When a family hears that VA can help with care at home, it is often describing two different programs. One is a monthly pension add-on paid to the veteran. The other is a set of health care services that VA may provide through its medical system. The two can overlap in the family's mind, but they differ on almost every question a family will ask.
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.
Door one: the pension add-on
Aid and Attendance is paid as part of the monthly pension. The veteran receives the money and decides how to use it, which means the family selects the caregiver or agency, sets the schedule, and pays the bill.1 The amount is set by pension rules, not by the hours of care, and the pension does not promise any particular number of hours.
Door two: VA health care in-home services
VA medical centers may offer in-home services such as homemaker and home health aide help, depending on the veteran's enrollment in VA health care, the clinical need documented by the care team, and what the local program provides.23 VA also runs caregiver support programs for families who provide care at home, and those programs have their own eligibility rules.4 In this door, VA's program, not the family, usually determines the provider and the schedule.
How to judge each door
For the pension add-on, check who is paid, how the family will be paid, how the provider is chosen, and how the family handles a gap in care. For the health care door, check whether the program is offered where the veteran lives, whether a copay applies, what the enrollment step requires, how hours are set and changed, and what happens if the assigned provider cannot come. Ask each question of the program itself, in writing where possible.
A side-by-side check
Compare the two on the same five points: who pays the provider, who chooses the provider, how many hours are promised, what must be enrolled or filed first, and how a dispute is raised. A door that looks generous on one point may be narrow on another. The comparison is only useful if both columns are answered from the program's own rules.
Using both
A veteran may qualify for one, for the other, or for both, and each program's rules govern its own part. Do not assume that approval in one means approval in the other, and do not assume that using one closes the other. Ask the VA medical center which programs are offered in your area, and bring the list of questions above to that conversation. Contact information for St. Louis offices is on Local Help: St. Louis Offices.