How Veterans Get In-Home Care Paid for by the VA (Homemaker and Home Health Aide Guide)

Does the VA pay for in-home care?

Yes. The VA's Homemaker and Home Health Aide program, usually written as H/HHA, pays a community home care agency to send a caregiver into a veteran's home. When it is approved, the VA pays the agency directly and the veteran pays nothing for the authorized hours.

This is one of the most underused benefits we see. Veterans who have been enrolled in VA health care for years often have no idea it exists, because it is not something the VA advertises. It comes up when someone asks for it.

What does the benefit actually cover?

H/HHA is non-medical care in the home. A caregiver helps with bathing, dressing, grooming, toileting, and transfers, and with the household side of things such as meal preparation, light housekeeping, laundry, and reminders about medication. It is the same work a private-pay client receives, paid for by the VA instead of the family.

It is not skilled nursing, and it is not a home health benefit. If the veteran needs wound care or physical therapy, that is a different referral through a different program, and the two can run at the same time.

Step 1: Confirm the veteran is enrolled in VA health care

H/HHA runs through the VA health care system, so enrollment comes first. A veteran who already sees a VA doctor is enrolled and can skip to step two.

A veteran who is not enrolled applies with VA Form 10-10EZ, which can be completed online at va.gov, by mail, or in person at a VA medical center. We can assist with helping speed up your processing time. The VA help line is 877-222-8387 and the staff there will walk through the application over the phone if that is easier than the website.

Do not skip this step assuming enrollment is impossible. Eligibility rules have expanded several times in recent years, and plenty of veterans who were turned away long ago now qualify. It costs nothing to apply.

Step 2: Ask the VA primary care provider for H/HHA by name

This is the whole ballgame. The referral originates with the veteran's VA primary care provider, so the request has to be made at a VA appointment, and it has to be specific.

Here is what to say, out loud, in the room:

"I would like to be evaluated for Homemaker and Home Health Aide services through Community Care. I am having trouble with bathing and dressing on my own, and my wife cannot lift me safely anymore."

Two things make that sentence work. It names the program correctly, which tells the provider exactly what to order rather than leaving them to guess. And it describes function, not feelings. "I need some help around the house" is a wish. "I cannot get out of the tub without someone pulling me up" is a clinical finding.

Before the appointment, write down the specific tasks that have become difficult, how often each one is a problem, and any falls or close calls in the last year with rough dates. Bring the list. Hand it to the provider. Appointments are short and memory is unreliable when someone is sitting on the paper-covered table trying to seem capable.

Step 3: The clinical assessment

The VA decides eligibility based on clinical need, not income. There is no means test for this benefit, and there is no requirement that the need be service connected. What matters is whether the veteran needs help with activities of daily living, and how much.

Typically a social worker or care coordinator gets involved and evaluates the level of need. Be candid during that conversation. The single most common reason a veteran gets fewer hours than they need is that they minimized their difficulties, out of pride, in front of the person deciding the hours. Family members should speak up if the veteran is understating things, kindly and in front of them, not in a hallway afterward.

Step 4: The referral goes to the Community Care Network

Once approved, the VA issues a referral through the Community Care Network. In California, that network is administered by TriWest. The referral goes to a credentialed community provider, which is where an agency like ours comes in.

The veteran can ask for a specific agency. If there is a preference, say so at the time of the request, because a referral already routed somewhere else takes longer to redirect than to aim correctly in the first place. A Precious Elder is a credentialed VA Community Care Network provider serving the South Bay.

Step 5: Care starts

The agency receives the authorization, calls the family, and schedules an in-home assessment. We meet the veteran, look at the home, learn the routine, and match a caregiver. Then care starts, usually within a week of the authorization landing.

The veteran never sees a bill for authorized hours. The agency bills the VA through TriWest.

How many hours does the VA authorize?

The authorization specifies a number of hours per week and an end date. The number is based on the clinical assessment, so it varies widely from one veteran to another. Some authorizations are a few hours a week. Some are substantially more.

Two practical points. First, the authorized hours are a cap, not a target, and hours worked beyond the authorization are not paid by the VA. A good agency tracks this closely and tells you before you cross the line rather than after. Second, families frequently want more hours than the VA authorized. That is completely normal, and the fix is straightforward: the VA hours cover part of the week and the family privately pays for the rest. We run this arrangement for a number of clients, with the VA block and the private block on the same calendar.

How does the authorization renew?

Every authorization has an end date. Put it on your calendar the day the authorization arrives, and ask your VA care team well ahead of that date how the renewal will be handled, so there is no gap in care.

If the veteran's condition has worsened, the renewal is also the moment to ask for more hours. Describe what changed since the last assessment, specifically.

What about respite for the family caregiver?

Respite care is a separate VA benefit, and it is meant for exactly the situation most families are in: a spouse or an adult child providing most of the care, running on empty, with no way to leave the house.

Respite covers periodic relief so the family caregiver can rest, work, travel, or attend to their own health. It is requested the same way, through the VA primary care provider, and it can exist alongside an H/HHA authorization. If you are the one holding everything together, ask about it by name. Nobody will offer it to you.

Why VA referrals stall, and how to unstick them

• Nobody asked for the program by name. "I need help at home" gets a sympathetic nod. "I would like to be evaluated for Homemaker and Home Health Aide services" gets an order. Use the program name.
• The veteran downplayed the need. A generation raised not to complain will describe a bad fall as a stumble. Bring a written list of what is actually hard and let the document say it.
• The referral was issued but never reached a provider. Referrals do get stuck in routing. If two weeks pass with no call from an agency, call the VA care coordinator and ask where the referral went and which provider received it.

Local VA facilities for the South Bay

Veterans in our service area are usually seen through the VA Long Beach Healthcare System or the West Los Angeles VA Medical Center. Both handle Community Care referrals. If the veteran is not sure which system holds their records, the VA help line at 877-222-8387 can sort it out in one call.

How A Precious Elder can help

We are a credentialed VA Community Care Network provider and we work with TriWest authorizations regularly, including the dual arrangement where VA hours and private hours sit side by side on one schedule. If you are trying to figure out where a referral is, what to say at the next appointment, or how many hours you actually need, call us at (310) 571-5852.