Take Control of Your Own Care: The Veterans Directed Care Program

If you are a veteran who needs help with daily activities like bathing, dressing, preparing meals, or getting around your home, the Veterans Directed Care (VDC) program puts you in the driver’s seat. Instead of the VA assigning you a home health agency or placing you in a facility, VDC gives you a personalized budget and the freedom to hire your own caregivers—including your own family members, friends, or neighbors—and decide exactly how to spend the money to meet your care needs.

This is not a small pilot program or a temporary experiment. Veterans Directed Care is an established VA benefit available to enrolled veterans of all ages who need personal care services and help with activities of daily living. It is modeled on the highly successful consumer-directed care approach that has been used in Medicaid programs across the country for decades. The core idea is simple: you know your needs better than anyone else, so you should control how your care dollars are spent.

Opportunity Snapshot

How Veterans Directed Care Works

The program operates on a straightforward model:

Assessment: A VA clinical team evaluates your care needs, including what activities of daily living you need help with, your medical conditions, your living environment, and your support system. Based on this assessment, the team determines the level of services you need.

Budget development: Working with a VDC counselor (provided by a local Aging and Disability Resource Center or Area Agency on Aging), you develop a spending plan that allocates your monthly budget across the services and supports you need. The budget amount is based on your assessed care needs—veterans with greater needs receive larger budgets.

Hiring and managing workers: You recruit, hire, train, and supervise your own care workers. This is the defining feature of VDC. You choose who comes into your home, what hours they work, and what tasks they perform. You can hire a family member (such as a spouse, adult child, or sibling), a friend, a neighbor, or a professional caregiver from an agency. The only restriction is that the worker must pass basic background checks and meet any state-specific requirements.

Ongoing support: Your VDC counselor provides ongoing assistance with managing the budget, processing payroll for your workers, handling employer paperwork (taxes, workers’ compensation), resolving problems, and adjusting services as your needs change. You are not alone in managing the program—the counselor is there to handle the administrative complexity so you can focus on your care.

What You Can Spend the Budget On

The VDC budget is flexible and can cover a wide range of services and supports that help you live independently. Common uses include:

Personal care workers: The primary expense for most participants. Workers help with bathing, dressing, grooming, toileting, transferring (getting in and out of bed or a wheelchair), eating, and mobility. You set the schedule based on when you need the most help—mornings, evenings, weekends, or all day.

Homemaker services: Help with cooking, cleaning, laundry, grocery shopping, and other household tasks that you can no longer manage independently. For many veterans, the inability to maintain their home is a primary driver of institutional placement. Homemaker services address this directly.

Companion services: A worker who provides supervision, socialization, and safety monitoring. This is particularly valuable for veterans with cognitive impairments or those who are isolated and at risk of falls or other emergencies when alone.

Respite care: Temporary relief for your primary caregiver. If a family member provides most of your care, the VDC budget can fund substitute caregivers to give your family member breaks—whether for a few hours, a weekend, or longer. Caregiver burnout is a leading cause of institutional placement, and respite care is a critical prevention tool.

Home modifications: Minor modifications to make your home safer and more accessible. Grab bars in the bathroom, ramp installation for wheelchair access, improved lighting, non-slip flooring, and other changes that reduce fall risk and improve mobility within your home.

Assistive devices and technology: Items that support your independence, such as raised toilet seats, shower chairs, reaching tools, medication management devices, or personal emergency response systems.

Transportation: Help getting to medical appointments, social activities, grocery stores, and other community destinations. For veterans in rural areas or without reliable personal transportation, this can be a lifeline.

Why VDC Is Different from Other VA Home Care

The VA offers several home care programs, but VDC stands apart in one crucial way: you control the budget and the hiring decisions.

VDC vs. VA Home Based Primary Care (HBPC): HBPC sends a VA clinical team to your home to provide medical care, but it does not provide personal care aides or homemaker services. VDC covers the daily living assistance that HBPC does not.

VDC vs. VA Homemaker/Home Health Aide Program: In this traditional program, the VA contracts with a home health agency that assigns workers to you. You get limited choice in who shows up, when they come, and what they do. VDC flips this model—you choose the worker, set the schedule, and direct the tasks.

VDC vs. VA Adult Day Health Care: Adult day programs provide care and activities at a VA or community facility during the day. VDC provides care in your home on your schedule. Some veterans use both programs depending on their needs.

VDC vs. VA Aid and Attendance: Aid and Attendance is an enhanced VA pension payment for veterans who need regular assistance. It provides a cash supplement to your pension but does not provide care coordination, counselor support, or employer-of-record services. VDC provides a managed care budget with infrastructure support, making it easier to hire and retain quality workers.

The Power of Hiring Family Members

One of the most transformative features of VDC is the ability to hire family members as paid caregivers. In most traditional VA and Medicaid programs, family caregivers provide care without compensation, often at enormous personal financial cost. They reduce work hours, leave jobs entirely, and sacrifice their own health and retirement savings to care for a loved one.

VDC changes this dynamic. A veteran’s spouse, adult child, sibling, or other family member can be hired as a paid personal care worker through the program. The family member receives a wage (set according to local labor market rates), has taxes properly withheld, and is covered by workers’ compensation insurance—all managed through the VDC fiscal intermediary.

This means the family member who is already providing care can receive fair compensation for their labor, maintain their own financial stability, and continue providing care without the resentment and burnout that come from unpaid, unrecognized work. For many veteran families, this single feature is the most valuable aspect of the entire program.

How to Enroll in Veterans Directed Care

Step 1: Talk to your VA social worker. If you are already enrolled in VA healthcare, contact the social work department at your VA medical center and express interest in Veterans Directed Care. If you do not have a social worker assigned to you, ask your primary care team for a referral.

Step 2: Complete a clinical assessment. The VA team will evaluate your care needs using standardized assessment tools. They will look at your ability to perform activities of daily living, your medical conditions, your cognitive status, your home environment, and your existing support system.

Step 3: Determine VDC availability. Not all VA medical centers offer VDC, and availability may depend on local partnerships with Aging and Disability Resource Centers. Your social worker can tell you whether VDC is available at your facility or can refer you to the nearest participating location.

Step 4: Meet with a VDC counselor. Once accepted into the program, you will be connected with a counselor from the local Aging and Disability Resource Center or Area Agency on Aging. This counselor helps you develop your spending plan, understand your responsibilities as an employer, and set up the logistical infrastructure for hiring workers.

Step 5: Develop your spending plan. With your counselor, create a detailed plan for how you will use your monthly budget. Identify who you want to hire, how many hours per week you need, and what other services or supports you want to purchase.

Step 6: Hire your workers and begin receiving services. Once your plan is approved, you recruit and hire your workers, orient them to your needs and preferences, and begin receiving care on your own terms.

Tips for Success in VDC

Be honest about your needs during the assessment. The level of your care budget depends directly on the assessment of your needs. Do not minimize your difficulties out of pride or stoicism. If you struggle with bathing, say so. If you fall frequently, report it. If you cannot cook safely, explain why. The more accurately the assessment reflects your actual situation, the more appropriate your budget will be.

Choose your workers carefully. The freedom to hire anyone is powerful, but it comes with responsibility. Look for people who are reliable, trustworthy, physically able to assist you, and willing to follow your directions. If hiring a family member, have a frank conversation about expectations, boundaries, and the employer-employee nature of the relationship.

Keep good records. Track your workers’ hours, maintain timesheets, and keep copies of your spending plan. Your VDC counselor handles most of the administrative work, but staying organized on your end makes everything run more smoothly and protects you during any review or audit.

Communicate with your counselor regularly. If your needs change, if a worker quits, if you want to adjust your spending plan, or if you have any concerns, contact your counselor promptly. The program is designed to be flexible and responsive, but it only works if you communicate.

Use the VA Decision Aid. The VA offers an online Veteran Decision Aid for Care at Home or in the Community that helps you evaluate which home care program best fits your needs. Access it through the VA Geriatrics and Extended Care website or ask your social worker for a copy.

Impact on Veterans and Families

Veterans Directed Care fundamentally changes the caregiving equation for veterans and their families. Instead of being passive recipients of whatever services the VA or a contracted agency chooses to provide, veterans become active directors of their own care. Research on consumer-directed care models consistently shows that participants report higher satisfaction, greater sense of control, better quality of life, and improved relationships with their caregivers compared to agency-directed models.

For family caregivers, the financial recognition provided by VDC is transformative. The National Alliance for Caregiving estimates that family caregivers of veterans spend an average of 14 hours per week providing care, with many spending 40 or more hours. The economic value of this unpaid labor runs into tens of thousands of dollars annually. VDC compensates a portion of this labor, reducing financial strain and allowing caregivers to sustain their efforts over the long term.

The program also reduces the likelihood of institutional placement. When veterans have adequate home-based support that they control and trust, they are more likely to remain safely at home rather than entering a nursing home or VA Community Living Center. This is not only what most veterans prefer—it is also significantly less costly for the VA and the healthcare system.

Frequently Asked Questions

Is VDC available to all veterans? VDC is available to enrolled veterans who are eligible for VA community care and meet the clinical criteria. Availability may vary by VA medical center, so check with your local facility.

Can I hire my spouse? Yes. Spouses are eligible to be hired as personal care workers under VDC. They receive wages, tax withholding, and workers’ compensation coverage through the fiscal intermediary.

What happens if my needs increase? Your care plan and budget are reassessed regularly. If your needs increase, the VA can adjust your budget upward to provide additional services.

Can I use VDC alongside other VA programs? Yes. VDC can complement other VA services such as Home Based Primary Care, telehealth, or VA medical appointments. Your care team coordinates across programs.

What if VDC is not available at my VA medical center? Ask your social worker about other VA home care options, including the Homemaker/Home Health Aide program, VA Aid and Attendance, or the VA Caregiver Support Program. These may provide some of the benefits you are looking for while VDC expands to more locations.

Contact Information and Resources

• VA Geriatrics and Extended Care: va.gov/geriatrics
• VA Caregiver Support Line: 1-855-260-3274
• Eldercare Locator (Aging and Disability Resource Centers): 1-800-677-1116 or eldercare.acl.gov
• VA social work referral: Contact the social work department at your local VA medical center

Veterans Directed Care represents the best of what veteran-centered care can be: flexible, respectful, empowering, and effective. If you are a veteran who needs help at home, this program lets you define what help looks like—on your terms, with the people you trust.