Families often reach for the phrase Aid and Attendance when what they mean is that Dad no longer gets out much. Those are two different standards in the VA pension framework. A veteran can be housebound without needing aid and attendance, and he can need a great deal of hands-on help without being housebound. A family that answers the wrong question ends up with a file that does not match it.

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 housebound means

VA's housebound standard asks whether a veteran is permanently confined to his bed, his chair, or the room of his residence, or substantially confined to his home and its immediate premises, and whether that confinement comes from a disability.[1] The test is about where daily life happens. It says nothing about how much help he gets once he is inside the house.

What aid and attendance means

Aid and attendance is about help with the body's ordinary work. VA's criteria list conditions such as being unable to dress or undress or to keep oneself reasonably clean and presentable, being unable to feed oneself because of weakness or lost coordination, and being unable to attend to the needs of nature. The criteria also cover a physical or mental condition that requires regular supervision to protect a veteran from the hazards of his surroundings.[2]

How to tell which problem you have

Write down one ordinary week in plain words. Do not write what the family wishes were true. Note where Dad spends most of the day, then note which tasks someone does for him and which he still does alone.

  • Does anyone wash, dress, or help him toilet every day, and does he need hands on him to do it?
  • Can he eat without someone cutting, guiding, or steadying the food?
  • If no one checked on him for a few hours, would the house itself present a risk tied to a physical or mental condition?
  • Do his doctors' notes describe the same limits you see at home? If they do not, write down the gap, because it will matter later.

A man who sits in one chair all day but washes, dresses, and eats without help has the housebound picture without the aid and attendance picture. A man who walks to the kitchen and goes out for appointments, but cannot dress or manage the toilet without someone beside him, may have the aid and attendance picture even though he is not housebound.

What the answer does not decide

Neither list tells you whether Dad qualifies for anything. It tells you which question the family is answering. Service, age, income, and net worth are separate gates with their own rules. Read the order on the Start Here page before you pull any records, so the file answers the right question from the first page.

Footnotes: [1] 38 CFR 3.351, special monthly pension for housebound status, VA.gov. [2] 38 CFR 3.352, criteria for determining need for regular aid and attendance, VA.gov.