How to Pay for a Caregiver

For many, caregiving involves increased expenses and decreased income. You suddenly need to think about medical fees, incontinence supplies, the cost of home modifications to improve safety, and assistive tools to help with daily tasks.

And, if you’re working, your boss probably isn’t too pleased with the extra time. You find yourself taking unpaid days off to help with a medical challenge or being passed over for a promotion.

We’ve discussed the topic before – including money saving tips for seniors and ways that caregivers can earn extra money. Today, we’re taking a different approach and focusing on the programs that can pay for caregiving.

Some of these programs will allow family members to get paid for the care they provide. Getting paid in this way offers much needed financial relief, especially if you are no longer employed.

Alternatively, programs might be used to pay for a professional caregiver. This approach frees up your time and energy, giving you the chance to earn more money – and to simply be there emotionally for your loved one.  

While many programs can pay for caregiving, the requirements for programs vary considerably based on location and specific circumstances. This typically means you need to dig into each program for yourself to determine what’s relevant for your situation.  

Programs That May Pay Family Members

Cash & Counseling Programs

Cash & Counseling programs are designed for people who need long-term care, including seniors. The programs are notable in that recipients are able to choose how they use the funds provided.

This allows them to select the specific services they need and who provides these services. Such programs provide more personalized support than usual, providing seniors with a greater sense of autonomy.

The benefits are easy to see.

Regardless of whether the senior hires a caregiver or pays you to provide care, these programs provide support you don’t need to pay for.

Who Gets Paid?

Cash & Counseling Programs generally allow professional caregivers or family members to provide care. Some states allow spouses to do so as well, but many do not.

There may be other rules or restrictions as well, so it’s important to check the specifics of your local programs before applying.

Funding and Eligibility

Cash & Counseling Programs are generally funded through Medicaid. Specifically, they’re based on Medicaid HCBS Waivers.

Because of this, seniors need to be Medicaid-eligible to qualify for the programs. Financial eligibility varies depending on the state and whether the senior is applying on their own or as part of a couple (more details can be found here). However, you probably already know whether the senior is Medicaid-eligible.  

After eligibility, there are three important areas:

• Assessment. If the senior is eligible, the next step is an assessment of current in-home needs. Doing so may involve speaking to caregivers and doctors. The assessment process aims to determine what tasks a senior can do themselves and which ones they cannot.
• Determination. The program then uses the assessment information to decide whether the senior is able to be in the program. If they are, then the program determines how many hours of in-home assistance would be approved if the care were coming from an agency. Based on this information and the rate for care workers in the state, a total is determined, which will be how much the senior is paid each month.
• Plan. The senior is then responsible for planning who provides the care and how much they are paid to do so. The rate of pay needs to be at least the minimum wage. The senior can also decide how else the money should be spent, such as on household items and other services. Various aspects of the program help seniors to achieve this goal and fill out any required paperwork and tax forms.

Some such programs are non-Medicaid funded. These may be more flexible with their financial requirements, although there are still some financial and functional requirements.    

Finding Programs

Cash & Counseling Programs originally started as a pilot program, but they’ve since expanded and are now available in most states.

However, programs have different names depending on your state, which makes matters a little complex.

Generally, you’d begin by applying for Medicaid locally. Once accepted, you can then find out the specific programs in your area and start applying for these

The site Paying for Senior Care has a comprehensive list of the current programs, with links to further details. However, it’s still important to check locally, as online lists aren’t always up-to-date.  

Long-Term Insurance

Insurance acts as another key source of funding for caregiving. There are many differences between insurance policies, which means that their requirements and expectations of caregivers may vary as well.

Some insurance policies do allow family caregivers to provide care. However, in some cases, the policy may only provide payment to an in-home care aide who is state certified.

You may be able to obtain this qualification yourself. A Place for Mom and PHI provide important information about what you can expect. Beyond this, there are often low-cost certification courses offered at local community colleges or similar locations.

This type of qualification is not just relevant to long-term insurance. As a result, the qualification may be appealing if you hope to be a professional paid caregiver.

Veteran-Directed Care

Veteran-Directed Care follows a similar idea as Cash & Counseling programs, meaning that Veterans get the chance to direct their own care.

This program is specifically designed for veterans who are at risk of being placed in an institution. The options provided aim to keep veterans living in their own homes and communities.

To do this, the program offers a range of different services. Beneficiaries can choose a combination of goods and services, based on what best meets their own needs.

As with the Cash & Counseling program, the Veteran-Directed Care program includes the potential to hire caregivers, which may be friends or family members.

However, the program does function a little differently. Notably, Veterans are able to authorize payments to care providers, but do not receive cash directly.

More information about this program and eligibility of requirements can be found here.

Veteran-Directed Care and Cash & Counseling programs are mutually exclusive. Seniors who are eligible for both will need to decide which best suits their needs.

Location Specific Programs

There are also many examples of programs that are specific to one part of the United States, such as a given state or city.

These programs can vary dramatically, including differences in where their funding comes from and precisely what they provide. Some may allow family members to get paid as caregivers, while others may focus on professional caregivers instead.

As a result, getting in touch with your local Area Agency on Aging can be a key way of figuring out which options are available in your area and relevant to your specific situation.

Programs That Focus on Professional Services

The programs discussed above include key ways that seniors can receive paid caregiving from either people that they know or outside persons.  

As a senior or professional caregiver, be sure to note which programs allow families to pay family members and which permit them to hire outside parties.

Some funding sources only allow funding to cover caregiving from accredited agencies.

These next options are relevant for anybody interested in becoming a paid caregiver. However, they don’t typically pay family members to provide care.

While you may not be able to directly work for your family member, there are many agencies that need to hire caregivers to fill these roles and to support seniors. The key programs that operate in this way are as follows.

Medicaid In-Home Care Assistance

People who have low income and few assets (aside from their home) are often eligible for Medicaid coverage.

The type of care provided typically includes low-level healthcare services and monitoring.

Much of that involves personal care, including areas of cooking, cleaning, dressing, bathing, eating and moving, along with other elements of daily living.

When in-home care is provided via Medicaid, this is typically achieved through a licensed home health agency. Through this approach, Medicaid directly pays the agency, which then sends aides to the senior’s home on a regular basis.

This approach works well in many situations. Notably, having paid care gives family members a much needed break and perhaps even helps them return to work. The paid caregiver may also be more skilled and experience than family caregivers, leading to a better quality of care.

However, some families still struggle with this situation.

This is partly due to challenges in finding the right fit. After all, you’ll want a caregiver that gets along well with the senior and one that’s easy to communicate with.

Care agencies often face staffing difficulties too, including high staff turnover and not enough staff members. This might mean the senior doesn’t get as much support as you would like or that the caregivers who visit often seem run down and not at their best.

High staff turnover may also mean that assigned caregivers change regularly. This can be very frustrating, as it takes time to adapt to each new person.

Medicare In-Home Care

Although the funding source is different, Medicare In-Home Care is relatively similar to the previous type of assistance.

Here, eligibility is mostly based on age and individuals who are 65 years or above may qualify for this type of insurance.

Medicare In-Home Care is also focused on people who are housebound or face major challenges in leaving the home.

If a senior does qualify, then they should recieve a specified amoutn of care weekly through a Medicare-certified home health agency.

What If They’re Not Eligible?

Most programs that pay for caregiving services have financial and health-based requirements. These are designed to ensure that those who most need support get it.

But, there are plenty of cases where people fall through the cracks.

Perhaps your aging parent has enough money to put them over the financial thresholds, but not enough to actually pay for the care they need. Or, their health issues might not be significant enough to make them eligible, even though they can’t safely live on their own anymore.

Sometimes you might be able to argue your case and prove the senior needs support. Other times, doing so simply won’t work.

Thankfully, this isn’t the end of the story. Even if the senior is ineligible for paid caregiving services, they may well be eligible for other forms of support. This includes services like Meals on Wheels and the Supplemental Nutrition Assistance Program (SNAP) to help with food costs.

Try asking at local senior centers and your local Area Agency on Aging. Such groups should know the programs available in your area, including ones you can’t easily find online.

Finding the right programs takes time and a decent amount of legwork. Still, they can make a huge difference in the long-term, so they’re worth pursuing.