VA Aid and Attendance is one of the most overlooked ways to pay for in-home care in North Dakota. It is a monthly cash benefit added to a VA pension for veterans and surviving spouses who need help with everyday activities, and the money can go straight toward a home health aide, a homemaker, or a family member who provides the care. With in-home care costs adding up quickly, that steady payment can change what is affordable.

This guide explains what in-home care costs here, how much Aid and Attendance pays, how your care costs can actually help you qualify, and where to get free help applying.

In This Guide

How Much In-Home Care Costs in North Dakota

In-home care is a major expense. In its 2025 Cost of Care Survey, CareScout (the successor to the Genworth survey) combined the former homemaker and home health aide categories into a single non-medical caregiver service. In North Dakota that runs about $77,792 a year, or about $34 an hour on the survey's basis of 44 hours of care a week for 52 weeks, down about 15 percent from the 2024 survey. That sits a little under the national median of about $35 an hour, roughly $80,080 a year on the same basis. The survey also prices in-home skilled nursing separately: a private duty nurse runs about $4,420 a year in North Dakota, which is about $85 an hour at just 1 hour a week for 52 weeks.

These are survey medians, not government figures, and the real number depends on how many hours of care your loved one needs. A few hours a day costs far less than around-the-clock help, but even part-time care adds up quickly, which is why a steady monthly benefit matters.

How VA Aid and Attendance Helps Pay for Home Care in North Dakota

Aid and Attendance is a higher pension rate for veterans and surviving spouses who need another person's help with daily activities such as bathing, feeding, and dressing. The award is paid monthly as part of your VA pension, and you arrange the care yourself. Many North Dakota families put it directly toward a home health aide, a homemaker, or a family caregiver.

Who Maximum annual rate
Veteran, no dependents $29,093
Veteran with one dependent $34,488
Surviving spouse, no dependents $18,697

Read those figures as ceilings, not as checks. The VA sets the payment on the difference between your income for VA purposes and the rate that applies to you, so a household with countable income receives less than the number above. The VA publishes these rates as annual figures, and federal rules work out the monthly payment by subtracting your countable income from the rate, dividing by 12, and rounding down to the whole dollar. That is why the deduction in the next section matters so much: lowering the income the VA counts raises the check.

The VA does not run or provide the care itself, and it does not pick your aide or agency. It pays the benefit, and you arrange the care. A North Dakota veteran with one dependent and little countable income could be paid close to the full $34,488 rate over the year, enough to cover a meaningful share of a part-time aide or homemaker.

How In-Home Care Costs Lower Your Countable Income for Aid and Attendance in North Dakota

Here is the part many families miss. VA pension, including the Aid and Attendance increase, is a needs-based benefit: to be eligible, your yearly family income and net worth have to meet limits set by Congress. Because the benefit is keyed to your income for VA purposes, lowering that income is what opens the door.

What you pay an in-home attendant for help with daily activities and household tasks is a deductible medical expense. Only the portion of those costs above 5% of your annual MAPR is deductible. For 2026, that floor is $872 a year for a veteran with no spouse or child, rising with dependents to $1,141 for a veteran with one dependent, though it is never figured on the aid-and-attendance or housebound increase. The expenses also have to be unreimbursed, so whatever insurance or another program pays back does not count.

Three conditions apply to in-home attendant care specifically. The attendant has to provide health care or custodial care. The payments have to be commensurate with the number of hours the attendant actually attends to the person, so an open-ended monthly sum unrelated to hours worked will not hold up. And the attendant has to be a health care provider, unless the veteran needs aid and attendance or is housebound, or unless 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. Those last two exceptions are what let a family hire a non-clinical aide, or a relative, and still deduct the bill.

Say a veteran with no dependents pays $34,000 a year for an aide. Subtract the $872 floor, and about $33,128 can be deducted from countable income. That deduction can take a veteran who looked "over income" and bring them within the limit, and because the payment is the gap between countable income and the rate, a lower countable income also means a larger monthly check. So if your income looks too high on paper, apply anyway once care costs are in the picture.

Who Qualifies

To qualify for Aid and Attendance, the veteran must:

  • Not have received a dishonorable discharge.
  • Meet the wartime service requirement. The VA lists three service paths, and which one applies turns on when service began. For active duty that started before September 8, 1980: at least 90 days of active duty with at least one day during a wartime period. For enlisted service that started after September 7, 1980: at least 24 months (with some exceptions), or the full period for which the veteran was called or ordered to active duty, with at least one day during wartime. For an officer who started on active duty after October 16, 1981: the veteran must not have previously served on active duty for at least 24 months, with at least one day during wartime.,
  • Meet at least one of four age or disability tests. Be 65 or older; have a permanent and total disability; be a patient in a nursing home for long-term care because of a disability; or be getting Social Security Disability Insurance or Supplemental Security Income. Any one of the four is enough on its own, so a wartime veteran under 65 who receives SSI meets this test without an adjudicated permanent-and-total rating.
  • Need aid and attendance under the criteria at 38 CFR 3.352(a), such as being unable to dress or undress, keep clean and presentable, feed oneself, or attend to the wants of nature, or needing regular care to stay safe from the hazards of daily life. Being bedridden qualifies, as does being a patient in a nursing home because of a loss of mental or physical abilities related to a disability, as does eyesight of 5/200 or less in both eyes or a visual field contracted to 5 degrees or less.
  • Have a net worth below $163,699. The VA's net-worth calculation is the sum of the claimant's and their dependents' assets and their annual income, so comparing assets alone against the limit gives the wrong answer. Assets exclude the primary residence, a vehicle, and basic home items such as appliances.

The VA applies a 3-year look-back on assets transferred for less than fair market value before you file. A surviving spouse applies through Survivors Pension, which has its own Aid and Attendance rate and the same $163,699 net worth limit.

Using Aid and Attendance to Pay a Family Caregiver

Many North Dakota families want a son, daughter, or other relative to provide the care. The pension arrives as cash, so it can go toward paying that person, and what you pay an in-home attendant counts as a deductible medical expense on the conditions set out above, as long as the payments track the hours the attendant actually works.

There is also a VA program built around paying the people you choose. Veteran-Directed Care (VDC) is a VA Geriatrics and Extended Care program that gives enrolled veterans of all ages a flexible budget, managed by the veteran or a representative, to hire and supervise their own workers so they can keep living at home; with that budget, veterans may hire family, friends, and neighbors. Enrolled veterans are eligible if they are eligible for community care, meet the clinical criteria for the service, and the program is available. VA medical centers run VDC through aging and disability network agencies, such as an Area Agency on Aging, where an options counselor does the assessment and care planning, arranges fiscal management services, and offers ongoing support.

How Aid and Attendance Works with North Dakota Medicaid

Aid and Attendance and North Dakota Medicaid long-term care are separate programs administered by different agencies, the U.S. Department of Veterans Affairs and North Dakota Health and Human Services, and a veteran or surviving spouse can be eligible for both.

One federal rule dominates the nursing-home case. When an unmarried veteran or surviving spouse with no dependents is receiving Medicaid-covered nursing home care, no pension or survivors pension above $90 a month may be paid for any period after the month the Medicaid payments begin (38 CFR 3.551, implementing 38 U.S.C. 5503(d))., The statute leaves out a State home for which the VA pays a nursing-home per diem, so if the stay is in a North Dakota state veterans home, check whether the cap applies with an accredited service officer rather than assuming it does. That rule caps the pension. It is not a personal needs allowance, and it does not by itself set one; each state's post-eligibility treatment of income decides that, so the $90 must never be assumed to sit on top of a state's personal needs allowance and the two must never be added into a combined figure.

North Dakota's own rule addresses the $90 directly, and it treats the money as a disregard rather than as a personal needs allowance. Under N.D. Admin. Code § 75-02-02.1-38.1, "Post-eligibility treatment of income," the income that "may be disregarded" includes, "For so long as 38 U.S.C. 5503 remains effective, ninety dollars of veterans administration improved pensions paid to a veteran, or a surviving spouse of a veteran, who has neither spouse nor child, and who resides in a Medicaid-approved nursing facility." How that disregard combines with any other allowance North Dakota applies is set by that same state rule, so confirm it with North Dakota Health and Human Services rather than assuming the amounts add.

North Dakota Medicaid does cover long-term care, including nursing facility services, for eligible residents who meet the state's income and asset limits. Where the pension keeps being paid, because you have a spouse or dependents, say, eligibility is only the first step: income that was disregarded in determining eligibility must be considered in the share-of-cost calculation, so the Aid and Attendance amount does not automatically stay out of that step, even if it was set aside at eligibility, and it can raise what a nursing-facility resident owes., Whether it actually does turns on the state's own post-eligibility rule, which can exempt the Aid and Attendance portion, so confirm with North Dakota Health and Human Services how it treats a full-rate Aid and Attendance amount before counting on either answer., What a North Dakota nursing-facility resident then applies toward the cost of care is what remains after six deductions in the state's own rule, taken in this order: the nursing care income level; amounts for a spouse's or family member's maintenance needs; health insurance premiums; long-term care insurance premiums for you or your spouse; documented medical or remedial care expenses that no third party, including Medicaid and Medicare, pays; and the cost of a guardian or conservator, up to five percent of countable gross monthly income. Those are deductions North Dakota allows in working out what you owe, not benefits you apply for. Both the federal and North Dakota post-eligibility rules cover nursing facilities and other institutions, not home- and community-based waiver services, so if you are staying at home on a waiver, ask North Dakota HHS how it treats your Aid and Attendance rather than reading the nursing-facility arithmetic across. Note that this is a different rulebook from the VA one: the unreimbursed-medical-expense deduction described earlier lowers the income the VA counts, not the income Medicaid counts. Because the rules interact in complex ways and depend on marital status, dependents, and unreimbursed medical expenses, confirm your specific situation with a VA-accredited service officer and North Dakota HHS before relying on both benefits.

How to Apply and Get Free Help

The steps below are the pension route, the one this guide is about: the VA's own condition is that you may be eligible for Aid and Attendance if you get a VA pension. Everyone on that route files VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination section a medical examiner fills out. That same form also covers Aid and Attendance that will be added to monthly compensation, so a veteran who receives VA disability compensation rather than a pension uses it too, and does not use the pension application below. A wartime veteran pursuing the pension route who is not already receiving a VA pension also files VA Form 21P-527EZ (Application for Veterans Pension), the means-tested wartime pension application. If you are still gathering your information, you can submit VA Form 21-0966 (Intent to File) first: submitting an intent to file can secure the earliest possible effective date for any retroactive payments you may be eligible to receive. You can file online at VA.gov, by mail to the VA Pension Intake Center, in person at a VA regional office, or through an accredited representative. How long a decision takes, the VA answers, "It depends." It processes claims in the order it receives them, unless a claim requires priority processing.

Do not do this alone. North Dakota veterans and their dependents can get free help with VA benefits through the North Dakota Department of Veterans Affairs (NDDVA) and the County and Tribal Veterans Service Officers it trains and supports. NDDVA says county service officers provide free, professional assistance with health care, compensation, pensions, long-term care, and burial benefits, with all services provided at no cost to veterans and their dependents, and it describes tribal service officers the same way. Every North Dakota county is legally required to appoint and fund a service officer under NDCC 37-14-18 and 37-14-19, though one officer may serve more than one county, so don't assume there is a staffed office in your own. Find your local service officer through the NDDVA website at veterans.nd.gov.

What if your claim is denied? A denial is not the end. After an initial VA decision you have three decision review options: a Supplemental Claim (file new and relevant evidence the VA did not have before), a Higher-Level Review (a higher-level reviewer looks at the case, with no new evidence submitted), or a Board Appeal (a Veterans Law Judge at the Board of Veterans' Appeals reviews the case). You elect one of the three, not several at once: under 38 CFR 3.2500(b), once you have filed under one option you cannot file under a different one while that review is pending final adjudication. The menu narrows after that: following a Higher-Level Review decision your options are a Supplemental Claim or a Board Appeal, and following a Board decision, a Supplemental Claim or an appeal to the U.S. Court of Appeals for Veterans Claims, which must be filed within 120 days of the date on the Board's decision letter. That court appeal is filed with the Court, not with the VA, and a notice of appeal that is properly addressed and mailed is deemed received on the date of the legible U.S. Postal Service postmark on the envelope, so a notice postmarked inside the 120 days is timely even if the Court receives it after. A Higher-Level Review or a Board Appeal has to be elected within one year of the date the VA issues notice of its decision. The exception is a contested claim, where several people claim a benefit only one of them can receive: there the only review is a Board Appeal, filed within 60 days of the VA's notice. A Supplemental Claim can be filed at any time after that notice, but waiting has a cost. A Supplemental Claim the VA receives more than one year after the date on the decision notice takes an effective date no earlier than the date the VA receives it (38 CFR 3.2500(h)(2)), and continuous pursuit of the claim is broken unless the VA grants an extension of the one-year period for good cause (38 CFR 3.109(b)), so filing late can cost back pay running all the way to your original claim date. File inside the year even though the door stays open. An accredited attorney, claims agent, or Veterans Service Organization representative can help you request a review, and the VA's search tool finds one.

Frequently Asked Questions

Can Aid and Attendance be used to pay for in-home care in North Dakota?

Yes. The pension is paid to you as monthly cash and you arrange the care. Many North Dakota families use it to pay a home health aide, a homemaker, or a family caregiver. The VA does not arrange or provide the care itself.

How much does Aid and Attendance pay toward home care?

The maximum annual pension rate with Aid and Attendance is $29,093 a year for a veteran with no dependents, $34,488 with one dependent, and $18,697 for a surviving spouse. Those rates are ceilings, not payments: the VA pays the difference between your income for VA purposes and the rate that applies to you. Your income also has to fall within the limits Congress sets.

My income seems too high. Should I still apply?

Often, yes. Your ongoing in-home care costs count as unreimbursed medical expenses and can be deducted from your countable income, but only the portion above 5% of your annual pension limit ($872 a year for a veteran with no spouse or child, and more with dependents). Large care bills can bring an "over income" veteran within the limit.

Can I pay my daughter to care for me with this benefit?

Yes. The pension is paid to you as cash, so it can go to a daughter or another relative who provides the care, and what you pay an in-home attendant is a deductible medical expense when the conditions above are met and the payments track the hours worked. The VA's Veteran-Directed Care program is another route: it gives an enrolled veteran a flexible budget to hire their own workers, including family, friends, and neighbors.

Compare Care Settings in North Dakota

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

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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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