VA Aid and Attendance is one of the most overlooked ways to pay for in-home care in Pennsylvania. It is a monthly cash benefit paid as part of 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. For a Pennsylvania family trying to keep a parent at home, that steady payment can change what is affordable.

This guide explains what in-home care costs here, how much Aid and Attendance can pay, 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 Pennsylvania

In-home care in Pennsylvania runs around the national line, but it is still a major expense. According to the CareScout 2025 Cost of Care Survey, in-home care from a non-medical caregiver runs about $77,792 a year, priced on 44 hours of care a week for 52 weeks, just below the national median of about $80,080 a year on that same 44-hour week.

These are survey medians, not government figures, and what you actually pay can vary with your loved one's care needs, which providers are available, and local market conditions. The real number for your family depends on how many hours of care your loved one needs. Either way, a steady monthly benefit takes pressure off the budget.

How Aid and Attendance Helps Pay for In-Home Care in Pennsylvania

Aid and Attendance is an increased monthly pension for veterans and surviving spouses who need another person's help with daily activities., VA can add the aid and attendance increase to monthly compensation benefits or to pension benefits. This guide covers the pension route, where VA's condition is that you may be eligible for this benefit if you get a VA pension. The VA pays the pension to the veteran or surviving spouse, not to a care provider. Many Pennsylvania families put it toward a home health aide, a homemaker, or a family caregiver.

Who Maximum Per Year
Veteran alone Up to $29,093
Veteran with one dependent Up to $34,488
Surviving spouse Up to $18,697

VA publishes these rates as annual maximums, but pension is paid monthly: VA subtracts your countable income from the annual rate, divides what is left by 12, and rounds down to the whole dollar. The maximum annual pension rate is a ceiling on what the VA will pay, not the amount it pays: the award is the difference between your income for VA purposes and that ceiling, so a household with other income receives less than the figures above. 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.

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

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 fall within limits Congress sets. Because the benefit is keyed to the income the VA counts, lowering that income is what opens the door.

When you have a genuine care need, your ongoing in-home care costs count as unreimbursed medical expenses (UMEs) that you can deduct from your income. Only the portion of those costs above 5% of your applicable maximum annual pension rate is deductible. For 2026, that floor is $872 a year for a veteran with no spouse or child, and it rises for a veteran with dependents, though it never reflects the Aid and Attendance increase itself.

In-home care has its own rule, at 38 CFR 3.278(d)(2). Payments to an in-home attendant for help with activities of daily living and instrumental activities of daily living are medical expenses as long as the attendant provides health care or custodial care, and the payments have to be commensurate with the number of hours the attendant actually spends attending to the person. The attendant must be a health care provider unless the veteran needs aid and attendance, 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 care the in-home attendant provides.

Say a veteran with no spouse or child pays $30,000 a year for an aide. Subtract the $872 floor, and about $29,128 can be deducted from countable income. That deduction can take a veteran who looked "over income" and bring them within the limit. 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, and must:

  • Meet the wartime service test, which turns on when service began. The VA lists three paths. Someone who started active duty before September 8, 1980 needs at least 90 days of active duty with at least one day during a wartime period. Someone who started active duty as an enlisted person after September 7, 1980 needs at least 24 months (with some exceptions), or the full period for which they were called or ordered to active duty, again with at least one day during wartime. Someone who started active duty as an officer after October 16, 1981 and had not previously served on active duty for at least 24 months is the VA's third path, again with at least one day during wartime
  • Meet at least one of four alternatives, any one of which satisfies this test on its own: 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. A wartime veteran under 65 who receives SSI qualifies here without any adjudicated disability rating
  • Meet one of the care-need tests. Need another person's help on a regular basis with daily activities (dressing or undressing, keeping clean and presentable, feeding yourself, attending to the wants of nature, adjusting a prosthetic or orthopedic appliance), or need regular care to protect you from the hazards of your daily environment; or be bedridden; or be a patient in a nursing home because of a loss of mental or physical abilities related to a disability; or have 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, which combines the claimant's and dependents' assets and income for VA purposes; assets exclude the primary residence, the car, and basic home items like appliances. The home's exclusion covers its lot up to 2 acres, and marketable land beyond that counts as an asset.

Staying at home does not disqualify you. Nursing-home care appears above as one alternative way to satisfy those tests, never as a requirement, and needing regular help with daily activities at home satisfies the care-need test on its own.

The VA applies a 3-year look-back on assets transferred for less than fair market value before you file, and a transfer that would have pushed net worth over the limit can trigger a penalty period of up to five years. A surviving spouse can qualify under the Survivors Pension, which carries its own rates and the same $163,699 net-worth limit.

Using Aid and Attendance to Pay a Family Caregiver

Many Pennsylvania families want a son, daughter, or other relative to provide the care. What the VA pension rules address is the money side: payments to an in-home attendant for help with daily activities count as deductible medical expenses when the attendant provides health care or custodial care, the payments are commensurate with the hours worked, and either the veteran needs aid and attendance or is housebound, or a clinician certifies in writing that the veteran requires that care. Keep records of the hours and the payments.

There is also a VA program built for this. Veteran-Directed Care (VDC) is a VA Geriatrics and Extended Care program that gives the veteran a flexible budget, managed by the veteran or their representative, to hire and supervise their own workers, and through that budget the veteran may also hire family, friends, and neighbors. Enrolled veterans are eligible if they are eligible for community care, meet the clinical criteria for the service, and it is available. VA medical centers deliver VDC through aging and disability network agencies, such as Area Agencies on Aging, whose options counselors assess needs, plan care, arrange fiscal management services, and provide ongoing support. Ask your VA social worker whether VDC is available in your area.

How Aid and Attendance Works with Pennsylvania Medicaid

Aid and Attendance is part of the federal VA pension, administered by the U.S. Department of Veterans Affairs, separately from Pennsylvania Medical Assistance (Medicaid), which is run by the Pennsylvania Department of Human Services (DHS). The two programs are run by different agencies under different rules, and a veteran or surviving spouse can receive both at the same time.

For the VA pension, the portion of unreimbursed care costs above VA's 5% threshold (explained above) can be deducted from countable income, which can raise the benefit. Pennsylvania Medical Assistance handles VA pension income in two separate steps. At the eligibility decision, states apply SSI income rules to aged, blind, and disabled applicants, and under SSI rules the aid and attendance and housebound allowances are not income, so it is the basic VA pension amount, not the Aid and Attendance increase, that counts toward the income limit; a state that uses eligibility criteria more restrictive than SSI may count it differently, so ask DHS how a VA pension will be treated in your own case. At the share-of-cost step, which applies once someone is eligible and living in a nursing facility, federal rules say income disregarded at eligibility must be considered, but Pennsylvania's own regulation (55 Pa. Code § 181.452) leaves the Aid and Attendance portion of a resident's VA pension out of the income that goes toward the cost of care. Only that portion is left out, not the whole pension, and the exception is a beneficiary VA has found incompetent, when VA states in writing that the benefit should be counted toward cost of care. A federal cap can also shrink the pension itself: for a veteran with no spouse or child, or a surviving spouse with no child, in a nursing facility under a Medicaid plan, VA pays no more than $90 a month in pension after the month of admission, and the facility can't reduce its Medicaid payment by that $90. Whether a State Veterans Home stay falls under the cap depends on whether VA pays that home a per diem for nursing home care, so check it with an accredited veterans service officer; where VA does pay that per diem, a different federal rule governs, so confirm with DHS how it treats the pension in that case. For the income that does count, the state must then subtract the deductions that calculation requires before it bills the rest, and incurred medical expenses that no third party pays are one of those deductions rather than the whole list. Do not assume medical expenses are the only thing that comes off: ask DHS which deductions apply in your case and in what amounts, including anything set aside for the person's own personal needs or for a spouse still living at home. That nursing-facility rule does not cover someone receiving Community HealthChoices (CHC) services at home, so a CHC household should confirm its own share of cost with DHS. Because the two programs count income and assets differently, VA pension income can affect your eligibility or share of cost, so the order and timing of applying can matter. Consult a VA-accredited representative or an elder law attorney before applying.

How to Apply and Get Free Help

The form that carries the request is VA Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination section a medical examiner has to fill out. It covers Aid and Attendance that will be added to your monthly compensation or pension benefits, so it is not limited to pension claimants.

The steps here are the pension route. On that route, a wartime veteran who is not already receiving a VA pension also files VA Form 21P-527EZ (Application for Veterans Pension), the wartime, means-tested pension application. If you receive VA disability compensation rather than a pension, ask an accredited representative which route fits your case before filing 21P-527EZ. You can file online at VA.gov, by mail to the VA Pension Intake Center, or in person at a VA regional office, and an accredited representative can help you file.

How long does a decision take? The VA's own answer is "It depends." It works through claims in the order it receives them, unless a claim requires priority processing.

Do not do this alone, and do not pay anyone to file. Pennsylvania veterans can get free help applying for county, state, and federal veterans benefits, including the non-service-connected disability pension, through the Pennsylvania Department of Military and Veterans Affairs (DMVA) and the County Directors of Veterans Affairs, accredited service officers who help identify benefits, determine eligibility, and prepare applications, and who never charge for their assistance. County directors are often located at the county courthouse, and DMVA's toll-free line is 1-800-547-2838. As of January 2026 the DMVA counted more than 200 accredited veterans service officers across Pennsylvania, all free to use, reachable through the department, county offices, and several veteran service organizations.

Frequently Asked Questions

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

Yes. Aid and Attendance is paid as part of the monthly VA pension to the veteran or surviving spouse, not to a care provider, so the household applies it to the in-home care bill. Many Pennsylvania 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 pension with Aid and Attendance is up to $29,093 a year for a veteran, up to $34,488 a year with one dependent, and up to $18,697 a year for a surviving spouse. VA publishes these rates as annual maximums; the monthly payment is the annual rate minus countable income, divided by 12 and rounded down to the whole dollar. Those are ceilings rather than payments: the VA pays the difference between the income it counts for your household and that limit, which is why deducting care costs matters.

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 applicable annual pension rate ($872 a year for a veteran with no spouse or child, and higher for a veteran 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?

Often, yes, and the payments can count as a deductible medical expense if the daughter provides health care or custodial care, the payments match the hours she works, and either the veteran needs aid and attendance or is housebound, or a clinician certifies the veteran requires that care. VA's Veteran-Directed Care program also gives an enrolled veteran a flexible budget to hire their own workers, including family, friends, and neighbors, if the veteran is eligible for community care, meets the clinical criteria, and the program is available. Ask your VA medical center social worker whether it is available locally.

Compare Care Settings in Pennsylvania

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

Learn More

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Your next step Find personalized help using VA benefits to pay for in-home care in Pennsylvania 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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