Dad’s monthly assisted living charge is not automatically the amount VA will deduct from household income. VA applies a facility worksheet that asks what care the facility provides, why Dad lives there, and which charges cover lodging, meals, health care, or custodial care.[1]

That makes paperwork part of the provider comparison. Before signing a residency agreement, give the worksheet from VA Form 21P-8416 to each finalist. Ask who will complete it, whether that person will sign the facility certification, and whether the billing office can produce the required fee breakdown. A facility that cannot answer those questions is leaving the family to reconstruct the expense after care begins.

Start with the same document at every facility

Use the “Worksheet for a Residential Care, Adult Daycare, or Similar Facility” included with VA Form 21P-8416. VA says each provider must complete the applicable worksheet when the claim includes residential care, adult day care, or a similar care facility.[1]

Ask each facility to show how it would answer these questions:

  • Is the facility licensed where licensing is required?
  • Do facility employees or contracted staff provide Dad with health care, custodial care, or both?
  • If Dad will live there, is the facility staffed by caregivers around the clock?
  • What services does Dad receive because of his disability?
  • Is receiving that care the primary reason he lives there?
  • Can the facility provide a current statement of Dad’s fees and a breakdown of the care received?

Those questions come directly from the VA worksheet.[1] Do not settle for “we work with veterans” or “our residents use Aid and Attendance.” Ask to see the actual billing categories and identify the employee who signs the certification.

Make the invoice separate four different things

Ask for a sample invoice showing lodging, meals, health care services or help with activities of daily living, and custodial care as separate entries. The VA worksheet directs claimants in qualifying situations to report those categories separately.[1]

VA defines custodial care for this worksheet as regular help with at least two recognized activities of daily living, or supervision because a person with a mental disorder would be unsafe if left alone.[1] The worksheet recognizes eating, bathing or showering, dressing, transferring, and using the toilet as activities of daily living.[1]

Compare the sample invoice with Dad’s service plan. If the plan promises bathing and dressing assistance but the invoice says only “monthly services,” ask the facility to explain how it will document the care. If a separate company supplies the hands-on care, ask whether that company will appear as another provider and complete its own paperwork.

Do not assume room and board will count

The worksheet treats meals and lodging differently depending on the claimant, the care being provided, the reason for living at the facility, and whether VA grants the applicable special monthly pension status.[1] In some worksheet paths, all facility payments may qualify. In others, meals and lodging do not qualify and only specified care charges should be claimed.[1]

That is why a salesperson’s promise that “the whole bill counts” is not enough. Ask the facility to complete the worksheet based on Dad’s actual care arrangement. Let VA decide which reported expenses are deductible.

Also separate pension from VA health care. VA explains that it does not pay room and board in residential settings such as assisted living through its health care long-term-care services, although eligible veterans may receive certain health services while living in a residential setting.[2] An unreimbursed expense used in a pension calculation is not the same thing as VA directly paying the facility.

Check whether another medical statement is needed

Depending on who the disabled person is and how the worksheet questions are answered, VA may require a statement from a physician or physician assistant. The statement must say that the person needs the facility’s health care services or custodial care because of a mental or physical disability and must describe that disability.[1]

Ask each finalist whether its staff will give Dad’s clinician a current service plan or care summary. The facility should document what it provides. The clinician should describe Dad’s medical need. Do not ask a salesperson to supply a medical conclusion.

Compare the change process, not just the first invoice

Dad’s care level and monthly charge may change. Ask each provider what document it issues when services, fees, or billing categories change. Find out whether the family receives an updated service plan and an itemized statement before the new charge begins.

VA Form 21P-8416 asks for the provider, service period, and monthly amount paid.[1] It is used to report medical or dental expenses paid by the claimant for the claimant or a household family member when those expenses were not reimbursed and are not expected to be reimbursed.[3] A clean change record makes it possible to match the amount reported to VA with the amount actually paid.

Keep contracts, service plans, invoices, proof of payment, worksheet copies, and notices of fee or care-level changes. VA says receipts generally do not have to accompany the medical expense report, but claimants should retain receipts and other payment documentation because VA may later verify the expenses.[3]

Use a five-question comparison call

  1. Who completes and signs the VA Form 21P-8416 residential care worksheet?
  2. Will the signed worksheet describe Dad’s current care rather than the facility’s general service menu?
  3. Can billing separate lodging and meals from health care and custodial care?
  4. Will the service plan identify which activities of daily living staff actually assist with?
  5. What updated documents will the facility issue when Dad’s care or monthly charge changes?

Write down the name and department of every person who answers. Before choosing a facility, send the completed or sample paperwork to the accredited representative helping with the pension claim. VA permits pension applications online, by upload, by mail, in person, or with the help of an accredited representative.[4] For St. Louis filing contacts, use the site’s Local Help: St. Louis Offices page.

The decision is not which facility says “Aid and Attendance” most confidently. It is which suitable facility can document Dad’s actual care, identify the person responsible for the worksheet, and produce a bill that the family can accurately report.

VA.gov footnotes

  1. VA.gov, VA Form 21P-8416, Medical Expense Report, including the Worksheet for a Residential Care, Adult Daycare, or Similar Facility.
  2. VA.gov, “VA Long-Term Care Services,” Geriatrics and Extended Care.
  3. VA.gov, “Submit Medical Expenses to Support a Pension or Parents’ DIC Claim,” for VA Form 21P-8416.
  4. VA.gov, “How to Apply for a VA Pension as a Veteran.”