chevron-down Created with Sketch Beta.


Experience January/February 2023

The Paydirt of Long-Term Care Nobody Knows About

Leasha West


  • Aid and Attendance (A&A) is a little-known benefit offered by the Department of Veterans Affairs (VA).
  • It is a non-service connected, tax-free lifetime pension designed to assist veterans and their surviving spouses who require the aid and attendance of another person to manage their daily living.
  • Determine if you qualify by looking at the clinical and financial requirements and strategies to address countable assets.
The Paydirt of Long-Term Care Nobody Knows About

Jump to:

Ever heard of Aid and Attendance? This best-kept secret of the Department of Veterans Affairs is a little-known benefit that makes all the difference in long-term care planning and peace of mind.

Just as the name indicates, A&A is a non-service connected, tax-free lifetime pension for veterans and their surviving spouses who require the aid and attendance of another person to manage their daily living.

Most veterans or their families don’t even know they’re entitled to a monthly income to help pay for the overwhelming cost of senior care. Additionally, A&A is the only veterans benefit that’s extended to a spouse. Let’s dive in.

Varied Names, All the Same

Aid and Attendance is also referred to as the A&A benefit, improved pension, VA assisted-living benefit, or veterans elder care benefit. Nevertheless, these interchangeable names all describe the same benefit.

A&A can be used for assisted living, home health care, adult day care, memory care, or a nursing home. This includes paying a family member who’s the caregiver of a veteran, with the exception of a spouse. Note: The housebound allowance is unrelated to A&A and is a completely separate benefit.

When referring to A&A, most people assume it’s about pensions, which isn’t the case. A&A is a medical rating and an additional amount of money available with all VA disability income benefits to help veterans cope with the added burden of helplessness.

Who Qualifies?

As with any government program, A&A has a few layers of qualifications consisting of service requirements, medical necessity, and financial eligibility. If the applicant is the spouse or surviving spouse who hasn’t remarried, the qualifications apply to both the deceased veteran and the applicant, who must satisfy additional requirements of their own. These may seem like a lot, but they’re not as cumbersome as they appear.

To begin, a veteran must have been on active duty during any of the following dates:

  • World War II: Dec. 7, 1941–Dec. 31, 1946
  • Korean Conflict: June 27, 1950–Jan. 31, 1955
  • Vietnam Era: Aug. 5, 1964–May 7, 1975; veterans who served in the Republic of Vietnam between Nov. 1, 1955–Aug. 4, 1964 are also eligible
  • American Merchant Marines: Dec. 7, 1941–Aug. 15, 1945
  • Gulf War: Aug. 2, 1990–a future date to be set by law or presidential proclamation

Veterans must have an honorable or general discharge or apply for a discharge upgrade.

Next, the veteran must be receiving the basic VA pension, or an application for it can be submitted with the A&A application. To qualify for the VA basic pension, you must meet one of the following criteria:

  • If you’re a veteran who’s 65 or older, you must have limited income.
  • If you’re under age 65, you must be receiving Social Security disability or supplemental security income.
  • You suffer from a permanent or total disability.
  • You reside in a nursing home.
  • If you’re a veteran who isn’t institutionalized, you must already be a senior-living resident or have an in-home caregiver.
  • Your eyesight is limited, even with glasses or contact lenses.
  • You must have served on active duty for a minimum of 90 consecutive days prior to Sept. 8, 1980, with at least one day of wartime, but not necessarily in combat, or you must have served on active duty for 24 months after Sept. 7, 1980, with at least one day during the wartime dates without an obligatory combat zone.
  • You’re an officer who began active duty after Oct. 16, 1981, and you haven’t served for the prior 24 months.

Veterans of the reserves who weren’t called to active duty aren’t eligible for A&A. Even though you completed active-duty training, it doesn’t count for A&A eligibility.

Meeting Clinical Reqs

Once the service, discharge status, and basic pension are cleared, then the meat of the A&A eligibility can be assessed. The clinical criteria are straightforward and requires only one of these requirements:

  • You require assistance with at least two activities of daily living, which include: bathing, dressing, eating, toileting, walking, grooming, and transferring. This need for assistance doesn’t have to be related to military service.
  • You reside in a nursing home.
  • You have a frequent need of adjustment for any special prosthetic or orthopedic appliances that can’t be performed without aid (this doesn’t include the adjustment of appliances that normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back).
  • You have a severe visual impairment with limited eyesight.
  • You have an incapacity, physical or mental, that requires care or assistance on a regular basis to protect you from hazards or dangers of the daily environment.
  • You’re bedridden with the exception of medical appointments and treatments.

Meeting Financial Reqs

The financials are usually evaluated last. Veterans don’t need to be destitute to be awarded A&A.

The VA enacted a ceiling for the combination of a veteran’s net worth and income that excludes the primary residence, vehicle, and personal belongings. There’s also a three-year lookback period to examine if any assets were gifted to reduce net worth or were sold below market value, both of which might affect eligibility.

For income, what’s called countable income is offset by deducting unreimbursed medical bills, prescriptions, Medicare, or private health insurance premiums and deductibles, to name a few. There’s an extensive list of expenses of allowable deductions to reduce the countable income.

Currently, the combined limit, which is comprised of net worth and income, is set at $138,489, though it changes annually.

Note: It’s possible to have $138,489 in assets alone and still qualify. For example, let’s say you have $138,489 in assets; however, your income is $5,500, and the expenses are $5,800, leaving a negative net income. In that case, you’d still qualify financially.

As mentioned earlier, payments to a family caretaker, including children and grandchildren, can be deducted from the veteran’s or the surviving spouse’s income. Applicants can then receive an increased pension equal to the amount they’ve paid to their family member who provided care.

Unfortunately, this doesn’t work for the veteran’s spouse because joint income is calculated as household income. Therefore, the salary received by the spouse would be included as their household income and wouldn’t be considered a deductible care expense.

What Are Countable Assets?

There are many strategies to legitimately cure being over-resourced. One way is to convert countable assets into noncountable assets.

Let’s say you have $300,000 in countable assets or are over-resourced by $161,511. To bring assets below the limit, you could:

  • Purchase a vehicle
  • Make home improvements, such as upgrading your home to become handicap accessible
  • Pay off or down your mortgage
  • Pay off your loans or credit card debt
  • Pre-pay your final expenses and funeral arrangements
  • Make a small gift, though be sure to first consult an accredited agent before deploying a gifting strategy

When Benefits Conflict

The A&A program is a lifesaver for most veterans and their families; however, it’s important to be aware of potential conflicts between VA pensions and assistance from other government programs. Depending on the individual circumstances, applying for A&A could backfire.

Veterans can’t receive both A&A and VA disability payments; instead, they’d receive the higher benefit of the two, if they qualified.

A veteran’s surviving spouse receiving dependency and indemnity compensation who’s no longer able to independently manage their everyday living can qualify for additional assistance under A&A. That said, a surviving spouse can’t receive both DIC and a death pension. Note: DIC rates are determined by the deceased veteran’s pay grade if they passed prior to 1993.

Any recipient of VA pensions may be disqualified from Medicaid benefits. Often, the income from A&A will exceed the maximum allowable monthly income to receive Medicaid assistance.

Can This Be Retroactive?

Unfortunately, the application process can be quite lengthy, spanning anywhere from 9-12 months. Filing an intent-to-file document at the beginning of the application process establishes the start date that would pay retroactively if your claim is approved. If you’re considering an application for A&A, it’s a good idea to submit the intent to file form 21-0966 right away.

Once your claim is approved, benefits are paid in a lump sum from the effective date locked in on the intent to file. In some cases, veterans’ families have taken out a loan to cover the cost of care while waiting on the application process, thus allowing an accelerated repayment when the application is approved and the benefit payments begin.

For many families, the A&A benefit provides an increased buying power, which opens up more options in choosing a senior living community that best fits the veteran’s needs. More importantly, it gives the veteran the ability to remain in the community much longer than their original budget may have otherwise allowed.

The coveted peace of mind in caring for a loved one just might be the best benefit of Aid and Attendance.