Types of VA-Supported Nursing Home Care
The VA provides nursing home care through several programs, each with slightly different admission criteria. The three primary types of VA-supported nursing home care are Community Living Centers, State Veterans Homes, and Community Nursing Homes.
- VA Community Living Centers (CLCs): These facilities are owned and operated by the VA, often located on or near a VA medical center campus. They offer both short-stay services like rehabilitation and respite care, and long-stay services for veterans needing ongoing skilled nursing.
- State Veterans Homes: These are owned and managed by state governments but are certified by the VA. The VA provides a portion of the funding, but each state establishes its own eligibility and admission criteria, which can vary.
- Community Nursing Homes: Through this program, the VA contracts with local, private nursing homes to provide care for veterans who want to remain closer to their families and communities. Eligibility for this program is also based on clinical need and service connection status.
Essential Eligibility Requirements
Regardless of the type of VA nursing home care, several fundamental requirements must be met before a veteran can be admitted. These are clinical, administrative, and logistical in nature.
Enrollment in VA Health Care
The first step for any veteran seeking VA-covered long-term care is to be enrolled in the VA health care system. A veteran can apply for enrollment online, by phone, by mail, or in person at a VA medical center. You will need to provide information such as military discharge papers (DD214), service history, household income, and details about insurance coverage.
Certified Clinical Need
A veteran's medical and psychiatric condition must be stable, and a VA physician or authorized medical provider must certify that the veteran requires institutional nursing home care. The clinical assessment will determine if the veteran has sufficient functional deficits that require inpatient care, such as needing hands-on assistance with multiple activities of daily living (ADLs).
Facility Availability
Admittance is not guaranteed, even if a veteran meets all other criteria. Placement is dependent on the availability of a bed or service at a nearby VA Community Living Center, State Veterans Home, or contracted Community Nursing Home. Some facilities, especially specialized units, may have waiting lists.
Understanding VA Priority Groups and Costs
VA eligibility and costs are significantly influenced by a veteran's assigned priority group. This system prioritizes veterans with the highest need based on disability rating, income, and other factors.
Priority Groups and Their Impact
Veterans are assigned to a priority group upon enrollment in VA healthcare. This rating affects not only eligibility for care but also the potential costs.
- Highest Priority (Priority Group 1): Includes veterans with a service-connected disability rating of 50% or higher, or those deemed unemployable due to a service-connected disability. They typically receive free VA nursing home care.
- Lower Priority Groups: Veterans with lower disability ratings or non-service-connected conditions may be placed in lower priority groups. Their admission may be contingent on available resources, and they may be responsible for copayments based on their income and assets.
Copayment Structure
For veterans in lower priority groups, copayments for long-term care are a possibility. For those with compensable service-connected disabilities, copayments are typically waived. For others, the VA will review financial information to determine copay amount, which can be up to a maximum daily rate (in 2025, a daily maximum of $97 is cited by some sources). Some veterans in need of extended care, especially for non-service-connected conditions, may need to complete VA Form 10-10EC to assess their financial status.
Comparison of VA-Supported Nursing Home Options
| Feature | VA Community Living Centers (CLCs) | State Veterans Homes | Community Nursing Homes (CNHs) |
|---|---|---|---|
| Operator | U.S. Department of Veterans Affairs | Individual State Governments | Private facilities contracted by VA |
| Admission Criteria | VA health enrollment, clinical need, availability. VA sets criteria. | VA health enrollment, clinical need, availability. State sets residency and other criteria. | VA health enrollment, clinical need, availability. VA sets criteria for contracted care. |
| Cost | Can be free for highest-priority veterans. Others may have copays based on financial status and priority group. | Varies by state. Some states may have residency or asset restrictions. VA may pay a portion of the cost. | Can be free for highest-priority veterans. Copays depend on priority group, financial status, and availability of resources. |
| Location | Typically on or near VA medical centers. | Varies by state; located within the respective state. | In communities, potentially closer to family. VA-contracted facility. |
| Target Population | Veterans requiring short-term or long-term skilled nursing. | Veterans; some states may admit spouses or Gold Star parents. | Veterans requiring skilled nursing in their community. |
The Application Process: Steps to Admission
Step 1: Enroll in VA Health Care
If not already enrolled, the veteran must first apply for VA health benefits using VA Form 10-10EZ. You can apply online, by mail, by phone, or in person at a VA medical center.
Step 2: Consult with a VA Social Worker
Engage with a VA social worker or case manager. They can explain all available care options, assess the veteran's clinical needs, and guide you through the next steps based on local facility availability.
Step 3: Complete Required Forms
Your social worker will assist with completing the Application for Extended Care Benefits (VA Form 10-10EC) to evaluate the veteran's financial information for copayment determination.
Step 4: Medical Evaluation
A VA medical professional will conduct a geriatric evaluation to determine the veteran's clinical need for skilled nursing care. The findings are crucial for securing admission.
Step 5: Wait for a Bed
Once all paperwork is submitted and approved, the veteran will be placed on a waiting list if no beds are immediately available. Placement priority is based on the veteran's priority group and the urgency of their medical need.
Conclusion
Getting into a VA nursing home is a multi-step process that starts with enrolling in the VA health care system and demonstrating a clinical need for skilled nursing. While service-connected disability status and priority groups play a major role in determining eligibility and cost, all veterans who meet the foundational requirements should consult with a VA social worker to navigate their options. The variety of care available through VA-operated CLCs, State Veterans Homes, and Community Nursing Homes ensures that veterans have access to long-term care solutions, though availability and location-specific criteria must be considered.
Additional Resources
For detailed information and to start the application process, visit the official VA website on long-term care.
