Veterans State Adult Day Health Care

To provide a community-based program designed to meet the needs of adults with impairments through individual plans of care.

This type of structured, comprehensive, nonresidential program provides a variety of health, social, and related support services in a protective setting.

By supporting
families and caregivers, an adult day services program enables the person to live in the community.

An adult day services program assesses the needs of the persons served and offers services to meet those needs.

The persons served attend on a planned basis.

Nothing in this generic description of adult day services may be construed to modify the specific services or eligibility requirements referenced in the definition of adult day care and adult day health.

Agency - Department of Veterans Affairs

The Department of Veterans Affairs strives for excellence in patient care and veteran's benefits for its constituents through high quality, prompt and seamless service to United States veterans.

Office - See Appendix IV of the Catalog for Veterans Hospital Facilities.
Website Address

Program Accomplishments

The State Home ADHC program was able to provide outpatient adult day healthcare to 20 participants in FY 2007 and is estimated to provide for 21 and 22 participants in FY 2008 and FY 2009, respectively.

Uses and Use Restrictions

Adult day health is a supervised daytime program providing skilled nursing and rehabilitative therapy services in addition to core services outlined in Public Law 106-117 Section 101.

(1) Adult day health services are only appropriate for adults with medical or disabling conditions that require the intervention or services of a registered nurse or licensed rehabilitative therapist acting under the supervision of the client's physician.

(2) The adult day health center must offer and provide on site the following services: (a) All core services under PL 106-117 Section 101; (b) Skilled nursing services other than routine health monitoring with nurse consultation; (c) At least one of the following skilled therapy services: physical therapy, occupational therapy, or speech-language pathology or audiology, as those services are defined under PL 106-117 Section 101 respectively; and (d) Psychological or counseling services, including assessing for psycho-social therapy need, dementia, abuse or neglect, and alcohol or drug abuse; making appropriate referrals; and providing brief, intermittent supportive counseling.

(a) The following personal care services as defined in PL 106-117 Section 101, "personal care services," or its successor: (i) Ambulation; (ii) Body care; (iii) Eating; (iv) Positioning; (v) Self-medication; (vi) Transfer; (vii) Toileting; (viii) Personal hygiene at a level that ensures client safety and comfort while in attendance at the program; and (ix) Bathing at a level that ensures client safety and comfort while in attendance at the program.

(b) Social services on a consultation basis, which may include: (i) Referrals to other providers for services not within the scope of Medicaid reimbursed adult day care services; (ii) Caregiver support and education; or (iii) Assistance with coping skills.

(c) Routine health monitoring with consultation from a registered nurse that a consulting nurse acting within the scope of practice can provide with or without a physician's order.

Examples include: (i) Obtaining baseline and routine monitoring information on a client's health status, such as vital signs, weight, and dietary needs; (ii) General health education such as providing information about nutrition, illnesses, and preventive care; (iii) Communicating changes in the client's health status to the client's caregiver; (iv) Annual and as needed updating of the client's medical record; (v) Assistance as needed with coordination of health services provided outside of the adult day care program.

(d) General therapeutic activities that an unlicensed person can provide or that a licensed person can provide with or without a physician's order.

These services are planned and provided as an integral part of the client's plan of care and are based on the client's abilities, interests and goals.

Examples include: (i) Recreational activities; (ii) Diversionary activities; (iii) Relaxation therapy; (iv) Cognitive stimulation; (v) Group range of motion or conditioning exercises.

(e) General health education that an unlicensed person can provide or that a licensed person can provide with or without a physician's order, including but not limited to topics such as: (i) Nutrition; (ii) Stress management; (iii) Disease management skills; (iv) Preventive care.

(f) A nutritional meal and snacks provided each four-hour period at regular times comparable to normal meal times, including modified diet if needed and within the scope of the program, as provided under Public Law 106-117 Section 101; (g) Supervision and/or protection for clients who require supervision or protection for their safety; (h) Assistance with arranging transportation to and from the program; and (i) First aid and provisions for obtaining or providing care in an emergency.

Eligibility Requirements

Applicant Eligibility

52.50 Eligible veterans.

A veteran is an eligible veteran under this part if VA determines that the veteran meets the definition of a veteran in 38 U.S.C.

101, is not barred from receiving this VA care under 38 U.S.C.

5303, 5303A, needs adult day health care, and is within one of the following Categories listed below: Public Law 106-117 Section 101, Adult Day Health-Eligibility.

(a) Veterans with service-connected disabilities; (b) Veterans who are former prisoners of war; (c) Veterans who were discharged or released from active military service for a disability incurred or aggravated in the line of duty; (d) Veterans who receive disability compensation under 38 U.S.C.

1151; (e) Veterans whose entitlement to disability compensation is suspended because of the receipt of retired pay; (f) Veterans whose entitlement to disability compensation is suspended pursuant to 38 U.S.C.

1151, but only to the extent that such veterans continuing eligibility for adult day health care is provided for in the judgment or settlement described in 38 U.S.C.

1151; (g) Veterans who VA determines are unable to defray the expenses of necessary care as specified under 38 U.S.C.

1722(a); (h) Veterans of the Mexican Border period or of World War I; (i) Veterans solely seeking care for a disorder associated with exposure to a toxic substance or radiation or for a disorder associated with service in the Southwest Asia theater of operations during the Gulf War, as provided in 38 U.S.C.

1710(e); (j) Veterans who agree to pay to the United States the applicable co-payment determined under 38 U.S.C.

1710(f) and 1710(g), if they seek VA (Department of Veterans Affairs) hospital, nursing home, or outpatient care.

(Authority: 38 U.S.C.

101, 501, 1741, 1743).

Beneficiary Eligibility

A veteran eligible for care in a VA facility needing adult day health care and meeting one of the following conditions: (a) has a service-connected disability for which such care is being provided; (b) has a non-service connected disability and sates under oath his inability to defray the expenses of necessary adult day health care; (c) was discharged or related from active military, naval and air services for a disability incurred or aggravated in the line of duty; or (d) is in receipt of, or but for the receipt of retirement pay would be entitled to receive disability compensation. A veteran must also meet State admission criteria.



Aplication and Award Process

Preapplication Coordination


This program is excluded from coverage under E.O.


Application Procedures

Letter of application from State addressed to the Chief Consultant, Geriatrics and Extended Care (114) Department of Veterans Affairs, 810 Vermont Avenue, N.W. Washington DC 20420.

Award Procedures

Recognition by the Secretary of Veterans Affairs for purposes of VA aid pursuant to Title 38 U.S.C. Section 1741.




Public Law 106-117, Section 101.

Range of Approval/Disapproval Time

From 30 to 60 days.


Not applicable.


Not applicable.

Assistance Considerations

Formula and Matching Requirements

38 U.S.C. 1741. For each veteran provided adult day health care, formula payments to the State are $64.13 per diem, or one-half the cost of care, whichever is less.

Length and Time Phasing of Assistance

There is no length limitation; grant payments are made monthly to the state.

Post Assistance Requirements


Monthly reports and quarterly statements of Federal aid claims are filed by the State with VA field station of jurisdiction.


In accordance with the provisions of OMB Circular No. A-133 (Revised, June 27, 2003). "Audits of States, Local Governments, and Nonprofit Organizations, nonfederal entities that expend financial assistance of $500,000 or more in Federal awards will have a single or a program specific audit conducted for that year. Nonfederal entities that expend less than $400,000 a year in Federal awards are exempt from Federal audit requirement for that year, except as noted in Circular No. A-133."


Cost records on which quarterly statements are based and attendance records to support report for days of care provided to veteran.

Financial Information

Account Identification



(Grants) FY 07 $362,000; FY 08 est $380,000; and FY 09 est $399,000.

Range and Average of Financial Assistance

$22,686 to $165,077; average $93,882.

Regulations, Guidelines, and Literature

VA Manual M-1, Part I, Chapter 3, State Veterans Homes, and M-5, Part VIII.

Information Contacts

Regional or Local Office

See Appendix IV of the Catalog for Veterans Hospital Facilities.

Headquarters Office

Chief Consultant, Geriatrics and Extended Care Service (114), Department of Veterans Affairs, Washington DC 20420. Chief, State Home Per Diem Program. Telephone: (202) 461-6771.

Criteria for Selecting Proposals

Not applicable.

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