By Sylvia Trein and Dana Taylor, LCSW
“We have always known there is a need to wrap our arms around our nation’s finest, our veterans. The fact that we recognized that and started this [program] long ago says something about our country.”
Dana Taylor, LCSW, is on a mission to better equip geriatric social workers and case managers amid dwindling opportunities for their clients. As existing health and home-based care struggles to accommodate ever-greater need, she wants the professionals in the trenches to have the VA’s Aid and Attendance benefit “as a resource in their back pocket.” Speaking to the audience of the 2023 CMSA annual conference, Taylor outlined who qualifies for the benefit, the twists and turns of access and compliance, and the value it can bring to the life of our veterans and their families.
As a Regional Director for private agency Veterans Home Care since 2008, Taylor has become deeply acquainted with the struggles faced by aging veterans and their families as they seek assistance from the VA for their growing medical expenses. Though the VA offers different benefits, they are little-publicized and difficult to access via complicated requirements and long application forms. Ongoing compliance is an important part of maintaining the benefit. Many families—and their case managers—are intimidated, not even wanting to open that can of worms.
At the same time, it is a huge, missed opportunity. The VA’s Aid and Attendance benefit:
- Is one of few benefits available to surviving spouses of veterans.
- Is tax-free.
- Is paid dependably, and never needs to be repaid if utilized within VA guidelines.
- Has had funding mandated by Congress since 1952 and will not run out without another act of Congress.
- Offers access to a wider selection of care placements and communities.
- Follows a patient as their care needs and provider’s change.
- Can be used for home care in the home as well as personal care at assisted living.
A Brief Overview of Veterans Benefits:
Pensions for American military personnel were first established by the Continental Congress in 1776. The first beneficiaries were soldiers injured during the Revolutionary War. In 1789, the first Federal Veteran’s Law was passed to extend these pensions, and surviving widows and orphans were added as beneficiaries in 1806. The next hundred years saw veterans’ medical care facilities and cemeteries established, and in 1930, a very fragmented set of veterans’ programs were consolidated into a Veterans Administration, or the VA. (This agency was renamed to the US Department of Veterans Affairs in 1989.)
Even with consolidation, the three main branches of the present-day VA—grouped into compensation (such as pensions), national cemeteries, and the medical system—do not communicate with one another. The term “VA benefits” is, for this reason, misleading; there are benefits scattered among the branches that do not necessarily overlap. This decentralized, somewhat siloed approach continues to be a source of difficulty today for veterans and their families navigating the VA. “‘Valuable Asset’ or ‘Very Aggravating.’ It really does stand for both,” says Taylor.
However, Title 38, passed in 1952, codified veterans’ benefits in a way that provided consistency and reliability. Even if access can prove a winding road, the destination is at least fixed in place. In 2021, about six million American veterans received some kind of pension or compensation, according to a US Census Bureau report, and about 450,000 “survivor” households (those without a living veteran) received benefits.
As Taylor mentioned, it is meaningful that a structure exists to provide care for those who have sacrificed for our country. And it can be a life-changing resource for individuals with accelerating needs and costs.
The Basics of Aid & Attendance:
Title 38 has two basic compensation programs: Service-Connected Disability Compensation, and Non-Service-Connected Pension. The Aid and Attendance benefit is an add-on to the latter.
While Service-Connected Disability Compensation is awarded to veterans who have a disability that is a direct result of their military service (for example, cancer caused by exposure to Agent Orange), the Non-Service-Connected Pension may be awarded to a veteran who has developed ailments unrelated to their service—common conditions of aging or results of later accidents, for example. An important note to highlight is that a veteran cannot receive benefits from both types of programs simultaneously. It is one or the other.
There are strict requirements to qualify for the VA’s various benefits. In the case of Aid and Attendance, think of the three M’s:
Qualifying WWI, WWII, and Korean War veterans must have served at least 90 consecutive days of active duty, with at least one day during the war. (Taylor’s agency lists date ranges for these wars here.) The location of their service does not impact their eligibility.
Veterans of the Vietnam War must have served in the country of Vietnam if their service was between 1961 and 1964 but could have been stationed anywhere if it was between 1964 and 1975. Persian Gulf War veterans could have been stationed anywhere but must have served for 24 consecutive months.
Form DD214 can be used to verify the military service requirement. Veterans must also have been honorably discharged.
Qualifying veterans must have their medical needs certified by a doctor, who will fill out form 21-2680 on their behalf to assert they require assistance with Activities of Daily Living (ADLs) such as bathing, dressing, or leaving their home for appointments. Any doctor who has filled out this form knows that the language and descriptions they use are important for communicating the real needs of their patient; however, this requirement is fairly straightforward.
Of the three M’s, this is the one that throws a wrench in the process for many applicants. Qualifying veterans must meet income and asset limits to access Aid and Attendance.
Assets are not as tricky to calculate as income. They must add up to under $150,000, and they exclude the applicant’s home and vehicle from the tally. What counts are any other property, bank accounts, stocks, annuities, cash value life insurance, and similar sources.
Concerning income, it is calculated by adding up sources such as Social Security checks, any other pension income, interest income from savings accounts, and the like. But the difficult part is that to qualify for Aid and Attendance, the veteran’s medical expenses must exceed income.
Taylor describes it as an old-fashioned weighing scale, where the medical expenses side always has to be a little heavier than the income side. This requirement is hard to meet because many of the expenses that most of us—including social workers and case managers—would consider to be medical do not, in fact, qualify. Costs like prescriptions, doctor copays, and hospital stays do not count. Rather, the VA counts costs that are recurrent and predictable, as well as legitimate. With this lens, qualifying costs can include ongoing care for conditions that are not going to improve, such as dementia, blindness, or mobility challenges.
Taylor adds two important notes about the third M:
- Eligible medical costs change and become more flexible once a veteran becomes entitled (that is, receives the Aid and Attendance benefit). It is easier from there onwards to show the medical side of the scale weighing heavier and maintain compliance.
- The Aid and Attendance benefit must be maintained by continued qualification. If income increases or medical costs drop, the veteran is responsible for reporting this change to the VA. Those who fail to report it, and who have slidden out of compliance with the program, might find themselves losing their benefit and even having to pay back funds that the VA decides were not rightfully distributed.
Successfully Claiming Aid & Attendance:
If your client meets the first two M’s and likely meets the third, the Aid and Attendance benefit is worth pursuing. Maximum monthly payouts for 2023 are approximately $2,230 for the veteran, $1,430 for a surviving spouse, and $2,640 for the couple. This can significantly alter the lives of individuals and families, as Taylor has witnessed thousands of times over her 15-year agency tenure.
Because the application process is so complex, grueling, and often ends in rejection, Taylor always recommends completing it through a Veterans Services Officer (VSO). VSOs are state employees who are highly knowledgeable about the VA and its programs but are not employed by the VA; they may be a representative from an agency like Taylor’s or from organizations such as the American Legion, VFW, or AMVETS. Beyond application, a VSO can help the veteran recipient remain compliant, as the VA audits beneficiaries frequently and at random.
“My main piece of advice is, if you deal with veterans, always connect them with a Veterans Services Officer, because they know that they should be informing the VA of any changes in their household. Even the applications that they send into the VA Pension Center hold more clout, because the VA Pension Center knows that the VSOs know what they’re doing. They know those applications are going to be easy to get through.”
The VA can take four to six months to process applications, but benefits are retroactive, and approved veterans receive payments for all months spent waiting for approval. In addition, applying through an agency like Taylor’s gives access to money up front (reimbursed from retroactive funds) and a much higher percentage of benefits awarded (her agency averages 92-95%).
Monthly Aid and Attendance payments reimburse for the medical costs of the prior month and are paid reliably. They can be used to pay for essential services at a wide variety of providers and communities, including for at-home care and assisted living facilities. Widows and widowers of deceased veterans can even apply for Aid and Attendance after their spouse has passed away. There are myriad reasons to take advantage of this benefit to which many of our veterans are already entitled.
Are you ready to connect with case managers and expand your reach to the case management community by becoming a CMSA Partner? Learn more https://cmsa.org/about/cmsa-partners/
Dana Taylor is an LCSW and a Veterans Home Care Regional Director. Taylor routinely meets with professionals from home care agencies, hospitals and veterans’ organizations as a subject matter expert on the VA Aid and Attendance benefit. She also works directly with veterans and their families. For any questions you may still have, you can email Dana Taylor at email@example.com.
Sylvia Trein is a freelance writer and editor reporting on diverse topics in healthcare, tech, consumer research and insights, and not-for-profits. She is based in Greenville, SC, and Fort Lauderdale, FL.
Veterans Home Care is a private company, not affiliated with the VA or any government agency. Their VetAssist Program offers in-home care and other services right away with no out of pocket costs and no waiting for VA funds to arrive for those who qualify.