To apply for Respite Care Admission, which includes the Trial Respite Admission, the following documents must be submitted and approved by the Healthcare Center (HCC) Admission Committee before a Veteran may be accepted into the Respite Care Program:
- Acknowledgment of review of Caregiver(s) Information Letter to be completed by Primary Caregiver.
- Acknowledgement of Fiscal and Personal Responsibility for Veteran to be completed by Primary Caregiver.
- Respite Care Program Application to be completed by Primary Caregiver including:
- Application Annex A - Caregiver/Veteran Questionnaire to be completed by Primary Caregiver (This is necessary for the caregivers at HCC to understand the Veteran’s preferences and his/her daily routine).
- Application Annex B - History and Physical to be completed by a primary care physician within ninety (90) days of submission of application.
- Application Annex C - Current Medication List to include all prescriptions and over the counter (OTC) medications. (This is critical information as some medications may not be available through the VA requiring advanced healthcare planning with the Primary Caregiver.)
- 10-10EZ – Application for Health Benefits
- DD214 – Report of the Veteran’s Discharge/Separation from the Armed Forces of the United States
These documents must be received and approved prior to the Trial Respite Admission date. It is the Primary Caregiver’s responsibility to ensure that all information provided is accurate and all documents are submitted in a timely manner. Upon receipt of the above documents the Admission Committee will determine if the HCC is able to provide Respite Care to the Veteran. You may send the completed documents via US Mail or facsimile to the HCC Facility. If you need assistance or have questions, please call 860-616-3733.
The Primary Caregiver MUST accompany Veteran throughout the Trial and Respite Care Program admission process unless specific permission has been given by the HCC Admission Coordinator to waive this requirement. The Primary Caregiver must be present until the Veteran is admitted into the Trial and Respite Care Program at which time the nurse will inform the caregiver that he/she may leave.
With the Respite Care Application, you must provide copies of:
If the Veteran has or is subject to a Power of Attorney, Conservatorship or Advance Directives, such as a Health Care Proxy and/or Living Will, copies of all such documents/orders must be provided to the HCC after approval of admission but at least five (5) days prior to the date of admission to be included in the Veteran’s record.
The Veteran will be discharged from the Respite Care Program within the length of time specified by the Primary Caregiver which shall not exceed twenty-eight (28) days in any one year period. If the Primary Caregiver is unable or unwilling to resume the Primary Caregiver role for the Veteran a written plan of care for the Veteran must be presented at the time of admission. Pursuant to State of Connecticut Department of Veteran Affairs (DVA) Regulations this plan should be “other than long-term admission to a departmental service, activity, or program.” It is imperative that the Veteran is dropped off and picked up no later than 10:00 A.M on the confirmed dates of admission and discharge. Please follow this rule as it provides the staff time to prepare for the next admission. If an unanticipated situation prevents pick-up or drop-off by 10:00 A.M., please notify the HCC Admission Coordinator or nurse station immediately.
In the event the Veteran’s stay in Respite Care Admissions exceeds the twenty-eight (28) day limit set by Connecticut Regulations of State Agencies Section 27-102l(d)-108(c)(3)(B) then charges will be assessed beginning on the 29th day of stay.
You may contact the Billing Office at 860-616-3646 or 860-616-3644 for current daily rate charges. If the unforeseen exceptional circumstance should result in the Respite Care becoming a regular long-term placement then compliance with all applicable state statutes governing DVA with respect to Medicaid Title XIX will be followed and enforced.