Can I Get Paid to Be a Caregiver for a Family Member?

5 options, including Medicaid and veterans programs, that may help alleviate the financial burden of taking care of someone you love

Deirdre van Dyk,

AARP

Reviewed by

Brendan Flinn, AARP Public Policy Institute

Comments

En español

Published November 18, 2019

/ Updated December 04, 2024

Stevie Jean/Gallery Stock

In this story

Seeking help • Medicaid recipients • Veterans services • Employed by family • Long-term care insurance • Paid caregiving leave • More resources

Caregiving for a family member can be time-consuming and emotionally draining. It can be financially draining, too.

About 48 million Americans provide care without pay to an adult family member or friend, and they do so for an average of nearly 24 hours per week, according to the “Caregiving in the U.S.” report by AARP and the National Alliance for Caregiving (NAC).

AARP found that 78 percent of family caregivers regularly incur out-of-pocket costs caring for a loved one, with the average annual expenditure topping $7,200.

That unpaid and often expensive commitment can make it hard for caregivers to make ends meet. Twenty-eight percent said they had stopped saving money, and 23 percent had taken on more debt, the AARP/NAC study found.

Your chances of getting paid to be a family caregiver are best if you are caring for a U.S. military veteran or for someone eligible for Medicaid, but other possibilities exist. Here are 5 options to explore.

1. Your family member is on Medicaid (or may be eligible)

All 50 states and the District of Columbia offer a version of self-directed Medicaid services for long-term care.

These programs allow qualified individuals to manage their own long-term home care services, as an alternative to the traditional model in which services are managed by an agency.

Benefits, coverage, eligibility and rules differ from state to state. Even the program name may be different. What is Consumer Directed Services in one state might be called Participant Directed Care in another.

Your local Area Agency on Aging (AAA) can help you to determine what caregiving support is available in your community. Your state Medicaid program can answer questions about the program and start the sign-up process.

If your loved one isn’t already on Medicaid but would like to apply. AAA and the state Medicaid office can help determine if your loved one qualifies; they will have to show that they have a low income and modest financial assets.

The application process

Each state has its own process to apply for self-directed care services. Generally, you will follow these steps.

Undergo an assessment. Your loved one is assessed for capacities, need, preferences, risks and strength as well as the desired measurable outcome. They can choose someone to help them with this process.

Create a service plan. Your loved one along with their representative, if they have selected to help them, will create a written service plan. They’ll need to detail information such as the daily living assistance they need help with — bathing, dressing, medication management, transportation to appointments, etc. — and contingency plans for coverage when the care provider is ill or has a day off.

Make a budget. A budget tailored to your loved one’s needs is created. States explain how dollar values for goods and services should be calculated.

Coordinate the care. Once everything has been approved, the state helps set out how services and the caregiver-worker will be managed.

2. Your family member is a veteran

The Department of Veterans Affairs (VA) allows qualified former service members to manage their own long-term services and supports. Veterans must be enrolled in VA health care and need help with daily living such as bathing, dressing and meals.

A flexible monthly budget, based on a VA assessment of the veteran’s needs, enables participants to choose the goods and services they find most useful, including a caregiver to assist with activities of daily living.

The veteran chooses the caregiver who can help them live at home and may pick any capable family member including son or daughter, sibling or spouse who lives, or is willing to live, with the vet.

Find and contact your nearest center for more information on the program.

Aid and Attendance (A&A) benefits

A&A benefits are available to veterans who qualify for VA pensions and meet at least one of the following criteria.

Requires help from another person to perform everyday personal functions such as bathing, dressing and eating.
Is confined to bed because of disability.
Is in a nursing home because of physical or mental incapacity.
Has very limited eyesight, less than 5/200 acuity in both eyes, even with corrective lenses, or a significantly contracted visual field.

Surviving spouses of qualifying veterans also may be eligible for this benefit.

To apply, complete the A&A application form. Explain how your illness, injury or disability affects your ability to do go through daily living, ideally including an attending doctor’s report.

You can mail the form to the address noted on this page or file in person at your regional VA benefits office.

Housebound benefits

Veterans who receive a military pension and are substantially confined to their immediate premises because of permanent disability can apply.

The application process is the same as for A&A benefits, but you cannot receive both housebound and A&A benefits at the same time.

Get Help. Help Others.

AARP’s Family Caregivers Discussion Group is a private Facebook group where caregivers can seek support and advice from other caregivers. The AARP website also has an online caregiving community where caregivers can interact with other caregivers.

Program of Comprehensive Assistance for Family Caregivers (PCAFC)

This program provides a monthly stipend to family members who serve as caregivers for veterans who need assistance with everyday activities because of a serious injury or illness sustained in the line of duty.

The veteran must be enrolled in VA health services, have a disability rating (individual or combined) of 70 percent or higher, and need in-person services at home related to everyday activities or supervision or protection because of their condition. The family caregiver can’t be providing the same help that is simultaneously given by another individual — such as a home health aide — or a program. The caregiver must be 18 or older and a child, parent, spouse, stepfamily member, extended family member or full-time housemate of the veteran.

PCAFC stipends are based on federal pay rates for the region where an eligible veteran lives.

Other caregiver benefits through the program include these:

Access to health insurance and mental health services, including counseling.
Comprehensive training.
Lodging and travel expenses incurred when accompanying vets going through care.
Up to 30 days of respite care per year.

3. Your family member employs you

If the person needing assistance is mentally sound and has sufficient financial resources, that person can choose to compensate a family member for the same services a professional home health care worker would provide.

If you and your loved one are exploring this route, these steps can minimize stress and family tension.

Put aside any awkward feelings about discussing what you both need. Talk about wages and paydays, health risks, scheduling, and how respite care, caregiver sick days and time off will be handled.

Draw up a personal care agreement between the caregiver and the care recipient. Spell out wages, services to be provided and when, among other terms. Consider involving siblings and other members of the immediate family in working out terms so they are not surprised later.

Consult an eldercare lawyer to review your contract to make sure it meets tax requirements. It’s a good idea if other interested parties, such as siblings, approve the written contract.

Beware of emotional pitfalls. If family members seem uncomfortable with the arrangement or disagree with the plan, consider a session with a neutral party, such as a family therapist or family mediator who specializes in eldercare.

Keep professional records. Specify services performed, dates of work and the amount paid.

Report income. As with any paid job, caregivers are legally required to report wages as taxable income.

4. Your family member has long-term care insurance

If your loved one has long-term care insurance, it probably covers some costs for home health care and personal care services.

However, not all policies extend that coverage to paying spouses or other family members living in the home. Ask your loved one’s insurance agent or insurance company for specifics and request a written confirmation of benefits.

5. You take paid family leave

The federal government created the Family and Medical Leave Act back in 1993, but the 12-week leave is unpaid. At the state level, there are options: Nine states plus the District of Columbia mandate paid family leave to caregivers, and a further nine states have voluntary paid family leave programs in place.

How much caregivers can be paid, and how long they can take the leave varies.

More resources

Medicare. While Medicare doesn’t pay family caregivers, it does pay doctors and other health care providers to train family caregivers. This includes education for daily tasks, such as incontinence, and serious illnesses, such as COPD. It may provide special training and respite for family members caring for a dementia patient.

Area Agencies on Aging can guide you to services that support caregivers and their loved ones. Search the eldercare locator or call 800-677-1116.

Military caregivers can visit the VA Caregiver Support page or call its hotline at 855-260-3274.

AARP has a toll-free caregiver support line, and agents can guide you to resources. The line is staffed Monday through Friday, 8 a.m. to 8 p.m. ET, at 877-333-5885, or in Spanish at 888-971-2013. AARP also has resources and guides for military caregivers.

Video: How Medicare Plans to Pay to Support Family Caregivers

United Way and AARP have a partnership that connects caregivers to help in their state or community. Check out AARP’s online family caregiver resource guides or call 211 for advice.

Editor’s note: This article was originally published in October 2016. It has been updated with more recent information and resources.

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Deirdre van Dyk is an AARP associate editor covering Social Security, caregiving, technology and fraud. She previously worked at USA Today and Time, where she covered business, government, sustainability and innovation.

Brendan Flinn, MPH, is the director of long-term services and supports at the AARP Public Policy Institute. Flinn works on policy affecting Medicaid, Medicare, home and community-based services (HCBS) and nursing homes.