Veterans and their spouses may not be aware of the Aid and Attendance Pension which is one of the lesser known long term care assistance programs. The Aid and Attendance Pension is offered through the U.S. Department of Veterans Affairs (VA). It’s really not a work related pension since it covers non-military service connected disabilities necessitating the need for aid and attendance of another person (hence the title). This program is very well suited for veterans and their spouses who need a little extra cash to pay for in-home care and the costs of assisted living care. The pre-planning for this program may, in some cases, conflict with other long-term care assistance programs such as Medicaid (see below).

Here is a brief summary of the five eligibility criteria for this program:

1. 90 days of active military service, one day of which was during wartime.

The types of military service are relatively broad and the regulations provide an extensive list of veterans considered to have performed active service. Active military service does not require that the veteran was in actual combat. At least one day of the veteran’s active service must be within a defined period of war. These periods include: World War II (December 7, 1941 to December 31, 1946), Korea (June 27, 1950 to January 31, 1955), Vietnam and the Persian Gulf.

2. The veteran was honorably discharged.

3. The veteran is permanently and totally disabled or over the age of 65.

4. The veteran (and/or his/her spouse) has limited assets and income.

The VA will not approve an application for this program if the claimant’s assets are deemed reasonably sufficient to provide for his/her care. As to assets, the VA uses general guidelines in their decision. A married couple may own their own home, other personal property to maintain their lifestyle and about $80,000 in bank and investment accounts. An unmarried Veteran or widowed spouse may also own a home, have some personal property but only have about $40,000 in bank and investment accounts.

An otherwise eligible Veteran and/or spouse must also meet income guidelines. Generally, the VA looks at the claimant’s gross income and subtracts unreimbursed medical expenses in determining eligibility. This can be a confusing process since the gross income calculation includes social security, interest income and tax deferred retirement accounts.

5. The Veteran and/or spouse must show a need for aid and attendance.

The regulations define the need for aid and attendance as “helplessness or being so nearly helpless as to require the regular aid and attendance of another person.” The VA looks at several factors to determine if this requirement is met such as the ability to dress or undress, feeding oneself, hygiene, bathing, etc.

A Veteran who qualifies for this program and demonstrates great financial need may receive in excess of $2,000 per month to help pay for care. The spouse of a veteran in similar circumstances may receive close to $1500 per month.

In June, 2012, the Government Accountability Office (GAO) released a yearlong investigation that concluded that weak oversight and unclear rules have resulted in abuse of this program. The abuse referred to in the report occurs when ineligible Veterans with assets greater than the amount allowed incorporate inappropriate means to reduce their assets. The GAO found that more than 200 firms exist across the country, including Northwest Washington, to help Veterans “restructure” assets in order to gain eligibility. These firms are particularly aggressive and often work through nursing homes or assisted living facilities to gain access to Veterans. The GAO also found that some firms overcharge Veterans for services, in some cases more than $10,000, or sell them financial products that are potentially harmful such as irrevocable trusts or annuities. These financial products or trusts may also result in ineligibility for state Medicaid assistance to help pay the costs of care that exceed the Aid and Attendance benefits.

In Washington State, the Attorney General’s office has undertaken a similar investigation and is working closely with the VA.

The VA has concurred with the GAO’s recommendations and is in the process of drafting new regulations to address these issues.

A bipartisan group of U.S. Senators has introduced legislation giving the VA legislative authority to support the new regulations.

Barry M. Meyers
Steven D. Avery
Elder Law Offices of Meyers & Avery