Dpt. of Veterans Affairs Respite Care: Benefits & Eligibility

Definition

Respite Care from the Department of Veterans Affairs is a program that provides trained caregivers that attend to the individual in need of care. This is done to give the primary caregiver of a veteran time to relax, run errands, and attend to his or her own needs, and overall, prevent caregiver burnout. Depending on geographic location and the recipient’s preference, care can be provided in the home, in adult day care, or in a VA medical or community living center. Respite caregivers are able to provide most, if not all, the assistance the primary caregiver is able to provide, such as (but not limited to) supervision, meal preparation, help dressing or bathing the care recipient, and medication reminders.

Alone, respite care is not a long-term solution for care, but when combined with other programs and cost reductions, such as tax credits, LIHEAP (Low-Income Home Energy Assistance Program), and transportation assistance, respite care might make the difference that enables a family to choose between residential and home care.

Qualifications for Veterans’ Respite Care

Respite care is a covered benefit for all veterans who are enrolled in the VA health care system and meet the following requirements. In rare cases, certain veterans may be eligible for VA health care without having to enroll in the VA health care program.

Age

There are no age requirements to be eligible for VA Health Care. However, one’s age impacts other eligibility criteria.  As an example, individuals 75 or older have less restrictive disability qualifications than do veterans of a younger age.

Disabilities / Health

Veterans must have a chronic illness or condition that results in a need for the level of care typically provided in a nursing home. However, it is not a requirement that the condition be related to their military service. Older or clinically depressed individuals have less restrictive disability requirements. Typically, persons with Alzheimer’s, Parkinson’s, and related dementias meet the disability requirement.

Marital Status

Marital status does not play a role in determining one’s eligibility for VA respite care. Most commonly, it is the spouses that are the primary caregivers, and hence, the recipients of respite care. However, there is no requirement that the individual be married.

Financial Requirements

A veteran’s financial resources may be considered when assigning a veteran a Priority Group. (Veterans who have greater financial and / or health needs are given greater priority, which is indicated by a lower Priority Group number). Financial resources may also be considered when determining if a veteran has to pay co-payments for health services and prescription drugs.

A veteran’s resources are defined as the sum of the veteran and their spouse’s income and assets (liquid and fixed) minus any allowances, such as medical bills. Veterans who have resources in excess of the limit are evaluated on a case-by-case basis to determine their need.

A very general rule of thumb is veterans can have up to $80,000 in resources or nearly $33,000 in annual income. Married veterans can deduct $123,600 from their total resources as “spousal resource protection”. However, there are many exceptions and these amounts change based on the veteran’s county of residence. Veterans with resources beyond the maximum allowable amount mentioned here should consult directly with the VA or a veterans’ benefits consultant to determine if they are eligible.

Veteran’s Service and Discharge

Veterans who enlisted in military service after the date of September 7, 1980 or became active duty after the date of October 16, 1981 are required to have 24 months of continuous active duty military service. In addition, they must have discharge status other than Bad Conduct or Dishonorable to be eligible for VA Health Care (and therefore VA Respite Care). There are exceptions to the 24-month rule for:

• Reservists or National Guard members that were called to Active Duty and completed their terms.
• Persons requiring treatment for a service-connected condition or disability.
• Persons discharged or released from active duty for a hardship or an “early out”.

Geographic / Place of Residence

A veteran’s geographic location does not impact eligibility directly, but the maximum allowable amount of resources changes depending on the county in which the veteran resides. In addition respite care must be available in the area in which one lives. 

Veterans must be living at home and have a primary caregiver in that environment. Those who reside in a VA medical center or community living center are already receiving care and therefore are not eligible for respite care.

Benefits

VA respite care is provided up to 30 days a year. A day is defined by a maximum of 6 hours when the respite care is provided at home, but a day is 24 hours when the respite is provided in a veteran’s community living center (also known as a VA nursing homes). The VA may offer an extension to the 30-day rule in the case where the primary caregiver to the veteran passes away. Respite care can be provided in a combination of settings. For example, a family may choose to split the days between in-home respite and care at a community living center.

Families do not receive a cash payout for respite care. They will either receive a caregiver directly or a voucher to receive respite care. Provided there are not waiting lists to receive VA respite care, appointments can typically be scheduled a few weeks in advance.

Costs

The cost of respite care is covered by the basic veteran’s Medical Benefits Package. A co-payment may be required dependent on one’s service-connected disability status and financial resources. The maximum co-payment for 2018 for respite care is as follows: $5 /day for in-home care, $15 / day for outpatient care, such as adult day care, and up to $97 / day for inpatient care, such as in a VA community living center. Make note, there are no co-payments until the 22nd day of services. 

How to Apply

To apply for VA respite care, one should contact their local VA administrator and fill out VA Form 10-10EC (application for Extended Care Benefits. One can learn more about the program here. Alternatively, one can call the Health Benefits Service Center at 877-222-8387.