Dementia Care in Virginia: A Caregiver's Guide (2026)

An estimated 164,000 Virginians age 65 and older were living with Alzheimer's in 2020, and about 333,000 family caregivers across the Commonwealth support people living with dementia.1

Dementia caregiving is its own kind of hard: the long arc, the behavioral changes, the safety worries, the grief that starts before any loss. This guide maps the Virginia-specific help available in 2026, from the free 24/7 helpline to Medicaid respite to the programs that can pay you for the care you already provide.

You do not have to navigate this alone, and you do not have to fund all of it from your savings.

Virginia Dementia Caregiving, by the Numbers

The Alzheimer's Association estimates that 164,000 Virginians age 65 and older were living with Alzheimer's disease in 2020. For 2025, it counts about 333,000 family caregivers across the Commonwealth providing an estimated 561 million hours of unpaid care, valued at roughly $12.8 billion.1

If the work feels overwhelming, that is not a personal failing. It is the reality of a condition that can ask a great deal of a family, for a long time.

Where to Start

When a diagnosis lands, or when caregiving starts to outpace what you can manage alone, two contacts open most doors in Virginia.2,8

Virginia's Dementia Support Infrastructure

Virginia's Department for Aging and Rehabilitative Services (DARS) runs Dementia Services, which helps people with Alzheimer's disease and other types of dementia, and their caregivers, across Virginia. DARS can be reached at 804-662-7000.2 DARS's Dementia Capable Virginia pages point families to their local Area Agency on Aging for services and caregiver support, and under the National Family Caregiver Support Program those agencies offer individual counseling, support groups, and caregiver training.3 For support at any hour, the Alzheimer's Association 24/7 Helpline is at 1-800-272-3900.2

Who Pays for Dementia Care in Virginia

Virginia's Medicaid (CCC Plus)

For Virginians who qualify, the Commonwealth Coordinated Care Plus (CCC Plus) waiver, received through a Cardinal Care managed care health plan or through fee-for-service, covers home- and community-based services including adult day health care, personal care, respite care (up to 480 hours per state fiscal year), private duty nursing, assistive technology, and environmental modifications.9 Outside Medicaid, the Department for Aging and Rehabilitative Services (DARS) runs the Respite Care Initiative, funded with state general funds, for caregivers of people 60 and older who have Alzheimer's disease or a related dementia; eight Area Agencies on Aging and one adult day center provide it, and it is limited to planned, part-time respite of no more than 40 hours a month.5

To get in, you request a Medicaid long-term services and supports (LTSS) screening through your local Department of Social Services; the person must be eligible for Medicaid for the waiver to pay for services.9 The screening weighs three things: functional capacity, meaning how much help the person needs with activities of daily living; medical or nursing needs; and the risk of nursing-facility placement within 30 days without community-based services. The functional rating is written up on Virginia's Uniform Assessment Instrument (UAI), and the question the screening answers is whether the person needs the level of care provided in a nursing facility, long-stay hospital, or specialized care nursing facility. There is also a financial test: waiver applicants are treated as if institutionalized, and the countable income limit is 300% of the SSI payment amount for an individual, which at the 2026 SSI rate of $994 a month works out to about $2,982 per month for a single applicant in 2026 (SSI amounts change in January, so the limit rises in January 2027; confirm the new figure with the Department of Medical Assistance Services), with countable resources capped at $2,000 ($3,000 for two people in the same aged, blind, or disabled eligible group; separate rules let a spouse who lives in the community keep some assets). That income figure is not a hard ceiling: Cover Virginia says people with income over the limit may still qualify if the private cost of long-term care is greater than their income, so apply and be screened rather than assume you are over. Cover Virginia says CCC Plus serves all ages and does not have a waiting list, whereas Virginia's developmental-disability waivers do have one, with slots allocated by urgency of need.4

Getting Paid to Care for a Loved One With Dementia

Some Virginia dementia caregivers can be paid for the care they provide. Under the CCC Plus Waiver's consumer-directed option, the person or their employer of record hires the attendant, and an adult child or other relative can be that attendant; a relative living in the same home can be paid only with written documentation that no other person or provider is available, and the employer of record cannot also be the paid attendant. Official sources still conflict on paying a spouse, so a spouse should confirm with DMAS or the health plan first.6 For veterans' families, VA's caregiver program is below. The full pathways and pay are covered in the Virginia paid family caregiver guide.

VA Benefits (for Veterans)

If the person you care for is a veteran, the VA's Program of Comprehensive Assistance for Family Caregivers (PCAFC) pays a monthly stipend to an approved Primary Family Caregiver, who can be a spouse, once that caregiver has enrolled in direct deposit through VA's customer engagement portal. And the Aid and Attendance (A&A) benefit is an increased monthly pension: a veteran or survivor may be eligible if they get a VA pension (for a veteran, one based on wartime service) and meet at least one of VA's listed requirements, such as needing another person's help with daily activities like bathing, dressing, and feeding.10 Call the VA Caregiver Support Line at 1-855-260-3274, Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.7,11

Veteran eligibility: VA publishes four conditions, and they are the first screen rather than the decision. The veteran must meet all four:7

• A VA disability rating, individual or combined, of 70 percent or higher.7
• Discharge from the U.S. military, or a date of medical discharge.7
• A need for at least six months of continuous, in-person personal care services.7
• Enrollment in VA health care.7

Meeting those four is necessary, not sufficient. The binding test is 38 CFR 71.20(a), which states seven requirements and requires every one of them. Four of the seven have no counterpart in the four above, and VA assesses them during the application process:7

• Participating in the program is in the veteran's best interest.7
• The personal care services the family caregiver would provide are not simultaneously and regularly provided by or through another individual or entity.7
• The veteran receives care at home, or will do so if VA designates a family caregiver.7
• The veteran receives ongoing care from a primary care team, or will do so if VA designates a family caregiver.7

The no-other-provider condition is the one most likely to surprise a family, because a household already receiving regular personal care through another program or entity can fail PCAFC on that ground alone.7

Medicare

Medicare Part B covers a separate cognitive assessment and care-plan visit (billed under CPT code 99483) when signs of cognitive impairment show up at a routine or yearly Wellness visit, with the Part B deductible and 20% coinsurance applying. Medicare also covers home health care for a person who is homebound and needs part-time or intermittent skilled services, and hospice when doctors certify a life expectancy of six months or less and the person chooses comfort care. It does not pay for long-term custodial care, the ongoing non-medical help with bathing, dressing, and using the bathroom. The Guiding an Improved Dementia Experience (GUIDE) Model, a voluntary CMS program that began July 1, 2024, adds dementia care navigation, a 24/7 support line, caregiver training, and respite where a participating provider is available. GUIDE serves only patients aligned to a participating provider: they must have Medicare Parts A and B with Medicare as primary payer, not be in Medicare Advantage or another Medicare health plan (including Special Needs Plans and PACE), not be in hospice, and not be a long-term nursing home resident. Since the performance year that began July 1, 2026, they must also live in a private residence or in a residential care community that CMS has approved as a partner of their GUIDE provider, and someone living in a memory care unit cannot be aligned. GUIDE respite is narrower still: for that performance year it is capped at $2,625 per eligible patient, paid by CMS to the participating provider, not the family, and only aligned patients with moderate or severe dementia whose primary caregiver is a relative or an unpaid nonrelative, and who do not live in assisted living or another residential care community, can get it.12 Not every provider takes part, so ask your doctor whether they are enrolled in GUIDE.

Respite for Dementia Caregivers

Respite is what makes the long haul survivable. In Virginia it comes from four doors: the CCC Plus waiver for eligible Medicaid members; the National Family Caregiver Support Program through your Area Agency on Aging; two DARS programs that are not Medicaid at all (the state-funded Respite Care Initiative, for caregivers of people 60 and older with dementia, and the Virginia Lifespan Respite Voucher Program, which has provided unpaid caregivers financial support of $595 per household per year); and licensed adult day centers. The Respite Care Initiative is limited to planned (not emergency), intermittent, part-time respite of no more than 40 hours a month, so it is not a source of emergency cover. For the full picture, see Respite Care in Virginia.5

One caution if you are counting on that voucher: DARS's published application limits voucher funding to a total of $595 per household, describes that funding as running until June 30, 2026 or until funds are exhausted, and says that because funding is limited, not all eligible applicants will be approved. That date has now passed, and Virginia's State Plan for Aging Services says DARS ran the program on a five-year federal grant from July 1, 2021 to June 30, 2026, so confirm with DARS's Division for Aging Services at 800-552-3402 that vouchers are still being issued before you build a plan around the money.5

Outside Medicaid, plan for cost: DARS's Dementia Capable Virginia pages say adult day programs typically charge a fee that private health insurance and Medicare do not cover, and that social respite programs typically charge too, though scholarships are often available.3

Safety, Behavior, and Planning

Dementia brings its own worries: wandering, driving, sundowning, and legal and financial planning. The Alzheimer's Association 24/7 Helpline (1-800-272-3900) offers support to caregivers any day of the year, but its staff do not give medical advice, diagnosis, or treatment, so bring memory and behavior changes to a qualified health care provider.2

Learn More

Find personalized help caring for a loved one with dementia in Virginia at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.