VA Aid and Attendance is one of the most useful and most overlooked ways to help pay for in-home care in Tennessee. It is paid as part of a veteran's or surviving spouse's monthly VA pension, and because it arrives as cash, the money can go straight toward an aide who comes to the house. For a family trying to keep a parent at home rather than move them to a facility, that monthly check can be the deciding factor.

This guide explains exactly how Aid and Attendance works for in-home care, how much it pays in 2026, who qualifies, and how to get free help filing the claim.

In This Guide

How Much In-Home Care Costs in Tennessee

In-home care in Tennessee runs meaningfully below the national median. According to the CareScout 2025 Cost of Care Survey, the statewide median for personal care or a home health aide is about $23 to $27 per hour, which works out to roughly $50,000 to $62,000 a year for 44 hours of care a week. By comparison, the national median for a non-medical caregiver in 2025 was about $35 per hour.

An aide helps with hands-on daily tasks such as bathing and dressing, while companion care covers errands and supervision. These are industry-survey medians, not government figures, and rates vary by metro, with Nashville generally higher than the Tri-Cities. Even at Tennessee's lower rates, paying for steady in-home care out of pocket adds up, which is why an extra monthly benefit matters.

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

Aid and Attendance is an increased monthly VA pension for a qualifying veteran or surviving spouse who needs help with daily activities. It raises the ceiling on the pension itself rather than paying a second benefit on top of the basic rate. It is paid as cash, so unlike a benefit that only covers care at a specific facility, the money can go toward an in-home aide, a homemaker, or other care costs at home.

Here are the maximum amounts payable in 2026 (rates effective December 1, 2025 through November 30, 2026). The VA publishes annual rates; a monthly amount is the yearly award divided by 12. Each figure is a ceiling rather than a payment: the VA pays the difference between your income for VA purposes and that limit.

Category Maximum Annual Amount Approximate Monthly
Veteran alone $29,093 about $2,424
Veteran with one dependent $34,488 $2,874
Surviving spouse $18,697 about $1,558

Against Tennessee's roughly $25-an-hour cost for non-medical home care, the maximum veteran rate covers a meaningful block of part-time in-home care each month. It rarely covers full-time care on its own, but combined with other income it can keep a loved one safely at home.

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

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 income for VA purposes, recurring out-of-pocket care costs can be subtracted from the income the VA counts, which can make a family that looked "over income" eligible after all.

The rule has a floor. Only the portion of your unreimbursed medical expenses above 5% of the applicable Maximum Annual Pension Rate (MAPR) counts, and that MAPR excludes any aid-and-attendance or housebound increase. The VA states the deduction 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. In-home attendant care counts as a deductible medical expense when the veteran needs aid and attendance or is housebound, or when a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist states in writing that the care is required.

For example, a veteran paying for an in-home aide might spend $18,000 over a year on that care. The first $872 does not count, but the remaining roughly $17,000 can be subtracted from countable income, often lowering it enough to qualify for the pension or increase the amount paid.

Who Qualifies

To qualify for Aid and Attendance, a veteran generally must meet all of the following:

  • Wartime service: at least 90 days of active duty with at least one day during a wartime period (such as World War II, Korea, Vietnam, or the Gulf War). Gulf War service has its own length-of-service rules.
  • No dishonorable discharge.
  • Any one of four situations: 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 single one of the four satisfies this test, so a wartime veteran under 65 on SSI qualifies without a permanent and total rating.
  • A need for aid and attendance: need help with daily activities such as bathing, dressing, or eating, or be bedridden, in a nursing home due to incapacity, or have severely limited eyesight.
  • Net worth under $163,699 for 2026, which counts the claimant's and any dependents' assets and income but excludes the primary residence, the car, and basic household items.

The VA reviews asset transfers made for less than fair market value during the three years before you file, so it is worth planning ahead. A surviving spouse can qualify under the Survivors Pension version of the benefit.

Using Aid and Attendance to Pay a Family Caregiver

Because Aid and Attendance is paid to the beneficiary as part of the monthly pension, families commonly use it to help compensate a relative who provides care at home.

If you want a more structured way to pay a family caregiver, ask your VA medical center about Veteran-Directed Care (VDC). VDC gives a veteran a flexible, clinically set budget to hire their own caregivers, including family, friends and/or neighbors and even a spouse, with a financial management service handling payroll. Eligibility requires VA enrollment, a clinical need for personal care, and risk of needing institutional care. VDC is a separate program from the Aid and Attendance pension, but the two can both support care at home.

How Aid and Attendance Works with Tennessee Medicaid

Aid and Attendance and TennCare, Tennessee's Medicaid program, are separate programs run under different rules, and a Tennessee veteran or surviving spouse can receive both at the same time. VA pension income is treated in two separate steps: for aged, blind, and disabled applicants, TennCare determines financial eligibility using SSI income rules, and under those rules the VA aid and attendance allowance isn't income, so it's the basic pension amount, not the Aid and Attendance increase, that counts toward the income limit. But once someone is eligible and receiving nursing facility or CHOICES waiver services, income disregarded at eligibility has to be counted in the patient liability, so the Aid and Attendance amount does count toward what they owe the facility, after the state deducts incurred medical expenses. Confirm the rule that applies with TennCare or the Tennessee Department of Human Services office taking the application. The two programs also cover different costs: Aid and Attendance is a flexible cash benefit that can pay for in-home care, while TennCare CHOICES covers long-term care services.

Because VA pension income factors into any patient liability or cost share, the order and timing of applying can affect eligibility for one or both. Applicants should consult a benefits counselor familiar with both programs before filing.

How to Apply and Get Free Help

Aid and Attendance is an increase added to a VA benefit you already have or are claiming, so the route depends on which benefit that is. The steps below are the pension route, the one this guide is about: the VA's condition is that "You may be eligible for this benefit if you get a VA pension." A veteran who receives VA disability compensation instead is on a different route, and Form 21-2680 covers Aid and Attendance "that will be added to your monthly compensation or pension benefits."

On the pension route you use two VA forms: Form 21-2680 (Examination for Housebound Status or Permanent Need for Regular Aid and Attendance), whose examination information section a medical examiner fills out to document the need for help, and Form 21P-527EZ (Application for Veterans Pension), the wartime, means-tested pension application, which a wartime veteran pursuing the pension route files if they are not already receiving a VA pension. 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. If you are still gathering records, you can file Form 21-0966 (Intent to File) first, because as the VA puts it, "Submitting an intent to file can secure the earliest possible effective date for any retroactive payments you may be eligible to receive." On how long a decision takes, the VA's answer is "It depends." It works claims in the order it receives them, unless a claim qualifies for priority processing.

Do not do this alone. The Tennessee Department of Veterans Services (TDVS) operates State Veterans Services field offices across the state that help veterans file claims for federal VA benefits, and TDVS points veterans to those offices for claims assistance and expertise. The federal benefits the VA administers include disability compensation and pension, and the VA describes Aid and Attendance as "monthly payments added to the amount of a monthly VA pension for qualified Veterans and survivors." That is the VA's wording for a higher pension ceiling, not a second check stacked on the basic rate. According to the VA, the services an accredited VSO representative provides on your VA benefit claims are always free, though an accredited attorney or claims agent can charge you fees. You can find your local TDVS State Veterans Services Office and make an appointment with a Veterans Resource Coordinator through the state's veterans field-office directory at tn.gov/veteran.

What to Do if Your Claim Is Denied

A denial is not the end of the road. If the VA denies your Aid and Attendance claim or grants less than you expected, you have three decision-review options after that initial decision:

  • Supplemental Claim: file new and relevant evidence the VA did not have when it reviewed the case before, such as an updated Form 21-2680 documenting a greater care need. You can file one at any time after the VA issues notice of a decision. A Supplemental Claim the VA receives more than a year after the date on the decision notice takes an effective date no earlier than the day the VA receives it, so filing late can cost back pay reaching to the original claim date.
  • Higher-Level Review: ask a higher-level reviewer to take a fresh look at the same evidence; no new evidence is submitted.
  • Board Appeal: appeal to the Board of Veterans' Appeals and have a Veterans Law Judge review the case.

A Higher-Level Review or a Board Appeal has to be elected within one year from the date the VA issues notice of its decision on the claim, which is the limit for most VA benefits; certain benefits have shorter ones, and the decision letter names the deadline. The menu narrows as a case moves along: after a Higher-Level Review decision your options are a Supplemental Claim or a Board Appeal, since there is no second Higher-Level Review, and after a Board decision they are a Supplemental Claim or an appeal to the U.S. Court of Appeals for Veterans Claims, which has to be filed within 120 days of the date on the Board's decision letter.

You do not have to navigate this alone either. An accredited Veterans Service Organization representative, attorney, or claims agent can help you choose the right option and file the request, and the VA's accredited-representative search tool will find one near you.

Frequently Asked Questions

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

Yes. Aid and Attendance is paid in cash as part of a monthly VA pension, so the money can go directly toward an in-home aide, a homemaker, or other care at home. It is not tied to a specific facility, which makes it well suited to families keeping a loved one at home.

How much does Aid and Attendance pay in 2026?

Up to $29,093 a year (about $2,424 a month) for a veteran alone, up to $34,488 a year ($2,874 a month) for a veteran with one dependent, and up to $18,697 a year (about $1,558 a month) for a surviving spouse. The VA publishes these as annual rates, and each one is a ceiling rather than a payment: the VA pays the difference between your income for VA purposes and the limit.

Does my parent's income disqualify them if it looks too high?

Not necessarily. The VA subtracts unreimbursed care costs above a yearly floor of $872 for a veteran with no spouse or child, and the floor rises with dependents, so families that look over the limit often still qualify once in-home care costs are counted.

Can a veteran get both Aid and Attendance and TennCare?

Yes, a veteran or surviving spouse can receive both. When TennCare evaluates eligibility it uses SSI income rules, under which the aid and attendance allowance isn't income (the basic pension amount counts), but once someone is eligible and receiving long-term care services, the Aid and Attendance amount does count toward their patient liability. Timing matters, so consult a benefits counselor familiar with both programs before filing.

Compare Care Settings in Tennessee

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

Learn More

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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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