VA Homemaker and Home Health Aide Program and Veteran-Directed Care

Quick answer: The VA Homemaker and Home Health Aide program pays approved community agencies to send aides who help eligible veterans with bathing, dressing, meals and other daily tasks at home. Veteran Directed Care gives some veterans a budget to hire their own caregivers. Both run through VA health care, based on clinical need, unlike Aid and Attendance, which is a pension payment.

When families research help for an aging veteran, the first program they usually hear about is VA Aid and Attendance, a monthly pension add-on for wartime veterans and surviving spouses who need help with daily activities. It’s valuable, but it isn’t the only way the VA supports care at home, and it isn’t the right fit for everyone.

The VA also runs in-home care programs through its health care system. These programs don’t depend on wartime service or a pension application. Instead, they’re based on the veteran’s enrollment in VA health care and their clinical need. The VA either pays an agency directly for the care, or gives the veteran a budget to direct it themselves.

This guide explains the VA Homemaker and Home Health Aide program, Veteran Directed Care, VA respite and caregiver support programs, and how they compare with Aid and Attendance. For the pension benefit, see our guide to VA Aid and Attendance for home care in California. This article is general information. VA programs and local availability change, so confirm details with your VA social worker.

How are VA health care home programs different from Aid and Attendance?

The key difference is how the benefit works:

VA Aid and Attendance

• A monthly payment added to a VA pension
• Requires wartime service (for the veteran) and meeting income and asset limits
• The family decides how to use the money, including paying a home care agency privately
• Applied for through VA benefits, not VA health care

VA health care in-home programs

• Services authorized by the VA health care team
• Require enrollment in VA health care
• Based on clinical need, not pension eligibility
• The VA pays an agency directly, or provides a budget the veteran manages
• May involve a copay depending on the veteran’s eligibility

Many veterans who don’t qualify for Aid and Attendance may still qualify for in-home care through VA health care. And some veterans use both.

What is the VA Homemaker and Home Health Aide program?

The VA Homemaker and Home Health Aide (H/HHA) program provides personal care and related support at home for veterans who need help with daily living. The VA arranges care through community agencies it has authorized, and pays those agencies directly.

Services can include help with:

• Bathing, grooming and dressing
• Toileting and continence care
• Moving around the home and transfers
• Meal preparation and eating
• Light housekeeping and laundry related to the veteran’s care
• Errands and shopping in some cases

Aides don’t provide skilled nursing. If the veteran needs a nurse or therapist, the VA may arrange skilled home health care separately.

The number of hours is determined by the VA care team based on an assessment of the veteran’s needs. Hours are often limited, such as a few hours several days a week, and may not cover all of the help a veteran needs. Families should treat the VA Homemaker and Home Health Aide program as a foundation and plan for the gaps.

Who qualifies for the VA Homemaker and Home Health Aide program?

Eligibility generally includes:

• Enrollment in VA health care
• A clinical need for the service, as determined by the VA care team, often related to needing help with activities of daily living or being at risk of nursing home placement
• Availability of an authorized agency in the veteran’s area

Veterans with a service-connected disability rating may have different priority and copay rules than other enrolled veterans. Some veterans pay a copay for long-term care services, depending on their eligibility and finances.

To start, ask the veteran’s VA primary care provider or VA social worker for an assessment for home and community-based services. The same assessment can open the door to the VA Homemaker and Home Health Aide program and other services at once.

How does VA community care home care work?

The VA often arranges in-home services through its community care network, which includes outside agencies approved to serve veterans. In VA community care home care:

• The VA care team assesses the veteran and determines eligibility and hours.
• The VA authorizes care with a community agency that serves the veteran’s area.
• The agency provides care according to the VA’s authorization.
• The VA pays the agency directly.

Families usually have limited choice of agency, depending on which agencies are authorized and have availability. If you’d like a specific agency, ask the VA social worker whether it participates. Waits for an agency with open capacity can occur in some areas.

What is Veteran Directed Care?

Veteran Directed Care (VDC) is a VA program that gives eligible veterans a flexible budget to manage their own in-home care. Instead of the VA choosing an agency, the veteran, or a family representative, decides who to hire and when they work.

Key features:

• A monthly budget based on the veteran’s assessed needs
• The veteran can hire caregivers, often including family members or friends
• Support from a local partner organization, often an Area Agency on Aging or Aging and Disability Resource Center, which helps with planning and paperwork
• A financial management service that handles payroll and taxes for caregivers

VDC is a good fit for veterans who want more control, have a family member who can provide care, or live in an area with few authorized agencies. It requires more involvement from the family to manage schedules and hiring. If your parent starts with the VA Homemaker and Home Health Aide program, ask whether switching to VDC later is possible.

VDC availability depends on whether the local VA medical center partners with a community organization to offer it. Ask the VA social worker whether VDC is available in your area.

What VA caregiver support programs help families?

The VA also supports family caregivers directly through its Caregiver Support Program. Two main programs exist:

Program of General Caregiver Support Services (PGCSS)

• Available to caregivers of enrolled veterans of any era who need help at home
• Provides education, training, peer support, coaching and referrals
• Each VA medical center has a Caregiver Support Program team

Program of Comprehensive Assistance for Family Caregivers (PCAFC)

• For family caregivers of eligible veterans with a serious injury or illness related to service, typically with a high service-connected disability rating and a need for personal care
• May include a monthly stipend, health insurance for the caregiver, mental health counseling, travel assistance and respite
• Requires an application and assessment

VA caregiver support can make a real difference for spouses and adult children providing daily care. Ask the Caregiver Support Program team at your local VA medical center which services fit your family.

Does the VA provide respite care?

Yes. The VA offers respite care for eligible veterans so family caregivers can take breaks. Respite may be provided:

• In the home, through an agency
• At an adult day health care center
• In a VA community living center or contracted nursing home

VA respite is often available for up to about 30 days per year, though the exact amount and how it’s used depend on the veteran’s eligibility and local resources.

Our guides to respite care in San Diego and respite care in Orange County cover other respite options families combine with VA benefits.

What other VA programs support veterans at home?

Other VA home and community-based services may include:

• Home Based Primary Care, in which a VA team provides medical care in the home for veterans with complex conditions
• Skilled home health care, for nursing and therapy
• Adult day health care
• Home telehealth, for monitoring chronic conditions
• Hospice and palliative care
• Home Improvements and Structural Alterations (HISA) grants, for accessibility changes like grab bars and ramps

Ask the VA social worker for a full assessment of home and community-based services.

What if VA hours aren’t enough?

VA in-home hours are often limited, and many veterans need more help than the VA provides, especially veterans with dementia, after a hospital stay or who live alone. Families often add private care for:

• Evenings, nights and weekends
• Supervision for veterans with memory loss
• Hospital discharge and recovery periods
• Transportation and appointment escorts
• Companionship

Nona’s personal care includes help with bathing, dressing, toileting and mobility, and our dementia care uses dementia-trained caregivers. Care costs $40 to $50 an hour depending on the level of care, with no deposits or weekly minimums, and 24-hour care is $850 to $1,100 a day. Families who receive Aid and Attendance often use it toward private care. Nona’s also accepts long-term care insurance and can be paid from trusts. For more on combining resources, see our overview of how to pay for home care in California.

For veterans in San Diego County and Orange County, Nona’s can often start care within 24 to 48 hours, sometimes the same day, which helps while a VA assessment or authorization is pending. We begin with a free in-home assessment. Our caregivers are W-2 employees, background-checked and listed on the Home Care Aide Registry, and schedules can change with 24 hours’ notice as VA hours are added or adjusted.

How do you get started with VA in-home care?

• Enroll the veteran in VA health care, if they aren’t already. You can apply online, by phone or at a VA medical center.
• Schedule a visit with the VA primary care provider.
• Ask for a social work referral and an assessment for home and community-based services.
• Ask specifically about the Homemaker and Home Health Aide program, Veteran Directed Care, respite and Caregiver Support.
• Ask about copays before services begin.
• Keep records of authorizations, hours and contact names.
• Consider Aid and Attendance separately if the veteran or surviving spouse may qualify.

In San Diego County, veterans are served by the VA San Diego Healthcare System, and in Orange County by the VA Long Beach Healthcare System and its clinics. Our guides to San Diego County senior resources and Orange County senior resources list other local organizations that help veterans and families.

Frequently asked questions

What is the VA Homemaker and Home Health Aide program?
It’s a VA health care program that provides personal care and related help at home for veterans who need help with daily living. The VA authorizes care through community agencies and pays them directly. Hours are based on the VA care team’s assessment of the veteran’s needs.

Who qualifies for VA in-home care?
Generally, veterans enrolled in VA health care who have a clinical need for help at home, as determined by the VA care team. Unlike Aid and Attendance, it doesn’t require wartime service or a pension application. Copays may apply depending on the veteran’s eligibility and finances.

What is Veteran Directed Care?
Veteran Directed Care gives eligible veterans a flexible budget to hire and manage their own caregivers, often including family members. A local partner organization helps with planning, and a financial management service handles payroll. Availability depends on the local VA medical center.

Can the VA pay a family member to be a caregiver?
Sometimes. Veteran Directed Care can allow veterans to hire family members. The Program of Comprehensive Assistance for Family Caregivers may provide a stipend to family caregivers of eligible veterans with serious service-related conditions. Ask the VA Caregiver Support team about eligibility.

Is VA in-home care the same as Aid and Attendance?
No. Aid and Attendance is a pension payment for wartime veterans and surviving spouses who meet income and asset limits. VA in-home care programs are health care services based on clinical need. Some veterans qualify for both.

What if the VA doesn’t provide enough hours?
Many families add private home care for evenings, nights, weekends or supervision. Veterans receiving Aid and Attendance often use that payment toward private care. Long-term care insurance, trusts and private funds can also help fill gaps.

How long does it take to start the VA Homemaker and Home Health Aide program?
Timing varies. The veteran must be enrolled in VA health care, complete an assessment and be matched with an authorized agency that has availability, and in some areas that can take weeks. Ask the VA social worker for a realistic timeline, and plan for private help in the meantime if your parent needs care now.

VA Homemaker and Home Health Aide program: key points

The VA Homemaker and Home Health Aide program and Veteran Directed Care are VA health care programs that support veterans at home based on clinical need, separate from the Aid and Attendance pension. The VA either pays authorized agencies directly or gives the veteran a budget to hire caregivers. Caregiver support programs and respite help family caregivers. Start with the VA primary care provider and social worker, and plan for private care if VA hours don’t cover everything.

If you’re arranging care for a veteran, Nona’s offers a free consultation at (855) 687-6662.