For families who want control over who comes into the home, Veteran-Directed Care (VDC) puts the budget in the veteran’s hands.
How it works
VDC is for veterans who need help with daily activities like bathing and dressing or tasks like fixing meals, who are isolated, or whose caregiver is under strain. Veterans get a flexible budget, managed by the veteran or family caregiver, to decide on the mix of services, hire personal care aides (which may include a family member or neighbor) and buy items and services that help them live independently1.
Who qualifies
Veteran-Directed Care is part of VA’s standard medical benefits package, so every enrolled veteran is eligible if VA finds a clinical need and the service is available locally2. Not every VA medical center offers every program, so ask a VA social worker what exists near you.
VDC is only available in certain locations, and a copay may apply depending on service-connected status1.
VDC vs. the caregiver stipend
VDC is different from the Program of Comprehensive Assistance for Family Caregivers, which pays a stipend to a designated family caregiver of a veteran with a serious service-connected injury3.
How to ask
Worked example
A veteran with Parkinson’s needs help bathing, dressing and cooking. His VA team finds he meets the clinical need and VDC is offered locally. He receives a flexible budget and, with his daughter managing it, hires a neighbor for mornings and his grandson for evenings, and uses part of the budget for a shower chair1. If VDC weren’t offered in his area, the team could arrange agency aides through homemaker and home health aide care instead6.
Copays
A copay may be charged based on service-connected disability status1. Extended care copays don’t apply at all to veterans with a compensable service-connected rating7. Ask the social worker to run VA Form 10-10EC.
Step by step
- Talk to your VA social worker to find out if VDC is offered where you live1.
- Have needs assessed, including daily activities and caregiver strain1.
- Decide who will manage the budget: the veteran or the family caregiver1.
- Choose and hire aides, which can include family or neighbors1.
- Review the plan as needs change.
Planning tools VA recommends
VA suggests using its Veteran Decision Aid for Care at Home or in the Community and the Caregiver Self-Assessment, which help families decide what home or long-term care fits now and later and how much the caregiver can take on1.
Common mistakes
How the budget and hiring work
In Veteran-Directed Care, VA works with a local aging and disability network agency, often an Area Agency on Aging or Aging and Disability Resource Center, which helps the veteran plan care and manage a flexible budget based on assessed needs9. The veteran, or a representative, decides who to hire, including family members or neighbors, and sets their schedules. A financial management service handles payroll and taxes for the workers91.
The budget can also cover some goods and services that help the veteran live at home, when they fit the care plan1.
Is self-direction a good fit?
- Good fit: a family with a trusted relative or neighbor willing to work regular hours, and someone organized enough to approve timesheets.
- Harder fit: no one available to hire, or no one able to act as the representative if the veteran has dementia.
- Consider instead: agency homemaker and home health aide care, where VA arranges the agency, or the PCAFC caregiver stipend for veterans rated 70% or more63.
Using VDC when a veteran has dementia
A veteran with memory loss can still use VDC through a representative who makes hiring and budget decisions on the veteran’s behalf9. Hiring a familiar person can reduce agitation compared with rotating agency staff. For care settings outside the home, see our Alzheimer’s care guide.
When needs change
The budget is based on assessed needs, so ask for a reassessment if the veteran’s condition worsens9. If home care is no longer enough, the team can help plan a move to a medical foster home or VA nursing home care10.