Family caregivers are a critical part of the American healthcare system, providing ongoing support to aging parents or loved ones with disabilities.
Caregivers are often providing long-term care to people within their own homes, with the role frequently lasting for 4 years or even longer.
Caring for a loved one can also be intense, both practically and emotionally, and caregivers often struggle to still earn at their normal levels. Indeed, many caregivers must give up their jobs or cut down their hours to be able to support their loved ones.
Other ways of earning need to be found, which is why we’re looking at how you can get paid as a family caregiver. There are plenty of ways to do so, along with some complexities to think about.
Below are five resources to consider to get paid as a family caregiver:
Medicaid offers a variety of self-directed programs, often through the home and community-based services (HCBS) waiver programs. Some of these are personal assistance services (PAS) programs, which focus on the activities of daily living, such as toileting and dressing. These programs provide valuable human services that help seniors to stay in their own homes for longer.
These Medicaid programs generally focus on home care, although there are some situations where they may apply to group home situations instead.
Seniors eligible for such Medicaid programs have control over some aspects of their care, including who provides it. The self-direction aspect of these programs often gives seniors the chance to hire family members as paid caregivers.
Bear in mind that the processes can take a while. As AARP points out, self-directed care typically involves assessment, planning, budgeting, and selection steps. Planning can be particularly detailed, as this can involve considering the level of care needed and developing a care plan.
Each of those steps take time, which may leave your loved one without support for longer than you would like. As such, it’s important to start early and look into home health care and financial assistance before doing so feels essential.
There is also the Medicare-Medicaid program, PACE, which has a consumer-directed focus, giving seniors more control over the care providers they use and the specific personal care services. In some situations, this program may pay for family caregivers as well.
Most states offer some type of self-directed program. However, the names of the programs vary from one state to the next, as do the specifics. There can be differences in services supported, the amount that caregivers are paid, and whether adult children or spouses can act as caregivers.
As a result, you’ll need to do some digging into state Medicaid programs. You’ll need to learn what’s available in your local area, along with the different program requirements. Local area agencies on aging (AoAs) can help to guide you, as they already have plenty of resources for the local area. The government’s Eldercare Locator also makes it easy to find local services.
Finding local experts can also help you to navigate the complexities of the different Medicaid programs, as they vary in their requirements and how you apply. Someone who knows the ropes can help you to make the best use of your time and increase the likelihood of success.
Because these programs run through Medicaid, Medicaid eligibility plays strongly in determining whether seniors are eligible or not. These criteria differ from state to state, so they’ll be determined by where you live.
There are functional criteria too, which look at the senior’s current abilities and the level of care they need.
If the senior isn’t eligible for Medicaid due to their finances, they may qualify for Medicaid’s Medically Needy Program. This program takes medical expenses into account when considering Medicaid eligibility and could allow some people to be eligible who weren’t before.
Many states also have additional programs that aren’t associated with Medicaid. These vary even more dramatically than the Medicaid-based ones.
You’ll see differences in what these programs are called, how they’re funded, who is eligible, and the services they offer.
For example, some programs may only offer support for people who need nursing home-level care, others may focus on people with disabilities, while still others may even provide services for healthy seniors.
With so many differences, it’s crucial to pay close attention to your local area. This is where the relevant programs are. Pay attention to where the information comes from as well, as many sites have out-of-date details, which might mean you don’t get a complete picture of eligibility requirements or all the benefits of a given program.
Here at Ready Set Care, we have a collection of state-specific caregiver compensation articles. Each of these provides details about the current programs that help caregivers to get paid. For example, California has just one option, In-Home Supportive Services (IHSS), while Texas has three. These articles can help you learn about your local choices, giving you a starting point for seeking services.
For those who have served their country and meet all the criteria, The Department of Veterans Affairs (VA) provides additional support.
A key area is the Veteran Directed Care Program. This was once known as Veteran-Directed Home and Community-Based Services and has a strong person-centered emphasis. The program allows veterans to direct the long-term care services and supports they receive, which includes being able to hire and pay caregivers.
There are also VA pension benefits that may help veterans to pay family caregivers, especially as these can scale based on need. For example, the VA Aid and Attendance Benefit are designed for disabled pensions who need regular support with activities of daily living. Such VA benefits can make a large difference, although some families may not be eligible.
Some of these benefits apply not just to veterans, but also to surviving spouses.
Long-term care insurance can be a valuable option.
As the name suggests, this specifically provides for long-term care, which can include care in a facility or home-based care. Some health insurance policies also have the option of a long-term rider. This allows seniors to use some of their death benefits to pay for long-term care while they are still alive.
There are some limitations though. First, the senior needs to be eligible for the insurance, which isn’t always the case. Some will be rejected, especially if they are in poor health. Even if the senior is accepted, long-term care insurance often comes with high premiums. It may simply be out of the reach of some people.
Also, long-term care insurance requires planning ahead. Seniors need to be paying into it before they start to need long-term support. As such, this mightn’t be viable for seniors who are starting to need long-term services and haven’t looked at the insurance angle.
You’ll also need to find out about the specific benefits of the insurance. Will the insurance pay for caregiving directly or give the senior money that they’re able to use for caregiving? Some policies may not even support family caregiving, so it’s crucial to check first.
Personal Care Agreements go by a few names, including a caregiver contract, elder care contract, or personal care agreement. The idea is to make a formal agreement within the family, so the caregiver can be paid regularly. The agreement may also act as a care plan, so everyone is on the same page about how the senior will be supported.
The agreement should outline the specific care services that are provided, compensation, and any other important areas. For example, what happens if home modifications are needed or the required level of care increases?
It’s helpful to get other people involved in the process, including professionals, to make sure that everything is reasonable and legal. Doing so is important for any type of family care situation, as it’s easy for things to get emotional and complicated.
Personal care agreements are often made between the senior and the adult child who will be the caregiver. However, other arrangements can be made as well, such as where non-caregiving children contribute financially to help pay the family caregiver.
Creating such a formal document with family members may feel a little strange. Still, doing so is important, as having everything in writing prevents problems later on.
Personal care agreements are often the most viable option for adult children and their aging parents. Many families simply aren’t eligible for government programs or find that the application process and waiting lists take far too long.
However, seniors often don’t have much money, so this approach can be difficult. As AARP highlights, one approach is to focus on the home.
Many older adults could easily downsize, a process that may earn them money and also mean that they’re in a safer environment (which is incredibly important for housebound seniors). Downsizing might even decrease the need for home modifications, which is relevant for safety too.
It's also possible to get a home equity loan or reverse mortgage. While those approaches can be helpful, they should be approached carefully, as there are risks.
The pay rate for family caregivers varies depending on the state and the program, but it’s never particularly high. You’re often looking at close to the minimum wage for your state.
Some states are also more generous than others. For example, California is one of the most powerful states for caregiving support, while many other states provide less.
There may also be a cap on the number of hours per month. You’ll only get paid for care up to that threshold. If you go beyond it, the extra hours are generally unpaid.
Social Security doesn’t directly pay for caregiver services. However, an aging parent might use their Social Security income to pay a family member for assistance.
This may be a necessary approach if the senior isn’t eligible for any of the programs highlighted on this list. However, many seniors have limited income, so the amount they can pay may be low.
Similarly, SSI doesn’t directly pay for caregiving, but seniors can use the money to pay family members if they choose.
Of course, SSI is an income-based program, so seniors who are eligible for SSI may also be eligible for some of the other programs highlighted on this list, including Medicaid waiver programs.
Getting paid as a caregiver isn’t your only option. You can also look for assistance programs, including ones that focus on caregiver support.
Respite care is a fantastic approach. Respite care means that someone else looks after your loved one for a while, providing you with a break and a chance to focus on your own mental health.
You can turn to your job as well. Some companies offer paid leave for caregiving. This could be perfect if you’re still working and only occasionally need time off to help your loved one.
There are also programs that won’t pay you to be your loved one’s caregiver but will pay someone else to do so (often someone from a home care agency). This is still incredibly helpful, as it frees up some of your time and energy. If someone else is doing some of the caregiving tasks, then you can use that time to rest and regroup, or to earn money.
Doing so could be even more powerful than getting paid as a caregiver. After all, caregiving is an exhausting role that can lead to physical and mental health problems. It might be wise to allow someone else to do some of the caregiving tasks, then just help out where you can.
Angelica P. Herrera-Venson, DrPH is a gerontologist, public health and Medicare expert, and published researcher in family caregiving and chronic health conditions. She is the author of The Multicultural Guide to Caregiving and has held prestigious fellowships, including the Health Policy & Aging program and Geriatric Psychiatry fellowship from the National Institute of Mental Health. Angelica was an Associate Director at the National Council on Aging and has worked extensively with Medicare and Medicaid dual-eligible patients. She is currently the owner of Kapok Aging & Caregiver Resources, a hub for caregivers from around the world.
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