Veteran’s Directed Home Services Program

Individuals enrolled in the Veteran’s Administration (VA) health care system may qualify for a program that provides both funds and flexibility for veterans to hire caregivers, including family members, and receive services to assist with activities of daily life within in their own home and community. The Veteran-Directed Home and Community Based Services program, started in 2009, is now available in at least 42 states. The VA plans to expand the program to serve additional areas by 2020.

The program operates differently from health related VA pensions, is open to veterans of any age, and is not need-based. There are no income or asset limits. Veterans receiving an Aid and Attendance pension may obtain services. To qualify, a veteran must have served 24 months of continuous active duty with a discharge status other than dishonorable or for bad conduct. Exceptions to the 24-month rule can be made for service related disabilities and conditions or if the veteran received a hardship or “early out” discharge.

Veterans seeking assistance must generally require a nursing home level of care. Persons requiring help with three or more activities of daily life usually qualify. Activities might include cooking, dressing, bathing, and grooming. Qualifications are less strict for veterans living alone, requiring hospice care or who are 75 years of age or older. Veterans suffering from moderate to severe Alzheimer’s will most likely be approved.

Working with a VA medical center and a local agency on aging, veterans, often with the aid of family, prepares a care plan and an estimated budget designed to allow them  to live at home or in the community rather than in a nursing facility. Creating the plan allows a veteran to be specific about personal needs and preferences. Veterans are free to coordinate with a VA medical center outside their immediate geographic area. After the plan is submitted, it may take several months of revision and negotiation to reach a mutually agreeable budget. Payments are not made until the budget has been approved.

The plan can include virtually any service and product required for the veteran’s care and health or which improves the ability to live independently. This may include home modifications for wheel chair ramps and vehicle access, electronic monitors, emergency alarms, homemaker services to assist with laundry, cooking and cleaning, personal care services to assist with bathing and dressing, adult day care, respite care, home delivered meals, caregiver training and transportation and escort services required for shopping or attending medical appointments.

The program does not pay for rent or personal care in an assisted living facility. Services must be provided to the veteran in his or her home, a caregiver’s home or in an independent living residence. Friends or family members including a spouse, adult children, and relatives may be hired as caregivers and are paid based on rates set by the VA adjusted for local factors.

As the program name states, the veteran directs what services will be provided in the home and chooses the personal caregivers rather than receiving care within the VA health care system. The monthly budget is determined by a veteran’s specific needs. The maximum amount allowed varies by state. As a general guideline, the budget should not exceed the cost of similar care at a VA skilled nursing facility.

Veterans authorize payments to providers, but do not actually receive cash. A financial management service working in cooperation with the VA will issue checks to service providers and reimburse the veteran for pre-approved supplies. The veteran, in effect, acts as the employer, hires and schedules care providers, and orders health care supplies.

Based on surveys, 95 percent of veterans participating in the program expressed satisfaction, saying it met their needs and improved access to health care. An ongoing evaluation scheduled to be completed in December 2019 will examine health outcomes including hospital and emergency room visits, nursing home admissions and days at home as well as costs associated with providing the directed services program.

The program continues to expand. In 2017, the VA began an effort to add an additional 90 VA Medical Centers to the program. Interested parties should contact a local Area Agency on Aging to determine program availability.

The VA estimates the number of veterans requiring long term care will double in the next decade. With an annual cost of $110,000 for a veteran to receive such care, the home and community based option offers a cost-effective, viable alternative to promote independent living for veterans while meeting their individual needs.

For More Information and Eligibility Determination please Visit DSHS.