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In This Issue:

1. Putting Home Care in Perspective

2. About The Firm

Putting Home Care in Perspective

The Evolution of Home Care

In the first century of our country’s history there was no such thing as nursing homes or assisted living. Society was mostly rural and people lived in their own homes. Families cared for their loved ones at home till death took them. In the latter part of the 1800′s because of an increasingly urban society, many urban families were often unable to care for loved ones because of lack of space or because all family members including children were employed six days a week for 12 hours a day. During this period many unfortunate people needing care were housed in County poor houses or in facilities for the mentally ill. Conditions were deplorable. In the early 1900′s home visiting nurses started reversing this trend of institutionalizing and allowed many care recipients to remain in their homes. Nursing homes or so-called rest homes were also being built with public donations or government funds. With the advent of Social Security in 1936, a nursing home per diem stipend was included in the Social Security retirement income and this government subsidy spurred the construction of nursing homes all across the country.

By the end of the 1950s it was apparent that Social Security beneficiaries were living longer and that the nursing home subsidy could eventually bankrupt Social Security. But in order to protect the thousands and thousands of existing nursing homes Congress had to find a way to provide a subsidy but remove it as an entitlement under Social Security. In 1965 Medicare and Medicaid were created through an amendment to the Social Security Act. Under Medicare, nursing homes were only reimbursed on behalf of Social Security beneficiaries for short-term rehabilitation. Under Medicaid, nursing homes were reimbursed for impoverished disabled Americans and impoverished aged Americans over the age of 65. It has never been the intent of Congress to pay for nursing home care for all Americans. The nursing home entitlement for all aged Americans was now gone.
Over the last 40 years, there has been a gradual change away from the use of nursing homes for long-term care towards the use of home care and community living arrangements that also provide in-house care.

With Proper Planning People Could Remain in Their Homes for the Rest of Their Lives

We are seeing a trend towards working conditions like those in urban America in the early 1900′s where both husband and wife are working and putting in longer hours. We are also seeing a return of the trend in the early part of the 20th century where outside visitor caregivers are becoming available to replace working caregiver’s and allow the elderly to receive long-term care in their homes. In addition there is a significant trend in the past few years for Medicaid and Medicare to pay for long-term care in the home instead of in nursing homes.

Given enough money for paid providers or government funding for the same, a person would never have to leave his home to receive long-term care. All services could be received in the home. Adequate long-term care planning or having substantial income can allow this to happen.
We only need to look at wealthy celebrities to recognize this fact. Christopher Reeve, the movie star, was totally disabled but he had enough money to buy care services and remain in his home. President Ronald Reagan suffered from Alzheimer’s for many years but received care at his California ranch. He was also wealthy enough to pay for care when needed. Or what about Annette Funicello or Richard Pryor? Income from their movie careers allowed them to receive care with their multiple sclerosis at home. We will be willing to bet that Mohammed Ali, who is severely disabled with Parkinson’s disease, will probably never see the inside of a care facility, unless he chooses to go there to die. With the proper planning and the money it provides, most of us could remain in our homes to receive long-term care and we would never have to go to an institution or a hospital.

The Popularity of Home Care

Most of those receiving long-term care and most caregivers prefer a home environment. Out of an estimated 8 million older Americans receiving care, about 5.4 million or 67% are in their own home or the home of a family member or friend. Most older people prefer their home over the unfamiliar proposition of living in a care facility. Family or friends attempt to accommodate the wishes of loved ones even though caregiving needs might warrant a different environment. Those needing care feel comfortable and secure in familiar surroundings and a home is usually the best setting for that support.
Often the decision to stay in the home is dictated by funds available. It is much cheaper for a wife to care for her husband at home than to pay out $2,000 to $4,000 a month for care in a facility. Likewise, it’s much less costly and more loving for a daughter to have her widowed mother move in to the daughter’s home than to liquidate mom’s assets and put her in a nursing home. Besides, taking care of our parents or spouses is an obligation most of us feel very strongly about.
For many long-term care recipients the home is an ideal environment. These people may be confined to the home but continue to lead active lives engaging in church service, entertaining grandchildren, writing histories, corresponding, pursuing hobbies or doing handwork activities. Their care needs might not be that demanding and might include occasional help with house cleaning and shopping as well as help with getting out of bed, dressing and bathing. Most of the time these people don’t need the supervision of a 24/7 caregiver. There are, however, some care situations that make it difficult to provide long-term care in the home.
Please note from the first set of numbers below that a great amount of home care revolves around providing help with activities of daily living. Note from the second group of numbers that the average care recipient has need for help with multiple activities of daily living. Finally, it should be noted from the second group that well over half of home care recipients are cognitively impaired. This typically means they need supervision to make sure they are not a danger to themselves or to others. In many cases, this supervision may be required on a 24-hour basis.
The following numbers were derived from the 1999 national caregivers survey:

Percent of Elderly Home Care Recipients Needing Help With Selected Activities of Daily Living:

Bathing 42%

Dressing 37%

Transferring 32%

Doing Light House Work 22%

Toileting 21%

Medication Reminders 19%

Preparing Meals 12%

Eating 11%

Shopping 6%

Using the Phone 2%

Managing Money 1%

Functional and Cognitive Impairments of Care Recipients as Reported by Their Informal Caregivers:

0 to 2 Activities of Daily Living (ADL) Limitations = 40%

3 to 4 ADL Limitations = 30%

5 to 6 ADL Limitations = 30%

Percent of Recipients with Cognitive Impairment = 54%

It is precisely the ongoing and escalating need for help with activities of daily living or the need for extended supervision that often makes it impossible for a caregiver to provide help in the home. Either the physical demands for help with activities of daily living or the time demand for supervision can overwhelm an informal caregiver. This untenable situation usually leads to finding another care setting for the loved one. On the other hand if there are funds to hire paid providers to come into the home, there would be no need for finding another care setting.
Problems That May Prevent Home Care from Being an Option

Caregivers face many challenges providing care at home. A wife caring for her husband may risk injury trying to move him or help him bathe or use the toilet. Another situation may be the challenge of keeping constant surveillance on a spouse with advanced dementia. Or a son may live 500 miles from his disabled parents and find himself constantly traveling to and from his home, trying to manage a job and his own family as well taking care of the parents. Some caregivers simply don’t have the time to watch over loved ones and those needing care are sometimes neglected.
The problems with maintaining home care are mainly due to the inadequacies or lack of resources with informal caregivers, but they may also be caused by incompetent formal caregivers. These problems center on five issues:

• Inadequate care provided to a loved one

• Lack of training for caregivers

• Lack of social stimulation for care recipients

• Informal caregivers unable to handle the challenge

• Depression and physical ailments from caregiver burnout
In order to make sure home care is a feasible option and can be sustained for a period of time, caregivers must recognize these problems, deal with them and correct them. The responsibility for recognizing these problems and solving them is another function of the long-term care planning process and the team of specialists and advisers involved, such as the Farr Law Firm.

Adequate Funding Solves Most Problems Associated with Providing Home Care

None of the problems discussed in this article would be an obstacle if there were enough money to pay for professional services in the home. These services would be used to overcome the problems discussed in the previous section. If someone desires to remain in the home the rest of his or her life and is not extremely wealthy, adequate pre-planning can often provide the solution.
Such pre-planning involves asset protection, and should ideally be done as early as possible. One type of asset protection is to purchase a long-term care insurance policy when you are still healthy and able to afford the premiums, being sure to get a policy with a good home care benefit. There is also significant financial assistance available in the form of the Veteran’s Aid and Attendance benefit for qualified veterans. If long-term care insurance is not an option and Veteran’s Aid and Attendance is not available, another possible option is to put money aside to pay for home care in the future. If putting money aside, you should consider putting it in a special type of irrevocable asset protection trust called the Living Trust Plus™, that is designed to protect assets from probate and from the expenses of long-term care. If Medicaid assistance is needed to pay for future long-term care, whether at home or in a nursing facility, the assets in the Living Trust Plus™ Asset Protection Trust will be exempt assets for Medicaid eligibility and will not be counted against you.
Unfortunately, not enough people think about the issue of needing long-term care when they are older. This lack of planning leads to fewer options for elder care when the time comes. Lack of significant wealth and lack of pre-planning means that most people do not have the luxury of remaining in their homes when the time comes. Fortunately, Medicaid is available to pay for nursing home care to finish out the rest of their lives. Every day, the Farr Law Firm helps clients needing nursing home care protect significant assets and still qualify for Medicaid when needed.
For more great articles, visit Evan’s Blog at http://blog.VirginiaElderLaw.com
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About the Firm

Evan H. Farr, CELA, CEA, author of The Virginia Nursing Home Survival Guide (available at Amazon.com), has been in private practice in Fairfax since 1987, and is the only attorney in Virginia who is both a Certified Elder Law Attorney and a Certified Estate Advisor.* Since 2007, Evan has been named by Virginia Super Lawyers Magazine as one of the top attorneys in Virginia, and in 2008 Evan was named byWashington, DC Super Lawyers Magazine as one of the top attorneys in DC. TheSuper Lawyers designation is bestowed upon the top 5% of lawyers in each state as chosen by their peers and through the independent research of Law & Politics.

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Warm Holiday Greetings from the Farr Law Firm!

In This Issue:

1.  New LTC Insurance Premium Deductibility Limits

2.  Pet Trusts — Important Planning for Pampered Pets

3.  Average Private Nursing Home Room Tops $90,000

4.  Medicare Preventive Services: What is Covered? 

5.  About The Farr Law Firm

6.  Newsletter Distribution

New LTC Insurance Premium Deductibility Limits

The Internal Revenue Service has announced the 2007 limitations on the deductibility of long-term care insurance premiums from taxes. Premiums for “qualified” (see explanation below) long-term care policies are treated as an unreimbursed medical expense. These premiums – what the policyholder pays the insurance company to keep the policy in force – are deductible to the extent that they, along with other unreimbursed medical expenses (including “Medigap” insurance premiums), exceed 7.5 percent of the insured’s adjusted gross income. Long-term care insurance premiums are deductible for the taxpayer, his or her spouse and other dependents. If you are self-employed, the rules are a little different. You can take the amount of the premium as a deduction as long as you made a net profit – your medical expenses do not have to exceed 7.5 percent of your income.

However, there is a limit on how large a premium can be deducted, depending on the age of the taxpayer at the end of the year. Following are the deductibility limits for 2007. Any premium amounts above these limits are not considered to be a medical expense.

Attained age before the close of the taxable year	Maximum deduction
40 or less	$290
More than 40 but not more than 50	$550
More than 50 but not more than 60	$1,110
More than 60 but not more than 70	$2,950
More than 70	$3,680

What Is a “Qualified” Policy?

To be “qualified,” policies issued on or after January 1, 1997, must adhere to regulations established by the National Association of Insurance Commissioners. Among the requirements are that the policy must offer the consumer the options of “inflation” and “nonforfeiture” protection, although the consumer can choose not to purchase these features. Policies purchased before January 1, 1997, will be grandfathered and treated as “qualified” as long as they have been approved by the insurance commissioner of the state in which they are sold. For more on the “qualified” definition, click here and scroll down to “The tax deductibility of long-term care insurance premiums”.

The Taxation of Benefits

Benefits from reimbursement policies, which pay for the actual services a beneficiary receives, are not included in income. Benefits from per diem or indemnity policies, which pay a predetermined amount each day, are not included in income except amounts that exceed the beneficiary’s total qualified long-term care expenses or $260 per day (for 2007), whichever is greatpeter.

The Georgetown University Long-Term Care Financing Project has a two-page fact sheet entitled ”Tax Code Treatment of Long-Term Care and Long-Term Care Insurance.” To download it in PDF format, click here .

Pet Trusts — Important Planning for Pampered Pets

Q:   What is a Pet Trust?

A:    A pet trust is legal instrument that you can create to insure your pet receives proper care after you die or in the event of your disability. In Virginia, pet trusts are authorized by Virginia Code Section 55-544.08.

Q:   How Do You Create a Pet Trust?

A:    To create a pet trust, you (the “Settlor”) give your pet and enough money or other property to a trusted person (the “trustee”) who is under a duty to make arrangements for the proper care of your pet according to your instructions.

In addition to naming a trustee, your pet trust will name a pet caretaker who will actually take possession of the pet and use the money you transferred to the trust to pay for your pet’s expenses. The trustee and caretaker may be the same person. Ideally you should name at least one, preferably two or three, alternate caretakers in case your first choice is unable or unwilling to serve as your pet’s caretaker.  To avoid having your pet end up without a home, consider naming a sanctuary or no-kill shelter, such as your last choice. In my practice, we typically name Friends of Homeless Animals of Northern Virginia –  http://www.foha.org — as the last in line, although for some clients FOHA may be the first in line.

Additionally, you may name a Trust Protector — someone to enforce the terms of the trust. If you don’t name a Trust Protector, one may be appointed by the court. In addition, any person having an interest in the welfare of the animal may request the court to appoint a person to enforce the trust or to remove a person appointed.  You may create a pet trust either (1) while you are still alive (i.e., a “living” trust) or (2) when you die by including the trust provisions in your will (i.e., a “testamentary” trust). If using a living trust, it can be either a stand-alone pet trust or provisions that you insert into a comprehensive living trust done as part of your estate planning. A living trust avoids delay between your death and the property being available for the pet’s care. For more information on the benefits of living trusts, seewww.virginiaestateplanning.com/revocable.html.

If you create a testamentary pet trust upon your death, the trust does not take effect until you die and your will is declared valid by a court (“probating the will”). Additionally, there may not be funds available to care for the pet during the gap between when you die and your will is probated.  In addition, a testamentary trust does not protect your pet if you become disabled and unable to care for your pet.

Q:  How much money do I need to put into a pet trust?

A:   You should consider many factors in deciding how much money to transfer to your pet trust.  These factors include the type of animal, the animal’s life expectancy, the standard of living you wish to provide for the animal, the need for potentially expensive medical treatment, and whether the trustee is to be paid for his or her services.  Adequate funds should also be included to provide the animal with proper care, be it a pet-sitter or a professional boarding business, when the caretaker is on vacation, out-of-town on business, receiving care in a hospital, or is otherwise temporarily unable to provide personal care for the animal.  You should avoid transferring an unreasonably large amount of money or other property to your pet trust because such a gift is likely to encourage your heirs and beneficiaries to contest the trust.  If the amount of property left to the trust is unreasonably large, the court may reduce the amount to what it considers to be a reasonable amount.

Q:   What types of instructions should I include in my pet trust regarding the care of my pet?

A:    Some examples of the types of instructions you may wish to provide are:  food and diet; daily routines; preferred toys; crates; grooming; socialization; medical care, including preferred veterinarian; compensation, if any, for the caretaker;
method the caretaker must use to document expenditures for reimbursement; whether the trust will pay for liability insurance in case the animal bites or otherwise injures someone; how the trustee is to monitor caretaker’s services; how to identify the animal; disposition of the pet’s remains, e.g., burial, cremation, memorial, etc.

Q:  Who should be the trustee of my pet trust?

A:   The trustee is typically either a trust company or a family member or other individual you trust to manage your property prudently and make sure the beneficiary is doing a good job taking care of your pet.  A family member or friend may be willing to take on these responsibilities at little or no cost.  However, it may be a better choice to select a professional trustee that has experience in managing trusts even though a trustee fee will need to be paid. If you do name an individual, you should name at least one, and preferably two or three, alternate trustees in case your first choice is unable or unwilling to serve as a trustee.  You probably also want to check with the person before-hand to be sure the persons you name as your trustees will be willing to do the job when the time comes.

Q:  What happens to the money remaining in the trust when my pet dies?

A:   You should name a “remainder beneficiary” — a person or organization to receive any remaining trust property after your pet dies.  Note that it is not a good idea to name the caretaker or trustee because then the person has less of an incentive to keep your pet alive.  Many pet owners elect to have any remaining property pass to a charitable organization that assists the same type of animal that was covered by the trust.

Q:   What happens if the trust runs out of money before my pet dies?

A:   If no money remains in the trust, the trustee will not be able to pay for your pet’s care.  Perhaps the caretaker will continue to do with his or her own funds.  If the caretaker is unwilling or unable to do so, you should indicate in your trust the person or organization to whom you would like to donate your pet.  In my practice, we typically name Friends of Homeless Animals of Northern Virginia – http://www.foha.org — as the caretaker of last resort.

Average Nursing Home Room Tops $90,000 a Year

The average daily cost of a private room in a nursing home in Northern Virginia is $91,615 a year, or $251 a day, according to the 2006 MetLife Market Survey of Nursing Home and Home Care Costs.

The average daily cost of a private room in a nursing home in the United States is $75,190 a year, or $206 a day, according to the survey. This is a 3.9 percent increase over last year, when the average daily rate for a private room in a nursing home was $74,095 a year, or $203 a day, according to MetLife.

Once again, the highest rates for a private room in 2006 were found in Alaska, where the cost is $578 a day on average. The lowest rates were again found in Shreveport, Louisiana, at $111 a day, a $4 drop from last year.

The survey also reports on the cost of a semi-private room, which in Northern Virginia now averages $208 a day, or $75,920 a year.

The study also found that the cost of a home health care aide averaged $19 per hour both here in Northern Virginia nationally, the same as last year.

For the full 2006 report, including a list of average daily nursing home and home health care costs in selected cities, click here .

Medicare Preventive Services: What is Covered?

As the saying goes “an ounce of prevention is worth a pound of cure,” and as you get older, taking preventative measures can keep you healthy. And if you are a Medicare beneficiary, there are a number of preventive services available to you. Anyone with Medicare Part B has access to the following preventive services:

 
• Initial physical exam. If your Medicare Part B coverage begins on or after January 1, 2005, Medicare will cover a one-time “Welcome to Medicare” preventive physical exam within the first six months that you have Part B. Additionally, those at risk for abdominal aortic aneurysms may be referred for a one-time ultrasound at their initial exam.
• Cardiovascular screening. Medicare covers one test every five years to check your cholesterol and other blood fat levels.
• Cancer tests. Medicare covers breast cancer screening (mammograms) once a year for women over age 40; cervical and vaginal cancer screening (pap test and pelvic exam) once every two years for all women; colon cancer screening (colorectal) every year to every four years, depending on the test; and prostate cancer screening (PSA) every year for men.
• Shots. Medicare covers flu, pneumococcal, and Hepatitis B immunizations.
• Bone mass measurements. For women, Medicare covers bone mass measurements to check if you are at risk for fracture due to osteoporosis. The test is covered once every 24 months.
• Diabetes. Medicare covers up to two diabetes screenings per year. In addition, it covers glucose monitors, test strips, and lancets for individuals with diabetes and offers self-management training.
• Glaucoma tests. One glaucoma test is covered each year for people at high risk for glaucoma.

 

For some of these tests, beneficiaries in regular Medicare pay nothing; for other tests, Part B’s 20 percent copayment applies. For more information from Medicare.gov about what preventive services are covered, click here .

About The Farr Law Firm

Evan H. Farr, author of The Virginia Nursing Home Survival Guide (available at Amazon.com), offers a complete range of legal services in connection with helping individuals, families, and small businesses in the protection, preservation, and transfer of wealth. The Farr Law Firm is an Estate Planning and Elder Law firm dedicated to helping protect seniors and their families by preserving dignity, integrity and family unity to the greatest extent possible. In addition to traditional estate planning (Wills, Living Trusts, Financial and Medical Powers of Attorney, etc.) for clients of all ages, we help our elderly clients with issues involving long-term care. We help clients find, get, and pay for the best possible long-term care; if a nursing home is the only option, we help clients find and get the best possible care while preserving and protecting their assets, including their homes, from the forced liquidation that is typically required in connection with entry into a nursing home. When needed, we complete the complex documents required for entry into a nursing home and for Medicaid.

Newsletter Distribution

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Many people want to plan the distribution of their estate so that their favorite charity receives some benefit. This is an admirable choice; we hope that by reading this article you understand the various avenues to achieve this goal.

Three avenues to leave some of your assets to charity are as follows:

#1: Create a Charitable Remainder Trust (CRT)

You can transfer assets to this type of trust, and receive income for the rest of your life. For example, if you choose to transfer real estate to the CRT, you can still receive income such as rent. You can even receive a percentage of the principal if you desire.

If you create a CRT, you can take a charitable deduction now on the current value of the assets that will pass at your death. Even better – you do not have to pay any capital gains tax. The CRT will be considered a “charitable entity” and is allowed to sell appreciated assets without having to pay capital gains tax. This can benefit you, because the more assets in the CRT, the more income for you!

If you wish, you can use this stream of income to purchase a life insurance policy for your heirs, which will serve as a replacement for the value of the assets that are transferred to the CRT.

#2: Create a Testamentary Charitable Lead UniTrust (CLUT)

This option is ideal for couples with high net worth. When one spouse dies, the selected assets are irrevocably transferred to a trustee.

#3: Create Your Own Charity!

Have you ever considered starting your own charity? Perhaps you want to give to a charity, but for one reason or another, you don’t trust the management.

Perhaps the easiest option is to establish a Foundation through the National Heritage Foundation (NHF). This option is available to people who are living, or it may be included in a Will or Living Trust.  If the NHF accepts your charitable goal, you will not have to worry about the administrative, accounting, or legal burdens.

The costs associated with establishing a Foundation at NHF are relatively inexpensive. However, your foundation will be subject to a 2.5% fee of all donations. To minimize this cost, you can apply indirectly through a “Philanthropic Development Officer” (PDO). Doing so will allow half of the NHF administration fee to be returned to your foundation.

More Seniors Say “No Thanks” to Nursing Homes

“Getting old is not for sissies” goes the quote. Perhaps one of the biggest challenges people face as they age is a seemingly inevitable and impending change to their living situation, whether it be due to health concerns, financial circumstances or both.  This feared transition may not be so inevitable after all.  With the right plan, seniors can qualify for Medicaid, take advantage of today’s latest elder care technologies, and protect the assets which otherwise could be drained by the catastrophic costs of long-term care.

Most people are familiar with care options such as In-Home Care, Assisted Living, and Nursing Homes.  All three of these options have their downsides – whether it is the relative expense of staying at home with a 24-hour caregiver, or the emotional and physical upheaval accompanying a move. But now, a fourth option is gaining popularity: Aging-in-Place . . . a care option that allows individuals to continue living independently in their own home without the need for a live-in caregiver.

Drug compliance is the most common issue for those living alone. For those with memory issues, pill-reminder services and gadgets can issue daily visual and audio alerts to take medication, dispense the correct pills at the right times, and can even send a confirmation message to a caregiver once the medication has been dispensed. If a dosage is missed, an alert is sent to the caregiver and appropriate action can be taken.^[1]

Falling is the leading cause of injury and death among those ages 65 and older.^[2] For those with a high fall risk, monitoring devices like eNeighbor^[3] use unobtrusive sensors to monitor a resident’s daily routine. If the resident were to fall and not be able to get up or reach the phone for help, the device would trigger a phone call to a list of contacts as well as a 24-hour call center.

“Remote monitoring” is an in-home technology that measures vitals such as heart rate, body weight, blood pressure, and blood glucose levels–making it useful to patients with a variety of health concerns, from cardiovascular disease to diabetes.^[4]

If you or a family member is contemplating long-term care options, an experienced elder law attorney can provide the solutions that you may be looking for.

“The quality, not the longevity, of one’s life is what is important.” These words spoken by Dr. Martin Luther King, Jr. were meant to inspire both the young and the old to follow their dreams; but these words may also offer wisdom to those who are diagnosed with a terminal illness.   The choice to fight a disease is admirable, but it can come with caveats: in the case of some breast cancer patients, the drug Avastin can cause holes to form in the stomach and intestines, among other things.

Though the FDA has recommended Avastin no longer be sold as a breast cancer treatment, Medicare continues to pay for the drug.  And although doctors can still prescribe Avastin for breast cancer, insurers may not be willing to pay for it. Including administration fees, one year’s worth of the drug can cost $100,000.  In the wake of this news, some families must weigh the pros and cons of “quality of life” and “longevity.” While medical professionals can provide much-needed guidance when it comes to such decisions, legal professionals can too.  They can ensure a client’s wishes are followed, through the use of specific legal instruments meant to preserve dignity and quality of life.

When Elizabeth Edwards succumbed to breast cancer late last year, she was with her family in her home. The decision to forego treatment and remain at home was a decision that was made after doctors indicated that further treatment would be of limited effect.  At the time, an expert observed; “Americans increasingly are treated to death, spending more time in hospitals in their final days, trying last-ditch treatments that often buy only weeks of time, and racking up bills that have made medical care a leading cause of bankruptcies.”

Ideally, families should have proper planning documents in place before crisis strikes.  But it’s never too late to implement a plan for a loved-one, even if they are already in a nursing home.  Whether that plan is as simple as naming a person to make critical end-of-life decisions, or also involves distribution of the estate after death, instilling a proper and effective plan can ease the anxieties of the patient and his or her loved-ones, so that the present focus can be shifted off those less important matters.  The most important matters are recalling the good times, celebrating the individual’s life, and creating even more memories.

To receive the Aid & Attendance Special Pension Benefit or Housebound Special Pension Benefit, a veteran must have served on active duty, at least 90 days, at least one day of which occurred during a period designated as wartime.

There must have been an honorable discharge. Single surviving spouses of such veterans are also eligible.   If younger than 65, the veteran must be totally disabled.

There must have been an honorable discharge. Single surviving spouses of such veterans are also eligible.   If younger than 65, the veteran must be totally disabled.

If age 65 and older, there is no prerequisite to prove disability.  However, the veteran or spouse must be in need of regular aid and attendance due to: Inability of claimant to dress or undress himself (herself), or to keep himself (herself) ordinarily clean and presentable; frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done lacking aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back etc.); inability to feed himself (herself) through loss of coordination of upper extremities or through extreme feebleness; inability to attend to the wants of nature; or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment.

Not all of the disabling conditions in the list above are necessary to exist.  It is only necessary that the evidence establish that the veteran or spouse needs “regular” (scheduled and ongoing) aid and attendance from someone else, not that there be a 24-hour need.

Determinations of a need for the aid and attendance or housebound benefit is based on medical reports and findings by private physicians or from hospital facilities. Authorization of aid and attendance or housebound benefits is automatic if evidence shows the claimant is a patient in a nursing home or that the claimant is blind or nearly blind or having severe visual problems.

- Courtesy of the Farr Law Firm, Fairfax Elder Law Firm