Guide to Long Term Care Planning

Resources for Senior Veterans and their Survivors

REQUEST HELP

Find information to help you receive additional income through the Pension with Aid and Attendance Program from VA to pay for home care, assisted living, or nursing care.

VETERANS ADVOCATES

An individual who advocates for veterans can help you understand long term care benefits available through the Dept. of VA.
Locate a nearby Advocate

SERVICES FOR VETERANS

Click here for national lists of Veterans Advocates, VA Medical Centers, VA Nursing Homes, VA Cemeteries, and VA State and County Service Officers.

Veterans’ Long-Term Care Benefits Guide

Clear options, eligibility checklists, and next steps for veterans and surviving spouses seeking care at home or in a facility.

Who This Is For

  • Older veterans and spouses who need help with daily activities or medical care
  • Family caregivers comparing VA benefits, State Veterans Homes, and community care
  • Surviving spouses seeking pension or Aid and Attendance

What You Can Do Here

  • Check your eligibility for VA long-term care programs
  • Understand costs, copays, and what benefits cover
  • Learn how to apply (step-by-step) with or without a VSO (Veterans Service Organization)
  • Explore State Veterans Homes and waitlist realities
  • See if Aid and Attendance or HISA can help pay for care or home modifications

Quick Eligibility Snapshot

  • You may qualify for one or more of these:
    • VA Health Care Long-Term Care Services: Enrolled veterans; priority and services depend on clinical need, service connection, income, and resources.
    • State Veterans Homes: State-run facilities for eligible veterans; some also admit spouses/surviving spouses and Gold Star parents (bed caps apply).
    • Pension with Aid and Attendance (A&A): Wartime service (active duty with wartime period), limited income/assets, and a medical need for daily help.
    • HISA Grant (Home Improvements and Structural Alterations): Grants to modify your home for disability-related needs; amounts vary by eligibility.

Types of Long-Term Care VA Supports

Non-Institutional (receive care at home or in the community)

  • Home-Based Primary Care: Ongoing medical care at home from a VA team for complex, chronic needs.
  • Homemaker/Home Health Aide (H/HHA): Help with bathing, dressing, meals, and safety in the home.
  • Adult Day Health Care: Daytime health, supervision, and social support in a center.
  • Respite Care: Short-term relief for caregivers at home or in a facility.
  • Home Hospice: Comfort-focused care for serious illness at home.
  • Community Residential Care: Room, board, and supervision if you don’t need nursing home care.
  • Telehealth: Remote monitoring and support for chronic conditions.

Institutional (receive care in a facility)

  • Community Living Centers (VA nursing home units)
  • Contract Community Nursing Homes (local, VA-approved)
  • State Veterans Homes (nursing care; some also offer assisted living/domiciliary, memory care, or adult day health)

State Veterans Homes: What to Know

  • Services: Primarily nursing home care; some offer assisted living/domiciliary and memory care. A few provide adult day health services.
  • Costs: Not fully free; residents typically pay a share based on income. Policies vary by state.
  • Who Can Live There: Rules vary (service era, active duty vs. reserves, income/medical need). Some accept spouses, surviving spouses, or Gold Star parents. Federal rules generally cap non-veteran family admissions to 25% of beds.
  • Residency: Some states require recent state residency (e.g., 90 days to 3 years).
  • Applications and Waitlists: Expect an application, review, and possible waitlist—especially for memory care units. Apply early and consider multiple facilities in your state.
  • Operations: Run by state agencies; some contract with third-party administrators.

Understanding Veterans Health Care and Costs

  • VA Health Care System: Offers hospital, outpatient, pharmacy, prosthetics, mental health, women’s health, rehabilitation, and specialized programs (e.g., limb loss, burns).
  • Access: Primary care often local (community clinics); specialized care may be at regional medical centers. Travel and temporary lodging assistance may be available for eligible veterans.
  • Copays: Based on priority group, income, and service connection. Many low-income veterans (Priority Group 5) pay no copays for care; prescription caps and exemptions may apply. Check current VA copay rules and income thresholds, which change periodically.

Pension, Aid and Attendance (A&A), and Compensation

  • VA Compensation: Monthly tax-free benefit for service-connected disabilities. No asset test. Ratings can be increased if conditions worsen.
  • VA Pension with A&A: For wartime veterans with limited income/assets and a medical need for daily assistance. A&A increases the pension amount. Surviving spouses may also qualify for a death pension with A&A.
  • Key Differences:
    • Compensation is for service-connected disability.
    • Pension is income-based for non-service-connected disability/need (with A&A for higher need).
  • Family Caregivers and Assisted Living Costs:
    • If A&A (or Housebound) is granted, VA allows costs paid to family caregivers and assisted living (including room and board when care is needed) as unreimbursed medical expenses for pension eligibility calculations.
    • VA pays the veteran/spouse, not the provider.

HISA Grants (Home Improvements and Structural Alterations)

  • What It Covers: Permanent home changes needed for disability (e.g., ramps, roll-in showers, widened doors).
  • Who May Qualify: Veterans enrolled in VA health care; amounts vary based on service connection and certain need-based categories.
  • Tip: Work with your VA clinical team for documentation and with the local VA medical center’s HISA committee.

How to Apply: Fast-Track Steps

  • For VA Health Care Long-Term Care Services
    1. Enroll in VA Health Care (if not already): Apply online at VA.gov or by phone/mail/in person.
    2. Get a clinical evaluation: Discuss daily needs, safety, and caregiver capacity.
    3. Explore options: Ask about H/HHA, Adult Day Health Care, Respite, Community Living Centers, and contract nursing homes.
    4. Request referrals and authorizations as needed.
  • For State Veterans Homes
    1. Identify facilities in your state.
    2. Review eligibility (service, residency, income/need).
    3. Gather documents: DD214, medical records, income/assets summary, marriage/death certificates if applicable.
    4. Submit the application early; ask about waitlists and memory care units.
  • For Pension with Aid and Attendance (Veterans or Surviving Spouses)
    1. Confirm wartime service and financial/medical eligibility.
    2. Gather documents:
      • DD214/discharge papers
      • Marriage/death certificates as applicable
      • Income, assets, and recurring medical expenses (caregiver/assisted living agreements, invoices)
      • Physician statement describing assistance needed with daily activities
    3. File the claim:
      • Use VA forms online at VA.gov or
      • Work with a free Veterans Service Organization (VFW, American Legion, DAV, state VA).
    4. Track your claim; respond quickly to VA requests.
    5. If approved, payments begin the month after the effective date; retroactive amounts may apply.
  • For HISA Grants
    1. Discuss needs with your VA provider; obtain clinical justification.
    2. Get itemized estimates for modifications.
    3. Submit HISA application to your VA medical center for committee review.

Frequently Asked Questions

Can I pay a fee to have someone file my VA claim?
Federal law strictly limits fees for filing claims. Free help is available from VSOs. Paying for pre-filing advice may be permissible, but paying for the act of filing is restricted. When in doubt, use a VSO.
Can family caregivers be paid?
VA pays you, not the caregiver. With A&A/Housebound, you can count caregiver costs (including family caregivers) as medical expenses for pension calculations if properly documented.
Does VA cover emergency care outside the VA?
Sometimes—under specific conditions (e.g., service-connected emergencies or when VA care wasn’t feasibly available). Always notify VA as soon as possible and confirm eligibility.
Will Medicaid affect VA pension?
If a single veteran on Medicaid resides in a nursing home, the VA pension may be reduced to a small personal allowance. Rules vary; coordinate with your state Medicaid office and VA.
What if the applicant is unable to sign?
A guardian, VSO, or authorized representative can assist. VA may appoint a fiduciary if needed.