top

How the VA’s Aid & Attendance and Housebound Pensions Benefit Veterans and Surviving Spouses with Dementia

Last Updated: November 04, 2019

 

With the progression of Alzheimer’s disease, vascular dementia, and other dementias, the need for long-term care inevitably becomes a necessity. Unfortunately, the cost of long-term care, whether it be in-home care, adult day care, or residential care (assisted living, memory care, also called Alzheimer’s care, and nursing home) can be quite costly. That said, for Veterans and their surviving spouses who have limited income and assets, but require dementia care, VA pensions through the U.S. Department of Veterans Affairs provide an option for offsetting the cost of long-term care.

 

Types of VA Pensions

A veteran’s pension is a tax-free, cash benefit that supplements the monthly income of low-income elderly or disabled Veterans and their surviving spouses (widows / widowers). While there is a basic VA pension, there are also two special monthly pensions, also called enhanced pensions, that provide an additional monetary benefit above and beyond that of the basic pension. These are called (1) Aid & Attendance and (2) Housebound. To be clear, in order to be eligible for the Aid & Attendance or Housebound enhanced pension, one must first be eligible for the basic pension. To better help one to differentiate between the basic pension and the enhanced pensions, a brief summarization follows.

Basic Pension – Sometimes called a death pension, it is for veterans and surviving spouses that are aged or disabled (one’s disability does not need to be related to their military service).

Aid & Attendance – Abbreviated as A&A, it is relevant for veterans and their surviving spouses who require assistance with day-to-day activities, such as bathing, dressing, eating, mobility, and toiletry. A&A is particularly relevant for persons with dementia, especially those who are in the mid-late stages of the disease, as the need for this type of assistance becomes necessary. This special monthly pension is 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 (or even all) 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 home (which also extends to those residing in assisted living, memory care, and nursing homes), and therefore, require assistance. The Housebound pension, like the A&A pension, is meant to help cover the cost of long-term care.

 

 Did You Know? There are free resources available to veterans with dementia and their caregivers.
Assistance Finding Memory Care Communities
Consultations on Medicaid Nursing Home Eligibility
Matching Service for Professional In-Home Care

 

VA Pension Eligibility Requirements

In order for a veteran or surviving spouse with dementia to be eligible for a VA pension, be it basic, Aid & Attendance, or Housebound, the following requirements must be met:

General Requirements

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 it is the surviving spouse 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 (SSDI) OR receive Supplemental Security Income (SSI)

 

Medical Eligibility Requirements

While there are no medical (functional) requirements in order to be eligible for the basic pension, persons with dementia must meet specific functional requirements in order to receive the additional benefit of Aid & Attendance or Housebound. Please note that the necessity for care must be backed up by a physician statement.

Aid & Attendance – One of the following requirements must be met in addition to the general requirements listed above.
• Require assistance from another person in order to complete daily living activities (taking a bath, dressing / 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 persons with dementia, the need for a protected living environment for safety purposes is also considered.
• Be 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 a related 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 a related dementia must spend the majority of their time in their “home”, which as previously mentioned, also extends to an assisted living facility, Alzheimer’s memory unit, or a nursing home. The inability to leave home and the need for care must stem from a permanent non-service connected disability. For example, a lack of motor skills due to Parkinson’s related dementia is likely functional cause for the Housebound pension. In addition to a physical disability, it could be a mental disability, such as anxiety or depression, which is commonly seen in persons with dementia, that prevents a Veteran or surviving spouse from leaving their “home”.

 

 Veterans and surviving spouses cannot concurrently receive Aid & Attendance and Housebound benefits.

 

Financial Requirements

Income Limits
In order for veterans and their surviving spouses with dementia to receive a VA pension, their income must be under the maximum annual pension rate (MAPR), or put differently, 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 his / her countable income minus the MAPR. The following MAPRs will be in effect from December 1st, 2019 – November 30th, 2020.

VA Pension Maximum Annual Pension Rate – Effective Dec. 1, 2019
Basic Pension Aid & Attendance Housebound
Veteran without a spouse or child $13,752 $22,938 $16,805
Veteran with a dependent spouse or child $18,008 $27,194 $21,063
Surviving spouse without a dependent child $9,223 $14,761 $11,273

 

While one’s income must be under the pension benefit rate, which may initially sound low, the VA does allow veterans and their surviving spouses to deduct unreimbursed medical expenses greater than 5% from their MAPR. Examples of expenses that may be deducted from one’s countable income are regularly purchased care supplies, such as diapers for incontinence, and recurring costs, like Medicare premiums, personal emergency response system subscriptions, and long-term care (i.e. in-home care, assisted living costs, including room and board, and adult day care). For persons with Alzheimer’s disease or related dementias who require substantial care, deducting these expenses can significantly lower their countable income. This, in turn, may allow them to qualify income-wise for Aid & Attendance or Housebound pension.

  Example:
Fred is a single 78 year old Veteran with Lewy body dementia who lives with his adult daughter. Due to the progression of the disease and his need for supervision and assistance with daily living activities, he attends adult day care during the week while his daughter works. His annual income is $25,000, and the maximum annual pension rate for Aid & Attendance is $22,938. At first glance, Fred has too much income to qualify for the A&A pension.

 

However, recurring medical and care costs in excess of $1,146 (5% of the Aid & Attendance MAPR) may be deducted from his annual income. Fred has $12,000 in adult day care costs annually, which means he can deduct $10,854 ($12,000 – $1,146 = $10,854) from his annual income of $25,000. This brings his countable income down to $14,146 ($25,000 – $10,854 = $14,146) and his annual A&A pension amount to $8,792 ($22,938 – $14,146= $8,792).

 

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. As of 12/1/19, this amount is set at $129,094, but prior to 10/18/19, there was no set net worth limit nor set asset limit.

That said, there are some assets that are not counted towards the net worth limit. These include 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 $129,094.

Another new rule, implemented as of 10/18/18, is a look back rule. This is a period of 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 in order to become net worth eligible. Violating the look back period results in a period of pension ineligibility, of which can be up to 5 years. If assets were gifted or sold for less than they are worth prior to 10/18/18, it does not violate the new look back rule.

 

Pension Benefit Amounts

The maximum annual pension rate amounts, effective December 1st, 2019 – November 30th, 2020 are as follows:

VA Pension Benefit Amounts – Effective Dec. 1, 2019
Basic Pension Aid & Attendance Housebound
Veteran without a spouse or child $13,752 $22,938 $16,805
Veteran with a dependent spouse or child $18,008 $27,194 $21,063
Surviving spouse without a dependent child $9,223 $14,761 $11,273

 

Remember, a veteran or surviving spouse’s benefit amount is their countable income minus the MAPR.

Pension benefit amounts can be used however a veteran or surviving spouse sees fit. For persons 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.

 

Qualifying for VA Pensions

For veterans and surviving spouses who are over the income and / or asset (net worth) amount, 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 relevant for persons with dementia who require a significant amount of 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 cancelled) funeral trust, or buying household items for fair market value. Another option is to make home safety modifications that enable persons with dementia to be able to continue living in their homes. Examples might include fencing in the yard 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.

Please note that 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 / or net worth limits, or are unsure if they are, working with a Veterans Service Officer (VSO) or Veterans pension planner is highly suggested. Services provided by VSOs 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 can be confusing. In addition, when “spending down” countable assets, persons can unknowingly violate the VA’s look back period and be penalized with a period of pension ineligibility. It’s also important to note 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.

It is typically expected that employing professional assistance can reduce the approval time for a VA pension for as long as one year to as fast as 3 months.

 

Applying for a VA Pension

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 persons 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.

Remember, there is also required documentation, such as proof of income and assets, a physician statement indicating the need for care, and military discharge papers, that must be included with the application. Please note that it may take several months for pension approval or denial.