VA Aid and Attendance is a monthly pension benefit that can help a wartime veteran or a surviving spouse pay for memory care in Hawaii, where dementia care is among the most expensive in the country. It is paid on top of the basic VA pension when someone needs regular help with daily activities — exactly the kind of help a person living with Alzheimer's or another dementia comes to rely on.

If you are arranging care for a veteran parent, this guide walks through what the benefit pays in 2026, why a dementia diagnosis so often qualifies, how Hawaii's high care costs can actually help you become eligible, and how to apply for free.

In This Guide

Key Takeaways

  • In 2026, Aid and Attendance adds up to $2,424/month for a veteran, $2,874/month for a veteran with one dependent, and $1,558/month for a surviving spouse.
  • Hawaii has the highest long-term care costs in the nation — assisted living runs about $11,311 per month, and secured dementia care typically costs more.
  • A dementia diagnosis often meets the benefit's core test: needing help with daily activities or protection from everyday hazards.
  • Your memory-care bills can be deducted from the income the VA counts, which can make a veteran who looks "over income" eligible.
  • Free claims help is available from the Hawaii Office of Veterans' Services.

How Much Memory Care Costs in Hawaii

Hawaii has the highest long-term care costs in the nation. Per the Genworth/CareScout 2024 Cost of Care Survey — the most recent state-level data — assisted living in Hawaii runs about $135,735 per year, or roughly $11,311 per month, compared with a national median of about $70,800 a year. A semi-private nursing-home room runs about $181,040 per year and a private room about $196,370 per year. These are industry-survey medians, not government figures, and costs vary across the islands and rise as care needs grow.

Memory care is harder to price precisely in Hawaii. The state does not issue a stand-alone memory-care license, and its assisted living rule does not set separate requirements for dementia or memory-care units; instead, dementia care is provided within settings already licensed by the Hawaii Department of Health, such as an assisted living facility, an adult residential care home, or a community care foster family home, some of which offer a secured or specialized dementia program. Because there is no defined memory-care rate, the assisted-living figure of about $11,311 per month is a reasonable starting anchor; the added security and specialized staffing a dementia program provides typically push memory care above that standard assisted-living rate. When you compare facilities, ask each one directly how it staffs and secures its dementia program, what training caregivers receive, and how it keeps residents safe, and confirm those answers in writing before choosing.

How Aid and Attendance Helps Pay for Memory Care

Aid and Attendance is an increase added to the basic VA pension for people who need regular help with daily living — and that increase is money you can put toward a memory-care bill. The amounts below are the maximum monthly benefit for 2026 (effective December 1, 2025 through November 30, 2026).

Who is applying Maximum Aid and Attendance (2026)
Veteran, no dependents $2,424 / month
Veteran with one dependent $2,874 / month
Surviving spouse $1,558 / month

Against a memory-care bill that starts around $11,311 a month in Hawaii, the benefit will not cover the whole cost, but it can meaningfully close the gap — and, as the next sections explain, the size of that bill is also what often makes a veteran eligible in the first place.

Why Veterans With Dementia Often Qualify

The VA's "aid and attendance" test asks whether a person needs help with daily activities such as bathing, dressing, feeding themselves, or adjusting prosthetic devices, or whether they need protection from the ordinary hazards of their daily environment. A veteran living with Alzheimer's or another dementia commonly meets this test: as the disease progresses, they need hands-on help with daily care and supervision to stay safe from everyday dangers like wandering, the stove, or medications. A person who is a patient in a nursing home due to mental or physical incapacity can also meet the standard. The need is documented by a doctor on VA Form 21-2680, which is part of the application described below.

How Memory Care Costs Lower Your Countable Income

VA Pension, including the Aid and Attendance increase, is a needs-based benefit: the VA pays the difference between the veteran's countable income and a yearly limit set by Congress called the Maximum Annual Pension Rate (MAPR). Because the benefit is keyed to countable income, you can lower that income by deducting continuing, unreimbursed medical expenses — but only the portion of those expenses that exceeds 5% of the applicable MAPR is deductible. For 2026, that annual floor is $872 for a veteran with no dependents and $1,141 for a veteran with one dependent.

Memory-care costs count toward this deduction. The cost of care in a residential facility, including the meals and lodging the facility charges, is a deductible medical expense when the facility provides health care or custodial care and the veteran either qualifies for Aid and Attendance status or has a written statement from a physician, physician assistant, nurse practitioner, or clinical nurse specialist that they need that care or must live in a protected environment because of a cognitive or other disorder. That condition is a natural fit for memory care.

Here is the practical effect. Suppose a Hawaii memory-care bill of about $11,311 a month — roughly $135,735 a year. After subtracting the $872 annual floor, nearly all of that cost is deductible from the veteran's countable income. A veteran whose income first looked too high to qualify can become eligible once those large, recurring care costs are deducted, because they easily exceed the 5%-of-MAPR floor and can reduce or zero out countable income.

Who Qualifies

Beyond the need for aid and attendance, the VA Pension has three other requirements:

  • Wartime service. At least 90 days of active duty with at least one day during a wartime period (WWII, Korea, Vietnam, or the Gulf War/post-9/11 era). Gulf War service requires 24 months of continuous active duty or the full period called to active duty.
  • Age or disability. The veteran must be 65 or older, or permanently and totally disabled.
  • Net worth. Total net worth must be under $163,699 for 2026, which counts assets and annual income but excludes the primary home, vehicles, and basic household items. The same net worth limit applies to a surviving spouse.

Be aware of the look-back rule. The VA reviews any assets transferred for less than fair market value in the three years before you file, and a transfer made to qualify can create a penalty period of up to five years. If you have given away or sold assets below value recently, get advice before applying.

How Aid and Attendance Works with Hawaii Medicaid

For a Hawaii veteran who needs long-term care, VA Aid and Attendance and Hawaii Medicaid are separate programs that can interact. Hawaii administers Medicaid long-term care through Med-QUEST. Under general federal rules, the VA pension — including the Aid and Attendance increase — is counted as income for Medicaid long-term-care eligibility, but the portion of that pension paid because of unreimbursed medical expenses is generally not counted toward the Medicaid income limit. This mirrors the same federal mechanism the VA uses on its own side: it subtracts recurring care costs that exceed 5% of the MAPR when it calculates the pension, so the Aid and Attendance amount already reflects those care costs.

Because the exact income and asset treatment depends on the specific Med-QUEST program and the current limits, confirm the details with Med-QUEST and a Hawaii benefits counselor before relying on any particular outcome.

How to Apply and Get Free Help

There are two forms at the heart of an Aid and Attendance claim:

  1. VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), completed with a doctor's examination documenting the need for help.
  2. VA Form 21P-527EZ (Application for Veterans Pension), if the veteran is not already receiving a VA pension.

You can submit the forms online at va.gov, by mail, or through an accredited representative. Processing often takes three to six months or longer, so file as soon as the need is documented.

You do not have to do this alone, and you should not pay anyone to file an initial claim. The State of Hawaii Office of Veterans' Services (OVS) provides assistance with VA claims, forms, and appeals to veterans, their dependents, and survivors, including help obtaining pension benefits such as Aid and Attendance, and may act on their behalf to secure those benefits. OVS maintains counselors across the islands, and you can reach the office by phone at (808) 433-0420 to connect with one. As a government service office, OVS assistance is provided at no charge to the veteran.

Frequently Asked Questions

Does a dementia diagnosis automatically qualify a veteran for Aid and Attendance?

Not automatically, but it often qualifies. The benefit's test is whether the person needs help with daily activities or protection from everyday hazards, which a progressing dementia commonly meets. A doctor documents that need on VA Form 21-2680, and the veteran must also meet the wartime-service, age-or-disability, and net-worth requirements.

My parent's income seems too high. Can they still qualify?

Possibly. Aid and Attendance is needs-based, and you can deduct continuing, unreimbursed medical expenses that exceed 5% of the applicable MAPR — $872 a year for a veteran with no dependents — from the income the VA counts. A large memory-care bill can reduce or even zero out countable income, making a veteran who looked over income eligible.

How much will Aid and Attendance pay toward memory care in Hawaii?

In 2026, the maximum is $2,424 a month for a veteran, $2,874 for a veteran with one dependent, and $1,558 for a surviving spouse. Against a Hawaii memory-care bill that starts around $11,311 a month, the benefit helps close the gap rather than cover the full cost.

Will Aid and Attendance affect my parent's Hawaii Medicaid?

The two programs interact. Under general federal rules, the VA pension counts as income for Med-QUEST long-term-care eligibility, but the portion paid because of unreimbursed medical expenses is generally not counted. Because the treatment depends on the specific Med-QUEST program and current limits, confirm with Med-QUEST and a Hawaii benefits counselor before relying on any outcome.

Next Steps

Start by gathering the veteran's service and financial records and asking the memory-care facility for a written statement of the care it provides. Then have a doctor complete VA Form 21-2680, and file the claim — with free help from the Hawaii Office of Veterans' Services at (808) 433-0420 if you want a counselor to guide you.

Compare Care Settings in Hawaii

Aid and Attendance can help pay for any care setting. See how it works for the others:

Learn More

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.

BC

Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.