How Veterans Can Use Aid and Attendance to Pay for In-Home Care

In-home care can be a cost-effective alternative to moving to a nursing home or assisted living community. But in-home care carries a price tag of its own. The national average for homemaker and home health aide services is $20 per hour, according to the 2015 Genworth Cost of Care national survey. For some military veterans and their widowed spouses, extra pension benefits can help defray the cost of in-home care. Here are common questions and answers about those programs.

What are Aid & Attendance and Housebound benefits?

Aid & Attendance (A&A) and Housebound benefits offer funds for qualified seniors who need daily help, either at home or in a nursing facility.

Housebound benefits are paid to veterans and survivors with permanent disabilities that mean they are “substantially confined to their immediate premises.”

Aid & Attendance benefits are payable to veterans and surviving spouses who meet at least one of these four qualifying conditions:

• need help with activities of daily living such as bathing, dressing, grooming, and eating;
• are nearly or completely blind (defined as eyesight of 5/200 or less in both eyes even with corrective lenses, or a visual field of 5 degrees or less);
• have a physical or mental condition for which they’re cared for in a nursing facility; or
• must remain in bed except for doctor-recommended therapies and treatments.

The VA specifies that pension recipients may receive either A&A benefits or Housebound benefits, but not both at the same time.

Who is eligible for Aid & Attendance or Housebound allowances?

To receive the Aid & Attendance or Housebound benefits, you must be a veteran or surviving spouse of a veteran who is eligible for the VA pension program. The program is for low-income veterans and surviving spouses, and there are income limits you must meet in order to qualify. Benefits are based on the difference between yearly income and the upper income cutoff limit, called the Maximum Annual Pension Rate.

For example, according to the December 2014 Veterans Pension table, a single veteran with no dependents is pension-eligible if he or she has a yearly income of less than $12,686. If that vet has an annual income of $5,000 and no deductible expenses, he or she could be eligible to receive $7,686 per year, or $640 per month. That money could go toward housekeeping help, home health aide services, and other necessary care.

If your current income is too high to qualify for the regular VA pension, you still may be eligible for a pension with Aid and Attendance or Housebound benefits because those programs raise the total income cutoff point.

For example, if the single veteran without dependents mentioned above becomes housebound, the annual income limit for eligibility rises to $15,725. If the veteran instead qualifies for Aid & Assistance, the annual income cutoff rises to $21,466.  And the VA considers other factors, too, including the annual amount of out-of-pocket medical expenses and the applicant’s net worth.

You can read over the entire pension application, which includes A&A and Housebound sections, here. Other scenarios, such as veterans with dependents and veterans who are married to each other, are also spelled out in the table. Use this eligibility calculator to find out if you may be eligible for A&A.

What will you need to apply for benefits?

To apply for A&A and Housebound, get in touch with the nearest regional Veterans Administration office or the one where you applied for your pension benefit. The office will need written evidence to support your application. The best option for that is a written report from your regular doctor that describes your health, mobility, and ability to perform daily tasks. The letter should also describe where you spend your days, what activities you can do, and whether you are able to leave your home regularly.

California Advocates for Nursing Home Reform (CANHR) also recommends saving at least a year’s’ worth of your out-of-pocket medical receipts. Those expenses can reduce your countable income and may help you gain eligibility.

How long does the application process take?

The VA says most of its claims are processed within 6 months. That’s a long time, but if you’re approved, benefits start from the date you applied, meaning you will receive some retroactive payments. Current average processing times for each regional VA office are available on the VA’s ASPIRE dashboard.

Applying for Aid and Assistance or Housebound VA pension benefits takes time and careful record-keeping. But the process pays off for many low-income veterans and surviving spouses by making it possible to pay for the in-home care they need to age in place.

Casey Kelly-Barton

Casey Kelly-Barton is an Austin-based freelance writer whose childhood was made awesome by her grandmothers, great-grandmother, great-aunts and -uncles, and their friends.