VA Caregiver Support Program: A Guide for Dementia Families

The VA Caregiver Support Program is the VA's service for family caregivers of veterans enrolled in VA health care. It runs two programs: the Program of General Caregiver Support Services, open to caregivers of veterans who served in any era, and the Program of Comprehensive Assistance for Family Caregivers, which adds a monthly stipend and health coverage for caregivers of eligible veterans with a service-connected rating of 70 percent or more.

For a family caring for a veteran with dementia, the split matters. Far more families can use the general program than the comprehensive one, and both start in the same place: the caregiver support team at the local VA, which the VA says is located at every VA facility.

The Program of General Caregiver Support Services, often shortened to PGCSS, may be right for you if you care for a veteran enrolled in VA health care, you provide personal care services, and you want more support or skills. You do not need to be a relative or live with the veteran.

VA.gov lists peer support mentoring, skills training, coaching, telephone support, online programs and referrals to available resources. The Caregiver Support Program site also mentions one-on-one coaching, group support and self-care. VA offers caregiver training through this program, and the Caregiver Peer Support Mentoring Program is open to caregivers of veterans of all eras.

There is no stipend in the general program, and no long application. You contact the caregiver support team or caregiver support coordinator at the nearest VA facility, or ask the veteran's VA health care team for a referral, and complete an intake. The veteran must agree to receive care from you and have you listed as their caregiver in their health record.

The Program of Comprehensive Assistance for Family Caregivers, or PCAFC, is the part people mean when they ask whether the VA pays family caregivers. The caregiver must be at least 18 and either a spouse, son, daughter, parent, stepfamily or extended family member, or someone who lives full time with the veteran or is willing to.

VA.gov says the veteran must meet all of these: a VA disability rating, individual or combined, of 70 percent or higher; a discharge from the military or a date of medical discharge; a need for at least six months of continuous, in-person personal care services; and enrollment in VA health care. The Caregiver Support Program site describes the rating as a serious injury or illness incurred or aggravated in the line of duty.

A veteran can name one Primary Family Caregiver and up to two Secondary Family Caregivers, who serve as backup to the primary caregiver when needed.

The VA defines personal care services as help with everyday personal needs, like feeding, bathing and dressing, and with safety, protection or instruction in the veteran's daily living environment. That second part is where dementia often shows up first.

The Caregiver Support Program lists three bases for needing personal care, and any one is enough: an inability to perform an activity of daily living; a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury; or a need for regular or extensive instruction or supervision without which the veteran's ability to function in daily life would be seriously impaired.

So a veteran who can still dress but cannot safely be left alone may still have a personal care need under these definitions. The VA makes that call in its own evaluation. The 70 percent service-connected rating is a separate requirement: a dementia diagnosis on its own does not open the comprehensive program, though the general program and the home services below remain available.

Primary and Secondary Family Caregivers can receive caregiver education and training, mental health counseling, and certain travel benefits when traveling with the veteran to receive care.

Primary Family Caregivers may also receive a monthly stipend; health care through CHAMPVA if they do not already qualify under another health plan; free legal and financial planning help; at least 30 days of respite care per year; telehealth therapy through the VA's virtual psychotherapy program for caregivers; and access to military commissaries and exchanges.

The stipend is based on the federal General Schedule annual rate for grade 4, step 1, in the locality where the veteran lives, divided by 12. Level one pays 62.5 percent of that monthly rate. Level two pays the full rate when the VA finds the veteran unable to self-sustain in the community. It is paid by direct deposit only, as the VA no longer issues paper checks.

Once in the program, you take part in wellness contacts at least once every 120 days, including one visit a year to the veteran's home.

The VA has published a final rule extending the transition period for legacy participants, legacy applicants and their Family Caregivers through September 30, 2028. The Caregiver Support Program says they will remain eligible and will not see their stipend decrease based on a reassessment during that period, with certain exceptions.

Separately, the VA proposed changes that would broaden the definition of serious injury, reassess eligibility less often, and expand and clarify the bases for finding a personal care need. The public comment period has closed, and the VA notes these changes are proposed and may change. Its suspension of required annual reassessments remains in place for now. If a past denial was close, ask your caregiver support team whether the final rule changes anything.

The veteran must be enrolled in VA health care first, using VA Form 10-10EZ if not already enrolled. For the comprehensive program, the veteran and caregiver apply together on VA Form 10-10CG, and both sign. You can apply online at VA.gov, mail the form to the 10-10CG Evidence Intake Center, PO Box 5154, Janesville, WI 53547-5154, or bring it to the caregiver support team at your nearest VA medical center. Do not send medical records with it.

With dementia, the veteran may not be able to sign. VA.gov says a representative needs legal authority to make decisions for the veteran, or to sign applications for them, and lists documents such as an Alternate Signer Certification, VA Form 21-0972, or proof your state accepts.

After you apply, the team contacts you, and you complete caregiver education and training and a home care assessment. The VA says it will assign you as a caregiver no later than 90 days after it gets your application. You can appeal or request a review if you disagree. The Caregiver Support Line, 1-855-260-3274 (TTY 711), is open Monday to Friday, 8 a.m. to 8 p.m. ET.

Homemaker and Home Health Aide care sends an aide, employed by an organization with a VA contract, to help with daily activities. Aides are not nurses and are supervised by a nurse. All enrolled veterans are eligible if they qualify for community care, meet the clinical criteria and the service is available. A copay may apply.

Respite care pays for someone to come to the home, or for adult day health care, while the family caregiver takes a break, and can cover a short nursing home stay when the family is away. Adult Day Health Care offers half or full days of activities, companionship and sometimes health services, usually several times a week.

Veteran Directed Care gives the veteran a budget, managed by the veteran or a representative, to hire their own workers, which might include a family member or neighbor. Home Based Primary Care brings a VA health care team, including visits from a physician, nurse practitioner or physician assistant, into the home.

Aid and Attendance is different again: a monthly payment added to a VA pension for veterans and survivors who need help with daily activities. Our guide to VA Aid and Attendance covers it. For copays on home services, the VA social worker can help you complete VA Form 10-10EC.

Confirm the veteran is enrolled in VA health care and find their latest disability rating letter. Call the Caregiver Support Line and ask to be connected to your local caregiver support team, then enroll in the general program whatever the rating.

If the rating is 70 percent or more, file VA Form 10-10CG, and sort out signing authority first if the veteran cannot sign. Ask the VA social worker about home health aide hours, respite, adult day health care, Veteran Directed Care and Home Based Primary Care, along with the Caregiver Self-Assessment and Veteran Decision Aid the VA provides.

If you need private help at home while VA applications move through, Dementia In Home sends 3 to 5 video profiles of caregivers with dementia experience within 48 hours, free. We are an independent, non-medical service, not part of the VA. Call (689) 333-6079.