VA benefits for home care in Pennsylvania: Aid and Attendance and other help for veterans

Can the VA help pay for home care?

Often, yes. Many veterans and surviving spouses in Pennsylvania use VA benefits to help pay for in-home care, and many families never hear about them until someone mentions it at a church supper or a VFW post.

Two different parts of the VA can help, and they work in different ways.

• A pension increase. The VA's benefits side pays the Veterans Pension and the Survivors Pension. Either can be increased by Aid and Attendance or Housebound. That money goes to the veteran or surviving spouse each month, and the family decides how to use it, including paying a licensed home care agency.
• In-home help through VA health care. If the veteran is enrolled in VA health care, the VA may arrange and pay for in-home help itself, through Homemaker and Home Health Aide care or Veteran-Directed Care, once a VA clinician confirms the need.

What is Aid and Attendance?

Aid and Attendance is an extra monthly amount added to a VA pension for a veteran or surviving spouse who needs regular help from another person. According to the VA, your parent may qualify if they receive a VA pension and at least one of these is true:

• They need another person to help with daily activities like bathing, eating and dressing.
• They have to stay in bed, or spend a large part of the day in bed, because of illness.
• They live in a nursing home because of a loss of mental or physical abilities related to a disability.
• Their eyesight is very limited, as the VA defines it.

The first one is the one most families meet. If your father needs help getting in and out of the shower, getting dressed or using the toilet, or if dementia means he should not be left alone, those are the things the doctor will write down.

The help can come from a family member, a private caregiver or an agency. Care does not have to be in place already, but a claim is stronger when the need is clearly written down.

What is the Housebound benefit?

Housebound is a separate, smaller increase for a veteran or survivor who gets a VA pension and spends most of their time at home because of a permanent disability. Your parent cannot receive Aid and Attendance and Housebound at the same time. If needs grow, ask your Veterans Service Officer about switching to an Aid and Attendance claim.

Who qualifies for the VA pension in the first place?

Aid and Attendance sits on top of a VA pension, so your parent has to qualify for the pension first. The pension is for wartime veterans with limited income and savings. In general, a veteran qualifies when:

• They were not dishonorably discharged.
• They served during a wartime period. For most older veterans that means at least 90 days of active duty with at least one day during a wartime period. Veterans who enlisted after September 7, 1980, generally need 24 months of service or their full call-up period. Wartime periods include World War II, Korea, the Vietnam era and the Gulf War era.
• They are 65 or older, or have a permanent and total disability, or live in a nursing home because of a disability, or receive Social Security Disability Insurance or Supplemental Security Income.
• Their yearly income and net worth are under limits that change each year. Net worth includes a spouse's assets, but not the home, the car or most household belongings.

Here is something many families do not know: the VA subtracts unreimbursed medical expenses, which can include paying for in-home care, when it figures out income. So a parent whose income looks too high on paper may still qualify once care expenses are counted.

Because the limits and benefit amounts change every year, check the VA's current pension benefit amounts rather than numbers from a seminar or ad. A Veterans Service Officer can run the numbers with you.

Can a veteran's widow get Aid and Attendance?

Yes. A surviving spouse who qualifies for the VA Survivors Pension can also receive Aid and Attendance or Housebound if she meets the same needs. Her own income and savings are what count.

The Survivors Pension has a few rules of its own. The veteran's service must meet the wartime requirements, and the surviving spouse generally must have lived with the veteran until he died (some separations are allowed) and not remarried. If your mom was married to a wartime veteran when he passed, it is well worth asking.

How do you apply for Aid and Attendance?

It takes some paperwork, but you do not have to do it alone. Here is the general path.

1. Gather papers. The veteran's discharge papers (the DD-214), marriage and death certificates for a widow's claim, Social Security numbers, a list of income and savings, and records of ongoing medical and care expenses.
2. Get the doctor's part done. The VA has an exam form (VA Form 21-2680) with a section the doctor fills out describing what help is needed. A short letter from the doctor about which daily activities need help is also useful.
3. File the pension claim. Veterans use VA Form 21P-527EZ. Surviving spouses use VA Form 21P-534EZ. Both can be filed online at va.gov or on paper.
4. Send it in. Online through va.gov, by mail to the VA's Pension Intake Center, or in person at a VA regional office. The Philadelphia and Pittsburgh regional offices serve Pennsylvania.
5. Wait and respond. The VA works through claims in order and may ask for more information. Keep copies of everything.

Who can help with a VA claim for free?

Every Pennsylvania county has a Director of Veterans Affairs, usually at the county courthouse or county office building. These directors are accredited and do not charge veterans or their families. Accredited Veterans Service Officers with groups such as the American Legion, the VFW and DAV help at no charge too. The Pennsylvania Department of Military and Veterans Affairs keeps a list of county directors.

Be careful with anyone who wants to be paid to prepare a first pension claim, or who suggests moving money around to "qualify." The VA allows accredited attorneys and claims agents to be paid only for certain work after a first decision, and moving assets can lead to penalties. Your county director is the safest first call.

What in-home help does VA health care offer?

If your parent is enrolled in VA health care, the VA itself may arrange help at home. Two programs matter most for families.

• Homemaker and Home Health Aide care. A trained aide helps with eating, dressing, grooming, bathing, toileting, getting around and grocery shopping. The aides work for an organization with a VA contract, under a nurse's supervision. A copay may apply depending on the veteran's disability status, and availability varies by area.
• Veteran-Directed Care. The veteran gets a flexible budget and, with a counselor's help, hires helpers, who can include a family member or neighbor. It is offered in some areas, not all.

Both start with the veteran's VA social worker. Many veterans in central Pennsylvania get care through the Lebanon VA Medical Center at 1700 South Lincoln Avenue in Lebanon. Others use a community clinic or a different VA medical center depending on where they live. Ask the primary care team for a social work referral, and say plainly that your parent needs help with bathing, dressing or supervision at home.

How can It's Your Home Care help a veteran's family?

With a pension increase, the money goes to your parent, and your family chooses who provides care. It's Your Home Care accepts VA benefits. We provide a written care plan and itemized invoices, which are also the kind of records the VA asks for when it counts care expenses.

With Homemaker and Home Health Aide care, the VA pays its contracted organization directly, so ask the social worker which organizations serve your parent's address.

VA claims take time. Many families start care privately for the hours that cannot wait, then adjust once the VA decides. Our page on home care for veterans and surviving spouses describes the care itself. Our guide to paying for home care in Pennsylvania shows how VA benefits can work together with long-term care insurance, the OPTIONS program and Medicaid programs.

What can you do this week?

A few small steps can get things moving.

1. Find the DD-214 or other discharge papers.
2. Call your county Director of Veterans Affairs and ask for an appointment about a pension with Aid and Attendance.
3. If your parent uses VA health care, ask the primary care team for a social work referral about help at home.
4. Ask the doctor to fill out the exam section of the VA form.
5. If help at home is needed now, call us at (717) 695-2704 or request a consultation. We can talk through what care might look like while the claim is in process, and explain how VA benefits work with our care.