Veteran Directed Care Program (formerly VD-HCBS) & How It Benefits Veterans with Alzheimer’s / Dementia
Veterans Directed Care Program Overview
The Veteran Directed Care (VDC) program is intended for veterans of all ages who are at risk of nursing home placement, but wish to continue living in their own home or the home of a friend or relative. To be clear, a veteran cannot live in an assisted living residence or a nursing home and receive assistance.
Being “at risk of nursing home placement” means they require a nursing home level of care which is demonstrated by the need for assistance with completing daily living activities, such as bathing, mobility, toiletry, eating, and preparing meals. For persons with Alzheimer’s disease and related dementias, assistance with these types of activities becomes a necessity due to the progressive nature of dementia. Therefore, the Veteran Directed Care program is extremely relevant for persons with dementia and their families, many of which serve as unpaid caregivers. For the purposes of this article, the focus of the VDC program will be for those with dementia.
VDC program participants are given an individualized budget based on their level of functioning and care needs. This budget is flexible, which enables veterans to choose long-term services and supports specific to dementia care needs that will best assist them in remaining in their homes. A particularly well liked benefit of this program is that veterans are able to hire their own caregivers, including relatives. This option allows spouses, adult children, grandchildren, nieces and nephews, and other family members to be paid for providing care for their loved ones with dementia.
Please note that the option to self-direct one’s own care is not appropriate for all persons with dementia, particularly those in the mid-late stages of the disease, due to cognitive decline. A veteran who does not have the cognitive capacity to self-direct his / her own care can have an authorized representative do so on his / her behalf. An authorized representative can be a relative, including the family caregiver.
The Veteran Directed Care program is part of the VHA’s (Veterans Health Administration) Medical Benefits Package (given eligibility criteria is met) and is a collaboration between the Veterans Health Administration (VHA) and the Administration for Community Living (ACL). The program is administered on a local level via Veterans Affairs Medicaid Centers (VAMCs). Please note that up until 2018, the Veteran Directed Care Program was known as the Veteran-Directed Home and Community Based Services (VD-HCBS) Program.
Veterans Directed Care Program Benefits
Veterans with dementia participating in the VDC program are allocated a flexible monthly budget, which allows them (or their authorized representatives) to select which care services and supports are best for their specific dementia care needs. (This includes hiring a family member, including a spouse, as a caregiver). This flexibility is invaluable for persons with dementia, as it is inevitable that as the disease progresses, one’s needs will evolve and a greater amount of supervision and care will be necessary.
Follows is a list of many ways in which VDC funds may be used. Please note that this list is not exhaustive. Veterans cannot receive the same service provided by VA through a different VA program.
- Adult Day Care / Adult day Health Care
- Assistive Devices for Dementia (automatic medication dispensers, memory picture phones, and reminder devices)
- Caregiver Support / Education / Training
- Chore Services (shoveling snow, yard clean-up, etc.)
- Electronic Monitoring Devices (wandering and location devices and personal emergency response systems)
- Financial Management Services (handles payments to caregivers and vendors)
- Home Health Care
- Homemaker Services (light cleaning, laundry, changing bedding, grocery shopping, etc.)
- Home Modifications (Grab bars, raised toilet seats, wheelchair ramps, specialized lighting, etc.)
- Meal Delivery
- Transportation (to dementia-related doctor appointments, for socialization, etc.)
- Vehicle Modifications
- Personal Care Assistance (bathing, dressing, personal hygiene, mobility, eating, medication reminders, etc.)
- Respite Care (in-home and out-of-home)
- Supplies, such as adult diapers
For illustration purposes, a few examples of how funds might be spent in each stage of dementia follows.
Early Stage Dementia
A senior with early Alzheimer’s disease is generally able to live independently, but is likely to have some issues with forgetfulness. For safety purposes, it can be helpful to install an automatic stove shutoff device or invest in an automatic pill dispenser. It might also be beneficial to hire someone once or twice a week to assist with household tasks and errands, such as grocery shopping, picking up prescription medications, paying the bills, light housecleaning, laundry and meal preparation.
Middle Stage Dementia
A person with mid-stage Parkinson’s disease dementia might suffer from sleep disturbances, and instead of sleeping at night, may sleep during the day. This makes it especially difficult for family caregivers, even those who live with their loved ones, to provide supervision during nighttime hours. In this case, a monitor that alerts the caregiver when the person with dementia gets out of bed can be helpful. Furthermore, at this stage of dementia, persons often require help with most activities of daily living. Family caregivers may find respite care, such as adult day care or hiring an in-home personal caregiver, extremely helpful.
Late Stage Dementia
In late stage dementia, regardless of the type of dementia, care needs are great. At this stage, it can be difficult for an informal caregiver to handle all of these needs, as individuals with dementia likely are able to do very little on their own. This is where home health care or in-home skilled nursing might be a good option. Also, individuals with late stage dementia often suffer from incontinence. Therefore, some monthly funds from VDC might go towards purchasing adult diapers.
Veterans Directed Care Program Eligibility
The Veteran Directed Care program is for veterans (of any age) who receive VA medical benefits, wish to self-direct their own care, and are at risk of nursing home placement This risk is often demonstrated by the need for assistance with daily living activities, such as bathing, dressing, mobility, transitioning, toiletry, and meal preparation. Other situations in which there might be a risk of nursing home placement include veterans living alone and in isolation, veterans who have informal caregivers who are overwhelmed, veterans on hospice care, and veterans who demonstrate significant cognitive impairment due to Alzheimer’s disease or a related dementia.
VDC is not a needs based program, which means there are no income or asset limits. Furthermore, marital status, nor having dependent children, impact eligibility. Veterans must have served active duty and must not have been dishonorably discharged. For veterans who served active duty prior to September 7,1980, there is no requirement of minimum duty. For those who served after this date, there may be a 24-month active service requirement.
Veterans must live in a geographic location in which the Veteran Directed Care program is offered. In addition to Puerto Rico and Washington DC, the program is available in the following 41 states: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, and Wisconsin.
VDC is not currently available in the following states: Delaware, Georgia, Kansas, Minnesota, Nebraska, North Dakota, Rhode Island, West Virginia, and Wyoming. It is anticipated that this program will be available nationwide in the future, but at this time, it is not clear when this is expected to happen.
How to Apply for Veterans Directed Care
To apply for the VDC program, veterans with dementia should contact their local Veterans Affairs Medical Center (VAMC). To find a VAMC in the area in which one resides, click here. Remember, VDC is not available through all VAMCs across the United States.
Veterans not currently receiving VA medical benefits must first apply and be found eligible for this benefit. For information on how to apply, click here.