A veteran diagnosed with Alzheimer’s Disease, Lewy Body, Frontotemporal, Vascular Dementia, or Parkinson’s Disease requires care as they progress through the stages of the disease. Symptoms of dementia will vary based on what part of the brain is affected, but with all types of dementia, care will inevitably be required. As patients need more care and support, the Department of Veterans Affairs (VA) offers a variety of benefits to assist veterans with Alzheimer’s or other dementias. Not all of the programs are commonly talked about, so many of them are not well-known veterans.
This is an in-depth examination of the different care options relevant to veterans with Alzheimer’s or dementia. Be aware that not all veterans are eligible for all of the programs. Qualification interdependencies may exist like being eligible for one program may automatically make one ineligible for another program.
Additionally, the location of where the care is provided is essential to veterans and their family members. We provide a chart that describes the locations in which programs offer care. This examines options at home, assisted living, nursing homes, adult day care centers, or hospice.
VA Health Care provides health care benefits for veterans who have actively served in the military. In addition to health care benefits, a variety of long-term care assistance services are available that support those with Alzheimer’s and dementia. Different from other VA programs with Alzheimer’s and dementia benefits, VA Health Care assists the entire progression of the condition from diagnosis through its terminal stage. Because of this, we will discuss VA Health Care benefits as they relate to the stages and needs of persons with Alzheimer’s or related dementias.
In the early stages of dementia, it may be difficult to tell whether your loved one is suffering from dementia. That is because the symptoms are mild, and most veterans can continue to function independently. For example, veterans with Alzheimer’s in the early stages of the disease may have difficulty remembering a word for an object or may not remember important dates, such as their anniversary. Vascular Dementia, on the other hand, may have a sudden onset, but it also may present with a gradual onset. With Lewy Body Dementia, which presents in two forms, Dementia with Lewy Bodies and Parkinson’s Disease Dementia, the early signs of dementia vary. In a veteran suffering from Dementia with Lewy Bodies, the initial symptoms may also present similarly to Alzheimer’s Disease, in which they may have difficulty with their memory. In comparison, a veteran suffering from Parkinson’s Disease Dementia may initially present with difficulty with movement, similar to someone suffering from Parkinson’s Disease. Veterans suffering from early stage Frontotemporal Dementia may come across as more easily distracted than normal, may exhibit behavior that is obsessive-compulsive, and may display disinhibited behavior.
It is during these early stages of dementia that it is essential to properly diagnose the disease so your loved one has a realistic expectation for the future and to come up with a care plan. A physical examination, medical history, and diagnostic testing (such as MRIs and Cat Scans) aid in a diagnosis. VA Health Care will cover all of these services. Some of these services can require a co-payment.
While the signs and symptoms of dementia cannot be reversed, certain medications may help with the symptoms of the disease. There is also the additional benefit that they can help veterans maintain their independence for as long as possible. Under the VA Health Care, most veterans will have their medications covered. Medicare Part D is also a helpful alternative. For example, certain medications may help lessen memory issues and confusion in veterans with Alzheimer’s, Vascular Dementia, and Dementia with Lewy Bodies. Veterans with Parkinson’s Disease Dementia might benefit from medication to aid with movement issues. In a veteran with Frontotemporal Dementia, medication to alleviate obsessive-compulsive behavior might be beneficial. In addition, medication to alleviate depression and anxiety is quite common for veterans who are suffering from dementia.
For families who are providing care for a loved one, there are a variety of supports available under VA Health Care that will assist them in their caregiving efforts, allowing the veteran to continue to live at home. These services are ideal for caregivers who want to continue to work outside the home or simply need a break from their caregiving duties. A veteran in the mid-stage of Alzheimer’s or Vascular Dementia may wander off, forget to turn off the stove, or may not properly take their medication, all of which cause alarm for their well-being. They may also suffer from delusions or hallucinations and their behavior may seem out of character, such as displaying periods of irritability and aggression. As Dementia Lewy Bodies and Parkinson’s Disease Dementia progress, they present more similar, and veterans with these types of dementia may have difficulty with their visual perception and exhibit shuffling gaits, which can create greater concern about falling and hurting themselves. Veterans with Frontotemporal Dementia may present with impulsiveness, may exhibit socially inappropriate behavior, and may also have issues with balance and movement.
During this mid-stage of dementia, many home and community support programs are available via VA Health Care to assist with the caregiving of a veteran with dementia. These include having a home health aide, adult day care, skilled home health care, home-based primary care, and respite care. Respite care offers primary caregivers a break from their caregiving duties. For a veteran to be eligible, your loved one must require nursing home-level care. Commonly veterans with mid-late stage dementia, regardless of the type of dementia, will meet the criteria for this level of care. VA Health Care may also provide care services in an assisted living setting, though they will not usually pay the full cost of assisted living.
As a veteran progresses into the late stages of dementia, extensive care that is around the clock will be needed which is most likely a higher level of care than a family caregiver can provide in their home. In late-stage Alzheimer’s, Lewy Body Dementia, and Vascular Dementia, a veteran may not be able to communicate verbally, may find it difficult to eat or swallow, may lose his or her ability to walk, and may easily become agitated. A veteran with late-stage Frontotemporal Dementia may also present similarly to other dementias in the late stages in that they may not be able to walk and may have difficulty swallowing.
VA Health Care will cover nursing home care, including skilled care, as well as hospice and palliative care. Hospice also makes grief counseling available to the families of veterans who are in their care.
The Veteran Directed Care (VDC) Program (previously called Veteran Directed Home and Community Based Services), allows veterans who require skilled services and assistance with day-to-day activities to get the support they need. That means that there is extra help for bathing, grooming, walking, eating, cooking, and cleaning. You or your loved one can direct their care services at home, in the community, or in an independent living facility. Through the consumer-directed program, veterans are allotted a budget to pay for care services, such as adult day care, respite care, and personal care assistance. An interesting aspect of VDC is that not only can the veteran direct his or her care, but the veteran’s caregiver may also fill this role. This is particularly beneficial when a veteran is in mid-to-late stage dementia and has difficulty with his or her memory, making decisions, or can no longer communicate. In addition, relatives and close friends may be paid as personal care aides via this program. Items that assist the veterans with dementia in continuing to live in the community may also be purchased, such as durable medical equipment, like a wheelchair, wander prevention systems, or home modifications may be made, such as the addition of grab bars and wheelchair ramps. Another beneficial service available to caregivers is caregiver education and training.
This program is part of the VA Health Care plan, so any veteran who is enrolled in VA Health Care may qualify for VDC given he or she has a clinical need. This program is not available in all areas of the United States, but rather only with participating VA Medical Centers. More information about the Veteran Directed Care program is available here.
VA Pensions provide supplemental income for low-income veterans or their surviving spouses and are ideal for aiding in the cost of long-term care associated with Alzheimer’s disease or related dementia. While there is a Basic Pension that provides monthly income assistance, there is also the Aid & Attendance Pension for persons with higher care needs. This pension is intended for those who require assistance with activities of daily living, which may include eating, walking, using the bathroom, grooming, and dressing oneself. The amount of income received via the Aid & Attendance Pension is more than what one may receive via the Basic Pension.
The Aid & Attendance Pension is relevant for veterans or their surviving spouses in the mid-to-late stages of dementia, but not in the early stages. This is because patients in the early stage will not be functionally eligible for the program (meaning their symptoms are not severe enough to qualify). More on Aid & Attendance eligibility and benefits.
The Aid & Attendance Pension has the benefit that additional income may be used as the veteran or their family sees fit to provide long-term care. This includes paying family members to provide care, adult daycare services, and respite care. These are all great options for a veteran or a surviving spouse who requires care assistance but does not require around-the-clock care. This pension may also be used to fund home modifications, such as wheelchair ramps, to allow the veteran to continue to live at home or in the home of a family member for a longer time. For those veterans and surviving spouses who require more care than their families can provide, pension funds may be used for skilled nursing, assisted living facilities, nursing homes, or memory care units.
Veterans who are receiving VA Disability compensation cannot simultaneously receive the Aid & Attendance Pension. Also, receiving a VA pension may disqualify a veteran from receiving Medicaid. However, a veteran may qualify for the Veterans Directed Home and Community Based Services (VD-HCBS) program while receiving the Aid & Attendance Pension.
The Dependent Parent Benefit is a needs-based cash benefit that can be beneficial in assisting with the costs of having a parent with dementia. To receive this benefit, veterans must have a parent that is financially dependent on them. Furthermore, the veteran must be receiving disability compensation or be receiving VA educational benefits and be enrolled at least half-time. A “parent” can be biological, adoptive, or an individual who played the role of a parent for the veteran for a minimum of one year before his or her active duty. The parent does not necessarily have to live with the veteran to be considered a dependent parent.
This cash benefit is above and beyond a veteran’s disability compensation and can be used however the veteran sees fit. As there are no restrictions on this income, it can be helpful through all stages of dementia. For instance, in the earlier stage of dementia, an automatic pill dispenser might be helpful as a reminder to take medications, or hiring someone a few days a week to assist with household activities, such as preparing meals, housecleaning, and laundry could provide peace of mind if the parent still lives alone. As the disease progresses and dementia care is needed, the extra income could go towards adult day care, respite care, or the cost of prescription medications to alleviate the symptoms of Alzheimer’s and related dementias. The funds could also go towards the cost of assisted living or nursing home care. More information about the Dependent Parent Benefit program is available here.
Veterans with mid-to-late stage dementia, and on occasion, veterans with sudden onset Vascular Dementia, may present with difficulty walking and mobility issues. Home Improvements and Structural Alterations (HISA) Grants provide financial assistance to make home modifications, such as additions of wheelchair ramps and widening of doorways for wheelchair access, for disabled veterans who demonstrate a medical need. Most veterans with dementia in the mid-to-late stage fit the criteria for being disabled and are eligible. Home modifications may be made to a veteran’s home, the home of a family member in which the veteran resides, or a rental home. A further benefit of HISA Grants is that the veteran’s disability need not be related to their military service. Therefore, even though most veterans cannot trace the onset of their dementia to their military service, they will still be eligible for this grant. More information about the Home Improvements and Structural Alterations program is available here.
State Veterans Homes are long-term care facilities that are run by individual states but are certified by, and receive payment from, the VA. The type of care provided in these homes can be:
– Nursing home care
– Memory care is ideal for veterans who do not have a full-time caregiver and are suffering from mid-to-late-stage dementia.
– Assisted living is ideal for veterans in the early stages since they can still function rather independently.
– Adult daycare which is not available in all areas but is ideal for veterans with mid-stage dementia who have caregivers, but who need a break from their caregiving duties.
All states have at least one State Veterans Home and some facilities allow admission of a veteran’s spouse. All types of long-term care via a State Veterans Home require that the veteran demonstrate a clinical need for that service. For VA nursing home care, veterans must have a minimum service-linked disability rating of 70%. More information about the State Veterans Home program is available here.
It is possible to be eligible for both Medicaid and VA benefits simultaneously to help pay for long-term care because of Alzheimer’s or dementia. Most people who qualify must decide what is better for their situation. There are many contributing factors, state-specific rules, and a complicated application process.
Long-term care Medicaid is a state and federal healthcare program for patients with low income and assets who require a specific level of care (generally, a nursing home). Long-term care includes full coverage for nursing homes, as well as home and community-based services and supports to prevent and delay unnecessary nursing home placements. In other words, if it’s possible to remain living in one’s own home or assisted living community with some additional help, rather than move into a nursing home, Medicaid will pay for the extra care (like home modifications or assistance with activities of daily living) through the home and community-based service waivers.
Generally speaking, Medicaid is better for paying for nursing home care, while the VA Aid & Attendance has the advantage of normally covering the cost of the long-term home and community-based services. More information about veterans benefits compared to Medicaid is available here.
|Compare Veterans’ Benefits for Alzheimer’s and Dementia|
|Location||VA Health Care||Aid & Attendance||VD-HCBS||HISA Grants||Veterans Homes|
|Adult Day Care||Yes||Yes||Yes||No||Yes (some)|
|Assisted Living / Memory care||Yes||Yes||Yes||No||Yes|
|Nursing Home Care||Yes||Yes||No||No||Yes|
|Respite Care||Yes||Yes||Yes||No||Yes (some)|