VA Aid and Attendance is one of the most useful and most overlooked ways to help pay for in-home care in Washington. For a veteran or surviving spouse who qualifies for a VA pension, it is paid as part of that monthly pension, and because it arrives as cash, the money can go straight toward an aide who comes to the house. With Washington's home health aide costs among the highest in the country, that monthly check can be the difference between keeping a parent at home and not.

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

In This Guide

How Much In-Home Care Costs in Washington

Washington's long-term care costs exceed the national medians in every setting, and in-home care is among the costliest in the country. According to the CareScout 2025 Cost of Care Survey (the Genworth/CareScout survey released in 2026 and the most recent state-level data), a non-medical caregiver in the home runs a median of about $8,580 a month, or roughly $102,960 a year, in Washington on a 44-hour-per-week basis.

The 2025 survey merged what used to be two separate lines, a homemaker (errands, meals, and housekeeping) and a home health aide (hands-on help with bathing, dressing, and similar daily tasks), into a single non-medical caregiver category. These are industry-survey medians, not government figures, and the Seattle metro runs higher than rural counties. Either way, paying for in-home care out of pocket adds up fast, which is why an extra monthly benefit matters.

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

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. That is the pension route, and it is the one this guide covers. Aid and Attendance is not limited to it: VA's own examination form, Form 21-2680, is used to apply for Aid and Attendance benefits "that will be added to your monthly compensation or pension benefits," so a veteran already receiving VA disability compensation seeks it on the compensation side instead. On the pension route, the benefit 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 2026 maximums (rates effective December 1, 2025 through November 30, 2026). Each one is a ceiling rather than a payment: VA pays the difference between the limit and your income for VA purposes, so a claimant with income receives less. VA publishes these rates as annual maximums, so a monthly amount is the yearly award divided by 12.

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

Against Washington's roughly $102,960-a-year cost for a non-medical caregiver, a veteran's $29,093 ceiling covers a meaningful share of part-time in-home care, and countable income reduces the actual award below it. It rarely covers full-time care on its own, but combined with other income it can keep a loved one safely at home.

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

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, 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 that exceeds 5% of the applicable Maximum Annual Pension Rate (MAPR) counts. For 2026, that floor is $872 per 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 or housebound increase. In-home attendant care counts as a medical expense when the attendant is a health care provider, when the person needs aid and attendance or is housebound, or when a physician, physician assistant, certified nurse practitioner, or clinical nurse specialist puts in writing that a physical, mental, developmental, or cognitive disorder makes that care necessary.

For example, a veteran paying for an in-home aide might spend $28,000 over a year on that care. The first $872 does not count, but the remaining roughly $27,000 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.
  • Age or disability, on any one of four paths: 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. Meeting any single one satisfies this test, so a wartime veteran under 65 on SSI qualifies here without a permanent-and-total rating.
  • A need for aid and attendance: need help with daily activities such as bathing, dressing, or eating, have to stay in bed or spend a large portion of the day in bed because of illness, be in a nursing home due to the loss of mental or physical abilities related to a disability, or have severely limited eyesight.
  • Net worth under $163,699 from December 1, 2025 through November 30, 2026. VA's net worth calculation includes your and your dependents' assets and annual income for VA purposes, so comparing savings alone against the limit gives the wrong answer; the primary home, a vehicle, and basic household goods are excluded.

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 members 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 Washington Medicaid

For a Washington senior who also needs Medicaid long-term care through Washington Apple Health, administered by the state Health Care Authority, the interaction matters because Apple Health counts most income when determining eligibility and a client's share of cost. Under Washington's published Apple Health rules, however, the Aid and Attendance allowance, the housebound allowance, and amounts a veteran's pension includes for unreimbursed medical expenses are not countable income for SSI-related Apple Health and must be split out from the total VA payment.

In other words, the medical-expense and attendance portions of a VA pension are generally excluded, while the basic pension amount is treated as income. This mirrors the general federal Medicaid rule that the Aid and Attendance and unreimbursed-medical-expense portion of a VA pension is set aside rather than counted.

That exclusion governs eligibility only. Once a person is eligible and receiving nursing-facility care, income that was disregarded in deciding eligibility must be considered again in the post-eligibility calculation under the federal rule at 42 CFR 435.725, so the Aid and Attendance amount is counted back in against the client's participation in the cost of care under Apple Health. The agency must then subtract the deductions that rule requires before the remainder is billed, and incurred medical expenses that no third party pays are one of them. Ask the Health Care Authority or your DSHS case manager which deductions apply and in what amounts, including whether anything is set aside for the client's own personal needs or for a spouse still living at home, before you budget on the gross figure. A client on a home and community-based waiver also has a post-eligibility calculation, but the rules that set it are the agency's to state rather than something to assume from the nursing-facility rule.

How to Apply and Get Free Help

Every Aid and Attendance claim starts with 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.

The steps that follow are the pension route, which is what this guide covers: VA's condition is that you may be eligible for this benefit if you get a VA pension. On that route, a wartime veteran who is not already receiving a VA pension files a pension claim as well, on Form 21P-527EZ (Application for Veterans Pension). That form is the wartime, means-tested pension application, so it belongs to the pension route only, and a veteran whose Aid and Attendance would be added to monthly disability compensation should not be sent to it. 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 attorney, claims agent, or Veterans Service Organization representative can file the claim for you. Asked how long a decision takes, VA answers "It depends," and says it processes 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 an initial claim. Washington veterans and their families can get help filing VA Pension and Aid & Attendance claims through the Washington State Department of Veterans Affairs (WDVA), a full-service state agency that describes itself as an advocate for veterans and their families and says it aggressively pursues all federal and state benefits and entitlements on their behalf. Its Veterans Service Offices and statewide referral service are staffed with qualified Service Officers who help with VA Disability Compensation, VA Pension or Widows Pension, Aid & Attendance, and health care benefits, and who represent veterans in cases adjudicated with the U.S. Department of Veterans Affairs in Seattle. WDVA's claims assistance page tells families to locate a Service Officer near them, and lists 1-800-562-2308 and benefits@dva.wa.gov.

Frequently Asked Questions

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

Yes. On the pension route, Aid and Attendance is paid in cash as part of the 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?

The 2026 maximum is $29,093 a year, about $2,424 a month, for a veteran alone; $34,488 a year, or $2,874 a month, for a veteran with one dependent; and $18,697 a year, about $1,558 a month, for a surviving spouse. VA publishes these as annual maximums, so the monthly figure is the yearly award divided by 12. They are ceilings, not payments: VA pays the difference between the limit and your countable income.

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, higher with dependents, from the income it counts, 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 Washington Apple Health?

Often yes. Under Apple Health rules, the Aid and Attendance allowance and the unreimbursed-medical-expense portion of a VA pension are not counted as income, though the basic pension amount is. That exclusion applies to eligibility; once someone is enrolled and receiving nursing-facility care, the Aid and Attendance amount does count toward their participation in the cost of care, after the agency takes the deductions that calculation requires. Incurred medical expenses that no third party pays are one of those deductions and not the only one, so ask the Health Care Authority or a DSHS case manager what else comes off, including anything set aside for the client's own personal needs or for a spouse still living at home. A waiver client also has a post-eligibility calculation, but the agency's own rules set it.

Compare Care Settings in Washington

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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