VA Aid and Attendance for In-Home Care in Tennessee

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, so the money can go 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

• Key Takeaways
• How Much In-Home Care Costs in Tennessee
• How Aid and Attendance Helps Pay for In-Home Care in Tennessee
• How In-Home Care Costs Lower Your Countable Income for Aid and Attendance in Tennessee
• Who Qualifies
• Using Aid and Attendance to Pay a Family Caregiver
• How Aid and Attendance Works with Tennessee Medicaid
• How to Apply and Get Free Help
• What to Do if Your Claim Is Denied
• Frequently Asked Questions
• Learn More

How Much In-Home Care Costs in Tennessee

In-home care in Tennessee runs below the national median. According to the CareScout 2025 Cost of Care Survey, the Tennessee median for a non-medical caregiver is $31 an hour, or $70,928 a year for 44 hours of care a week.3 By comparison, the national median for a non-medical caregiver in 2025 was $35 an hour, or $80,080 a year at the same hours.3

In Tennessee, agencies providing this kind of non-medical help are licensed as personal support services agencies, and their workers help with self-care such as bathing, dressing and eating, plus household tasks such as meal preparation, laundry and shopping.3 These are industry-survey medians, not government figures, and CareScout publishes only the statewide figure, not rates for individual Tennessee cities.3 Even below the national median, 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.1 Because it comes as part of the monthly pension payment, 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). Each figure is a ceiling rather than a payment: the VA pays the difference between your income for VA purposes and that limit. The VA publishes these as annual rates but pays pension monthly; under 38 CFR 3.273, it subtracts your countable income from the annual rate and divides what's left by 12.1

Tennessee's median of $70,928 a year for a non-medical caregiver at 44 hours a week is well above even the $29,093 maximum veteran rate, so on its own the benefit pays for part-time in-home care rather than full-time care.3 Combined with other income, it can still help 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.1 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.1 Payments to an in-home attendant count as a medical expense when the attendant provides health care or custodial care and the payments match the hours worked. The attendant has to be a health care provider unless the veteran needs aid and attendance or is housebound, or a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist states in writing that the veteran requires the care the attendant provides.1

For example, a veteran with no spouse or child 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, which can lower it enough to qualify for the pension or increase the amount paid.1

Who Qualifies

To qualify for Aid and Attendance, a veteran generally must meet all of the following:2

• Wartime service: at least one day of active duty during a wartime period (such as World War II, Korea, Vietnam, or the Gulf War), plus a minimum length of service. A veteran who started active duty before September 8, 1980 needs at least 90 days; one who started as an enlisted person after September 7, 1980 generally needs 24 months or the full period they were called to serve.
• 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 meets it 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.1

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.2 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 as part of the monthly pension, the beneficiary can put it toward paying a relative who provides care at home. VA's rules also say that care from a relative or another member of the household does not prevent the VA from granting the allowance.2

If you want a more structured way to pay a family caregiver, ask your VA medical center about Veteran-Directed Care (VDC). VDC is a VA Geriatrics and Extended Care program that gives an enrolled veteran a flexible budget, managed by the veteran or their representative, to hire and supervise their own workers, including family, friends and/or neighbors.5 An enrolled veteran is eligible if they are eligible for community care, meet the clinical criteria for the service, and VDC is available where they live. VA medical centers deliver it through local aging and disability network agencies, which help plan the care and arrange fiscal management services.5

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.4 TennCare CHOICES provides long-term services and supports at home, in the community, or in a nursing facility for eligible adults 65 and older and adults 21 and older with physical disabilities. Its home care groups are Group 2, for people who qualify for nursing home care but choose care at home instead, and Group 3, for people who don't qualify for nursing home care but need care to delay or prevent it.4

VA pension income is treated in two separate steps. When TennCare decides financial eligibility, its policy excludes VA Aid and Attendance and Housebound allowances, so it's the basic pension amount, not the Aid and Attendance increase, that counts toward the income limit.4 The second step is the cost share someone already eligible owes. The federal share-of-cost rule usually pointed to (42 CFR 435.725) covers residents of nursing facilities and similar institutions, not CHOICES members receiving home care, so a veteran getting CHOICES services at home should ask TennCare which rule sets their cost share.4 For a nursing facility resident, an Aid and Attendance amount the VA is still paying at the full rate can count toward the patient liability. TennCare also states that the VA pension isn't limited to $90 a month for someone receiving home and community-based services.4 Confirm the rule that applies with TennCare or the office taking the application.4

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.4 Applicants should consult a benefits counselor familiar with both programs before filing.4

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."6

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.6 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."6 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.6

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.4 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."4 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.4

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:7

• 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. Outside a few narrow exceptions, 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.

You elect one of these reviews, not two at the same time: under 38 CFR 3.2500(b), once you have filed one you cannot file for a different one on the same claim or issue while that review is pending final adjudication, so the choice is worth getting right the first time.7 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. One exception is a contested claim, where several people claim a benefit only one can receive: that review goes only to the Board, within 60 days.7 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 file that one with the Court itself, not with the VA. If you mail the notice of appeal, it counts as received on the date of the U.S. Postal Service postmark on the envelope, so long as the notice is properly addressed to the Court and the postmark is legible, which means a notice postmarked inside the 120 days is timely even if it reaches the Court later.7

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.7

Compare Care Settings in Tennessee

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

• How Aid and Attendance Pays for Assisted Living in Tennessee
• How Aid and Attendance Pays for a Nursing Home in Tennessee
• How Aid and Attendance Pays for Memory Care in Tennessee

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.