The expense side of an aid and attendance claim does not have one shape. Who lives in the house, who pays the aide, and whose income is counted all change what has to be documented and how. Start with the household you actually have, then match the records to it.[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.

Shape one: a veteran living alone with a paid aide

In this shape the expenses usually come from the veteran's own accounts. The file needs the signed agreement, each invoice, proof of payment from the veteran's account, and a dated record of the hours worked. Ask a Veterans Service Officer which in-home costs VA accepts as unreimbursed medical expenses, because not every bill from an aide qualifies.[2]

Shape two: a veteran with a spouse at home

Here the spouse's income is counted in the household, and the spouse may also be providing daily help. Clarify whether the spouse's time is paid, whether a paid aide covers some hours, and how the household keeps the two separate on paper. Arrangements that involve paying a relative are an area where the rules are specific, so ask a representative before any payment is made. Get the answer in writing where possible.

Shape three: a family member paying out of pocket

When a son or daughter pays the aide, the receipts must show who paid, for what, and when. Use one account for care payments if possible. If that is not possible, keep the paper trail complete with checks, transfers, and invoices that name the veteran as the patient or service recipient. Ask the representative whether the payer's costs can be included in the claim and how the records must read to be accepted.

Records that fit any shape

  • A dated log of care hours, signed by the provider or the family member who recorded them.
  • Invoices showing the provider's name, service dates, and the amount charged.
  • Proof of payment for each invoice.
  • A copy of the signed agreement and any changes to it.
  • Other medical costs the veteran pays, such as insurance premiums and out-of-pocket treatment costs, kept in the same file.

Questions to bring to the representative

  • Which in-home expenses does VA accept for a household shaped like ours?
  • Does a spouse's time or income change how the expenses are counted?
  • If a family member pays, how should the payments be documented so they are not mixed with other money?
  • Which of our records should go to VA now, and which should stay at home for a later review?

For local help with the expense records, see the St. Louis offices page. The desk's approach to sources is described on the How We Write This Briefing page.

Notes

  1. VA.gov, Veterans Pension benefits page, including the section on unreimbursed medical expenses.
  2. VA.gov, Pension medical expense information and the Medical Expense Report, VA Form 21P-8416.

Sources for these notes are listed on the Sources page.