VA benefits for senior care in North Dakota cover more than most families realize. If your loved one is a veteran, the VA offers home-based medical care, nursing homes, monthly cash payments, and more. The challenge usually isn't eligibility. It's knowing what to ask for.

This guide covers every VA program that helps pay for or provide senior care, how to access them in North Dakota, and what happens when VA care isn't enough on its own.

In This Guide

VA Senior Care Benefits in North Dakota: Long-Term Care Options

The VA offers multiple long-term care programs. Access isn't automatic once a veteran is enrolled: VA also has to conclude the veteran needs that specific service for their ongoing treatment and personal care, and the service, or a space in the care setting, has to be available near them. That test isn't closed: VA says it may also consider other factors, like the veteran's service-connected disability status or insurance coverage.

Home Based Primary Care (HBPC)

A VA physician supervises a health care team that visits the veteran at home. HBPC is designed for veterans with complex medical needs who have difficulty getting to a clinic regularly. The team typically includes a doctor, nurse, social worker, and may include rehabilitation therapists and a dietitian.

This isn't the same as home health care through Medicare. HBPC provides ongoing, coordinated primary care at home, not just short-term skilled visits. For veterans who qualify, it's one of the best programs the VA offers.

Adult Day Health Care

Veterans attend a structured daytime program that provides social activities, companionship, recreation, care, and support. It also gives family caregivers reliable daytime respite. Programs may be at VA facilities or contracted community adult day centers.

Community Living Centers (VA Nursing Homes)

Community Living Centers are VA nursing centers designed to feel like home, providing nursing-home-level care. They serve veterans who need short-term rehabilitation (after surgery or hospitalization), long-term nursing care, hospice care, or respite care.

For North Dakota veterans, the nearest CLC may be at a VA medical center in the region. Your VA social worker can help you find the closest option and confirm eligibility.

Community Nursing Home Program

The VA contracts with community (non-VA) nursing homes so veterans can get nursing home care near home. The VA covers this care for eligible veterans, though an extended-care copay can apply: none for the first 21 days of care in a 12-month period, and starting on the 22nd day the VA bases the copay on the level of care being received and the financial information provided on the Application for Extended Care Services (VA Form 10-10EC). In a largely rural state like North Dakota, this program matters: it lets a veteran receive nursing home care closer to home rather than traveling hundreds of miles to a VA facility.

Respite Care

All enrolled veterans are eligible for VA respite care if they meet the clinical criteria for the service and it is available. Through the VA Program of Comprehensive Assistance for Family Caregivers (PCAFC), eligible Primary Family Caregivers receive at least 30 days of respite care per year. Respite can be in-home (a substitute caregiver comes to the house, or the veteran attends an adult day health care program) or facility-based (the veteran stays temporarily in a CLC or community nursing home), and Nursing Home Respite Care is available for a maximum of 30 days per calendar year. Contact the VA Caregiver Support Line at 1-855-260-3274.

Not sure which VA program fits your family's situation? Chat with Brevy to get a personalized recommendation.

North Dakota Veterans Home

North Dakota operates one State Veterans Home, the North Dakota Veterans Home, located at 1600 Veterans Drive in Lisbon, on a 90-acre wooded campus bordering the Sheyenne River. It has served honorably discharged veterans and their spouses since 1893, and provides two levels of long-term care across 142 private rooms and 4 semi-private rooms, each with its own bathroom.

Care Level Details
Basic Care For residents who independently care for their own needs; requires total independence with personal care such as bathing, dressing, eating, walking, toileting, and transferring, with medical and nursing supervision available; 98 beds
Skilled Care Nursing home care for residents who need ongoing nursing supervision or help with activities of daily living; a licensed Medicare/Medicaid provider; 52 beds

Specific eligibility and admission requirements are set by the Home. Contact the North Dakota Veterans Home directly for current availability, rates, and admission policies.

VA Aid and Attendance

The Aid and Attendance pension is a monthly cash benefit for veterans (or surviving spouses) who need help with daily activities.

2026 Rates

The VA sets these as maximum annual amounts ($29,093 for a veteran alone, $34,488 with a spouse, $18,697 for a surviving spouse), and the monthly figure is that yearly rate divided by 12.

Category Monthly Amount
Veteran alone Up to $2,424
Veteran with spouse Up to $2,874
Surviving spouse Up to $1,558

Who Qualifies

To be eligible, the veteran must:

  • Have served during a wartime period
  • Have no dishonorable discharge
  • Meet at least one of four conditions: be at least 65 years old, 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
  • Need regular help with daily activities
  • Have a net worth below $163,699. VA's net worth calculation includes the claimant's and their dependents' assets and their income for VA purposes, so comparing assets alone against the limit gives the wrong answer; the primary home isn't counted,

The VA enforces a 3-year look-back period on asset transfers.

How to Apply

Apply using VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination information section a medical examiner completes, and Form 21P-527EZ (Application for Pension). The VA does not publish an expected processing time for these claims; it works through them in the order it receives them, unless a claim qualifies for priority processing.

Don't do this alone. The North Dakota Department of Veterans Affairs and the County and Tribal Veterans Service Officers it trains and supports provide free help with VA claims, including pensions and long-term care benefits, at no cost to veterans and their dependents.

For the full application walkthrough, see our VA Aid and Attendance guide.

Veteran-Directed Care

The Veteran-Directed Care (VDC) program gives veterans a flexible budget to hire their own caregivers, including family members. The veteran (or their representative) decides who provides care, what services to purchase, and how to manage the budget.

A financial management services provider helps the veteran manage the employer responsibilities of being the hiring party. This is a good option for veterans who want control over their care and prefer family members as caregivers. Veterans may hire family, friends, and/or neighbors, including a spouse: unlike the VA Pension and Aid and Attendance benefit, VDC has no prohibition on paying a spouse to provide the care.

Contact your local VA medical center's social work department to ask about VDC availability in your area.

Community Care Through the MISSION Act

The VA MISSION Act of 2018 has, since 2019, let an enrolled veteran get care from a community (non-VA) provider at the VA's expense. Two requirements always apply: you must be enrolled in or eligible for VA health care, and you must have approval from your VA health care team before you get care from a community provider, except in certain cases like urgent or emergency care. At least one of six additional conditions must also be true, including:

  • The VA can't provide the care within its standards for wait times: 20 days (primary care, mental health, and extended outpatient care) or 28 days (specialty care)
  • Your average drive time to a VA facility exceeds 30 minutes (primary care, mental health, and extended outpatient care) or 60 minutes (specialty care)
  • The service you need isn't provided at any VA health facility
  • You and your VA provider agree that care from an in-network community provider is in your best medical interest
  • You qualified under the 40-mile distance requirement as of June 6, 2018, and you live in North Dakota (the same condition covers Alaska, Montana, South Dakota, Wyoming, or another location that would still make you eligible under those requirements)

On May 19, 2025, the VA streamlined the "best medical interest" pathway by implementing language in the Dole Act (Public Law 118-210, enacted January 2, 2025) that removes the extra step of review by a second VA doctor, giving eligible veterans faster access to community care.

For North Dakota veterans in rural areas far from a VA medical center, the MISSION Act can be the difference between getting timely care and waiting months.

How VA Senior Care Benefits in North Dakota Work with Medicare and Medicaid

VA benefits don't replace Medicare or Medicaid, a veteran isn't required to enroll in Medicare to keep VA health care, and a veteran or surviving spouse can often qualify for a VA pension and Medicaid at the same time., But the two don't coordinate or pay each other: you choose which coverage to use each time you get care, and VA health care isn't creditable coverage for Medicare Part B, so delaying Part B while relying on the VA alone leaves a lifetime penalty that grows every year.

  • VA + Medicare: Many veterans use both. Medicare covers care from non-VA providers, while VA covers care at VA facilities. You can't bill both for the same service, but having both gives you more options.
  • VA + North Dakota Medicaid: Aid and Attendance and North Dakota Medicaid long-term care are separate programs run by different agencies, and a veteran or surviving spouse can be eligible for both. North Dakota Medicaid covers long-term care, including nursing facility services, for eligible low-income residents who meet the state's income and asset limits. One important federal rule: when an unmarried veteran or surviving spouse with no dependents is receiving Medicaid-covered nursing home care, no VA pension (including Aid and Attendance) in excess of $90 per month will be paid to or for the beneficiary for any period after the month in which the Medicaid payments begin (38 CFR 3.551). That federal rule caps the pension; it does not itself set North Dakota's Medicaid personal needs allowance, which is fixed by the state's own post-eligibility rule. North Dakota's rule, N.D. Admin. Code § 75-02-02.1-38.1 ("Post-eligibility treatment of income"), lists among the income that may be disregarded, 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. Where the pension keeps being paid (to a beneficiary with a spouse or dependents, say), eligibility is only the first step: income disregarded in deciding eligibility must still be counted in the share-of-cost calculation, so the Aid and Attendance amount does count toward the cost of care. What the resident owes is what remains after a set of deductions the agency must make, taken in order: an allowance for the resident's own personal needs, an allowance for the maintenance needs of a spouse still at home, an allowance for the maintenance needs of other family at home, incurred medical or remedial care costs that Medicaid does not cover, and any SSI or state supplement the resident keeps receiving. Those are deductions the state must make, not benefits a family has to ask for. North Dakota is one of the eight states that use Medicaid eligibility rules more restrictive than SSI, so 42 CFR 435.725, the section that governs institutional post-eligibility treatment in most states, does not on its own settle the calculation here, and the amounts come from North Dakota's own post-eligibility rule. A beneficiary receiving home and community-based waiver services rather than Medicaid-covered nursing home care is in a different calculation again, which 42 CFR 435.725 does not settle either. Confirm both with North Dakota Health and Human Services before planning around a figure.,

Because these 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 Health and Human Services before relying on both benefits.

How to Get Started

1
Step 1

Confirm VA health care enrollment

If the veteran isn't already enrolled in VA health care, apply at va.gov/health-care/how-to-apply. Once you're enrolled, the VA assigns you to one of eight priority groups based on military service history, disability rating, income level, whether you qualify for Medicaid, and other benefits you may be receiving, with veterans who have service-connected disabilities assigned the highest priority. Some veterans are exempt from copays because of their disability rating, income level, or special eligibility factors.

2
Step 2

Get free help before you file

Don't file claims or applications alone. The North Dakota Department of Veterans Affairs provides personalized assistance with claims (find your local service officer at veterans.nd.gov), as do the County and Tribal Veterans Service Officers it trains and supports, who provide free, professional assistance with health care, compensation, pensions, long-term care, and burial benefits at no cost to veterans and their dependents.

3
Step 3

Gather records

You'll need the veteran's DD-214 (discharge papers), medical records documenting the need for care, and financial information. If you can't find the DD-214, the National Personnel Records Center can provide copies (request through va.gov).

Frequently Asked Questions

Do you have to be service-connected disabled to get VA long-term care?

Not for all programs. The VA assigns veterans with service-connected disabilities the highest priority, and the lowest priority to veterans who earn a higher income and have no service-connected disability. Priority Group 1, the highest, covers a service-connected disability the VA has rated 50% or more disabling, a service-connected disability the VA has concluded makes the veteran unable to work, or receipt of the Medal of Honor. Some veterans are exempt from copays because of their disability rating, income level, or special eligibility factors. But other enrolled veterans can access many programs too, depending on their priority group and available resources. Aid and Attendance doesn't require a service-connected disability at all. It requires wartime service, no dishonorable discharge, need for help with ADLs, and at least one of these: 65 or older, permanently and totally disabled, a patient in a nursing home for long-term care because of a disability, or receiving Social Security Disability Insurance or Supplemental Security Income.

Can a veteran's spouse live in the North Dakota Veterans Home?

In some cases, yes. The North Dakota Veterans Home serves honorably discharged veterans and their spouses, though specific eligibility and admission requirements are set by the Home. Contact the Home directly for current admission policies.

How long does it take to get Aid and Attendance approved?

The VA does not publish an expected processing time for these claims; it works through them in the order it receives them, unless a claim qualifies for priority processing. A North Dakota County or Tribal Veterans Service Officer can help you prepare and file the claim at no cost. You can apply while your loved one is already receiving care.

Does the VA pay for assisted living?

The VA doesn't directly operate assisted living facilities, but Aid and Attendance is paid to the veteran as an increase to the monthly VA pension, and the household can put that money toward assisted living. The cost of the care itself can also count as a deductible medical expense when VA calculates the award, but only if the veteran is receiving health care or custodial care in the facility and either needs aid and attendance, is housebound, or a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist has stated in writing that they need to be in a protected environment. Veteran-Directed Care is a different tool: its flexible budget is for hiring and supervising workers who help a veteran live at home or in their community, so ask the VA social worker making the referral whether it fits an assisted living plan. The North Dakota Veterans Home's Basic Care unit is a different thing: it is designed for residents who care for their own needs independently, requiring total independence with bathing, dressing, eating, walking, toileting, and transferring, so it isn't a substitute for assisted living once hands-on help is needed.

Next Steps

If you're caring for a veteran who needs help, start by finding your local County or Tribal Veterans Service Officer through the North Dakota Department of Veterans Affairs at veterans.nd.gov. They can assess which benefits apply and help you file, free of charge.

Learn More

VA BenefitsVA Aid and Attendance in North DakotaVA Aid and Attendance in North Dakota for 2026: who qualifies, pension maximums up to $34,488 a year (about $2,874 a month), how to apply, and free local help. Care TypesHome Care vs Home Health in North DakotaHome care vs. home health in North Dakota: home health is skilled care Medicare covers; home care is non-medical help it won't. It decides who pays. Care TypesNursing Homes in North DakotaNursing homes in North Dakota in 2026: a semi-private room runs about $138,335/year, above the national median. What it costs, who pays, and how to choose. Care TypesCost of Senior Care in North DakotaWhat senior care costs in North Dakota in 2026: assisted living about $56,745 a year, a nursing home about $138,335. See every setting and how to pay. Care TypesAssisted Living vs Nursing Home in North DakotaAssisted living vs. nursing home in North Dakota: about $4,729/mo private-pay assisted living vs. $138,335/year skilled nursing, and who pays differs sharply.
Your next step Find personalized help navigating VA senior care benefits in North Dakota 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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