Via the U.S. Department of Veterans Affairs (VA), relatives, including adult children and even spouses, can be paid to provide care for veterans who are aged, disabled, or have Alzheimer’s disease or another type of dementia. This is done through VA programs that allow for consumer direction, also called self-direction, cash and counseling, or veteran directed services. Via these options, veterans are given a flexible budget (or cash allowance) that allows them to hire their own caregivers, which is especially ideal as a means to pay unpaid family caregivers.
Having said that, there are multiple programs through which one may receive compensation as a caregiver. These programs have different eligibility criteria both for the care recipient and the caregiver who hopes to be compensated.
VA Programs that Pay Veterans’ Caregivers
Veteran Directed Home & Community Based Care
The VA offers Veteran Directed Care (VDC), previously called Veteran Directed Home and Community Based Services (VD-HCBS), for veterans of all ages who are enrolled in the VA’s medical benefits package. Through this consumer directed option, veterans who require skilled services and assistance with daily living activities, such as bathing, grooming, dressing, preparation of meals, and medication management, are given an individualized budget to obtain the assistance they require.
With this flexible monthly budget, veterans are able to choose how they spend it, whether it is purchasing items to aid independence or hiring a caregiver to provide homemaker and personal care assistance. This includes the ability to hire relatives, even spouses, adult children, and grandchildren, to provide the needed care.
The caregiver rate of pay is hourly, which is nationally set by the VA Health Administration, and adjusted at a local level. The veteran works with a financial management service that handles the financial aspects of being an “employer’, such as making payments for care and services. Clearly stated, veterans do not receive cash via this program, but rather they have a budget in which there is flexibility in how they spend it.
Veteran Directed Care, which can be thought of as a nursing home diversion program, is a pilot program and is not currently available in all states. However, with time, this program should be available nationwide. To find out more about this program, click here, or to see if it is available in your area, contact your local VA Medical Center.
Aid & Attendance Pension Benefit
The Aid & Attendance (A&A) pension is a cash benefit for veterans and surviving spouses who require long-term in-home care, assisted living, or nursing home care. Since the focus of this article is on how informal caregivers, such as family members, can get paid to provide care for a veteran, in-home care is relevant.
Through the A&A pension benefit, veterans and surviving spouses are given a monthly cash allowance. Effective 12/1/19 through 11/30/20, a single veteran with no dependents may be entitled to as much as $1,912 / month, a married veteran or a veteran with a dependent may be entitled to as much as $2,266 / month, and a surviving spouse may be entitled to as much as $1,230 / month. These funds can be used as the veteran or surviving spouse sees fit, including using them to pay an adult child, grandchild, or another family member to provide them with in-home care.
When calculating one’s A&A pension benefit amount, some annual unreimbursed (meaning insurance doesn’t cover the cost) medical and long-term care costs can be deducted from one’s income. This allows some veterans and surviving spouses who would otherwise be over the income limit to qualify for the A&A pension. One such allowable deduction is the cost of paying a caregiver, including relatives, such as adult children, grandchildren, and siblings to provide care. Paying a spouse to provide care is not a viable option, as both the veteran and spouse’s income is considered in calculating one’s pension benefit amount.
Please note: The A&A pension is an “add-on” financial benefit to the basic veteran or survivor pension (also called death pension). Stated another way, in order to be eligible for A&A, one must first be eligible for the basic VA pension or the basic survivor pension. In addition to meeting eligibility requirements for a basic pension, one must meet a disability requirement in order to be eligible for the A&A pension. For instance, a veteran or surviving spouse who requires assistance with Activities of Daily Living (ADLs), such as mobility, transferring, eating, and bathing, would meet the disability requirement. In addition, a diagnosis of Alzheimer’s disease generally meets the disability requirement since it is assumed the individual requires a protected living environment. To learn more about eligibility requirements and the application process, click here.
Housebound Pension Benefit
The Housebound pension is a monthly monetary benefit for veterans and surviving spouses who are permanently disabled, and due to the disability, are mostly unable to leave their homes. Like with the A&A pension, financial assistance via the Housebound pension can be used to hire a relative or friend to provide personal care assistance and homemaker services.
Spouses, unfortunately, cannot be paid to provide care, as their income is also considered when calculating a veteran’s pension amount. However, other relatives, such as adult children, nieces and nephews, and grandchildren, can be paid to be caregivers. These caregiver payments can be deducted from an applicant’s countable income when calculating his / her pension amount, effectively increasing one’s monthly cash payment. This, in turn, allows a veteran or surviving spouse to continue to pay a family caregiver to provide in-home care assistance.
For the period of 12/1/19 through 11/30/20, the maximum monthly benefit amount for an unmarried veteran without dependent children is $1,400 / month, for a married veteran or a veteran with a dependent child, the maximum benefit amount is $1,755 / month, and for a surviving spouse with no dependent children, the maximum benefit amount is $939 / month.
Like with the Aid & Attendance pension benefit, the Housebound pension benefit is available as an additional cash benefit to the basic veteran’s pension or the basic survivor’s pension. (If one is not eligible for either of the abovementioned basic pensions, he / she is not eligible for the housebound pension benefit.) For information about other eligibility requirements and the application process for the basic veteran’s / survivor’s pension and the housebound pension, click here.
Program of Comprehensive Assistance for Family Caregivers
While not currently a program for elderly veterans, the Program of Comprehensive Assistance for Family Caregivers (PCAFC) does provide monthly cash benefits to family caregivers of veterans. This program, which may be informally called the Family Caregiver Program, is for veterans who were critically hurt in the line of duty on, or a later date, than September 11, 2001. Veterans must require care assistance with at least one of their activities of daily living and / or require supervision. They must also be enrolled in the VA’s health care program. In addition to the cash benefit, family caregivers can receive education and training, counseling, and as many as 30 days of respite care per year. Although there is no set date, PCAFC will be expanding. It is anticipated that this program will be available to Veterans who sustained a critical injury in the line of duty on, or prior to, May 7, 1975, starting in mid-2020. This program will further expand in 2021 to Veterans who were critically injured in the line of duty between the dates of May 7, 1975 and September 10, 2001. For more information, click here.
Next Steps: Applying & Organizing for Family Compensation
It is highly advised that one seek counsel from a VA planner prior to applying to any of the above programs that allow veterans and surviving spouses to hire relatives as paid caregivers. The application process can be tricky, and supporting documentation is required in addition to the application. Also, VA planners can assist in maximizing one’s A&A or Housebound pension payment by ensuring all eligible medical expenses, such as paying a family caregiver, is deducted from one’s countable income. Said another way, the assistance of a VA planner is the best way to ensure one receives the maximum amount of financial assistance possible. Find a professional VA planner in your area here.