Veteran Directed Care Program (formerly VD-HCBS) & How It Benefits Veterans with Alzheimer’s / Dementia

Last Updated: May 31, 2023


Veterans Directed Care Program Overview

The Veteran Directed Care (VDC) program is meant for veterans of all ages who need to be placed in a nursing home but want to continue living in their own home or the home of a friend or relative. This program requires that a veteran cannot live in an assisted living residence or a nursing home to receive this assistance.

  The Veteran Directed Care Program was formerly called Veterans-Directed Home and Community-Based Services or VD-HCBS. Many documents still refer to the program by its previous name.

Being “at risk of nursing home placement” means that your loved one has shown a need for assistance because they can not complete activities of daily living, such as bathing, mobility, toiletry, eating, and preparing meals independently. For people with Alzheimer’s disease and related dementias, assistance with these types of activities will become necessary as the disease progresses. The Veteran Directed Care program is beneficial for patients with dementia because family members generally work as unpaid caregivers. For this article, the focus of the VDC program will be on veterans with dementia.

 In the VDC Program, family members can be compensated to care for veterans with dementia.

VDC program participants are given a budget based on their function and care needs. This flexible budget enables veterans to choose long-term services and supports specific to dementia that will best assist them in remaining in their homes. A benefit of this program is that veterans can hire their caregivers, including relatives. This option allows spouses, adult children, grandchildren, nieces and nephews, and other family members to be paid to care for their loved ones.

Keep in mind that the option to self-direct one’s care is not appropriate for all people with dementia because of cognitive decline in the mid-late stages of the disease. Veterans who do not have the cognitive capacity to self-direct their care can have an authorized representative do so on their behalf. This person can be a relative, including the family caregiver.

The Veteran Directed Care program is part of the VHA’s (Veterans Health Administration) Medical Benefits Package and is a collaboration between the Veterans Health Administration (VHA) and the Administration for Community Living (ACL). The program is administered locally via Veterans Affairs Medicaid Centers (VAMCs). Please note that up until 2018, the Veteran Directed Care Program was known as the Veteran-Directed Home and Community-Based Services (VD-HCBS) Program.


Veterans Directed Care Program Benefits

Veterans with dementia participating in the VDC program are allocated a flexible monthly budget. This allows them (or their authorized representatives) to select which care services will best support their needs. This can include hiring a family member or a spouse as a caregiver.

The following is a list of the different ways in which VDC funds may be used. Please note that this is not a comprehensive list. Also, veterans cannot receive the same service provided by VA through a different VA program.

– Adult Day Care / Adult Day Health Care

– Assistive Devices for Dementia (automatic medication dispensers, memory picture phones, and reminder devices)

– Caregiver Support / Education / Training

– Chore Services (shoveling snow, yard clean-up, etc.)

– Electronic Monitoring Devices (wandering and location devices and personal emergency response systems)

– Financial Management Services (handles payments to caregivers and vendors)

– Home Health Care

– Homemaker Services (light cleaning, laundry, changing bedding, grocery shopping, etc.)

– Home Modifications (Grab bars, raised toilet seats, wheelchair ramps, specialized lighting, etc.)

– Meal Delivery

– Transportation (to dementia-related doctor appointments, for socialization, etc.)

– Vehicle Modifications

– Personal Care Assistance (bathing, dressing, personal hygiene, mobility, eating, medication reminders, etc.)

– Respite Care (in-home and out-of-home)

– Supplies, such as adult diapers

As your loved one progresses through the stages of dementia, their care needs change. The flexibility of the budget that is given through the VDC program enables many supportive choices to be made. Here are a few examples of how funds might be spent in each stage of dementia.

Early Stage Dementia
A senior with early Alzheimer’s disease is generally able to live independently but is likely to have some issues with forgetfulness. For safety purposes, installing an automatic stove shutoff device or investing in an automatic pill dispenser can be helpful. It might also be beneficial to hire someone once or twice a week to assist with household tasks and errands, such as grocery shopping, picking up prescription medications, paying the bills, light house cleaning, laundry, and meal preparation.

Middle Stage Dementia
A person with mid-stage Parkinson’s disease dementia might suffer from sleep disturbances, and instead of sleeping at night, may sleep during the day. This makes it especially difficult for family caregivers, even those who live with their loved ones, to provide supervision during nighttime hours. In this case, a monitor that alerts the caregiver when the person with dementia gets out of bed can be helpful. Furthermore, at this stage of dementia, persons often require help with most activities of daily living. Family caregivers may find respite care, such as adult day care or hiring an in-home personal caregiver, extremely helpful.

Late Stage Dementia
In late stage dementia, regardless of the type of dementia, care needs are great. At this stage, it can be difficult for an informal caregiver to handle all of these needs, as individuals with dementia likely can do very little on their own. This is where home health care or in-home skilled nursing might be a good option. Also, individuals with late-stage dementia often suffer from incontinence. Therefore, some monthly funds from VDC might go towards purchasing adult diapers.


Veterans Directed Care Program Eligibility

The Veteran Directed Care program is for veterans of any age who:

– Receive VA medical benefits

– Want to self-direct their care

– Are at risk of nursing home placement

This risk is shown through the need for assistance with daily living activities, such as bathing, dressing, mobility, transitioning, toiletry, and meal preparation. Other situations in which there might be a risk of nursing home placement include veterans living alone and in isolation, veterans who have informal caregivers who are overwhelmed, veterans on hospice care, and veterans who demonstrate significant cognitive impairment due to Alzheimer’s disease or related dementia.

VDC is not a needs-based program, which means there are no income or asset limits. Neither marital status nor having children impacts eligibility. Veterans must have served active duty and not have been dishonorably discharged. For veterans who served active duty before September 7, 1980, there is no requirement for minimum duty. For those who served after this date, there can be a 24-month active service requirement.

Veterans must live in a geographic location in which the Veteran Directed Care program is offered. As of May 2023, the program is to those who live in Puerto Rico and Washington DC, or the following 44 states: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, Wisconsin, West Virginia, and Wyoming.

VDC is not currently available in Delaware, Georgia, Kansas, Minnesota, Nebraska, and North Dakota. It is anticipated that this program will be available nationwide in the future, but there is no idea when that is expected to happen.


How to Apply for Veterans Directed Care

To apply for the VDC program, veterans with dementia should contact their local Veterans Affairs Medical Center (VAMC). To find a VAMC in the area in which one resides, click here. Remember, VDC is not available through all VAMCs across the United States.

Veterans not currently receiving VA medical benefits must first apply and be eligible to receive this benefit. For information on how to apply, click here.