Community Nursing Home Program

Since 1965 VA has provided Community Nursing Home (CNH) care to eligible Veterans under contracts in the community. Together the programs for CNH, Community Care Network/Triwest Contracts (CCN), state Veterans homes (SVH), and VA Community Living Centers (CLC) represent the VA options for rehabilitation and long-term care. Offering VA oversight of care in contracted community locations is a key part of the VA CNH Program, which strives to keep Veterans closer to home. For more information about above listed VA funded nursing home programs, please call your VA Medical Center PACT Social Worker.

CNH Program Eligibility

Eligibility is based upon an evaluation for the following:

Medical need for skilled nursing care, or long-term care.
Service connection (SC) of a single category rating of 60% with individual unemployability or 70%-100% SC, or need for skilled care for a SC condition, or hospice related care.
Review of documented need which shows a Veteran requires, hands on weight bearing support for three or more activities of daily living (ADL), such as bathing, toileting, dressing, transferring, bed mobility, hygiene, or general mobility support.
Respite is provided to those who meet the above requirements and have a minimum of two ADL needs requiring weight bearing support.

Care Concerns

Every Nursing home is required to have an ombudsman assigned by the state of Oregon. This information should be shared with Veterans and families upon admission and should be posted at the NH in a prominent area. The CNH team highly recommends concerns be presented to the staff at the facility for immediate resolution, then to the ombudsman if more help is needed. The Department of Health and Senior Services also has an abuse and neglect hotline that can be utilized. The CNH team is happy to work with Veterans and CNHs to resolve concerns as well.

Types of CNH Care

Short-Stay Skilled Care: This care is for Veterans with conditions requiring care by licensed staff members such as a nurse, therapist, wound care specialist or dietitian. Veterans entering the program for short stay will be supported for discharge from the CNH Program with-in 100 days or transition to long term care.

Long-Term Care: This care is for Veterans with chronic health problems who require the daily support of skilled nursing staff. Most Veteran’s entering long-term care can expect to make the nursing home their permanent residence. Some Veteran’s will require longer than 100 days for healing and recovery. Any stay longer than 100 days, even one with plans to return home, is considered long-term care.

Respite: This care is for Veterans whose chronic health problems require a continuous caregiver at home. Respite care provides temporary care giving relief at one of our VA Community NH Placements. This option is available up to 30 days per calendar year and can be used in one setting or broken up into two 15-day settings.

Hospice Care: This care is for SC and NSC Veterans with a terminal illness who require the daily support of skilled nursing staff. A VA provider must certify hospice care is appropriate. In addition, NSC Veterans must have a documented prognosis of less than two months by an MD or NP. An NSC Veteran can only be granted a one time, contracting exception of 60 days, to bridge to Medicaid or private pay.

Impact of benefits and compensation

Veterans Benefit Administration does not reduce SC compensation due to CNH admission, but the Aid and Attendance portion of the benefit ends after 90 days and may result in an over payment. A Veteran or responsible family member should make arrangements to set aside Aid and Attendance funds in the event they should be repaid to the VBA.

Included CNH benefits

The VA CNH Program per diem rate is intended to be all inclusive and covers the following areas:

Skilled nursing care 24 hours/day;
A semi-private room (Veterans can choose to pay extra for a private room if available);
Evaluation of therapy needs;
Approved therapy services (pre-authorization required)
House MD services at the CNH;
Routine supplies, labs and x-ray care;
Medications (special consideration for high cost meds);
Please alert the CNH team immediately if there are billing concerns or assessed copayments.

Veteran responsibility during CNH stay

Make financial arrangements with the CNH if a private room is desired;
Provide clothing and personal care items including CPAP/BIPAP/AVAP (mark all clothing with Veterans name);
Provide a television and cable service, if desired (some locations DO provide, please check in advance);
Arrange for a small amount of spending money for snacks, outings or haircuts (can be securely deposited in a resident fund account);
Make arrangements for transportation to/from non-VA medical appointments unless the VA is the payer source for that care.

Hospitalization during CNH stay

If a Veteran is sent to a community emergency department, we suggest the Veteran or family call 1- to have a claim entered for this ED room visit. This must be done within 72 hours of presenting to the ED. If a Veteran is admitted to community hospital, it is also imperative, your CNH team be notified within 72 hours of presenting to the non-VA ED so we can ensure your hospital admission is covered and paid for under eligible VA benefits.

Veteran/family can request a transfer to the nearest VA medical center. Please speak to your admitting hospital staff about this request.

The VA contract for CNH care will close after 15 days if the Veteran has not returned to the CNH, and a new authorization may be required. Please have the hospital make inquiry to VA CNH program coordinator.

Home visits during CNH stay

Veterans using VA-funded programs for long-term care may request up to six days/year for leave of absence, unless a therapeutic need is identified. The nursing home house physician must be willing to write orders for any leave of absence. An absence cannot exceed 24 hours at a time unless therapeutically determined as appropriate by the CNH team. During short-stay skilled and hospice care, leave can be approved by VA for day visits only.

Discharge planning

Short-stay skilled care provides a bridge back home or to lower level care such as assisted living, residential care or adult foster home. During a short-stay placement, the CNH program case managers will work with the nursing facility to assess when a Veteran is ready to discharge. The CNH team will work with the Veteran’s primary care team to arrange community services such as: in-home services (Home Health), equipment needs and medications. This process should start early with the Veteran and family actively involved.