Introduction: In many cases the
cost of in-home care can be deducted from income in order to qualify
for the
Veterans Aid & Attendance Non Service Connected Pension.
There is a special rule, however, for the spouse of a living
veteran. For the cost of in-home care to be deductible for the
spouse of a living veteran, the caregiver must be a “licensed health
professional.”
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Who
is a licensed health professional in California? The answer
to that question is troublesome because California (as does every
state) uses different verbiage from the VA (a Federal agency). In
California, there are several categories of persons who receive
their credentials from agencies of the California government. Two
are somewhat troublesome to define for purposes of the VA rules,
those being certified nursing assistant (CNA) and home health aid (HHA)
. [Back to Top of
Article]
Wikipedia: The CNA and HHA are
certified, not licensed. According to Wikipedia they fall within the
definition of “unlicensed assistive personnel....This is an umbrella
term to describe a job class of paraprofessionals who assist
individuals with physical disabilities, mental impairments, and
other health care needs with their activities of daily living (ADLs)
and provide bedside care — including basic nursing procedures — all
under the supervision of a Registered Nurse, Licensed Practical
Nurse or other health care professional.”
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Statutes: Although, in California,
certification for the CNA and HHA comes from the Department of
Public Health, there appears to be no statute that prevents an
individual from working in-home without a certification. All Federal
and California statutes only seem to apply to requiring a
certification to work in a Medicare or Medi-Cal certified facility.
42 U.S.C. §§ 1395i-3(b)(5)(A)(i)(I), 1396r(b)(5)(A)(i)(I); 42 C.F.R.
§ 483.75(e)(2)(ii)(A); Calif. W & I Code 10751. Licensing does not
appear to be required to perform these job duties if the work is in-home.[Back
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California Community
Colleges: The California Community College website provides
a job description for a CNA. Amongst other things, it states that a
CNA reports to the “professional nursing staff.” The suggestion here
would be that a CNA is not a “professional” level job. Further,
Federal law defines who is a Licensed Health Professional for
purposes of Medicare and Medi-Caid certified facilities at 42 C.F.R.
§ 483.75(e)(2)(ii)(A). CNA and HHA are conspicuously absent from the
list.[Back to Top of
Article]
Recommendation: Although the
answer may not be perfectly definitive, it seems reasonably certain
that neither a CNA or a HHA are licensed health professionals within
the meaning of the VA regulation. Therefore, I would suggest that if
a spouse of a living veteran wants to deduct the cost of in-home
care in order to qualify for the VA Aid & Attendance Non Service
Connected Pension, that person use a licensed healthcare
professional and not a CNA or HHA. Obviously, the greater cost in
hiring an LVN, for example, would have to be weighed against the
amount of the projected VA benefit.
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Keywords: Veterans Aid & Attendance Non Service
Connection Pension, Licensed Health Professional, Licensed
Healthcare Professional, Certified Nurse Assistant, Certified
Nursing Assistant, Home Health Aid, In-Home Care
