Getting Paid to Care for a Family Member in California

Family caregiving is normally an unpaid role. You’re volunteering your time and energy to support a loved one through their most challenging years.

However, long-term unpaid caregiving is often impractical. The costs get too high too quickly. As their health condition worsens, you’ll inevitably find your family member’s needs may increase to the point that you simply can’t hold down a regular job. This is especially true with serious health problems, such as dementia.

The most powerful solution is to get paid to care for a family member. This way, you’re not trying to juggle providing support and holding down a job. You can instead simply focus on being a caregiver.

Can You Get Paid to Care for a Family Member?

The short answer is yes. People can get paid to care for a family member. This includes caring for an aging parent, a spouse, an aunt, or someone more distant.

This payment often comes through Medicaid waivers, where seniors on Medicaid have some funding to pay for in-home care. In California, that’s what you know as ‘Medi-Cal.’  

They’ll also need to meet requirements for in-home caregiving support, which includes having significant medical needs. Once granted approval, they can designate you as her caregiver of choice. You’ll need to complete a background check and brief orientation. You’ll also sign up to submit either electronic or paper-based timesheets. You become a state employee, and your loved one becomes your supervisor on record.

What Can You Expect?

California is particularly powerful in this arena, offering more support than most other states. California’s In-Home Supportive Services (IHSS) program through Medi-Cal permits direct payment to family members for caring for aging or disabled relatives. The process for qualifying from start to finish takes about two to three months.

To be eligible for IHSS, your loved one must reside in California, be at least 65 years of age or disabled, a U.S. Citizen or qualified alien, and live in their own home. In addition, they must meet the income requirements for Medi-Cal. The pay rate varies by County, and as of January 1, 2024, Los Angeles County’s pay rate is $18.00 per hour. There will also be a cap on the number of hours per month.

IHSS provides eligible participants with in-home support, and they can nominate who provides the care. If a parent, spouse, or other loved one is eligible for the program, they will elect you as their designated caretaker (otherwise, they may nominate someone else and give you a much-needed break to work part—or full-time). 

In the case of persons with documented Alzheimer’s and dementia, the authority for hiring and overseeing a paid caregiver is typically granted to the spouse first, an adult child, or the individual holding guardianship or Power of Attorney on record.

Step 1:  Submitting Your Loved Ones’ Application.

The first step is to complete and submit an official application: Form SOC 295, found at the bottom of this page: https://www.cdss.ca.gov/in-home-supportive-services. Remember that your loved one is the applicant, not you. You can complete the intake entirely by phone by talking with a human services specialist by calling (888) 944-IHSS, the Los Angeles County line. If you prefer, you can download the application and drop it off at your local County office. The representative can point you to the closest one.

In our personal situation, we applied on behalf of my father, who had advanced Alzheimer’s disease and required 24/7 supervision and significant care. He was receiving full-time care from my mother at home but it had got to a point where her own health was severely failing. Given my father’s impaired decision-making abilities, we had to complete an Authorized Representative form (SOC 839) to designate my sister to make decisions on his behalf and allow her to be responsible for hiring caregivers and signing off on timesheets. My mother preferred to designate my sister for this role, as she felt she would be more adept at managing this than herself.

In the absence of a spouse, an applicant must still produce this Authorized Representative form, even if they have a Power of Attorney, conservatorship, or legal guardianship, to identify the person (an adult child or anyone else) who will act in their best interests during this process and after approval.

Step 2:  Verifying Medi-Cal.

Once the department receives the application, they must verify that your loved one is already a Medi-Cal recipient. Your family member must meet the financial requirements for Medi-Cal, which are based on California’s poverty level rates. For example, a family of two adults cannot earn more than $28,208 annually.

If they aren’t already, you’ll need to work with them to get them qualified for Medi-Cal. You’ll be prompted to apply in person, by mail, or online as noted in the steps here: https://www.dhcs.ca.gov/services/medi-cal/Pages/ApplyforMedi-Cal.aspx

In the process of applying for Medi-Cal, you’ll want to work closely with the representative to assess your family member’s financial situation and any assets. There is a spend-down period where you may be asked to pay toward your own expenses until they qualify for Medi-Cal, if their earnings are above the limit. The applicant’s home or a second vehicle are not counted as assets when determining eligibility. However, the state can recover the costs spent by Medi-Cal by collecting on their home if it is still under their name, as it is subject to Medi-Cal Estate Recovery Claim.

Step 3:  Getting Their Health Care Certification Completed.

You have 45 days from the date of your application to submit the doctor’s signed form, Health Care Certification (Form SOC 873). You’ll want to contact their healthcare provider to ensure they complete this form and that all their medical records are up to date and reflect your family member’s current condition.

The main goal of this form is to understand their level of dependency and need for activities of daily living, such as their ability to bathe, dress, and eat independently, manage things like shopping for food and keeping up their home, and walk with or without assistance.

Call your loved one’s doctor’s office to confirm that the documents were submitted to the right place.

Step 4:  In-Home Assessment.

A social worker will need to conduct an in-home assessment of your loved one’s functional status and document the needed tasks along with the initial intake. In addition to in-home care, the case worker may identify other services that improve their quality of life, such as assistance with paying energy bills and medications or connecting them with transportation vouchers. 

If your loved one’s care needs change, it’s essential to communicate that to your assigned case worker so that you may qualify for additional hours of paid support.

In my family’s own circumstances, it was during this stage that my mother had to complete additional paperwork from her medical provider to demonstrate that she had her own health issues that prevented her from providing full support to my father (the applicant on paper, who had Alzheimer’s disease).

Step 5:  Authorization and Registration.

Once your loved one is approved and you are selected to become your family member’s provider (or their ‘employee’ in IHSS terms), you can begin enrollment as an IHSS provider by calling (888) 822-9622. If you have others that you wish to share the responsibility of care with, you will need to have them enroll as well.

You’ll be asked to watch a few orientation videos and complete other forms. You have 90 days to complete everything from the date you initiated the process. It’s important to wait for fingerprinting until your County or IHSS office prompts you.

Once you pass a criminal background check and complete the orientation, you’ll want to get familiar with the timesheet tracking system:  https://www.etimesheets.ihss.ca.gov/login. As the paid caretaker, you must complete timesheets like any other employee.

What If You Experience Delays?

With many places experiencing workforce shortages, it seems everything is taking longer to process. It’s important to verify absolutely everything along the way. You’ll sometimes have to be graciously aggressive to nudge the paperwork along.

Contact the Los Angeles County IHSS office at (866) 613-3777 to check on the status of their application and ensure you have the right email, address, or fax number for where they expect to receive and review applications. You’d be surprised how often staff just sit on paperwork and haven’t had the time to call applicants to let them know that some small piece of information was missing. Stay persistent, and don’t be afraid to appeal if they are denied. 

While You Wait

Qualifying for IHSS from start to finish can take two to three months. In the meantime, you may want to call Los Angeles County’s Family Caregiver Support Program at (800) 510-2020 to seek respite care. The program qualifies unpaid family caregivers for hours of respite based on the level of care needs, and resources available. The goal isn’t to provide 100 percent coverage. Rather, it’s intended to allow caregivers some time off to get relief, rest, and recoup.

Choosing One or Multiple Caregivers

Despite the obvious benefits, getting paid to care for your family member isn’t always the right move. Once your loved one is approved for IHSS, you may realize this is a perfect opportunity to share the workload with another trusted person. Your family member will be approved for hours based on their level of care need and their risk of needing long-term, institutional care. My own father was qualified for a whopping 283 hours per month (the current max) at his most advanced stage with Alzheimer’s disease when he needed 24/7 watchful care. In the early stages of his application, we had to demonstrate that my mother (his spouse) had her own health issues that limited her ability to care for him fully.

You and your loved one (depending on their decision-making capacity) could use that same money to hire someone else entirely, which could be a better choice for some of you. That could be a friend, neighbor, or other family member. Sharing the approved IHSS hours with another person may allow you to remain engaged in other work, keep a part-time job, or a side hustle. Not to mention, sharing the workload can help alleviate or minimize caregiver burnout.

Say that your loved one is approved for 50 hours/week. You can coordinate with another IHSS-approved caregiver to share the responsibility and workload. You could take three days per week in the evenings or only handle weekends, while the other takes morning shifts during the week. If you don’t know anyone, you can hire from the IHSS provider directory. You’ll need to contact and interview potential candidates from the list.

Even without the financial pressure somewhat eased, caregiving is no easy feat. It can be exhausting and overwhelming. It can also alter your relationship with your family members, sometimes leading to resentment and anger. Often, other previously willing helpers may step back under the assumption that ‘it’s your problem now’ or ‘you’re the one getting paid.’ 

There’s no right or wrong answer. The best approach will depend on your situation and the people involved. The important thing is to take the time and think things through. Doing this also means that if you decide to step into the caregiving role, you do it by choice, not because you think you should.

Other Ways of Alleviating the Financial Strain

Getting paid to care for a family member is viable, particularly if they’re eligible for Medicaid. However, it takes time to get this set up. Remember that getting paid to provide care only addresses the financial side of caregiving to some degree. The role is still draining, and you may still spend more than you’re getting paid.

There are other ways to increase your monthly income and lessen expenses that may provide you with the flexibility you need. You can explore ways to access other crucial benefits you may be missing out on through the National Council on Aging’s Benefits Checkup Tool: https://benefitscheckup.org/. By entering your zip code, it can point you to local and national programs that you or your family member qualify for to find relief, and which can offset the costs for food, medications, health expenses, utilities, housing, and more.

You can also seek free respite care from the Los Angeles County Department of Aging and Disabilities by calling (800) 540-4442. They can provide occasional and brief assistance for up to a certain number of qualifying hours. Medi-Cal eligibility is not a factor. Respite hours are usually disbursed by need, not income. This is perfect for when you need to attend your own medical appointments or have a scheduled procedure. Don’t forget about those! The staff can also help you navigate other local programs, such as setting up free home-delivered meals.

Save on gas and time by setting up door-to-door transportation with the County by calling (888) 863-7411, which offers rides for frail and/or disabled seniors 60 and older within Los Angeles County. This is ideal for medical appointments you cannot attend, and your loved one is okay being away from you.

For food support, you can apply to CalFresh over the phone at (866) 613-3777 to get financial assistance for purchasing food.

While these benefits don’t equate to full-time work pay, they can help lessen the impact of being under or unemployed while you care for your aging parent, spouse, or loved one. With some dedication, diligence, and loads of patience, the time invested in setting up these resources can begin to ease the financial toll of stepping back from the rigid 9 to 5 workweek.

Other ways to reduce expenses are less obvious. For example, you can list your loved one as a dependent on your taxes. This is possible if you pay for more than 50% of their expenses, including room and board, food, utilities, medical bills, and the like. Check with your tax expert.

Lastly, you can find alternative ways to earn some money. Since the pandemic, the number of remote, independent workers has been steadily rising. If it is feasible, you can pursue part-time or remote work.

This will also help reduce the sense of isolation that comes with caregiving. These are just a few strategies for earning extra money while giving you flexibility.

• Provide after-school care to neighbors’ kids, set up your profile on Care.com or SitteryCity.com, or let others know you’re available through NextDoor or Facebook.
• Petsit from your home to small animals. You can set up your profile on Rover.com, Care.com, or similar.
• Design your own crafts and sell them on platforms like NextDoor, Etsy, Facebook Marketplace, and others. 
• Look for remote work options. Call center or tutoring jobs are good options if you have the right equipment at home. Use big search engines like Indeed, ZipRecruiter, or SimplyHired and select the ‘remote work’ filter for other remote work options.
• Get certified as a medical transcriptionist.

Deliver food through Uber, GrubHub, Dasher, or Postmates if you have a reliable car and are okay getting away for an hour here and there. Or look for Courier jobs, where you’ll be delivering small packages and can set your own schedule.