Veteran-Directed Care (VDC): A VA Budget the Veteran Controls — and Family Can Be Hired

These are the easy-to-miss angles — the early-eligibility rules and quiet ways veteran families leave help on the table. Each one is explained in full below.

Veteran-Directed Care, usually shortened to VDC, is a VA program for veterans who need a lot of help at home. Instead of the VA sending an agency aide on the agency's schedule, the VA approves a flexible budget for the veteran, and the veteran decides how that money is spent.

VA's own page describes it simply: "Veterans hire their own workers to meet their daily needs to help them live at home or in their community." In the veteran handbook used by local programs, being veteran-directed means you decide what services, supports, and goods you need, when they are provided, who provides them, where, and how.

VDC has been around since 2008. ACL's introductory fact sheet says the Veterans Health Administration and the Administration on Aging — now part of the Administration for Community Living (ACL) — developed VDC in 2008 for veterans with nursing home level of care needs. It is delivered in partnership with local Aging and Disability Network Agencies: Area Agencies on Aging, Aging and Disability Resource Centers, Centers for Independent Living, and State Units on Aging. That is why the person who helps you plan is usually not a VA employee but a counselor at a local aging or disability agency.

It is one of the least-known VA programs, and the published numbers are small. ACL's Veteran-Directed Care page showed 6,085 veterans enrolled when we checked. That page does not display an "as of" date, and other ACL pages show different figures from different snapshots, so treat any single number as a rough sense of scale rather than a current count.

Yes, in many cases. This is the part families are most surprised by. ACL's introductory fact sheet says veterans have control over a flexible service budget they can use "to hire family, friends, and neighbors to provide the care they need." The VDC Operations Manual template lists the ability to "Hire and supervise their own workers, including family or friends."

Spouses are not excluded by the federal program documents we reviewed. VA's own published story about VDC describes Army veteran Bob Bashaw, who hired his wife Susan; Navy and Army veteran Caren Scalla, who employed her daughter and grandson; and Air Force veteran Thomas Ellington, whose wife and daughter assist with his care.

There is one rule that trips families up, and it is worth reading twice. If you appoint someone to act as your authorized representative — the person who manages the budget and the hiring on your behalf — that same person cannot also be one of your paid workers. The Operations Manual states plainly that "Veteran representatives may not serve as paid workers," and that the veteran "hires employees who are legally allowed to work in the United States and may not be the Veteran's authorized representative." If you want your daughter paid as a caregiver, name a different trusted person as your representative.

Local rules can add requirements on top of the federal ones. The Operations Manual says each VDC provider "specifies any additional hiring requirements, as dictated by state policy," and that background check procedures follow state policy. So confirm the specifics for your area with the VDC provider before you promise anyone a job.

There are two layers here, and most articles only tell you about the first one. We want you to know about both, because the second is where families get surprised.

The first layer is the plain-language gate. ACL states: "All Veterans, regardless of age, who are enrolled in the VA health care system and meet the clinical need for the service, are eligible to participate in VDC if it is offered at a local VA Medical Center." VA's own Veteran-Directed Care page words it slightly differently and adds a condition ACL's sentence leaves out: "All enrolled Veterans are eligible for Veteran Directed Care if they are eligible for community care, meet the clinical criteria for the service, and it is available." So community care eligibility is part of the picture — ask your VA social worker how that applies to you.

There is no age limit. VDC serves younger veterans with spinal cord injury, ALS, MS, Parkinson's, and traumatic brain injury as well as older veterans with dementia or frailty. And it is a VA health care benefit, so it turns on enrollment and clinical need, not on having a particular disability rating.

The second layer is clinical, and it is a real bar. The VDC Operations Manual template says: "In order to meet clinical eligibility for VDC, Veterans must meet nursing home level of care, meaning an interdisciplinary team has made a clinical judgment that the Veteran would, in the absence of HCBS, be eligible to receive services in a skilled nursing facility." The manual adds that veterans must also express an interest in self-directing their services. The bulleted criteria below describe the target population the VA uses to identify veterans most in need of VDC — they sit underneath that nursing-home-level-of-care judgment, not instead of it.

Even if you do not tick those boxes, the manual says the VAMC's clinical care team may determine that a veteran who does not meet clinical eligibility is in need of VDC services, as long as the team documents clinical justification in the veteran's medical record. So a "you don't quite meet the criteria" answer is not always the end of the conversation.

None of this is a promise, and nothing on this page is an eligibility decision. Only the VA can decide whether you qualify. Ask, and ask in writing if you can.

The VA medical center sets it, not the veteran and not the agency. The Operations Manual lists among VAMC responsibilities: "Determine the budget amount using the Purchased HCBS Case Mix and Budget Tool," and referrals include "VDC budget level and average monthly spending authorization information." The veteran handbook explains it plainly: the budget "is the amount of available funding for each individual participant. It is based on the Veteran's needs." Your Person-Centered Counselor receives that number from the VA and tells you what it is while you are deciding whether to choose VDC over traditional VA services.

We are not going to quote a dollar amount for your budget, because there is not one. It depends on your assessed needs, your area, and your VA medical center. Ask your VA social worker what your authorized monthly amount would be before you commit to anything.

Worker pay is also local, and the only published figure we could find is several years old. The VDC Operations Manual template (February 2023) says the average VDC worker hourly rate ranges from $15.00 to $20.00 per hour, excluding employer tax costs, and that this "may be exceeded if necessary." It also says workers will not be paid more than the hourly rate the state program allows for agency services. Within your budget, you as the employer have the right to determine and establish hourly rates. Confirm the current allowed range in your area with the VDC provider — that 2023 figure may well have moved, and we could not find a newer published one.

The budget is not only for wages. The Operations Manual says purchases must meet all of a set of tests: meet the identified needs, goals, and outcomes in your spending plan; improve your ability to remain safely at home; address your ADL or instrumental ADL needs; be the least costly alternative that reasonably meets your needs; not be provided or paid for by VA, Medicare, Medicaid (Medi-Cal in California), TRICARE, or other insurance; not be something you are responsible for as a homeowner to maintain, repair, or replace; and be for you. Within those tests, spending plans can include quite a lot.

No. The veteran handbook is blunt about this: "Veteran-directed does not mean doing things all by yourself – people are available to support you along the way."

Two supports come with the program. First, a Person-Centered Counselor from the local aging or disability agency. They help you understand VDC, assess your needs and think through your goals, develop and evaluate your spending plan, understand and complete required paperwork, and solve problems that come up. The Operations Manual says the provider conducts reassessments and develops service plans annually and as needed — semi-annually in the first year — and conducts face-to-face or virtual visits at least quarterly.

Second, a Financial Management Service (FMS) provider. The handbook says the FMS acts as your payroll agent and takes care of timesheets, payroll, taxes, and other employer requirements; processes payroll and pays workers by check or direct deposit; issues W-2 forms to your employees and pays their payroll taxes on your behalf; arranges workers' compensation coverage (the handbook notes this is not required in all jurisdictions); completes provider background checks; and sends you a regular budget report of how much you have spent and how much is left. The handbook states that everyone who self-directs in VDC must use the FMS provider.

If managing hiring and the budget is more than you want to take on, you can appoint a representative — a family member, friend, or another trusted person — to do it on your behalf. The handbook suggests choosing someone who will follow what you say you need, stays in regular contact, and ideally visits at least once a week. Remember the rule from earlier: that person cannot also be a paid worker.

Be prepared for a hard answer: it is not available everywhere, and California coverage is thin. This is the single biggest reason families never hear about VDC.

ACL's "Find a VDC Program" list, checked in August 2026, showed San Diego Health Care System partnered with Aging and Independence Services, with no asterisk — meaning it had referred veterans to VDC. VA Long Beach Health Care and VA Loma Linda Health Care both appeared with the same two partner agencies named, The Center for People with Disabilities and Dayle McIntosh Center, but both were marked with an asterisk. The list's legend explains the asterisk: "There are 40 VAMCs who have not yet referred Veterans to VDC and are denoted by an asterisk (*) below." VA Greater Los Angeles did not appear on the California list at all when we checked. Elsewhere in California, San Francisco, VA Palo Alto, and Northern California Health Care System were listed, all with asterisks.

Nationally the picture is patchy and the published numbers disagree with each other. ACL's program page said 95 VA medical centers had made at least one VDC referral and 48 had not. ACL's Veteran-Directed Care page displayed 82 VA medical centers offering VDC with 298 partner agencies. The "Find a VDC Program" legend said 40 had not yet referred. And ACL's May 2023 introductory fact sheet said VDC was available at 71 VAMCs in 37 states, the District of Columbia, and Puerto Rico. Different pages, different snapshots, mostly without dates. The honest summary is that coverage is partial and changing.

So do not treat any list, including this one, as final. Ask your own VA medical center directly. ACL's instruction is exactly that: "For more information on availability of VDC locally and for questions regarding eligibility, please contact your local VAMC." And ask your local Area Agency on Aging too — some agencies are approved VDC providers even where the nearest VA has not started referring.

These three get confused constantly, and they are not the same thing. It is worth knowing which door you are knocking on.

VDC is a VA health care benefit. It is based on VA enrollment, community care eligibility, and clinical need — not on a disability rating and not on your income or assets. The money goes into a budget you direct, and the people you hire become your employees, paid with W-2s and payroll taxes handled by the FMS provider.

IHSS (In-Home Supportive Services) is California's program, not the VA's. The California Department of Social Services lists the requirements: you must be a California resident, have a Medi-Cal eligibility determination, live at home or in an abode of your own choosing (not a hospital or licensed facility), and submit a completed Health Care Certification form. You apply by completing form SOC 295, Application for In-Home Supportive Services, and submitting it to your county IHSS office. Family members commonly serve as IHSS providers. A veteran may be eligible for IHSS whether or not VDC exists at their VA — these are separate systems and it is worth checking both.

PCAFC (the Program of Comprehensive Assistance for Family Caregivers) pays a monthly stipend directly to a designated Primary Family Caregiver, not to the veteran. It has a much narrower gate: for PCAFC purposes, "serious injury" means a service-connected disability rated at 70 percent or more by VA, alone or combined with other service-connected disabilities. The veteran must also need in-person personal care services for a minimum of six continuous months, and meet other conditions. The stipend is based on the OPM General Schedule grade 4, step 1 annual rate for the locality pay area where the veteran lives, divided by 12, multiplied by 0.625 at Level One or 1.00 at Level Two. One of PCAFC's listed requirements is that the personal care services the Family Caregiver would provide "will not be simultaneously and regularly provided by or through another individual or entity" — which is exactly the kind of thing you should ask the VA about before assuming you can have PCAFC and VDC at the same time. Ask; do not assume.

Use the program's name. Staff at a busy VA medical center will not always volunteer a program that their site may not run. Being specific gets you a real answer instead of a general referral.

VA's own Veteran-Directed Care page tells you the entry point: "Talk with your VA social worker to find out what specific help you may be able to receive," and adds, "If Veteran-Directed Care seems right for you, talk with your VA social worker and find out if it is available in your location." If you are already getting Homemaker and Home Health Aide hours and they are not enough, say so — ACL's fact sheet notes that veterans who require more care than is traditionally offered through H/HHA are often offered the option to self-direct through VDC.

If your VA medical center does not offer VDC, that is not the end of the road. Ask the same social worker what else is available: Homemaker and Home Health Aide care, adult day health care, respite, Home Based Primary Care. And separately call your Area Agency on Aging through the Eldercare Locator at 1-800-677-1116 to see what local options exist. For caregiver questions, the VA Caregiver Support Line is 1-855-260-3274 (caregiver.va.gov shows hours of Monday through Friday, 8 a.m. to 8 p.m. Eastern — confirm current hours when you call).

Free, accredited help is available for benefit claims, and you should use it. VA-accredited Veterans Service Organization representatives help with VA benefit claims at no charge, and California County Veterans Service Officers assist veterans and families at no cost. You can search for an accredited representative near you on VA's website.

Write down who you spoke to and when. If you are told no, ask what specifically you did not meet, and ask whether the clinical care team can document a clinical justification — the VDC Operations Manual allows for that.

VA long-term care services can carry a copay for some veterans, and some veterans pay nothing. VA's copay page, with rates effective January 1, 2026, says: "You won't need to pay a copay for geriatric care or extended care for the first 21 days of care in a 12-month period." After that, published geriatric and extended care rates are up to $97 per day for inpatient care, up to $15 per day for outpatient care, and up to $5 per day for domiciliary care for homeless veterans. VA explains that starting on the 22nd day, copays are based on the level of care you are receiving and the financial information you provide on your Application for Extended Care Services, VA Form 10-10EC. Many veterans owe nothing. Ask your VA social worker what your copay would actually be. Do not guess from a table, including ours.

For help with VA benefits claims, use free help first. VA states that "the services an accredited VSO representative provides on your VA benefit claims are always free." California County Veterans Service Offices also assist veterans and families at no charge. Accredited attorneys and claims agents may charge fees, but federal rules under 38 CFR 14.636 sharply limit when: generally they may not charge for services provided before you are given notice of the agency of original jurisdiction's initial decision on the claim.

That last point matters because it is where scams live. Anyone who offers to "get you approved" for a VA benefit for an up-front fee, a percentage of your back pay, or a "processing charge" should be treated with suspicion. Legitimate help with an initial claim does not cost money. If someone pressures you to sign quickly, asks for your VA login, or asks you to route your benefit payments through them, stop and call a County Veterans Service Office or an accredited VSO instead.

SoCal Home Health is an independent educational resource. We are not affiliated with, endorsed by, or acting on behalf of the U.S. Department of Veterans Affairs, the Administration for Community Living, or any California county agency, and nothing here is an eligibility decision. Only the VA can determine what you qualify for.