Dear Sgt. Shaft:
I have questions about long-term health care for veterans. I have looked on the VA web page and can't find any information. Also, when I talked with personnel at the local VA Medical Center, they told me the most recent directives were published in 1991, which was prior to Public Law 104-262 (Eligibility Reform). My specific questions:

• As a 60% service-connected disabled veteran, what are VA's rules for long-term care?
• Is there any information on long-term care on VA's web pages?
• What are the most current directives for long-term care for severely disabled veterans, either in a VA or non-VA facility?
• What do persons do if the care needed is not for a service-connected condition?

Your column has helped many disabled veterans. If you can answer the above issues, you will help thousands more.

A Confused Disabled Veteran
Indianapolis, IN

Dear Confused:
After receiving your letter, I queried the Veterans Affairs flacks at the VA Central Office. The response I received was simply, "Veterans may be provided limited nursing home care." Nursing home care eligibility was not changed by the Eligibility Reform Act except that zero percent service-connected non-compensable veterans receiving care in VA nursing homes must agree to make co-payments to receive their care, unless being treated for their service-connected disability. Nursing home care is authorized by 38 U.S.C. Sections 1710 and 1720. Nursing home care in VA facilities may be provided when medically indicated and to the extent resources and facilities are available to both service-connected and non-service-connected veterans. Certain non-service-connected and zero percent service-connected veterans with higher income levels are required to make co-payments for their care. Veterans who have been furnished hospital, nursing home, or domiciliary care in VA facilities may be transferred to community nursing homes at VA expense. Under this contract program, nursing home care at VA expense is limited to a period to time not to exceed six months following hospitalization in a VA facility. Contract care for veterans who received hospital care for a service-connected disability is not subject to the six-month limit. The State Home Per Diem Program, a grant-in-aid program, allows VA to pay states an established per diem rate which covers up to half the cost of care for eligible veterans in VA-recognized state nursing homes. States may set additional eligibility standards, such as residency requirements.

Legislation before Congress, H.R. 2116 as amended, The Veterans' Millennium Health Care Act, will address some of the long-term care issues facing veterans, including: 

• mandating that VA operate and maintain a national program of extended care services and would specify that the program must include geriatric evaluations, nursing home care (in-house and contract), adult day health care, domiciliary care and respite;
• require VA to maintain nationally the level of "in-house" extended care services provided as of September 30, 1998;
• require VA, in addition to maintaining capacity, to develop and begin to implement by January 1, 2000 a plan for carrying out the recommendations of the Federal Advisory Committee on the Future of VA Long-Term Care that VA should increase both home and community-based care options as well as the percentage of the medical care budget dedicated to such care;
• mandate VA to provide needed extended care services in the case of veterans who are 50% service-connected or in need of such care for a service-connected condition, and provide such veterans highest priority for placement in VA nursing homes.

For more information regarding this important legislation and coverage not listed above, contact the House Veterans Affairs Committee at 202-225-3527.

Shaft Kudos

The Sarge urges all members of the House of Representatives to join their colleague, Representative John McHugh (R-NY) in his efforts to say "Thank you" to our World War II veterans and their families by cosponsoring H.R. 2319, which will help to reduce costs of building the nation's Memorial to honor our World War II veterans. H.R. 2319 clarifies Public Law 103-32 (which authorizes the construction of a memorial to honor members of the Armed Forces who served in World War II and those who supported them at home) by stating that the American Battle Monuments Commission and the World War II Memorial Advisory Board are eligible for nonprofit mail rates in carrying out their congressionally-mandated task for raising the necessary voluntary contributions for this memorial. Although the Internal Revenue Service has ruled that donations are tax deductible, the Postal Service has refused to allow the Commission and Advisory Board access to reduced postal rates that are available to other nonprofit mailings. This must be changed in order to help fund this Memorial. House members should call the Postal Subcommittee (202-225-3741) to join Congressman McHugh in this effort.

Friend Jim Fischl, president of the VA Alumni Association, has announced that Chairman of the Board of Veterans Appeals, E.D. Clark, will be luncheon speaker at the September 23 meeting at Pier 7 Restaurant, beginning at 12 noon. The Sarge is looking forward to addressing this distinguished group in December. For more information about the VA Alumni Association or the September 23 luncheon, contact Leon Sanchez at 703-451-7529.

Hats off to American Legion Post 290 and the Richmond, Va. VA Medical Center in their attempt to provide more efficient health care to veterans in Fredericksburg and seven surrounding counties. Beginning September 28, a VA clinical team, along with American Legion Post members, will try to contact all area eligible veterans and process them into the VA system at the Stafford Regional Medical Health Center. The Sarge urges all vets to contact Jim Huntzinger, Rehabilitation & Service Officer, at 540-752-1944 for more information about this worthwhile endeavor.