Step 1: Determine the Veteran’s General Eligibility for VA Benefits

If you are caring for a veteran and want to help them take advantage of VA assistance for their memory care needs, then your first step should be to inquire about their eligibility and enrollment status for both VA healthcare and VA pensions. Chances are good that most elderly veterans are already signed up for the benefits they qualify for, but sometimes veterans may not realize they are eligible.

Healthcare eligibility‍

If the veteran you care for is not already enrolled in VA Healthcare, you can check her or his eligibility for enrollment in this VA healthcare eligibility article. This article includes helpful explanations of VA Priority Groups. All veterans receive a priority designation of 1 to 8 based on wartime or combat service dates, service-related disability ratings, and income, among other factors.

The lower the number of priority group veterans receive, the higher their priority for enrollment and care. Those with higher priority numbers may be denied coverage or charged a copay for some services. The VA’s budget for care changes year to year based on congressional approval. Priority groups allow the VA to serve those in the most need or with the most service-connected disabilities when congressional funding is low.

If you determine that the veteran you care for is probably eligible for care but is not signed up for it, you can visit the VA website to see a detailed list of documents needed and steps to take. VA Healthcare applications are usually processed within a week.

Pension eligibility

Many veterans who qualify for VA healthcare don’t qualify for a VA pension. To qualify for a pension, a veteran must meet several requirements, including having served at least one day during a wartime period. Official wartime period dates can be viewed here. For more information on pension eligibility, you can explore the VA Pension website. If the veteran has never applied for a pension or has applied and been denied in the past, applying late in life may still be worth it.

For veterans who just don’t have the financial means to pay for full-time memory care, pensions can provide the funds needed to dramatically improve their quality of life. Veterans who already receive a regular pension may also be eligible for additional pension allowances because of their need for help with activities of daily living like cooking and bathing, or because they are housebound.

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Step 2: Utilize Diagnostic Services from the VA

Once you’re established general eligibility for VA Healthcare, you’ll need to have your loved one’s suspected or diagnosed dementia evaluated by a VA doctor. This locator tool can help you find the phone number for the nearest VA location and ask to set up an appointment.

Important things to know about visiting a VA doctor for dementia concerns:

- The VA selects a and doctor for the veteran

- Veterans in some priority groups pay copays

- The VA can help with transportation to an appointment in some cases

- The VA may bill to cover some of the care they provide, and this billing method could eliminate some of the copays

- If appointment wait times or distance are prohibitive, you may seek approval to receive for the veteran

- A first visit may include tests or a general physical as well as discussion of dementia

Keep in mind that receiving an official diagnosis of Alzheimer’s or other forms of dementia may be an emotional experience for both you as the caregivers and for the veteran you care for. Ask your VA or community care provider about resources for coping, and plan to reread any provided pamphlets later to go over information you may have missed during the appointment.

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Step 3: Utilize Medical Shared Decision Making Resources

After diagnosis, medical shared decision making can help you decide your next steps for treatment. Medical shared decision making refers to the process in which patients, their loved ones, and their care team all come together to make healthcare decisions. With many options for memory care both at home, in the community, and in VA centers, it’s important that everyone involved has a chance to voice their concerns and preferences with the medical team.

Shared Decision Making for Veterans 

The Shared Decision Making Worksheet for Veterans might be useful for veterans in the early stages of dementia. You can read this worksheet with the veteran and write down their answers for them if they prefer that. However, sometimes a veteran experiencing dementia will be unaware of their own lapses in memory or will be emotionally unable to cope with facing changes brought on by dementia. In such a case, this worksheet may not be as helpful. Its utility will depend largely on the veteran’s current state of mind, health, and desire to communicate.

Self-Assessment for Caregivers 

Regardless of whether the veteran is able to complete the above worksheet, you as a caregiver can still use the Caregiver Self Assessment worksheet, also provided by the VA. After completing this worksheet, you can use the included contact information to reach out to a VA social worker. Discussing your results with a social worker can help you to decide if you need more support or resources to prevent you getting burnt out in you important caregiver role.

After completing one or both of the above worksheets, you may want to bring them to the next appointment the veteran has with his or her VA doctor.

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Step 4: Apply for Appropriate VA Assistance

Looking into VA resources that can help with long term memory care needs can be a confusing experience. There are many paths to memory care, and your best option depends on a combination of personal preferences, caregiver abilities, financial position, and clinical need. Your care team will probably suggest a program or service they think is suitable for the veteran, but you can also ask about the services listed below.

Keep in mind that eligibility or admission for most of the programs below is heavily tied to the veteran’s priority group. You may not be able to determine eligibility for a program until you speak directly with a VA caseworker or Veterans Service Officer.

The following three options provide funding or help for at-home care options:

- Homemaker and Home Health Aide Care

- Aid and Attendance and Housebound Allowance

- Veteran Directed Home Based Care (VD-HCBS)

These three options provide care in residential settings for those who cannot receive proper memory care at home:

- Community Nursing Homes 

- VA Community Living Centers 

- State Veterans Nursing Homes

Other VA resources to look into:

The following options don’t provide full-time memory care, but they can all be a piece of the full care puzzle for patients with dementia.

- Skilled Home Healthcare or Home-Based Primary Care: Visits from doctors, therapists, pharmacists, and nurses to meet medical and nursing needs for those who have a clinical need not leave their homes for care.

- Respite Care: Access to temporary caregivers at home, in an adult daycare, or in a nursing home so that primary caregivers can run errands, take breaks, or even take much-needed vacations.

- Telehealth: Remote health monitoring through at-home medical devices that can be transmitted to VA medical staff. Care coordinators can review health data and determine if it needs to be passed along to a doctor for immediate attention.

- Palliative Care and Hospice: Palliative care and hospice care both focus on managing pain and symptoms, but hospice is for the last six months of life. Both kinds of care are frequently available through various VA programs.

- HISA Grants: HISA Grants aren’t for healthcare at all, but they provide funding for home alterations that are necessary to accommodate a disability. This may be helpful in cases where a veteran with dementia is also struggling with other physical disabilities.

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Step 5: Plan to Be Flexible About Care

One of the most important qualities a caregiver can have is flexibility. This is especially true for families who decide to provide care in-home with the help of support programs from the VA. It’s important to be willing to change a care plan if it’s no longer working.

Developments that may require you to change a home memory care plan:

- The caregiver’s cognitive or physical health declines, limiting their strength or mobility

- The veteran develops secondary mobility or health problems that make home care more difficult or impossible

- The veteran develops a habit of wandering and cannot be confined in the home

- The caregiver no longer gets enough sleep because of the veteran’s dementia-related altered sleep habits

- The veteran becomes too aggressive and hostile for the caregiver to safely interact with when alone

- The caregiver begins to feel overworked, isolated, unsafe, depressed, or anxious

Even with help from the Aid and Attendance pension, the Homemaker and Home Health Aide Program, or VD-HCBS, the conditions listed above could make providing care at home unrealistic, depending on the exact circumstances.

To truly provide the best care possible, plan to check in with yourself periodically, looking at your needs and the veteran’s needs. Discuss any new difficulties and concerns with other family members or the veteran’s social worker, actively seeking out objective opinions on how the home memory care you’re providing is working.

Ultimately, one of the most loving things you can do for a veteran with dementia is to connect them to the care that’s best for them. If at some point that means moving them to a quality residential facility funded by the VA, you can feel good about that choice.

For additional information, go to the VA website.