The Department of Veterans Affairs (VA) is dedicated to supporting veterans in various aspects of their lives, including ensuring access to appropriate living arrangements when they are no longer able to live fully independently. One crucial program in this effort is the Community Residential Care (CRC) program. This program connects veterans with community-based living options that provide a supportive environment and health care supervision. This article delves into the key aspects of the VA’s Community Residential Care program, focusing on recent updates and what veterans and their families need to know.
What is the Community Residential Care (CRC) Program?
The VA Community Residential Care program is designed to assist veterans who, due to medical, psychiatric, or psychosocial conditions, cannot live independently but do not require hospitalization or nursing home care. These veterans often lack suitable family or caregivers to provide the necessary daily support and supervision. CRCs offer a home-like setting within the community, providing a crucial bridge between independent living and more intensive care environments.
Key Features of CRC:
- Enriched Housing: CRCs are not just housing; they offer an enriched environment tailored to the needs of veterans requiring supervision and assistance.
- Health Care Supervision: While not medical facilities, CRCs provide health care supervision, ensuring residents’ well-being is monitored.
- Support with Daily Living: Residents receive assistance with activities of daily living and instrumental activities of daily living, promoting their comfort and functionality.
- Community-Based: Located within communities, CRCs help veterans remain connected to society while receiving necessary care.
- VA Oversight: The VA approves and monitors CRCs to ensure they meet specific standards of care and safety.
It’s important to note that CRC facilities are community-based, and their employees are not VA employees. Veterans have the choice to reside in any CRC; however, the VA recommends and refers veterans only to CRCs that have applied for and met VA approval standards. This ensures a baseline of quality and safety for veterans entering these facilities.
Updated Regulations for VA-Approved CRCs
Recently, the VA finalized a rule amending its regulations governing standards for VA-approved Community Residential Care Facilities. These updates are crucial for ensuring veterans receive appropriate care and that the financial aspects of CRC residency are transparent and fair. The final rule, effective August 14, 2019, brings clarity and updates to several key areas:
Defining Levels of Care: Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs)
The updated rule introduces clear definitions for “activities of daily living” (ADLs) and “instrumental activities of daily living” (IADLs), which are essential for determining the level of care a veteran needs.
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Activities of Daily Living (ADLs): These are fundamental self-care tasks, including:
- Walking
- Bathing, shaving, brushing teeth, combing hair
- Dressing
- Eating
- Getting in or out of bed
- Toileting
These ADLs serve as a standard measure of an individual’s functional status and are crucial in assessing the basic care needs of CRC residents.
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Instrumental Activities of Daily Living (IADLs): These tasks are not essential for basic survival but are vital for living independently in a community. IADLs include:
- Housekeeping and cleaning room
- Meal preparation
- Taking medications
- Laundry
- Assistance with transportation
- Shopping for groceries, clothing, or other items
- Ability to use the telephone
- Ability to manage finances
- Writing letters
- Obtaining appointments
IADLs reflect a person’s ability to interact with their environment and manage everyday life outside of basic self-care.
By defining these terms, the VA aims to standardize the understanding of care levels required and provided within CRCs, ensuring veterans receive the appropriate support based on their specific needs.
Base Level of Care Requirements in CRCs
A significant aspect of the updated rule is the establishment of a “base level of care” that every VA-approved CRC must provide. This base level ensures that all veterans in CRCs receive a minimum standard of services, regardless of the facility. The base level of care includes:
- Room and Board: Providing a safe and comfortable living space.
- Nutrition: Offering three meals per day and two snacks, with adjustments for special dietary needs.
- Laundry Services: Ensuring residents have clean clothing and linens.
- Transportation: Providing or arranging transportation to VA and healthcare appointments, and accompanying residents if necessary.
- 24-Hour Supervision: Offering around-the-clock supervision when indicated by the veteran’s needs.
- Assistance with ADLs and IADLs: Providing care, supervision, and direct assistance with both activities of daily living and instrumental activities of daily living.
For veterans requiring more than this base level of care, the rule mandates that CRCs must provide a “medically appropriate level of care.” This ensures that facilities are equipped to handle varying needs within their resident population.
Understanding the Costs and Rate Approval Process
The financial aspect of community residential care is a critical consideration for veterans and their families. The VA clarifies several points regarding the cost of CRC care in the updated regulations:
- Veteran’s Financial Responsibility: It is explicitly stated that the cost of community residential care is not the responsibility of the United States Government or the VA. Veterans are responsible for financing their CRC care from their own resources.
- Reasonable Rate for Base Level of Care: The rule emphasizes that the cost of CRC should reflect the cost of providing the defined base level of care. This aims to ensure that rates are justified by the services provided.
- Agreement and VA Approval: An agreement on charges and payment procedures must be established between the veteran (or an authorized representative) and the CRC. Crucially, this agreement must be approved by a VA approving official. This approval process is a safeguard to protect veterans from unreasonable charges.
- Annual Rate Review: CRC charges are subject to annual review by both the facility and the VA, or more frequently if there are changes in the veteran’s care needs.
- Rate Reasonableness and Comparability: The VA approving official assesses whether the charges are reasonable and comparable to the average rate for residential care in the State or Region for the same level of care. This benchmark ensures that CRC rates are in line with prevailing market rates.
- Annual CPI Increase Limit: Year-to-year increases in CRC charges for the same level of care are capped at the annual percentage increase in the National Consumer Price Index (CPI). This measure is in place to prevent excessive rate hikes.
Flexibility in Rate Approval:
The VA recognizes that individual needs vary and provides flexibility in rate approval:
- Lower than Average Rate: A rate lower than the average can be approved if agreed upon by the CRC and the resident, provided it doesn’t compromise the level of care needed.
- Higher than Average Rate: A higher rate can be approved if justified by the individual needs of the resident that exceed the base level of care. Examples of services justifying a higher rate include:
- Managing resident funds disbursement
- Special dietary requests
- Accompanying residents to activity centers
- Scheduled socialization activities
- Supervision for unsafe smokers
- Bowel and bladder care
- Behavioral issue intervention
- Transportation beyond VA/healthcare appointments
This flexibility allows for tailored care plans and pricing that accommodate the diverse needs of veterans in CRCs.
Addressing Comments and Concerns
During the rulemaking process, the VA received comments from the public, which they addressed in the final rule. Key concerns and VA responses include:
- Financial Assistance: One commenter suggested the VA should provide financial assistance for CRC care, similar to programs for homeless veterans. The VA clarified that current law (38 U.S.C. 1730) explicitly exempts the VA from responsibility for payment of CRC care. Therefore, providing financial assistance is outside the scope of this regulation and current VA authority.
- Standardization of Care and Level of Care Concerns: Concerns were raised about ensuring standardized levels of care and preventing “low-level care” suggestions to save costs. The VA responded by emphasizing that the rule establishes a base level of care that all CRCs must meet. Furthermore, the VA’s rate approval process includes reviewing the veteran’s required level of care and comparing it to the proposed CRC rate, ensuring that care levels are appropriate and justified. The VA also clarified that the determination of the level of care is based solely on clinical need, not financial considerations.
These responses highlight the VA’s commitment to addressing concerns while operating within its legal and regulatory framework to improve the CRC program.
Effect of the Rulemaking
This final rule reinforces the VA’s commitment to ensuring high standards within Community Residential Care facilities and clarifies the processes for rate setting and approval. It provides a more robust regulatory framework for the CRC program, directly impacting veterans, CRC operators, and VA officials involved in veteran care. The rule emphasizes that all existing and future VA guidance must align with these updated regulations, ensuring consistency and clarity in program implementation.
Conclusion
The updated regulations for the VA Community Residential Care program represent a significant step towards enhancing the quality and transparency of care for veterans in community-based residential settings. By clearly defining levels of care, establishing a base level of services, and refining the rate approval process, the VA aims to protect veterans’ interests and ensure they receive appropriate, dignified care within their communities. Veterans and their families seeking community residential care should familiarize themselves with these updated regulations and work closely with VA officials and approved CRCs to ensure a smooth and beneficial care arrangement.
