VA’s Aid & Attendance and Housebound Pensions and Their Benefits for Veterans with Dementia

For veterans and their surviving spouses, VA pensions can help with the high costs of long-term dementia care. That means that veterans who have Alzheimer’s disease or dementia can afford the help they need as the disease progresses. They lose the ability to live independently in their own homes or assisted living communities and require more support and medical care.

There are multiple types of VA pensions through the U.S. Department of Veterans Affairs. They provide additional cash assistance to low-income veterans, helping pay for in-home care, adult day care, assisted living, memory care (also called Alzheimer’s care), and nursing homes. Detailed below are the physical and financial eligibility requirements, as well as how to apply.

Types of VA Pensions

Veterans’ pensions are tax-free cash benefits that supplement the monthly income of low-income elderly or disabled Veterans and their surviving spouses. Keep in mind that to be eligible for the Aid & Attendance or Housebound pension, one must first be eligible for the Basic Pension. The three types of pensions are:

Basic Pension – This benefit is also known as a death pension. It is for veterans and surviving spouses that are aged or disabled. The disability does not need to be related to their military service.

Aid & Attendance – Abbreviated as A&A, this is an important benefit for veterans and their surviving spouses who need help with activities of daily living like bathing, dressing, eating, mobility, and toiletry. A&A is particularly relevant for patients with dementia, especially those in the middle and later stages of the disease when this type of assistance becomes necessary. A&A is a unique monthly pension intended to help with the long-term care costs of adult day care, in-home care, assisted living, memory care, and skilled nursing. Based on an individual’s stage of dementia and the progression of the disease, most of these types of care may be needed at one point or another.

Housebound – For veterans and surviving spouses who are permanently disabled and unable to leave their homes and need extra assistance. The definition of home can include assisted living, memory care, and nursing home. The Housebound pension, like the A&A pension, is meant to help cover the costs of long-term care.

VA Pension Eligibility Requirements

For a veteran, or surviving spouse with dementia, to be eligible for any VA pension the following must be met:

General Requirements

These are the four basic rules one must follow to receive a VA pension:

1) The Veteran must have served at least one day during a period of wartime, as well as have served a minimum of 90 days active duty. Below are the eligible periods of war.
• World War II: December 7, 1941 – December 31, 1946
• Korean War: June 27, 1950 – January 31, 1955
• Vietnam War: February 28, 1961 – May 7, 1975 for those serving in Vietnam. Otherwise, effective dates are August 5, 1964 – May 7, 1975
• Gulf War: August 2, 1990 – a currently undetermined date

2) The Veteran must not have been dishonorably discharged.

3) If the surviving spouse is applying for a pension, he/she must have been living in the same household as the Veteran at the time of his / her death. In addition, the surviving spouse must be single when he/she files a pension claim.

4) The Veteran or surviving spouse must be a minimum of 65 years old OR under 65 years old and officially disabled OR reside in a nursing home OR receive Social Security Disability Insurance OR receive Supplemental Security Income.

Medical Eligibility Requirements

There are no medical requirements to be eligible for the basic pension. There are medical requirements that must be met to receive the additional benefits from Aid & Attendance or Housebound. The necessity for care must be backed up by a physician’s statement. Additionally, the following must be completed:

Aid & Attendance – One of the following requirements must be met (in addition to the general requirements listed above):
• Require assistance from another person to complete daily living activities (taking a bath, dressing, and undressing, transitioning from bed to a chair, using the toilet and cleaning up after oneself, getting from one room to another, etc.). Generally, the Veteran or surviving spouse must require assistance with a minimum of two daily living activities. For people with dementia, it is also taken into consideration that for a safe and protected living environment, extra support and care are needed.
• Are bedridden
• Be a nursing home resident due to a loss of mental or physical functioning. This could be a result of the progression of Alzheimer’s disease or dementia.
• Be legally blind. By VA standards, this means corrected vision of 5/200 or less in both eyes or concentric contraction of the visual field equal to 5 degrees or less.

Housebound – Veterans and surviving spouses suffering from Alzheimer’s disease or dementia must spend the majority of their time in their homes. The definition of a home also extends to assisted living facilities, Alzheimer’s memory units, or nursing homes. The inability to leave their home combined with the need for care must stem from a permanent non-service-related disability. For example, a lack of motor skills due to Parkinson’s disease dementia would be considered a functional cause for the Housebound pension. In addition to a physical disability, it could be a mental disability, such as anxiety or depression. This is commonly seen in patients with dementia and is a reason why a Veteran or surviving spouse has difficulty leaving their home.

Financial Requirements

Income Limits

For veterans and their surviving spouses with dementia to receive a VA pension, their income must be under the maximum annual pension rate. In other words, their household income must be less than the benefit amount set forth by the VA. Essentially, a veteran or surviving spouse’s benefit amount is their countable income minus the maximum annual pension rate. The following maximum annual pension rates will be in effect from December 1st, 2022– November 30th, 2023.

While one’s income must be under the pension benefit rate, the VA does allow veterans and their surviving spouses to deduct unreimbursed medical expenses greater than 5% from their maximum annual pension rate. Examples of expenses that may be deducted from one’s countable income include:

– regularly purchased care supplies, such as diapers for incontinence

– recurring costs, like Medicare premiums

– personal emergency response system subscriptions

– long-term care (in-home care, assisted living costs including room and board, and adult day care)

For patients with Alzheimer’s disease or dementia who require substantial care, deducting these expenses can significantly lower their countable income. This may allow for income-based qualification for the Aid & Attendance or Housebound pensions.

Net Worth Limit

The VA also has a net worth limit, which became effective 10/18/18, and combines a veteran or surviving spouse’s annual income and assets. In 2023 this amount is set at $150,538, but before 10/18/18 there was no set net worth limit nor set asset limit.

Some assets are not counted towards the net worth limit, including the veteran or surviving spouse’s primary home and the land the home sits on (up to 2 marketable acres), household furnishings and appliances, personal items, and a vehicle.

As an example of how net worth is calculated, say a Veteran or surviving spouse has $80,000 in non-exempt assets and $22,000 in countable annual income. His or her net worth is equivalent to $102,000 ($80,000 + $22,000 = $102,000), and he or she is net worth eligible because the total is less than $138,489.

Another rule, implemented as of 10/18/18, is a look-back rule. This is 36 months in which the VA looks back to make sure that the Veteran or surviving spouse has not given away assets or sold them for less than they are worth to become net worth eligible. Violating the look-back rules results in a period of pension ineligibility of up to 5 years. If assets were gifted or sold for less than they are worth before 10/18/18, it does not violate the look-back rule.

Pension Benefit Amounts

The maximum annual pension rates, effective December 1st, 2022–November 30th, 2023 are as follows:

Remember, a veteran or surviving spouse’s benefit amount is their countable income minus the maximum annual pension rate.

Pension benefit amounts can be used however a veteran or surviving spouse sees fit. For patients with dementia, the monthly cash allowance might go towards in-home personal care assistance and supervision, adult day care, assisted living, memory care, nursing home care, or other long-term care costs. And unlike benefits received through Medicaid, VA pensions can be used to pay for room and board, in assisted living and memory care communities. In comparison, Medicaid will only pay for care costs in assisted living.

Qualifying for VA Pensions

For veterans and surviving spouses who are over the income and asset limits, there are ways in which they can still qualify for a pension.

Excess Income

Veterans and surviving spouses are able to deduct unreimbursed recurring medical and care expenses that are greater than 5% of the maximum annual pension rate. This deduction is particularly important for patients with dementia who spend a significant amount on long-term care, as these care expenses can be deducted from one’s annual income, lowering their countable income.

Excess Assets

Veterans and surviving spouses who have assets that put them over the net worth limit can “spend down” countable assets by paying off debt, purchasing an irrevocable (cannot be changed or canceled) funeral trust, or buying household items for a fair market value.

Another option is to make home modifications that enable persons with dementia to be able to continue living safely in their homes. Examples might include fencing in the yard or special locks to help prevent wandering, installing a chair lift for assistance getting up and down the stairs, and replacing a bathtub with a walk-in shower.

Prior to the new rules set forth by the VA on 10/18/18, annuities were used as a planning technique to lower a veteran or surviving spouse’s assets. Annuities take a lump sum of cash and convert it to monthly income. However, annuities are now considered a violation of the VA’s look-back rule. To be clear, annuities that can be cashed out are considered part of a veteran or surviving spouse’s net worth, while annuities that cannot be cashed out are in violation of the look-back rule.

Professional Planning Assistance

For Veterans and surviving spouses with dementia who are over the income and net worth limits, or are unsure if they are, working with a Veterans Service Officer or Veterans pension planner is highly suggested. For help finding a Veterans Service Officer, click here. Services provided by Veterans Service Officer are free of charge, while some Veterans Advocates may charge a fee. Learn more about Veterans’ Benefit Advisors here.

Calculating countable income can be complicated and knowing which expenses can be deducted is often confusing. In addition, when “spending down” countable assets, people can unknowingly violate the VA’s look-back period and be penalized with a period of pension ineligibility.

It’s also important to know that the application process can be difficult and time-consuming, as one must fill out the appropriate paperwork and include specific documentation. Incorrectly filling out paperwork, submitting the wrong paperwork, or not including all of the required documentation will result in a delay or denial of pension benefits.

Seeking help from professionals can lead to faster approval of a VA pension. It is typically expected that employing professional assistance reduces the approval time for a VA pension from as long as one year to as fast as 3 months.

Applying for a VA Pension

Prior to applying for a VA Pension, it is encouraged that veterans take a VA Pension Online Eligibility Test. Doing so will let a veteran or their spouse know if they are eligible and approximately how much financial assistance they could receive. If you do not qualify, you might choose to work with a VA Pension planner to become eligible.

Veterans and surviving spouses can apply online on the U.S. Department of Veterans Affairs website or fill out the Application for Veterans Pension form, 21-P-527EZ, and submit it to the VA pension management center in your region. Those applying for Aid & Attendance or Housebound must also complete form 21-2680, Examination for Housebound Status or Permanent Need for Regular Aid and Attendance. For patients with dementia residing in a nursing home facility, form 21-0779, Request for Nursing Home Information in Connection with Claim for Aid and Attendance, must be completed and submitted.

It may take several months for pension approval or denial. The process can be sped up by remembering the documentation that must be included with the application, like:

– proof of income and assets (bank statements, tax returns, etc.)

– a physician statement indicating the need for care

– military discharge papers

– marriage certificate

– receipts for medical expenses