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Inequities in access to VA'S aid and attendance enhanced pension benefit to help Veterans pay for long-term care.

Thomas KS, Corneau E, H Van Houtven C, Cornell P, Aron D, M Dosa D, M Allen S. Inequities in access to VA'S aid and attendance enhanced pension benefit to help Veterans pay for long-term care. Health services research. 2021 Jun 1; 56(3):389-399.

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OBJECTIVE: To examine characteristics that are associated with receipt of Aid and Attendance (AandA), an enhanced pension benefit for Veterans who qualify on the basis of needing daily assistance, among Veterans who receive pensions. DATA SOURCES: Secondary data analysis of 2016-2017 national VA administrative data linked with Medicare claims. STUDY DESIGN: Observational study examining sociodemographic, medical, and healthcare utilization characteristics associated with receipt of AandA among Veterans receiving pension. PRINCIPAL FINDINGS: In 2017, 9.7% of Veterans with pension newly received the AandA benefit. The probability of receiving AandA among black and Hispanic pensioners was 4.6 percentage points lower than for white pensioners (95%CI  =  -0.051, -0.042). Married Veterans receiving pension had a 4.4-percentage point higher probability of receiving AandA (95%CI  =  0.039, 0.048). Most indicators of need for assistance (eg, home health utilization, dementia, stroke) were associated with significantly higher probabilities of receiving AandA, with notable exceptions: pensioners with a diagnosis of Post-Traumatic Stress Disorder (marginal effect  =  -0.029 95%CI  =  -0.037, -0.021) or enrolled in Medicaid (marginal effect  =  -0.053, 95%CI  =  -0.057, -0.050) had lower probabilities of receiving AandA. Unadjusted and adjusted rates of receiving AandA among Veterans receiving pension varied by VA medical center. CONCLUSIONS: This study identified potential inequities in receipt of the AandA enhanced pension among a sample of Veterans receiving pension. Increased Veteran outreach, provider education, and VA office coordination can potentially reduce inequities in access to this benefit.

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