VA Form 10-3567c: State Home Inspection – Domiciliary Care – VA Form 10-3567c is a critical document used by the U.S. Department of Veterans Affairs (VA) to inspect and ensure quality standards in State Veterans Homes providing domiciliary care. This article provides veterans, families, and State Home administrators with up-to-date information on the form, its purpose, standards, and the inspection process.
What Is VA Form 10-3567c?
VA Form 10-3567c, titled “State Home Inspection Standards – Domiciliary Care,” is an official VA checklist and inspection tool. It helps VA surveyors evaluate whether State Veterans Homes meet federal standards for domiciliary care programs. The form covers key areas such as resident rights, quality of life, care delivery, staffing, safety, and administration.
Download the official VA Form 10-3567c here: Download VA Form 10-3567c PDF
Purpose of State Home Inspections for Domiciliary Care
State Veterans Homes (SVHs) are owned and operated by individual states but receive VA per diem payments for caring for eligible veterans. Annual inspections using tools like VA Form 10-3567c ensure compliance with 38 CFR Part 51 standards, maintaining high-quality care and justifying federal funding.
Understanding Domiciliary Care in VA State Homes
Domiciliary care provides a home-like environment with shelter, food, and necessary medical services for veterans who do not need full nursing home care but require assistance due to chronic conditions or lack of adequate means of support. It focuses on veterans who can perform most activities of daily living but need support to live independently.
Key Standards Covered in VA Form 10-3567c
The form evaluates compliance across multiple domains required under Subpart E of 38 CFR Part 51:
- Resident rights and behavior
- Quality of life and dignity
- Admission, assessment, care planning, and discharge
- Quality of care and nursing services
- Physician and medical practitioner services
- Specialized services and environmental requirements
- Administration and record-keeping
- Physical environment, safety, and infection control
Inspectors mark standards as substantially met (S), partially met (P), or not met, with detailed notes.
VA Inspection Process for State Veterans Homes
VA conducts annual unannounced surveys (typically every 12 months or within 270-450 days) for recognition and continued certification. These comprehensive reviews include clinical care, life safety, facility conditions, staffing profiles (often using related Form 10-3567), and financial audits.
Homes must meet or exceed standards to continue receiving per diem payments for eligible veterans.
Eligibility for Domiciliary Care in State Homes
Veterans must generally meet criteria such as having no adequate means of support or specific income thresholds, along with functional abilities. Recent updates allow waivers in certain cases if in the veteran’s best interest. State Homes submit VA Form 10-10SH for individual veteran approvals.
Benefits of VA-Certified State Veterans Homes
Certified homes provide cost-effective, high-quality residential care. As of June 2026, there are 47 domiciliary programs within the network of 177 State Veterans Homes serving veterans nationwide.
How to Find a VA State Veterans Home
Use the National Association of State Veterans Homes directory to locate facilities near you. Contact your state veterans affairs office or local VA medical center for admission details.
Related VA Forms and Resources
Frequently Asked Questions (FAQs)
What does VA Form 10-3567c inspect?
It inspects domiciliary care standards including resident care, safety, rights, and facility operations.
Who completes VA Form 10-3567c?
VA surveyors complete it during annual inspections of State Veterans Homes.
Are inspections announced?
Most annual surveys are unannounced to ensure real-world compliance.
Conclusion
VA Form 10-3567c plays a vital role in upholding quality domiciliary care for America’s veterans in State Homes. Understanding this form and the standards helps veterans and families make informed choices about long-term care options. For the latest information, always refer to official VA sources.
Official Download: VA Form 10-3567c PDF