VA Long-Term Care: Home Care, Nursing Homes and Hospice
VA's Geriatrics and Extended Care programs run from a few hours of help at home to nursing home and hospice care. Here is what each program is, how a veteran gets started, and what the copay rules say.
When a veteran needs more help with daily life, whether after a hospital stay, with a chronic illness, or with age, VA's Geriatrics and Extended Care programs are where that help sits. They range from a few hours of help at home each week to full-time nursing home care and hospice. Here is each program as VA describes it, how to get started, and what the copay rules say.
Three things come up for almost every program
VA's long-term care page says a veteran may qualify for these services when all three of these are true: they are signed up for VA health care, VA concludes they need the specific service, and the service (or space in the care setting) is available near them. VA may also consider service-connected disability status or insurance coverage.
In practice: enrollment first, then a clinical assessment by the VA care team, and the limit is what is offered locally.
Care at home and in the community
| Program | What VA says it is |
|---|---|
| Adult Day Health Care | A program a veteran goes to during the day for social activities, peer support, companionship and recreation; health services from nurses, therapists, social workers and others may also be available |
| Homemaker and Home Health Aide care | A trained aide who comes to the home to help with daily activities such as eating, getting dressed, grooming, bathing, using the bathroom, moving from one place to another and grocery shopping |
| Veteran-Directed Care | A budget for home and community services that the veteran or the veteran's representative manages, with a counselor's help |
| Palliative care | Comfort care focused on relieving suffering and controlling symptoms; it can be combined with treatment aimed at curing or controlling the illness |
| Hospice care | Comfort care for a veteran with a terminal condition and less than 6 months to live who is no longer seeking treatment other than palliative care |
Adult Day Health Care
VA says the program may be provided at VA medical centers, State Veterans Homes or community organizations, in half-day or full-day sessions, typically several times a week. It is meant for veterans who need help with daily living, who are isolated, or whose caregiver is under strain, and it can give a family caregiver respite.
Homemaker and Home Health Aide care
The aides work for an organization that has a contract with VA. VA says they are not nurses but are supervised by a registered nurse, and that an aide may come several times a week or just once in a while, based on assessed needs.
Veteran-Directed Care
Veterans in this program get a budget for services that they or their representative manage. A counselor helps plan the spending and hire workers, and VA says those workers might include the veteran's own family member or neighbor. It is open to veterans of all ages who need personal care and help with daily activities, who are isolated, or whose caregiver is experiencing burden. Whether it is offered depends on the veteran's VA location.
Nursing home options
VA's long-term care page describes three settings for full-time nursing home care. All three provide 24-hour nursing, medical care and help with daily tasks.
| Setting | Who runs it |
|---|---|
| Community Living Center (CLC) | VA. A CLC is a VA nursing home |
| Community nursing home | A nursing home in the community that VA contracts with |
| State Veterans Home | The state government. VA certifies and surveys these homes but does not manage them |
Community Living Centers
VA says CLC stays are most often short stays after a hospital discharge, and in rare instances last the rest of a veteran's life. Core services include 24-hour skilled nursing, restorative care, social work and geriatric evaluation; some CLCs also offer dementia care, respite, and palliative and hospice care. A veteran must be enrolled and be medically and psychiatrically stable, and VA says eligibility is based on clinical need and setting availability, with criteria involving service-connected status, level of disability and income.
Community nursing homes
VA says it will only pay for community nursing home care when a veteran meets eligibility criteria involving service-connected status, level of disability and income. A veteran who does not meet them would use their own resources, which VA notes may include Medicare or Medicaid.
State Veterans Homes
These homes may provide nursing home, domiciliary or adult day care, and each state sets its own admission rules. VA says a recognized home may receive VA payments to help defray the cost of veterans' care, that the cost to the veteran varies by state, and that VA does not pay for care for non-veterans.
Hospice and palliative care
Both are part of VA's standard medical benefits package, so VA says every enrolled veteran is eligible if they meet the clinical need. Hospice can be provided at home, in an outpatient clinic or in an inpatient setting, and it includes bereavement support for the family. Palliative care is not only for the end of life: VA says it can start at diagnosis and continue alongside treatment.
Who pays: the copay rules
Extended care copays are set by 38 CFR 17.111, separately from the outpatient and medication copays in our priority groups guide.
| Rule | What 38 CFR 17.111 says |
|---|---|
| First 21 days | No copay for the first 21 days of extended care in any 12-month period |
| Adult day health care | Up to $15 a day after the first 21 days |
| Nursing home care | Up to $97 a day after the first 21 days |
| Not subject to the copay | Among others: a veteran with a compensable service-connected disability; a veteran whose annual income is below the VA pension rate in 38 U.S.C. 1521(b); care for a noncompensable 0% service-connected disability; care for military sexual trauma; Medal of Honor recipients |
| Catastrophically disabled veterans | Exempt from the copay for adult day health care, non-institutional respite care and non-institutional geriatric care |
| How the amount is set | By the available resources of the veteran and spouse, reported on VA Form 10-10EC |
The figures are daily maximums; what a veteran owes depends on available resources. For the first 180 days of extended care those are based on income, and from day 181 on, assets count as well.
Hospice is different: 38 CFR 17.108 lists it among the services not subject to copayments, and VA's hospice page says there are no copays whether VA or a VA-contracted organization provides it. VA says copays may be charged for palliative care, and for homemaker and home health aide care based on service-connected disability status.
How a veteran gets started
Enrollment comes first. A veteran who is not yet in VA health care applies with VA Form 10-10EZ; our priority groups guide covers how that works.
After that, VA's pages point to the same person for almost every program: a VA social worker, who can explain what help may be available, find a nearby program or home, and help with the arrangements. For palliative care, VA also suggests the veteran's primary care provider.
The paperwork for extended care is VA Form 10-10EC, the Application for Extended Care Benefits. Under 38 CFR 17.111, a veteran who is not exempt from the copay submits it when care is first requested, again after a break in care of more than 30 days, and each year with the 10-10EZ. The social worker can also share VA's Veteran Decision Aid and Caregiver Self-Assessment.
The bottom line
The same three questions come up for almost every program: enrollment, clinical need, and local availability, and VA nursing home care also involves service-connected status, level of disability and income. A compensable service-connected rating removes the extended care copay, hospice carries none, and for a veteran who is not exempt the first 21 days in a 12-month period are free of copay, with a capped daily amount after that. The first conversation is with a VA social worker.
Frequently Asked Questions
Does VA pay for nursing home care?
It can. VA offers nursing home care in its own Community Living Centers, in community nursing homes it contracts with, and through State Veterans Homes. VA says eligibility is based on clinical need and setting availability, with criteria involving service-connected status, level of disability and income. A veteran who does not meet the criteria for a community nursing home would pay with their own resources, which may include Medicare or Medicaid.
How much is the VA nursing home copay?
Under 38 CFR 17.111 there is no copay for the first 21 days of extended care in a 12-month period. After that, nursing home care is up to $97 a day and adult day health care up to $15 a day, depending on the available resources the veteran reports on VA Form 10-10EC. A veteran with a compensable service-connected disability is not subject to the extended care copay.
Is VA hospice care free?
Yes. 38 CFR 17.108 lists hospice care among the services not subject to copayments, and VA's hospice page says there are no copays for hospice whether VA provides it or a VA-contracted organization does. VA describes hospice as comfort care for a veteran with a terminal condition and less than 6 months to live.
Can a family member be paid to care for a veteran through Veteran-Directed Care?
VA says veterans in the program manage a budget for services and get help hiring workers, which might include their own family member or neighbor. The program depends on clinical need and on whether it is offered at the veteran's VA location.
Where does a veteran start?
Enroll in VA health care if not already enrolled, then talk with a VA social worker. The social worker can explain which programs fit, whether they are available nearby, and how to complete VA Form 10-10EC, the Application for Extended Care Benefits.