VA Aid and Attendance can help pay for home care in Washington, DC, from an agency aide or a family member, by raising the pension a veteran who needs daily help can receive.,

If you've started sleeping over at your parent's place a few nights a week because bathing or dressing alone isn't safe anymore, you're probably weighing two hard choices: hire an aide, or cut your own hours at work. Both cost real money. CareScout puts DC's 2025 median for a non-medical caregiver at $86,944 a year, based on 44 hours a week. The pension is one piece of paying for that. The Washington DC VA Medical Center also delivers some care in veterans' homes directly, and DC Medicaid's EPD Waiver can fund a personal care aide for a veteran who qualifies.,

In This Guide

What In-Home Care Costs in DC

Seeing the yearly price of help at home for the first time can knock the wind out of you, especially when you've been providing that help for free. According to the CareScout Cost of Care Survey, whose DC results were released on March 2, 2026, the 2025 median annual cost of in-home care from a non-medical caregiver in DC was $86,944, based on 44 hours a week for 52 weeks. The DC figure showed no change from 2024, and it sits above CareScout's 2025 national median of $80,080 on the same basis.

Type of care DC 2025 median (annual) U.S. 2025 median (annual) What the figure is based on
Non-medical caregiver at home $86,944 $80,080 44 hours a week, 52 weeks
Adult day health care $28,600 $24,700 5 days a week, 52 weeks
Private duty nurse at home $3,900 $4,680 1 hour a week, 52 weeks

The DC private duty nurse median of $3,900 a year is priced on just one hour of nursing a week, so it isn't comparable to the 44-hour caregiver figure above it. These are CareScout survey medians, not government rates. CareScout collects its rates at the metropolitan-area level, and its one DC region also takes in Arlington and Alexandria, so an agency's quote for your parent's actual schedule may land above or below the median. For every care setting side by side, see our guide to the cost of senior care in DC, and for the full set of payment options, our guide on how to pay for in-home care.

How Aid and Attendance Helps Pay for Home Care in DC

VA Aid and Attendance is an increased monthly pension payment added to a VA pension, so on the pension route it arrives as part of the veteran's own pension payment. VA describes Form 21-2680 as the way to apply for Aid and Attendance benefits "that will be added to your monthly compensation or pension benefits."

On the pension route, qualifying raises the veteran's Maximum Annual Pension Rate (MAPR). VA says "Your MAPR amount is the maximum amount of pension payable," and the higher Aid and Attendance rate replaces the basic rate rather than arriving as a second payment on top of it. Because the pension is needs-based, keyed to income for VA purposes, the MAPR is a ceiling and not what every family receives. VA publishes the current annual maximums, by household size, on its Veterans Pension rates page; check them there against DC's $86,944 median for a full-time non-medical caregiver.

Set against a bill that size, the VA pension alone may not stretch far, and seeing that gap can be discouraging. The cost of care at home, though, is also what can make the pension larger.

How Home Care Costs Lower Your Countable Income

A glance at the income limit can make a family rule itself out too early. Please don't stop there. VA Pension, including its Aid and Attendance increase, is a needs-based benefit, and a claimant can lower their income for VA purposes by deducting unreimbursed medical expenses. The rule in 38 CFR 3.278(a) is plain that "Payments for such medical expenses must be unreimbursed to be deductible from income."

There's a floor. Only the part of unreimbursed medical expenses above 5% of the applicable VA pension MAPR counts, and VA's Veterans Pension page, as of September 2026, puts it this way: "If you have medical expenses, you may deduct only the amount that's above 5% of your MAPR amount ($872 for a Veteran with no spouse or child)." The floor rises with dependents, but it is figured on the MAPR excluding the Aid and Attendance or Housebound increase, so qualifying for Aid and Attendance doesn't raise it.

In-home care has its own rule, 38 CFR 3.278(d)(2). Payments to an in-home attendant for help with activities of daily living (ADLs) and instrumental activities of daily living (IADLs) count as medical expenses as long as the attendant provides the veteran with health care or custodial care, and the payments must be commensurate with the number of hours the attendant spends with the veteran. Our guide to unreimbursed medical expenses walks through the other expenses VA counts.

Can Aid and Attendance Pay a Family Caregiver in DC?

Asking this question can leave you feeling a little guilty. Wanting to be paid for hours you'd otherwise spend at a job is a fair question, not a selfish one.

Under 38 CFR 3.278(d)(2), VA's in-home attendant rule, the attendant must be a health care provider unless one of two things is true: the veteran needs aid and attendance or is housebound, or a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist states in writing that, because of a physical, mental, developmental, or cognitive disorder, the veteran requires the health care or custodial care the attendant provides. For a family member who isn't a licensed aide, that exception is the part that matters.

The same rule sets two conditions you'll want to meet on paper, not just in practice:

  • The care has to be real care. The attendant must provide health care or custodial care, and the regulation defines custodial care as regular help with two or more ADLs, or supervision because the person needs regular care to be protected from hazards in their daily environment.
  • The pay has to match the hours. Payments must be commensurate with the hours the attendant actually attends to the veteran, so keeping a simple record of the hours you work, and paying for those hours, gives VA something concrete to count.

A family caregiver doesn't block the pension increase itself, either. Under 38 CFR 3.352(c), VA's Aid and Attendance rule, the performance of the needed aid and attendance by a relative or another member of the household will not prevent VA from granting the additional allowance.

The pension isn't the only route to paying a relative. Veteran-Directed Care (VDC) is a VA program that gives a veteran a flexible budget for services, managed by the veteran or the family caregiver, and VA says the personal care aides a veteran hires "might include their own family member or neighbor." VA says all enrolled veterans are eligible for VDC if they meet the clinical need for the service and it is available, and that the program "is only available in certain locations." In the model VDC Veteran Handbook from the Administration for Community Living (ACL), a Person-Centered Counselor helps the veteran build a spending plan, and a financial management services provider acts as payroll agent, handling timesheets, payroll and taxes; ACL notes local programs can vary. Ask the veteran's VA social worker whether VDC is available through the DC VA.

VA's Own In-Home Care Through the DC VA

The U.S. Department of Veterans Affairs also delivers care at home directly through its health care system, which can matter as much as a check.

VA Washington DC health care says the Washington DC VA Medical Center, at 50 Irving St. NW, provides "medical care and rehabilitation services to Veterans in our Community Living Center and in their homes," with services that include home-based primary care, medical foster home support, and hospice and palliative care. The medical center's main number is 202-745-8000.

Nationally, VA's long-term care menu for veterans signed up for VA health care also includes homemaker and home health aide (H/HHA) services, adult day health care, respite care, skilled home health care, hospice care, and palliative care. Access to VA long-term care isn't automatic. VA says all three of these conditions must be true: the veteran is signed up for VA health care, VA concludes the veteran needs a specific service to help with ongoing treatment and personal care, and the service, or space in the care setting, is available near the veteran. Because of the availability condition, treat H/HHA, adult day health care, respite and VDC as VA programs to ask about, not as services guaranteed at the DC VA.

For a DC veteran, the VA pension, VA's own in-home care and DC Medicaid's EPD Waiver are run by different offices and open by different tests, as the table below lays out.,,

Route Who runs it What it provides What decides access
Aid and Attendance pension VA benefits side Higher maximum pension paid to the veteran Wartime service, need for help, income and net worth
VA in-home care (HBPC, H/HHA, respite, VDC) VA health care Care or a care budget delivered through VA VA health care enrollment, clinical need, local availability
EPD Waiver DC Department of Health Care Finance Personal care aide and other home services Medicaid financial rules plus a level-of-need assessment

What VA's home programs cost

Some veterans owe no copay at all because of their disability rating, income level, or special eligibility factors. For a veteran who isn't exempt, no copay is owed for the first 21 days of geriatric or extended care in a 12-month period; from the 22nd day, the copay depends on the level of care and the financial information on the Application for Extended Care Services (VA Form 10-10EC). In 2026, VA's copay for outpatient extended care such as adult day health care and daily respite is up to $15 a day, and VA respite care, overnight or daily, is available up to 30 days each calendar year. Those amounts are ceilings: under 38 CFR 17.111, VA's extended care copay rule, a veteran pays only to the extent the veteran and spouse have available resources, and for the first 180 days of care only income counts, with liquid and fixed assets counting from day 181.

38 CFR 17.111 says VA's adult day health care copay applies only "to the extent the veteran has available resources," and 38 CFR 17.111 exempts, among others, a veteran with a compensable service-connected disability and a veteran whose annual income is below the amount in effect under 38 U.S.C. 1521(b). Our guide to VA adult day care covers the day-program side in more depth. Respite can also come to you: VA says its Homemaker and Home Health Aide program can be used to get respite care at home for veterans and their family caregiver, through aides who work for an organization under contract with VA.

Do You Qualify for Aid and Attendance?

If you're trying to work out whether Dad qualifies, take VA's tests one at a time. Under VA's 2026 Veterans Pension rules, the veteran needs qualifying active-duty service with at least 1 day during a wartime period VA recognizes, no dishonorable discharge, and at least one of these: age 65 or older, a permanent and total disability, a nursing home stay for long-term care because of a disability, or Social Security Disability Insurance or Supplemental Security Income. VA also cautions that a veteran with an other than honorable, bad conduct, or dishonorable discharge may not be eligible, and names two ways to try to qualify: a discharge upgrade or a VA Character of Discharge review. On top of that, the veteran must need another person's help with daily activities like bathing, feeding and dressing, or meet another aid-and-attendance test, such as having to stay in bed, or spend a large portion of the day in bed, because of illness, or having severely limited eyesight.

For the pension year running December 1, 2025 to November 30, 2026, the net worth limit is $163,699, and VA's net worth figure includes both assets and income for VA purposes, excluding the primary home, the car, and basic home items. If money has already moved, say a gift to a grandchild in the last three years, read the next rule before you file, because a transfer VA counts can hold up the VA pension, for as long as five years, rather than just trim it. Under 38 CFR 3.276, VA also looks back 36 months before it receives the pension claim for assets transferred for less than fair market value that would otherwise have pushed net worth over the limit, and can impose a penalty period of up to 5 years. For the full rules, including how a surviving spouse qualifies, see our guide to VA Aid and Attendance in DC.

DC Medicaid Help at Home: The EPD Waiver

When the pension and VA's own programs still leave a gap, DC Medicaid may help fill it. The Elderly and Persons with Physical Disabilities (EPD) Waiver is a Medicaid home and community-based services waiver that lets DC residents who would otherwise need nursing home care get services at home or in an assisted living community. The waiver is operated by the Department of Long-Term Care within the DC Department of Health Care Finance, serves about 3,000 people, and the services the DC Department of Aging and Community Living lists include case management, Personal Care Aide (PCA) services, Personal Emergency Response Services, Services MyWay and assisted living.

DACL lists seven conditions, and meeting the age and residency ones alone isn't enough. An applicant must be a U.S. citizen or have qualifying immigration status, live in DC, be 65 or older (or 18 to 64 with a physical disability), have a DC Medicaid provider complete a Prescription Order Form, have Liberty Healthcare complete a face-to-face level-of-need assessment, have countable assets of no more than $4,000 for an individual, and meet the income limit or be able to meet the spend down obligation.

The EPD income limit is the federal Special Income Level: 300% of the Supplemental Security Income federal benefit rate, or $2,982 a month for an individual in 2026. DACL's own EPD page still shows the 2023 figure of $2,743, and the standard rises each year with the SSI cost-of-living adjustment.

If your parent gets Aid and Attendance, you'll wonder whether it counts against that limit. At the initial eligibility step, states that use SSI income rules do not treat VA aid and attendance and housebound allowances as income, and DC is one of the 1634 states where the Social Security Administration (SSA) makes the Medicaid eligibility decision, so outside the eight 209(b) states the allowance is not countable income at that step. Which rule governs after eligibility depends on the state and the care setting, so check DC's own rule for your parent's situation rather than assume. VA and Medicaid also count income and assets differently, so the order and timing of applying matter. Talk to an accredited representative before filing either one. Our guide to DC's EPD Waiver covers the application step by step.

Hiring a Home Care Agency Safely in DC

Letting a stranger into your parent's home is its own kind of worry. DC's licensing law gives you something concrete to check. Under D.C. Code § 44-501, a "home care agency" is an agency, other than a hospice, that directly provides skilled nursing and at least one other therapeutic service, which can include personal care, to a sick or disabled person at home. Under D.C. Code § 44-502, it is unlawful to operate a covered agency in DC without a license, and a license expires one year after it is issued or last renewed unless renewed.

DC Health lists home health agencies among the health care facilities it licenses and certifies, and DC's home care agency rules sit in 22-B DCMR Chapter 39. If your parent has Alzheimer's disease or another dementia, D.C. Code § 7-744.02's dementia training requirement covers home care agencies whose program participants have Alzheimer's disease or a related dementia, so it's fair to ask an agency how its aides are trained. For the difference between non-medical home care and skilled home health, see our DC home care vs. home health guide.

How to Apply and Get Help in DC

You don't have to put the claim together alone. The paperwork starts with VA Form 21-2680, the Examination for Housebound Status or Permanent Need for Regular Aid and Attendance, whose examination section a medical examiner must fill out. A wartime veteran who isn't already getting a VA pension also files VA Form 21P-527EZ, the Application for Veterans Pension. If you're still gathering records, VA Form 21-0966 (Intent to File) comes first; VA says it "can secure the earliest possible effective date for any retroactive payments you may be eligible to receive." You can apply online at VA.gov, by mail to the VA Pension Intake Center, or in person at a VA regional office.

In DC, the District's Mayor's Office of Veterans Affairs (MOVA) helps veterans and family members with federal VA claims through its District Veteran Service Officers, and its claims page lists VA Non-Service Connected Pension Claims among the claim types its team assists with. MOVA is at One Judiciary Square, 441 4th St NW, Suite #707 North; phone (202) 724-5454; email ova@dc.gov.

VA says an accredited Veterans Service Organization (VSO) representative's help on your claim is always free, while an accredited attorney or claims agent can charge fees. VA's benefits office for the District is the National Capital Region VA Regional Benefit Office at 1722 I St NW (800-827-1000), which encourages visitors to book an appointment through VA's VERA system.

Frequently Asked Questions

Can my dad get Aid and Attendance and DC's EPD Waiver at the same time?

Yes. VA pension, including Aid and Attendance, and DC Medicaid are separate programs run by different agencies under different applications, and an older veteran can qualify for and receive both at the same time.

What happens to Dad's VA pension if he later moves into a nursing home on DC Medicaid?

For a veteran with no spouse or child whose nursing home care Medicaid covers, federal law under 38 U.S.C. 5503(d) caps the VA pension at $90 a month. VA says the facility can't count that $90 as income toward the cost of care, and the veteran keeps the full $90 for personal expenses.

How long does VA take to decide an Aid and Attendance claim?

VA doesn't give a timeframe. Asked how long a decision takes, VA answers "It depends," and says it processes claims in the order it receives them unless a claim needs priority processing. Filing an Intent to File early can protect the start date for back payments while you gather paperwork.

Besides the aide's pay, what other costs can lower income for the VA pension?

Health insurance premiums can. Under 38 CFR 3.278(c)(5), premiums for Medicare Parts A, B and D and for long-term care insurance count as medical expenses for the VA pension, so the veteran can deduct them along with the aide's pay, subject to the same 5% floor.

Learn More

VA BenefitsVA Aid and Attendance in DCVA Aid and Attendance in Washington, DC for 2026: who qualifies, the $163,699 net worth limit, VA's annual pension ceilings, and where to get filing help in DC. VA BenefitsVA Benefits for Senior Care in DCHow VA health care, the DC VA Medical Center's nursing home, Aid and Attendance, and the Armed Forces Retirement Home help senior veterans in Washington, DC. VA BenefitsVA Aid and Attendance for Assisted Living in DCHow VA Aid and Attendance helps pay for an assisted living residence in Washington, DC: the fee deduction rule, who qualifies, EPD Waiver and OSSP, and help. VA BenefitsVA Aid and Attendance for Memory Care in DCDementia can qualify a DC veteran for VA Aid and Attendance. How the medical test works and how the benefit helps pay for memory care in Washington, DC. VA BenefitsVA Aid and Attendance for a Nursing Home in DCHow DC families pay for a veteran's nursing home: the DC VA Community Living Center, Aid and Attendance with private pay, DC Medicaid, and the $90 rule. VA BenefitsHow VA Aid and Attendance Pays for In-Home CareHow VA Aid and Attendance helps pay for in-home care in 2026: the amounts, paying a family caregiver, Veteran-Directed Care, and how to apply. Care TypesHome Care vs. Home Health in Washington, DCHome care vs. home health in Washington, DC: what Medicare won't pay for, what DC Medicaid's personal care aide benefit covers, and how DC licenses agencies. Care TypesCost of Senior Care in Washington, DCCost of senior care in Washington, DC: in-home care $86,944 a year, a nursing home $146,730 a year, every setting compared, plus DC vs. Maryland and Virginia. MedicaidHow DC Medicaid Pays for Care at Home: The EPD WaiverHow District of Columbia Medicaid HCBS waivers work in 2026: the EPD Waiver, who qualifies, what it covers, income and asset limits, and how to apply.

Find personalized help paying for in-home care for a veteran in DC 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.

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