The Department of Veterans Affairs (VA) has established regulations to ensure veterans who are not in need of hospitalization or nursing home care, but require supportive living environments, receive appropriate care in community residential care facilities (CRCs). This final rule clarifies and updates the standards for these facilities, focusing on the level of care veterans should receive and the process for determining appropriate rates. This regulation is crucial for veterans and their families seeking supportive living options and for facilities aiming to provide high-quality, VA-approved care.
What is the Community Residential Care Program?
The Community Residential Care (CRC) program is designed to support veterans who, due to medical, psychiatric, or psychosocial conditions, cannot live independently but do not require intensive hospital or nursing home care. These veterans often lack suitable family or support systems to provide the necessary supervision and assistance. CRCs offer a home-like setting where veterans receive room, board, help with daily living activities, and supervision tailored to their individual needs. It’s important to note that CRC employees are not VA employees, and the VA’s role is to ensure standards are met and to connect veterans with approved facilities.
Image showing the Document Drafting Handbook, relevant to the regulatory context of the Community Residential Care Program.
Key Aspects of the Updated CRC Regulations
The updated regulations, effective August 14, 2019, focus on several key areas to enhance the quality and oversight of Community Residential Care Programs. These include defining levels of care, clarifying rate approval processes, and ensuring facilities meet specific standards.
Defining Levels of Care: Base Level and Beyond
One significant update is the clear definition of a “base level of care” that all VA-approved CRCs must provide. This includes essential services such as:
- Room and board: Providing a safe and comfortable living space and meals.
- Nutrition: Offering three meals a day and two snacks, catering to special dietary needs when necessary.
- Laundry services: Ensuring residents have clean clothing and linens.
- Transportation: Providing or arranging transport to VA and healthcare appointments, and accompanying residents if needed.
- 24-hour supervision: Offering continuous supervision when required based on individual needs.
- Assistance with Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs): Supporting veterans with self-care tasks and activities necessary for independent living within the community.
Activities of Daily Living (ADLs) are defined as fundamental self-care tasks, including:
- Walking
- Bathing, shaving, brushing teeth, combing hair
- Dressing
- Eating
- Getting in and out of bed
- Toileting
Instrumental Activities of Daily Living (IADLs) encompass tasks that enable independent living within a community, such as:
- Housekeeping and room cleaning
- Meal preparation
- Medication management
- Laundry
- Transportation assistance
- Shopping for groceries, clothing, and other items
- Using the telephone
- Managing finances
- Writing letters
- Obtaining appointments
For veterans requiring more than the base level of care, CRCs are obligated to provide a medically appropriate level of care to meet those needs. This ensures that the program is adaptable to a range of veteran requirements within a community setting.
Image of the Federal Register publication date, highlighting the official announcement of the proposed rule amendment for Community Residential Care Facilities.
Cost and Rate Approval for Community Residential Care
The regulations address the financial aspects of community residential care transparently. It is explicitly stated that the VA and the U.S. Government are not responsible for covering the costs of CRC care. Veterans finance their care through their own resources, emphasizing the importance of a clear agreement between the veteran (or their representative) and the CRC facility regarding charges and payment procedures.
VA plays a crucial oversight role by reviewing and approving these agreements. The rule specifies that:
- Cost Reflection: CRC costs should align with the expense of providing the defined base level of care.
- Agreement and Approval: Charges and payment procedures must be agreed upon by the resident (or representative) and the CRC, subject to VA approval.
- Annual Review: CRC rates are reviewed annually by the facility and the VA, or more frequently if care needs change.
- Reasonable and Comparable Rates: Charges must be reasonable and comparable to the average rate for similar residential care within the State or Region, for the same level of care.
- CPI Increase Limit: Year-to-year rate increases for the same level of care cannot exceed the annual percentage increase in the National Consumer Price Index (CPI).
The VA approving official has the authority to approve rates that are lower or higher than the regional average under specific conditions:
- Lower Rates: May be approved if agreed upon by the CRC and resident, provided the lower rate doesn’t compromise the required level of care.
- Higher Rates: May be approved if justified by the individual needs of the resident exceeding the base level of care and agreed upon by both parties. Examples of services justifying higher rates include managing resident funds, special dietary needs, social activities, supervision for unsafe behaviors, and specialized care needs like bowel and bladder management.
This structured approach ensures rate fairness and protects veterans from unreasonable charges while allowing for flexibility based on individual care requirements and facility offerings.
Image displaying the legal code 38 U.S.C. 1730, referencing the US Code section that authorizes the Community Residential Care program.
VA’s Role and Veteran Choice
While veterans have the autonomy to choose any CRC, the VA recommends facilities that have applied for and met VA approval standards outlined in 38 CFR 17.63. This approval process ensures facilities meet criteria related to:
- Physical facility integrity
- Healthcare provision
- Living standards
- Cost transparency
Approved CRCs are placed on a VA referral list, facilitating connections between veterans seeking community residential care and vetted, quality facilities. This referral system is a vital part of how the VA assists veterans in finding suitable living arrangements.
Conclusion: Enhancing Veteran Care in Community Settings
The final rule amending regulations for the Community Residential Care program represents the VA’s commitment to refining and strengthening support for veterans in community-based settings. By clarifying care standards, rate approval processes, and facility requirements, these updated regulations aim to ensure veterans receive appropriate, high-quality care tailored to their needs while maintaining transparency and fairness in the financial aspects of residential care. This ultimately enhances the well-being and quality of life for veterans who benefit from community residential care programs.
This updated framework is designed to be helpful for veterans, their families, and community residential care providers, fostering a system that prioritizes veteran needs and ensures quality care within supportive community environments.
