Section 51.51 - [Effective 11/29/2024] Eligible veterans-domiciliary care(a) A veteran is an eligible veteran for the purposes of payment of per diem for domiciliary care in a State home under this part if VA determines that the veteran is not barred from receiving care based on his or her service (see 38 U.S.C. 5303 , 5303A ), is not barred from receiving VA pension, compensation or dependency and indemnity compensation based on the character of a discharge from military service (see 38 CFR 3.12 ), and the veteran is: (1) A veteran whose annual income does not exceed the maximum annual rate of pension payable to a veteran in need of regular aid and attendance; or(2) A veteran who VA determines has no adequate means of support. When an applicant's annual income exceeds the rate of pension described in paragraph (a)(1) of this section, VA will determine if the applicant has no adequate means of support. This determination will be made through an assessment of the veteran's deficits in health or functional status that may render the veteran incapable of achieving or sustaining independence in the community as determined by the Chief of Staff of the VA medical center of jurisdiction, or designee. Assessment of whether the veteran has no adequate means of support will be based on objective evidence that considers factors that are inclusive of but not limited to:(i) The impact of the severity of the veteran's medical condition, disabilities, and symptoms on the veteran's safety in the community;(ii) The impact of the severity of the veteran's medical condition, disabilities, and symptoms on the veteran's ability to provide self-care;(iii) The availability of community or family support systems;(iv) The impact of the severity of the veteran's medical condition, disabilities, and symptoms on the veteran's ability to access and utilize community support systems;(v) The risk of loss of housing in the community;(vi) The risk of loss of the veteran's income;(vii) Access to outpatient mental health and substance use disorder care; and(viii) The current effectiveness of any outpatient mental health and substance use disorder care provided to the veteran.(b)(1) For purposes of this section, the eligible veteran must be able to perform the following: (i) Daily ablutions, such as brushing teeth, bathing, combing hair, and body eliminations, without assistance.(ii) Dress himself or herself with a minimum of assistance.(iii) Proceed to and return from the dining hall without aid.(iv) Feed himself or herself.(v) Secure medical attention on an ambulatory basis or by use of a personally propelled wheelchair.(vi) Have voluntary control over body eliminations or have control by use of an appropriate prosthesis.(vii) Make rational and competent decisions as to the veteran's desire to remain in or leave the State home; or, if the veteran lacks the general capacity to make this residential care placement decision, as defined by State law, then the veteran's legal representative designated in accordance with State law, is authorized to make this decision on behalf of the veteran.(2) The Chief of Staff of the VA medical center of jurisdiction, or designee, may waive the requirements in paragraph (b)(1) of this section for purposes of payment of per diem for domiciliary care in a State home on or after January 5, 2021, if the veteran is able to perform not fewer than four of the requirements set forth in such paragraph; or such waiver would be, based on a clinical determination, in the best interest of the veteran because receipt of domiciliary care in the particular State home would likely be beneficial to the veteran. This clinical determination must consider whether receiving domiciliary care in the State home would significantly enhance the veteran's ability to live safely, would support the veteran's potential progress in rehabilitation, if such potential exists, and would create an environment that supports the health and well-being of the veteran. In granting a waiver of paragraph (b)(1) of this section, the Chief of Staff of the VA medical center of jurisdiction, or designee, must make a finding that the State home has the capability to provide the domiciliary care that the veteran needs. 83 FR 61275 , Nov. 28, 2018 83 FR 61275 , 12/28/2018; 89 FR 86249 , 11/29/2024