An Evaluation of the Veterans Administration Housebound and Aid and Attendance Allowance Program

This project had two major goals: (1) To describe the workings of a successful, large-scale, case disability allowance program from an administrative perspective. The Veterans Administration (VA) allowance program is described in detail, to provide a benchmark for future research and program design. (2) To examine the question whether recipients of a cash allowance for long-term care are worse off than similar persons who receive in-kind subsidies. This study does so by examining the life circumstances of 139 recipients of the VA Housebound Allowance or Aid and Attendance Allowance. The health, functional needs, and use of services of these persons are compared with those of 610 persons interviewed in the 1983 National Long-Term Care Survey who received services in-kind. This report represents the first outside evaluation of this program. The analytical results of the study suggest that recipients of the cash disability allowance received similar levels of long-term care and were no worse off than the comparison group with regard to acute health care utilization. Evidence on hours of care per week and the direct (non-administrative) costs of the VA cash allowance program suggest that the cast benefit may be the more cost-effective alternative for many beneficiaries. [152 PDF pages]