Beyond Aid and Attendance: VA Home Care Benefits Your Clients May Qualify For

When elder law attorneys think about VA benefits, Aid and Attendance is usually the first program that comes to mind. Unfortunately, the 2018 rule changes made VA planning feel a lot less useful than it once was. The good news is there are other VA benefits that can help, especially for clients who want to stay at home as long as possible.

For our November AshBer webinar, we were joined by Don Quante, President, CEO, and Founder of Veterans Benefits Software Inc., for a discussion about VA home care benefits and where they can fit into the planning elder law attorneys are already doing for clients and their families.

Much of the conversation centered around three programs: Homemaker and Home Health Aide Care, Veteran Directed Care, and the Aid and Attendance pension.

1.  Homemaker and Home Health Aide Care

The VA's Homemaker and Home Health Aide program can provide in-home assistance to eligible veterans who need help remaining safely at home.

This isn't a monthly cash benefit like many other benefits you may be used to working with. Instead, the VA works with approved home care providers to provide services based on the veteran's needs. The amount of care isn't the same for everyone. The VA looks at the veteran's individual situation, including things like mobility, activities of daily living, cognitive impairment, fall risk, the home environment, and the availability of other caregivers.

One important distinction is that this program is based on the veteran's clinical need rather than the financial eligibility rules attorneys may associate with Aid and Attendance.

It's a program to remember when a family assumes the veteran won't qualify for any help because of income or assets.

2. Veteran Directed Care

Veteran Directed Care offers another way for eligible veterans to receive support at home, but with more control over who provides that care.

Under the program, the veteran receives a budget based on an assessment of their needs and may be able to hire caregivers, including family members or people they already know. Many families are already doing this work on their own, and this benefit can make a real difference for them.

We see families who could use this every day. An adult child spends several days a week caring for a parent, or a spouse is trying to keep a loved one at home while the help they need keeps increasing. This benefit can help lessen that burden.

In those situations, it is worth asking whether VA benefits have been explored before assuming the family has to shoulder the entire cost of care themselves.

3. Aid and Attendance Is Still Part of the Conversation

Aid and Attendance is the most familiar benefit to most elder law attorneys.

The VA's pension with Aid and Attendance can provide a monthly benefit to qualifying veterans and surviving spouses who meet the applicable service, medical, and financial requirements.

The rules changed considerably in 2018, including the addition of a three-year look-back period and transfer penalties. For some practitioners, that effectively ended the conversation about VA planning.

There are still planning opportunities, though they require closer review now. It’s important to understand how today's VA planning decisions can affect asset transfers and Medicaid eligibility down the road. That's where the attorney's role comes in.

VA Benefits Don't Always Have to Be Used One at a Time

One point Don covered was the distinction between benefits administered through the Veterans Health Administration and those administered through the Veterans Benefits Administration.

Homemaker and Home Health Aide Care and Veteran Directed Care fall on the health-care side. Aid and Attendance is part of the benefits side. Depending on the client's circumstances and eligibility, benefits available through these different programs may be able to work together.

For an elder law attorney, this means more options for building a long-term care plan for the families they serve.

Where the Legal Planning Comes In

Families don't necessarily need an attorney to learn about VA benefits or apply for them. There are Veteran Service Organizations and other resources available to help veterans with claims, and there are specific rules governing accreditation and the fees attorneys may charge in connection with VA claims.

There are planning opportunities outside of making the application itself, though. A family may need a caregiver agreement because a child is already being paid to provide care. There may be a home they want to protect. Assets may need to be addressed before the veteran can qualify for Aid and Attendance. An irrevocable funeral plan may make sense as part of the spend-down. And whatever is done today needs to be considered in light of possible Medicaid eligibility later.

During the webinar, Don walked through an example of a veteran who was paying his daughter for weekend care while also paying a home care agency during the week. He had income coming in, assets above the VA limit, and a home he wanted to preserve for his daughter. The planning involved looking at the caregiver arrangement, the veteran's assets, the home, funeral planning, and the benefits that might be available through more than one VA program.

That's the kind of plan where an elder law attorney can contribute without being tied strictly to filing the VA application.

Ask About Military Service

When you're talking with a family about long-term care, don't overlook the veteran connection.

Was the client a veteran? Was their spouse? Is an adult child providing unpaid care? Is the family trying to keep someone at home but starting to struggle with the cost? Those questions may lead to benefits the family didn't know were available.

Not every veteran will qualify, and every situation is different. But when you're already looking at Medicaid, long-term care costs, caregiver arrangements, funeral planning, and asset protection, VA benefits belong in the conversation.

AshBer works with elder law attorneys and their teams across the country on Medicaid planning and the financial products that support those plans. A big thank you to Don for joining us for our November webinar and giving us another area to think about when we're helping attorneys find solutions for their clients.