A veteran diagnosed with Alzheimer’s Disease, Lewy Body, Frontotemporal, Vascular Dementia, or Parkinson’s Disease, will require care as he or she progresses through the stages of condition. The symptoms of dementia will vary based on what part of the brain is affected, but with all types of dementia, care will be required as the diseases progress. Fortunately, the Department of Veterans’ Affairs (VA) offers a variety of benefits to assist veterans with Alzheimer’s or other dementias as they require increasing care assistance. Furthermore, many of these programs are not well known to the average veteran.
What follows is an examination of all the different care options relevant to veterans with Alzheimer’s or dementia. Readers should be aware that not all veterans are eligible for all of the programs that follow. Additionally, qualification interdependencies may exist (i.e. being eligible for one program may automatically make one ineligible for another program).
The location in which care is provided is often importance to the veterans and their family members. Further down the page we provide a chart that describes the locations in the programs offer care, for example, at home, in assisted living, nursing home, 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 the basic health care benefits, a variety of long-term care assistance services are available that are relevant to those with Alzheimer’s / dementia. Different from other VA programs with Alzheimer’s / dementia benefits, VA Health Care provides assistance over the entire progression of the condition from diagnosis through its terminal stage. Therefore, we will discuss VA Health Care benefits as the relate to the stages and need of persons with Alzheimer’s or related dementias.
In the early stages of dementia, it may difficult to discern if a veteran is indeed suffering from dementia since the symptoms are rather 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 that the veteran may have difficulty with their memory. On the contrary, 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 in nature, and may display disinhibited behavior.
It is during these early stages of dementia that it is important to properly diagnose it in order for the veteran and his or her family to have realistic expectations 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, can aid in diagnosis and VA Health Care will cover all of these services. Make note, some of these services may require a co-payment.
While the signs and symptoms of dementia cannot be reversed, certain medications may help with the symptoms of the diseases, as well as help veterans maintain their independence for as long as possible. It is under VA Health Care, that most veterans will have their medications covered. Medicare Part D is also an 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 in movement issues. In a veteran with Frontotemporal Dementia, medication to alleviate obsessive-compulsive behavior might be beneficial. In addition, medication to alleviate depression and / or 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, but who are caring for a veteran who should not be left unsupervised. For instance, 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 wellbeing. They may also suffer from delusions and / or hallucinations and their behavior may seem out of character, possibly displaying periods of irritability and aggression. As Dementia Lewy Bodies and Parkinson’s Disease Dementia progress, they present more similarly in nature, and veterans with these types of dementias may have difficulty with their visual perception and exhibit shuffling gaits, which can create greater concern for falling and hurting oneself. 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 there are many home and community supports available via VA Health Care to assist with the caregiving of a veteran with dementia. These include having a homemaker / 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, he or she must require a nursing home level of care. Commonly veterans during 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 won’t necessarily pay the full cost of assisted living).
As a veteran progresses to the late stages of dementia, extensive care (around the clock) will be needed and the veteran will most likely require a higher level of care than a family caregiver is able to 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 / 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 the 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 hospice care.
Veteran Directed Home and Community Based Services (VD-HCBS) allow veterans who require skilled services and assistance with day to day activities, such as bathing, grooming, walking, eating, cooking, and cleaning, to direct their own care services in the home, community, or in an independent living facility. Though this consumer directed program, veterans are allotted a budget to pay for care services, such as adult day care, respite care, and personal care assistance, as they see fit. An attractive aspect of VD-HCBS is that not only can the veteran direct his or her own 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 is no longer able to communicate well. In addition, relatives and close friends may be paid as personal care aides via this program. Another attractive service available to caregivers is caregiver education and training. 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 addition of grab bars and wheelchair ramps.
This program is part of the VA Health Care plan, so any veteran who is enrolled in VA Health Care may qualify for VD-HCBS given he or she has a clinical need. Please make note, this program is not available in all areas of the United States but rather only with participating VA Medical Centers.
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 a 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. Make note, the amount of income received via the Aid & Attendance Pension is above and beyond 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 persons in the early stage will not be functionally eligible for the program (meaning their symptoms are not severe enough to qualify).
A great benefit of the Aid & Attendance Pension is that the additional income may be used as the veteran or family sees fit to provide needed long-term care. This includes paying family members to provide care, adult day care services, and respite care, which 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, in order to allow the veteran to continue to live at home or in the home of a family member for a longer period of time. For those veterans and surviving spouses who require more care than their family can provide, pension funds may be used for skilled nursing, assisted living facilities, nursing homes, or memory care units, often referred to as Alzheimer’s care.
Make note, 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.
Veterans in 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 therefore 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, as long as the owner grants permission for the modifications. 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.
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 may include nursing home care, including memory care (which is ideal for veterans who do not have a full-time caregiver and are suffering from mid-to-late stage dementia) and assisted living (which is ideal for veterans in the early stages since they can still function rather independently).
Also, available in some locations is adult day care (which is ideal for veterans in 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 do 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.
|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)|