TDIU benefits granted under the VA Rating Schedule are intended to compensate veterans for the average impairment in earning capacity that results from service-connected disease or injury. TDIU is a special additional benefit to address the truly unique disability picture of a veteran who is unemployable solely from service-connected disability, but for whom the application of the Rating Schedule does not fully reflect the veteran’s level of impairment. TDIU allows the veteran to receive compensation at a rate equivalent to that of a 100% schedular award.

3. VA pays basic compensation benefits to veterans incurring disabilities from injuries or diseases that were incurred or aggravated while on active military duty. VA rates the severity of all service-connected disabilities by using its Schedule for Rating Disabilities. The schedule lists a multitude of disabilities and assigns each disability a percentage rating, which is intended to represent an average earning impairment the veteran would experience in civilian occupations because of the disability. Veterans awarded service-connected disabilities are assigned single or combined (in case of multiple disabilities) ratings ranging from 0 to 100%, in increments of 10%, based on the rating schedule; this is known as a schedular rating. Diseases and injuries incurred or aggravated while on active duty are called service-connected disabilities. To avoid an unfair “one size fits all” disability evaluation, disability compensation can be increased to the full 100% level if VA determines that the veteran is factually unemployable (not able to engage in substantially gainful employment) based only on the service-connected disability exceeding in severity anticipated in the rating schedules. VA can assign a total disability rating of 100% to veterans who cannot perform substantial gainful employment because of service-connected disabilities, even though their schedular rating is significant but less than 100%...but is in fact totally disabling.

The initial cost estimate by LSC of $4.5 million if approved by the public is inaccurate. Several facts need to be considered that should reduce this significantly:

1. Most importantly, the GAO reports that 54% of TDIU veterans are age 65 or older, and thus already eligible for the senior property tax exemption if in their home ten years or more. Those TDIU veterans present no additional burden for the property tax exemption program. An unknown number of TDIU veterans under age 65 have partners over age 65 and thus otherwise eligible for the exemption.

2. 2847 Colorado TDIU veterans who are permanently and totally disabled from line-of-duty injuries are barred from the exemption. Colorado has 13589 VA 100% permanently and totally disabled veterans, 76% of whom are homeowners No VA data seems available to determine how many of these are “P&T (permanent and total)” to qualify for the current property tax exemption. VA reports the ratio of TDIU/100% veterans is about 45/100, and 46% of TDIU veterans are age 65 or younger. Thus, Colorado is ignoring the needs of 20% of our totally disabled homeowning vets under age 65. The exemption for TDIU veterans would be under $2 million annually.

3. Colorado seems unique among the states in distinguishing between VA 100% schedular and TDIU. Military.com rates Colorado, prizing ourself as “Veteran Friendly,” only as a mediocre 27th among the states offering veterans’ benefits.

4. 60%+ of TDIU veterans are in the World War II-Vietnam era. The age group 50-65 represents 28% of all TDIU recipients. Their participation in a property tax exemption program is just for a few years before aging into the senior exemption...they “age out” of any potential TDIU burden on the state.

According to the National Center for Veterans Analysis and Statistics, the total veteran

population is set to decline from 20.8 million in 2015 to 12.0 million by 2045; total annual change is -1.8

5. 27.2% of Colorado’s veteran households have an “extraordinarily high” burden of total income for housing. 6.9% of veterans live below the poverty line, although totally disabled veterans’ disability benefits are above that level unless family size is considered.

6. 35% of TDIU beneficiaries have mental health conditions as their major diagnosis (of which more than two-thirds are posttraumatic stress disorder [PTSD] diagnoses), followed by musculoskeletal conditions (29%), and cardiovascular conditions (13%.)

7. Of all Colorado veterans receiving disability compensation, 6% are rated as 100% permanently and totally disabled. 4.5% of Colorado’s total veteran population have a disability rating of TDIU.

8. It is misleading to refer to this category of veterans as “individually

unemployed" without further explanation. Rather, they are totally disabled veterans who, solely because of their military injuries or illnesses, have been carefully assessed by VA physicians, claims officials and vocational specialists as being totally and permanently disabled, unable to work above any marginal employment. The term “total disability for individual unemployability” should be used throughout, rather than “unemployed!” TDIU veterans aren’t unemployed; they have left active duty service physically unable to work, whereas VA-rated 100% disabled veterans are often able to continue useful employment, trained for other opportunities, other careers, and are encouraged to find work for obvious financial and mental health reasons. “Extraneous” factors, such as nonservice-connected disabilities, injuries occurring after military service, availability of work, or voluntary withdrawal from the market are not considered as factors for TDIU ratings.

Where the rating schedule is found to be inadequate to fairly compensate a veteran for the inability to be gainfully employed, Veteran Benefit Administration (the administrative portion of VA) may refer cases consideration of a TDIU rating on an “extrascheduler” basis

9. The US Department of Veterans Affairs has just two categories of veterans assessed to be totally and permanently disabled due to their injuries or illnesses. There are no differences in their federal benefits or compensation.

a. VA “100% permanent and total schedular.” is a rating schedule which assigns a degree of total disability using a formula set by law ( 38 CFR 3.340, 38 CFR 3.341(a), and 38 CFR 4.16) for a full range of illnesses and/or injuries suffered by veterans while on active duty (or, for Reserve Components, while on active training status for when called to federal service.)

b. The second is TDIU, a unique program created in 1933 to “fill the gap” in situations where a veteran’s line-of-duty illnesses or injuries are far more serious and exceed the schedular provisions, or when the combination of the veteran’s active duty illness or injuries are at least 70% but when considered with with other, lesser military injuries or illness have made the veteran totally disabled. This involves separate medical and administrative assessments: one evaluating military-related disabilities and a second to consider whether those military disabilities alone make employment impossible. This leaves the TDIU veteran at a fixed disability compensation at the 100% level, never able to continue productive employment.

TDIU criteria for unemployability are quite similar to those used by the Social Security Administration to determine total disability, except TDIU is far more restrictive, being based solely on military line-of-duty injuries or illnesses. SSDI considers the broader picture, including all military and civilian issues to determine total disability. A veteran can be SSDI-eligible for overall disability yet unqualified for TDIU unless military disabilities make anything above-marginal employment impossible. Note that many veterans having between 10%-90% VA disability (neither 100% nor TDIU) but are qualified to receive SSDI. Between SSDI, VA 100% disability and TDIU, TDIU is the most serious and restrictive disability scheme.

Like SSDI, a TDIU veteran is monitored for their continuing total disability. Earned income, whether employed or self-employed, other than sheltered workshop or below-poverty level income is disqualifying. Such a situation would result in termination of federal TDIU and any related state benefits. This limit applies only to the veteran's earnings, and not to the veteran's unearned income or household income. Managing TDIU benefits involves not only assessing initial eligibility for benefits, but also ensuring beneficiaries’ ongoing eligibility by identifying those who are not in compliance with the earnings limit.

VA rating specialists initiate TDIU evaluations when a veteran or their VA physician submits an application for TDIU benefits or his or her application for compensation benefits contains clear evidence of unemployability. In all cases, before granting benefits, rating specialists must evaluate the impact that the veteran’s service-connected disability(ies) have on his or her ability to perform gainful employment, which for decision-making purposes is generally interpreted as employment that is more than “marginal employment.”

Marginal employment for a TDIU veteran may also be held to exist, on a case-by-case basis, for a veteran maintaining employment at a sheltered workshop or family business with annual earnings at or below the poverty threshold.

VA rating specialists are to rely on various sources of information for the evidence needed to support such a determination, including an employment and earnings history furnished by the claimant, basic employment information from the claimant’s employers (if any), and a medical exam report from Veterans Health Administration (the medical side of VA.) If the claimant had received vocational rehabilitation assistance from VA or disability benefits from SSA, the rating specialist might also seek information on these services or benefit decisions. Many veterans seeking TDIU benefits seek a vocational evaluation, offered by many states’ employment agencies to assess any remaining employability.

Quality of life reduction, a serious issue and often a factor in other disability compensation programs, is not assessed in VA issues. About 30% of totally disabled veterans receive assistance from family members with activities of daily life impairments, thus greatly reducing household income.

Wes Carter, Chair

The C-123 Veterans Association

A DISABLED VETERAN AND MILITARY RETIREE LOOKS AT HB23-1084 -Continuation of Military Retirement Benefit Deduction in Colorado

This measure deserves the full support of the Colorado legislature and the voters. It certainly has mine!

HB23-1084 is important. It carries a small and reasonable cost that brings advantages to the state well beyond the investment. It should be approved this session.

DECLARATION: Neither this bill nor HB23-1002 will affect me as my retirements are already exempt from Colorado’s income tax. I am a VA-rated 100% disabled veteran and also a 26-year military retiree separated from the Air Force at a 100% medical disability, thus my state income tax is already exempt for other provisions of the law.

At first glance, I believed HB23-1002 for disabled veterans should be a priority over HB23-1084. Instead, I now urge approval of both measures because they are good for veterans and great for Colorado. This year both bills are firmly supported by the United Veterans of Colorado.

Since 2011 I’ve urged legislative action to help other totally disabled veterans and thus have long supported measures such as HB23-1002. Colorado’s constitution currently provides a partial property tax exemption to VA-rated 100% disabled vets but fails to address VA’s second category of disabled veterans who are totally disabled, those the VA rates as “totally disabled for individual unemployability (TDIU.)

HB23-1052 addresses that oversight and supports nearly 3,000 of Colorado’s most seriously and totally disabled veterans whose injuries or illnesses prevent any employment. I expected to strongly favor only this initiative because of the moral imperative of meeting the needs of these vets. 

I’ve changed my view. I see both measures as vital legislation for Colorado in 2023, particularly because HB23-1084 is an economic “no-brainer,” bringing much more to Colorado than it costs

Retired military who chose Colorado as their home following active duty do so for many reasons. Clearly, important among them is a favorable treatment of their military retirement income. Colorado currently exempts a modest portion of a military pension; HB23-1084 merely extends it to 2034. This measure pays for itself far beyond its modest cost,

In 2021 28 states exempted all of a military retirement from state income taxes, and that number rose to 32 in 2022. Eleven states, including Colorado, currently offer an exemption for at least some portion of a military retirement. Seven states and the District of Columbia have no military pension exemption. To our disadvantage, Colorado will join that short list in 2024 unless HB23-1084 is approved to continue our partial exemption.

Governments and legislators see the importance of being “veteran-friendly” but unfortunately Colorado only ranks a modest 27th among the states.

Being “military-friendly” recognizes a retiree’s long service to the state and nation and it makes great economic sense. Thanks in part to the current partial exemption provided military pensions in Colorado, our 50,000 retired military have brought their steady retirement income. Most brought their military experience, skills and knowledge to join our workforce or start their own businesses as second careers. Servicemembers already here have been encouraged to stay after leaving active service, and others selected our state as their new home, in part because of the current partial exemption for military pensions.

States value retired military members because they bolster the state economy by bringing retirement income and non-taxed VA benefits, like the GI Bill. Typically, their federal benefits leave them independent of state support services. According to a California study considering state taxation of military pensions, researchers determined there would be significantly more jobs, millions added to total personal income, billions added to gross state product and to business sales if military pensions were exempted.

Another recent study by the Towson University Regional Economic Studies Institute (RESI), found that “If (the state) does not exempt military retired pay from state income taxes … countless other service members and their families will opt to retire to military retiree-friendly states.”

The Towson study also stated that when military retirees reenter the workforce, their taxable income generates an economic impact in addition to that of their military pensions. Their second careers can last from 15 to 20 years. Military retiree household spending — groceries, rent, mortgage payments, automobile purchases and recreation spending, to name a few items — also benefits the economy. As average to above-average wage earners, these are the folks Colorado wants to attract and keep.

HB23-1084 is a golden opportunity to increase state revenues by passing legislation that would continue to partially exempt military retired pay from state income tax. This legislation would help stem a migration of skilled and experienced personnel who retire from the military and leave Colorado because of state income tax higher than other states.

Military vets are good neighbors who pay their bills, volunteer in the community and have an appreciable level of discretionary income. Most other states have learned this and realize that exempting military pensions from state income taxes means losing a little in revenue but building a stronger fiscal base by increasing the total number of state taxpayers. States that understand the economics of exempting military retired pay reap the benefits that come with creating an attractive fiscal landscape. 

We need to keep our “landscape” military-friendly with HB23-1084.

United Veterans Coalition of Colorado 2023 Legislative Goals

 2023 Colorado legislative goals:

1. HB23-1084    Continuation Of Military Retirement Benefit Deduction

2. HB23-1052    Mod Prop Tax Exemption for Veterans with Disability (TDIU veteran's property tax exemption)

VICTORY FOR GOLD STAR SPOUSES!

AMENDMENT E APPROVED BY 88% OF COLORADO VOTERS!

In a sweeping victory for the United Veterans of Colorado and Gold Star Spouses, voters approved amending the Colorado Constitution Article X Section 3.5 to extend the partial property tax exemption to Gold Star Spouses.

 Several years of efforts, of resolutions passed by the American Legion, leadership of the UVC and patience of the Gold Star spouses themselves, all finally came to the best possible resolution – not only passed as required with 55% of the voters approving, but by an overwhelming 88%.

Gold Star Spouse Property Tax Exemption WILL Be On November Ballet

The Colorado state constitutional amendment adding Gold Star Wives (Spouses) to the state's disabled veteran and senior property tax exemption WILL be on the November ballot, having been passed unanimously by both houses of the Colorado legislature. 

This reflects terrific leadership by the legislative committee of the United Veterans Coalition, which made it their Number One legislative objective for 2022.

Congratulations to all who worked on this initiative and now, let's get the vote out for November!

In 2013 I identified three flaws in the state's property tax exemption law: failure to include disabled military retirees, failure to include Gold Star Wives, and failure to include veterans considered totally disabled by the VA with a rating called "total disability for individual unemployability."

So far, the first two are resolved and now we can set our sights on our worthy TDIU veterans, denied important state property tax benefits for far too long.

GOLD STAR SPOUSES PROPERTY TAX EXEMPTION ADVANCES TO SENATE FLOOR

Yesterday the Colorado Senate Appropriations Committee voted unanimously its approval of the Gold Star Spouses property tax exemption bill. Several senators on the committee spoke to the importance of this bill.

Once approved by the Senate and signed by the governor, the bill goes to voters in each senatorial district as a referendum on amending the state constitution to include Gold Star Spouses for the partial property tax exemption. Presently, survivors of totally disabled vets already receiving the exemption continue the exemption. The original language of the property tax exemption unfortunately didn't address the situation of servicemembers who die on active duty.

TDIU = actual VA TOTAL disability rating

A previous director of the Colorado Division of Military and Veterans Affairs wrote me six years ago to state that one reason Colorado denies TDIU veterans the state partial property tax exemption is that the state law requires a VA TOTAL DISABILITY RATING, and he explained that TDIU is somehow "only" compensation at the 100% rate and not an actual disability rating. 

CDMVA hasn't made any visible effort to care for TDIU veterans the same as it cares for 100% schedular. A variety of reasons have been tossed out but as for TDIU being an actual disability,VA disagrees with CDMVA.

From Title 38, Chapter 4 (§ 4.15 Total disability ratings)

"It is the established policy of the Department of Veterans Affairs that all veterans who are unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities shall be rated totally disabled"