A&A and Housebound benefits both offer assistance that helps veterans  function more independently, but A&A benefits are only for those who are  in need of regular aid and attendance of another person, whereas  Housebound benefits are for those who may be substantially confined to  their homes. Enhanced Monthly Benefit Population Is Changing and Costs Are Growing

VA data at the end of fiscal year 2010 showed that for the overall enhanced  monthly benefit population (including veterans and survivors), most  recipients were veterans, over age 65, receiving the benefit as part of their  monthly pension benefit, and receiving the A&A supplement, but the  composition and characteristics of the recipient population is changing (see  fig. While veterans over age  65 comprised the majority of the overall enhanced monthly benefit  population from fiscal years 2000 to 2010, there was an increased share of  survivors, recipients age 65 or younger, those receiving the benefits under  the disability compensation program, and those receiving the Housebound  benefit enhancement. For fiscal years 2000 to 2010, the total VA paid for enhanced benefits  increased from approximately $124 million to $409 million; however, VA  does not know the portion of enhanced benefit costs paid specifically for  A&A and Housebound benefits. VA stated that it does not separately  compile and monitor costs specifically attributable to A&A and  Housebound benefits because they are not “stand-alone” benefits. Enhanced Monthly Benefits Help Veterans Obtain Needed Services, but High Service Costs and Limited Availability of Services in Some Locations Can Pose Difficulties

Veterans and family members who participated in our focus groups and  one-on-one interviews said that enhanced monthly benefits help them  obtain needed assistance in different ways. For example, these benefits  helped them pay for in-home services by private providers, offset lost  income of family members who provide care, or defray the costs of an  assisted living facility. The cost of these services varies  among and within states. Also, services are less available in some rural areas,  which can limit recipients’ ability to obtain them. Many Elderly Veterans May Be Unaware of Enhanced Monthly Benefits Despite VA’s Outreach Efforts

		Many Elderly Veterans Reportedly Lack Awareness of Enhanced Monthly Benefits

VA’s data for fiscal years 2000 to 2010 indicate that elderly veterans and  their surviving family members are the primary recipients of enhanced  monthly benefits, although many other potentially eligible elderly veterans  likely are unaware of these benefits. Also, a 2004 VA study found that while 62 percent of pension  recipients might be eligible for these benefits, only about 22 percent  received them.925,000 veterans and between 940,000 and 1.38 million surviving family  members would be eligible for, but would not be receiving, VA pension  benefits. VA’s general outreach activities tend to focus on benefits such  as health care, disability compensation, education, and home loans. During these elderly outreach activities, regional office staff  may have one-on-one conversations with attendees and provide  information on enhanced monthly benefits to those who indicate they  need assistance to perform everyday living activities. Recommendation for Executive Action

To enable VA to improve its efforts to educate veterans and their family  members about enhanced monthly benefits, we recommend that the  Secretary of VA direct the Undersecretary for Benefits to take steps to  conduct more focused outreach to potential recipients, which could entail  the following:  Improving communication of and accessibility to information about  enhanced monthly benefits. III), VA concurred with our recommendation  and provided information on a number of actions the agency planned to  take or explore to address it. Appendix I: Objectives, Scope, and Methodology

The objectives of our review were to determine (1) characteristics of  enhanced monthly benefit recipients, (2) how enhanced monthly benefits  help veterans obtain needed services, and the associated difficulties they  face in obtaining these services, and (3) the Department of Veterans  Affairs’ (VA) efforts in educating veterans and their family members about  the availability of the benefits. We reviewed  relevant federal laws and regulations. We assessed VA’s print and online informational  materials for clarity and the extent to which they provide complete  information on eligibility and application requirements for enhanced  monthly benefits.
Why GAO Did This Study

The Department of Veterans Affairs (VA) offers Aid and Attendance (A&A) benefits to individuals who need regular assistance and the attendance of another person or Housebound benefits to individuals who are substantially confined to their homes. These benefits, which increase recipients monthly disability compensation or pension payments, are called enhanced compensation or enhanced pension, respectivelycollectively referred to as enhanced monthly benefits. This report describes (1) characteristics of enhanced monthly benefit recipients; (2) how the benefits help veterans obtain needed services, and the associated difficulties they face in obtaining these services; and (3) VAs efforts to educate veterans and their family members about the availability of the benefits. GAOs work included analyzing VA case-level demographic data from fiscal years 2000 to 2010 on enhanced monthly benefit recipients, conducting facilitated focus groups with veterans and their family representatives, and interviewing VA headquarters and regional officials on VAs outreach efforts for enhanced monthly benefits, as well as reviewing relevant federal laws and regulations.

What GAO Found

According to VA data during fiscal years 2000 to 2010, most enhanced monthly benefit recipients were veterans, over age 65, and receiving the A&A enhancement as part of their pension benefit. The recipient population is changing, however. In particular, the percentage of enhanced monthly benefit recipients age 65 or younger increased from 18 percent to 24 percent over the decade. Also, the percentage of recipients paid benefits under the disability compensation program increased from 15 percent to 26 percent. The cost of enhanced monthly benefits has increased from $124 million in fiscal year 2000 to $409 million in fiscal year 2010; however, VA does not know what portion of these costs was paid specifically for A&A and Housebound benefits. VA maintains data on enhanced monthly benefit recipients total payments but does not separately identify the amount awarded as an A&A or Housebound benefit. VA officials stated that under its current system, separately tracking the costs of these benefits would be complicated and difficult.
Enhanced monthly benefits helped veterans obtain services to perform everyday living activities in different ways, but high service costs and limited service availability in some areas can make it difficult to acquire the services. Benefit recipients GAO spoke with said that they used their benefits to pay for in-home services by private providers, offset lost income from family members who provided care for them, or defray the costs of an assisted living facility. However, obtaining services from private providers can still pose difficulties for some recipients because of the generally higher cost of services in large urban areas or the limited availability of services in rural areas.
VA conducts a number of outreach activities to educate veterans and their family members about available benefits; however, a large number of elderly veterans may not be aware of their potential eligibility for enhanced monthly benefits. A VA study found that of pension recipientswho are mainly elderly veterans62 percent might be eligible for enhanced monthly benefits but only 22 percent received them, which the study primarily attributed to lack of awareness about the benefits. VAs outreach efforts may not be sufficient to inform elderly veterans about enhanced monthly benefits because outreach activities do not typically focus on these benefits, some printed material lacks information on eligibility and application requirements for these benefits, and the extent to which regional offices conduct elderly outreach varies, among other reasons.

What GAO Recommends

GAO recommends that VA conduct more focused outreach to better educate potential recipients about enhanced monthly benefits. VA agreed with the recommendation and described a number of actions it would take or explore to address it, such as including more detailed information in its printed material on enhanced monthly benefits.