VA Home Care Benefits Guide

Start Here: The Social Worker Is the Door

Almost every program on this page (homemaker aides, home-based primary care, respite, nursing home coverage, adult day care) is requested the same way: through a VA social worker, not through a form you fill out online at home.

If you're not sure where to begin, call your VA medical center, press the option for Social Work Service or Geriatrics & Extended Care (GEC), and say: "I'd like to talk about home and community care options for myself/my veteran." They'll set up an assessment and walk you through eligibility.

VA Form 10-10EC (Application for Extended Care Benefits) is the copay-determination form you'll complete with the social worker. It's not a separate application for each program. It's how the VA figures out what, if anything, you'll be charged based on your service-connected status and income.

Good news most veterans don't know: most of these programs are available to any enrolled veteran, not just service-connected ones. Clinical need (help with bathing, dressing, managing chronic illness) is what matters, not your rating percentage. Exceptions are called out program-by-program below.

Which Program Do I Need?

Check every situation that applies, veterans often need more than one program, and some combinations unlock specific answers.

Care at Home

These programs bring care directly to the veteran's house.

1. Homemaker / Home Health Aide (H/HHA)

A trained aide comes to the home to help with daily living.

What it is:: A VA-supervised aide helps with bathing, dressing, grooming, toileting, feeding, mobility, light housekeeping, and medication reminders. Non-skilled personal care.
Who qualifies:: Any enrolled veteran who needs help with activities of daily living and is eligible for community care.
What it costs:: Possible copay based on service-connection and income (determined by Form 10-10EC). Veterans at 50%+ SC generally pay nothing for SC-related care.
How to request:: Ask your VA social worker for an H/HHA referral.

Common mistake: H/HHA is not 24/7 live-in care, and the aide is not a family member you pay. For those situations, see Veteran-Directed Care (below) or the PCAFC caregiver stipend (caregiver section). VA.gov source

2. Skilled Home Health Care

Medical care at home: nurse, PT, OT, speech therapy.

What it is:: A nurse or therapist comes to the home for wound care, post-op rehab, IV/catheter management, chronic disease teaching, or skilled therapy, usually after a hospital stay.
Who qualifies:: Enrolled veterans with a clinical need for skilled services ordered by a VA provider.
What it costs:: Copay possible for Priority Groups 7-8. Often covered by Medicare's home health benefit if you have Medicare; VA coordinates.
How to request:: Referral from your PCP, HBPC team, or social worker.

Time-limited. Skilled home health is intermittent. Once the veteran plateaus, the visits stop and the plan may switch to H/HHA for ongoing personal care. VA.gov source

3. Home-Based Primary Care (HBPC)

A VA primary care team comes to you.

What it is:: A full VA interdisciplinary team (doctor/NP, nurse, social worker, dietitian, pharmacist, psychologist, rehab) provides primary care in the veteran's home. Designed for veterans too medically complex or frail to come to clinic.
Who qualifies:: Enrolled veterans with complex chronic illness, homebound or semi-homebound, living within a VAMC's HBPC catchment area. The HBPC team decides who enrolls.
What it costs:: Copay possible per 10-10EC; most HBPC patients pay nothing because they're in high-priority groups.
How to request:: Ask your VA primary care team or a social worker for an HBPC referral.

HBPC is not a concierge doctor. It's reserved for veterans whose health genuinely prevents clinic visits. It's also a prerequisite for the Medical Foster Home program (see below). VA.gov source

4. Home Telehealth

Remote monitoring and care coordination through a tablet or phone.

What it is:: VA gives you a tablet, connected devices (BP cuff, scale, glucometer, pulse ox), or an app. A VA care coordinator tracks your daily readings and steps in early if something looks off.
Who qualifies:: Enrolled veterans with a qualifying chronic condition (CHF, COPD, diabetes, hypertension, PTSD, depression) and a VA provider willing to refer.
What it costs:: Free, part of primary care.
How to request:: Ask your PCP for a Home Telehealth referral.

Heads up: This is the largest home-telehealth program in the country, but it augments, not replaces, your regular care team. VA Connected Care source

5. Veteran-Directed Care (VDC)

The veteran gets a monthly budget and hires their own caregivers, including family.

What it is:: A flexible monthly budget (paid through a state Aging & Disability agency partnered with the VA) that the veteran, or a surrogate, uses to hire personal care workers, including family members and friends.
Who qualifies:: Enrolled veterans of any age who meet nursing-home-level clinical need, are eligible for community care, and live where VDC is offered. Availability is uneven. It depends on whether the veteran's VA medical center has partnered with a local Aging agency.
What it costs:: No copay for the service.
How to request:: VA social worker referral. The Aging agency then enrolls you and trains the veteran (or surrogate) on how to manage payroll for the hired workers.

Paying family: VDC generally allows paying adult children, siblings, friends, and neighbors, but in most states you cannot pay a legal spouse as the worker. Rules come from federal Medicaid/FLSA frameworks VDC borrows. VA.gov source

Care Outside the Home

Programs that get the veteran out of the house or into a supported residence.

6. Adult Day Health Care (ADHC)

A daytime therapeutic program at a VA facility, State Veterans Home, or community center.

What it is:: Supervised daytime activities, meals, nursing oversight, rehab, and peer support: half or full days, multiple days a week. Also gives family caregivers a break during the workday.
Who qualifies:: Enrolled veterans who meet clinical criteria for ADL help or social isolation risk.
What it costs:: Copay possible per 10-10EC.
How to request:: VA social worker.

Very uneven availability. Many VA medical centers don't contract with community ADHC providers. This is not the same as a drop-in senior center. The VA doesn't fund those. VA.gov source

7. Respite Care

Short-term substitute care so the caregiver can rest.

What it is:: Temporary care so the regular caregiver can rest, travel, or handle other obligations. Delivered three ways: in-home (aide comes to you), community (adult day program), or facility (short stay in a VA Community Living Center or contracted nursing home).
Who qualifies:: Enrolled veterans who meet clinical criteria and whose caregiver needs relief.
What it costs:: Copay possible per 10-10EC. PCAFC-enrolled caregivers receive 30+ days of respite a year as a protected benefit.
How to request:: VA social worker.

Nursing-home respite is capped at 30 days per calendar year. In-home respite doesn't have a single hard cap but is rationed by the local VAMC's budget. VA.gov source

8. Community Nursing Home Program

VA-paid long-term nursing home care, with a major catch.

What it is:: The VA contracts with private nursing homes to pay for long-term skilled nursing care, so veterans can stay closer to family instead of transferring to a VA Community Living Center.
Who qualifies:: By statute, VA must cover nursing home care indefinitely for veterans who are (a) rated 70% or higher service-connected, (b) need nursing home care because of a service-connected condition, or (c) rated 60% and deemed unemployable (TDIU). Clinical need must also be established.
What it costs:: Free for statutorily eligible veterans.
How to request:: Social worker at the discharging hospital or outpatient clinic.

The biggest surprise for families. A veteran rated under 70% SC who needs permanent custodial nursing home care is generally not covered by the VA long-term. Other veterans may get short-term coverage (typically up to 6 months post-hospitalization) or must use Medicare (short-term rehab only), Medicaid, or private pay. Enrollment in VA healthcare does not guarantee nursing home coverage. VA.gov source

9. Medical Foster Home (MFH)

A small private home with 24/7 care, an alternative to a nursing home.

What it is:: A trained caregiver hosts up to 3 veterans in their private home and provides 24/7 personal care, meals, and medication oversight. The veteran's VA HBPC team provides medical care in the home.
Who qualifies:: Must be enrolled in Home-Based Primary Care (HBPC), this is a hard prerequisite, and live in an area with an active MFH program. Only about 115 VA medical centers run MFH programs.
What it costs:: Private pay: $1,500-$3,000/month paid directly to the caregiver. VA does not fund the room and board. Many veterans use VA Pension + Aid & Attendance to cover the fee.
How to request:: Ask your HBPC team or VA social worker whether your VAMC participates.

Often the cheapest alternative to a nursing home once A&A pension is added, and many veterans prefer it because it's a real home, not an institution. But if your VAMC doesn't run the program, there's no workaround. VA.gov source

Serious Illness & End-of-Life Care

10. Palliative Care

Symptom and quality-of-life care alongside treatment, not just for end of life.

What it is:: An interdisciplinary team focused on pain and symptom management, advance care planning, and psychosocial support for veterans with a serious illness. Can start at diagnosis and continue through treatment, including curative treatment like chemo or dialysis.
Who qualifies:: Enrolled veterans with a serious illness. No prognosis requirement.
What it costs:: Standard VA copay rules apply.
How to request:: Ask any VA provider for a palliative care consult. Every VA medical center has a palliative care team.

Palliative is NOT hospice. Veterans and families often decline a palliative referral because they think it means "giving up". It doesn't. Palliative care runs alongside active treatment. VA.gov source

11. Hospice Care

Comfort care for terminal illness.

What it is:: Comfort-focused care for veterans with a terminal illness and a prognosis of 6 months or less who are no longer pursuing curative treatment. Delivered at home, in a VA Community Living Center, or through a contracted community hospice.
Who qualifies:: Any enrolled veteran who meets the clinical 6-month prognosis. No rating threshold.
What it costs:: Always free. No copay, ever.
How to request:: PCP, HBPC team, or social worker. VA also partners with community hospices through the "We Honor Veterans" program.

VA hospice is more flexible than Medicare hospice. You don't have to give up seeing your regular VA providers when you enroll. VA.gov source

Caregiver Programs

This is the section most families land on. The VA has two caregiver programs, and the differences matter:

12. PCAFC, Program of Comprehensive Assistance for Family Caregivers

The one with the monthly stipend.

What it is:: Monthly tax-free stipend paid to a designated Primary Family Caregiver, plus training, mental health support, 30+ days of respite, and CHAMPVA health coverage.
Who qualifies:: All three must be true:
• Veteran is enrolled in VA healthcare
• Veteran has a single or combined service-connected rating of 70%+
• Veteran needs at least 6 continuous months of in-person personal care because of the SC condition
Caregiver must be 18+, a family member or live full-time with the veteran. All service eras are now covered (fully phased in October 2022 under the MISSION Act).
Stipend amount:: Paid at two levels, tied to the local OPM GS-4 Step 1 federal pay rate. Level 1 (significant help): 62.5% of the annual rate ÷ 12. Level 2 (unable to self-sustain, continuous supervision): 100% of the annual rate ÷ 12. Dollars vary by the veteran's OPM locality pay area. Current stipend fact sheet.
How to apply:: VA Form 10-10CG online at caregiver.va.gov or through the Caregiver Support Coordinator at your VA medical center.

Reassessments: VA reassesses PCAFC participants on a schedule. Eligibility criteria tightened in 2020 when the program expanded to all eras; some legacy participants were moved between tiers or discharged. The program stipend is compensation paid to the caregiver, not wages to the veteran, and is not counted as income for most federal means-tested programs. PCAFC eligibility source

13. PGCSS, Program of General Caregiver Support Services

The one with no stipend but still very real support.

What it is:: Training, counseling, peer mentoring, self-care coaching, an online workshop ("Building Better Caregivers"), and access to respite care for the veteran.
Who qualifies:: Any caregiver (family, friend, neighbor) of a veteran enrolled in VA healthcare. No rating minimum. No era restriction. No clinical severity test.
What it costs:: Free. No stipend.
How to access:: Contact the Caregiver Support Coordinator at any VA medical center, or enroll at caregiver.va.gov.

This is the program most people miss. Many families hear they don't qualify for PCAFC (because the veteran isn't 70%+ SC) and assume there's "nothing for them." PGCSS is what they're missing. PGCSS fact sheet

Money to Pay for Care

Some veterans need care the VA won't directly provide: a private-pay Medical Foster Home, assisted living, or a caregiver the veteran wants to pay out of pocket. These programs help pay the bill.

14. Aid & Attendance and Housebound (Pension Add-On)

A monthly pension add-on for wartime veterans with limited income who need care.

What it is:: An add-on to VA Pension (or Survivors Pension) that raises the maximum annual pension rate, letting more of your unreimbursed medical expenses offset countable income. In practice, veterans paying out-of-pocket for a caregiver, nursing home, assisted living, or Medical Foster Home often see their monthly pension check rise significantly once A&A is added.
Aid & Attendance qualifies if:: You need help with daily activities, OR are bedridden, OR are a nursing home patient because of disability, OR have corrected vision of 5/200 or worse in both eyes.
Housebound qualifies if:: You are permanently and substantially confined to your home due to disability. You cannot receive both A&A and Housebound at the same time. A&A is the higher rate.
How to apply:: File VA Form 21P-527EZ (Pension application) along with VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), completed by your doctor. For details on what the VA looks for in the 21-2680, when a VA exam is ordered, and how to document the criteria under 38 CFR 3.352(a), see the A&A Exam & Evidence Guide. For full Pension eligibility, MAPR rates, and how Pension fits next to military retirement, CRDP, and CRSC, see the Pension & Combat Pay guide.

Income & Net Worth Limits (effective Dec 1, 2025 - Nov 30, 2026)

Your countable income, after unreimbursed medical expenses are deducted, must be below the Maximum Annual Pension Rate (MAPR) for your situation. Separately, your net worth (assets plus annual income, minus your primary home, vehicle, and personal belongings) must be below $163,699.

Veterans Pension, Maximum Annual Pension Rate
Your situation	Annual MAPR
Single veteran	$17,441
Single veteran + Housebound	$21,313
Single veteran + Aid & Attendance	$29,093
Veteran with 1 dependent	$22,839
Veteran with 1 dependent + Housebound	$26,710
Veteran with 1 dependent + Aid & Attendance	$34,488
Two veterans married, both need A&A	$46,143
Each additional dependent child (add to MAPR)	+$2,984

Survivors Pension, Maximum Annual Pension Rate
Surviving spouse situation	Annual MAPR
Surviving spouse alone	$11,699
Surviving spouse + Housebound	$14,298
Surviving spouse + Aid & Attendance	$18,697
Surviving spouse with 1 dependent child	$15,311
Surviving spouse + 1 dep. child + Housebound	$17,902
Surviving spouse + 1 dep. child + Aid & Attendance	$22,304

The most misunderstood part: Unreimbursed medical expenses, such as caregiver wages, assisted living or nursing home fees, Medical Foster Home room & board, long-term care insurance premiums, Medicare premiums, prescription copays, and in-home personal care, reduce your countable income for MAPR purposes.

Rates update every December 1 with the Social Security COLA. Verify current figures at va.gov/pension/veterans-pension-rates.

A&A is NOT the same as SMC-L. Aid & Attendance (Pension) is a need-based add-on for wartime veterans with limited income who need help. SMC-L (Compensation) is extra compensation for service-connected veterans needing aid and attendance, regardless of income. They're completely different programs. A veteran can receive A&A-Pension or SMC-L, not both, since Pension and Compensation don't stack. See our SMC Guide for the Compensation side.

Bonus: A veteran "in receipt of increased pension based on the need for aid and attendance or housebound status" is automatically placed in VA Healthcare Priority Group 4, which means little or no copays for VA care. VA.gov source

Home Modifications & Accessible Housing

Two different VA programs pay for physical changes to a home. They have very different purposes and caps.

15. HISA, Home Improvements and Structural Alterations Grant

A lifetime grant for medically necessary home modifications.

What it is:: A VA grant that pays for ramps, widened doorways, roll-in showers, grab bars, stairlifts, accessible sinks, and electrical/plumbing tied to medical equipment.
Lifetime caps:: $6,800 if the modification is for a service-connected condition, or for a non-SC condition if the veteran has a 50%+ SC rating, or for a 38 USC 1151 injury.
$2,000 if the modification is solely for a non-service-connected condition and the veteran does not have a 50%+ SC rating.
Eligibility:: Enrolled in VA healthcare, with a VA physician's written prescription stating the modification is medically necessary.
Does NOT cover:: New construction, exterior walkways to outbuildings, decks/patios, spas, or routine maintenance (roof, HVAC replacement).
How to apply:: Submit a package to your local VA Prosthetic and Sensory Aids Service: VA Form 10-0103, physician prescription, itemized contractor estimate, a color photo of the area, and owner/landlord authorization (notarized if renting).

Lifetime benefit. Once you've spent your $6,800 or $2,000, that's it. Amounts can be split across multiple projects, but the cap is permanent. HISA can stack with SAH/SHA (next) as long as the work isn't duplicated. VA Prosthetics source

16. SAH / SHA Grants, Specially Adapted Housing

Much larger grants to buy, build, or substantially modify an accessible home.

What they are:: Two separate housing grants, SAH (Specially Adapted Housing) and SHA (Special Housing Adaptation), administered by VBA Housing, not VHA Prosthetics. Far larger than HISA, but require specific severe service-connected disabilities.
SAH eligibility:: Permanent and total SC disability from: loss or loss of use of both legs; one leg + cane/crutch/brace residuals; blindness in both eyes + loss of use of a leg; loss of both arms at/above elbow; severe burns; or (for post-9/11 veterans) loss of one lower extremity.
SHA eligibility:: Permanent and total SC disability from: blindness in both eyes (20/200 or worse); loss of use of both hands; severe burns; or certain respiratory/breathing injuries.
Caps (FY 2026):: SAH: up to $126,526. SHA: up to $25,350. Caps rise each October with the new fiscal year.
How to apply:: VA Form 26-4555 online at va.gov/housing-assistance/disability-housing-grants.

You can split the grant. SAH and SHA can be used across up to 6 separate events in a lifetime, and veterans often don't realize the grant can pay to buy or build a new accessible home, not just modify an existing one.

How to Actually Get Any of This

Every program on this page takes one of four paths. Match your situation to the right one:

Home & community-based care (programs 1-11): Call your VA medical center's main number, ask for Social Work Service or Geriatrics & Extended Care (GEC). Say: "I'd like to talk about home and community care options." They'll set up an assessment and complete VA Form 10-10EC for copay determination.
Caregiver programs (PCAFC & PGCSS, 12-13): Apply online at caregiver.va.gov (Form 10-10CG for PCAFC), or call your VAMC's Caregiver Support Coordinator.
Aid & Attendance / Housebound Pension (program 14): File Pension application VA Form 21P-527EZ together with Form 21-2680 completed by your doctor. A VSO can help. find one here.
Home modification grants (HISA, SAH/SHA, programs 15-16): HISA goes to your local VA Prosthetic and Sensory Aids Service using Form 10-0103. SAH/SHA is applied for online at va.gov/housing-assistance/disability-housing-grants using Form 26-4555.

Not sure which door to knock on? Start with Social Work Service. They can hand you off to the right program team, including the Caregiver Support Coordinator, Prosthetics, or an HBPC team.

Full Program Comparison

Comparison of all 16 VA home and community-based care programs, showing eligibility, cost, and how to request each
Program	Who Qualifies	Cost	How to Request
Homemaker / HHA	Any enrolled vet with ADL need	Possible copay	Social worker
Skilled Home Health	Clinical skilled-need order	Copay possible; Medicare may cover	PCP or social worker
Home-Based Primary Care	Complex, homebound, in VAMC catchment	Most pay nothing	PCP or social worker
Home Telehealth	Enrolled vet with chronic condition	Free	PCP referral
Veteran-Directed Care	Nursing-home-level need + VDC available locally	No copay	Social worker
Adult Day Health Care	ADL need or isolation risk	Copay possible	Social worker
Respite Care	Caregiver needs relief	Copay possible; 30-day facility cap	Social worker
Community Nursing Home	70%+ SC, SC-caused need, or 60% + TDIU	Free if statutorily eligible	Social worker
Medical Foster Home	Enrolled in HBPC; local program required	$1,500-$3,000/mo private pay	HBPC team
Palliative Care	Serious illness, any stage	Standard copays	Any VA provider
Hospice Care	6-month prognosis	Always free	PCP, HBPC, or social worker
PCAFC	70%+ SC + 6 mo care need	Free + monthly stipend	Form 10-10CG
PGCSS	Any enrolled vet's caregiver	Free, no stipend	Caregiver Support Coordinator
A&A / Housebound Pension	Wartime vet + low income + care need	Increases pension	Form 21P-527EZ + 21-2680
HISA Grant	Enrolled vet + MD prescription	$6,800 SC / $2,000 NSC lifetime	Form 10-0103 to Prosthetics
SAH / SHA Grant	Specific severe SC disabilities	Up to $126,526 / $25,350	Form 26-4555

"This Is NOT the Same Thing"

The four mix-ups that cost veterans and families the most:

Homemaker/HHA ≠ PCAFC

One sends a VA-supervised aide to help with bathing and meals. The other pays a family member a monthly stipend to be the primary caregiver. Different eligibility, different process.

Palliative Care ≠ Hospice

Palliative care runs alongside treatment at any stage of a serious illness. Hospice requires a 6-month prognosis and forgoing curative treatment. Don't decline a palliative referral thinking it means "giving up."

A&A (Pension) ≠ SMC-L (Compensation)

Both are called "Aid & Attendance." A&A-Pension is a need-based add-on for wartime veterans with limited income. SMC-L is extra compensation for service-connected veterans who need aid, regardless of income. See our SMC Guide for SMC-L.

HISA ≠ SAH / SHA

HISA is a small medically-necessary modification grant ($6,800 or $2,000 lifetime) for any enrolled veteran. SAH/SHA are large housing grants (up to $126,526) for specific severe service-connected disabilities. Totally different programs.