When the VFW name comes up, the son usually hears one thing: the pension pays for care. The pension pays a monthly sum of money. VA also runs its own care programs, and some of them put an aide in the home or a seat in a day program through VA rather than through a private contract. Copayments may apply depending on enrollment, so the cost question is real. Put those programs next to a private aide before you sign anything, because they answer different questions.1

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

What you are comparing

The Aid and Attendance pension is a payment the family can spend on any care they choose. The programs below are services, not cash. One veteran can have a pension award and a VA-arranged service at the same time, but the family has to check, program by program, what is covered and what is left for the family to pay or arrange.2

What it costs: The Missouri median for non-medical in-home care is $33 an hour, per the CareScout (Genworth) Cost of Care Survey 2025 state data tables, released March 2026. New Plan Care's standard rate is $34 an hour with a four-hour minimum, so a visit starts at $136 (newplancare.com/services).

The three programs to ask about

Homemaker and Home Health Aide care. For a veteran enrolled in VA health care, VA can arrange a trained aide to help with personal care and some household tasks when the veteran's VA care team finds the need. The hours are set by the care team, not by the family. Ask whether the aide is a VA employee or a contractor, and who supervises the aide's work.3

Veteran-Directed Care. Where it is offered, the veteran receives a budget and directs the choice of worker and the schedule through a VA-contracted program. This sits closer to a private hire than the homemaker program, and the paperwork is different. Availability depends on the VA facility and the region, so ask whether your VA medical center offers it at all.4

Adult day health care. Some VA facilities run day programs that provide supervision, meals, and activity during working hours. It covers the family's workday more than the veteran's nights, so it fits a different gap than an aide who comes to the house.5

State veterans homes. A state-run veterans home is a facility placement, not in-home help. Whether round-the-clock care is needed is a clinical call for Dad's doctor and VA care team, not a budget call. If that line is ever in question, ask the state veterans agency for its list of homes and its admission steps.6

Five points to compare on one sheet

  1. Who qualifies and who decides. Ask for the eligibility rule in writing and the name of the person who makes the decision.
  2. Who picks the aide. VA arranges the worker, a contractor supplies the worker, or the veteran directs the hire under a budget.
  3. Hours and tasks. Ask the weekly hours, which tasks are covered such as bathing, dressing, meal preparation, and housekeeping, and whether any night or weekend coverage exists.
  4. Costs. Ask whether any copayment applies, how it is calculated, and how often it is billed, then compare that line against the private rate you were quoted.
  5. Gaps and continuity. Ask who covers when the aide is absent, whether the same person returns, and what happens when the program has no opening.

What to ask the VA facility

Call the VA medical center that treats Dad, and ask for the geriatric or extended care office or the social worker assigned to his case. Ask for answers in writing wherever you can get them. Ask whether Dad is enrolled and in what priority group, whether his care team considers in-home help at all, how long the wait is, how many hours would be approved if he qualifies, whether a private aide can work alongside a VA-arranged one, and who the family should call when something changes.

Where a private aide still fits

VA hours may be fewer than the family needs, may not fall at the times the family needs them, or may not be offered in the county at all. A private aide can fill those gaps. Before the first private shift, confirm with the VA care team that the private hours will not conflict with VA-arranged visits, and keep one written log that records visits from every source so the family can show what was done and by whom. The hiring paper itself is covered in the broader briefing.

What to keep

Keep the VA enrollment letter, any eligibility decision, every copayment statement, and the visit log for each program. For help finding a VA contact or a county office, see Local Help: St. Louis Offices. For how this desk checks its claims against the public record, see Sources, and for the full set of pieces in order, start with The Aid and Attendance Briefing.

Notes

1 VA.gov, pages on VA health care delivered in the home and in the community.
2 VA.gov, the pension benefits overview for veterans and survivors, including Aid and Attendance.
3 VA.gov, the Homemaker and Home Health Aide program page.
4 VA.gov, the Veteran-Directed Care page.
5 VA.gov, the adult day health care page.
6 VA.gov, the State Veterans Homes page.