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.
A family caregiver should not assume the older person will be automatically eligible to participate in a program which pays caregivers. Factors such as one’s income, savings, marital, or veteran status can all impact eligibility. Furthermore, one might meet all of a program’s requirements, but still be put on a waiting list for benefits.
That unpaid and often expensive commitment can make it hard for caregivers to make ends meet. Twenty-eight percent say they have stopped saving money, and 23 percent have taken on more debt, the AARP/NAC study found. Growing awareness of this financial burden has fueled a national conversation around issues like paid leave and even outright payment for family caregivers.
Give some thought to what the needs are and do some planning before applying to be paid as a family caregiver, including
- What is the age of the individual that requires care?
- What is the relationship between the caregiver (who wishes to be paid) and the care recipient?
- What level of care is required?- be specific about the needs of the older adult needing care in activities of daily living (ADLs), including the ability to feed themselves, bathing, toileting, dressing, and transferring from bed to chair to toilet
- Some assistance
- Significant assistance
- 24/7 care or supervision
- For approximately how long will the care receiver need assistance?
- Less than 3 months
- 3 months to 1 year
- 1 to 2 years
- Over 2 years
- What is the marital status of the person that requires care?
In Texas, there are both state and federal programs that pay family members to care for a loved one.
Texas Medicaid has a wide variety of programs that help low-income women, families, seniors, and kids stay healthy
- Medicaid for the Elderly and People with Disabilities
- Medicaid for Parents and Caretakers
To learn more about Texas Medicaid, visit the following resources and websites:
- STAR+PLUS waiver, which is a Medicaid program that provides care services to individuals who do not live in nursing homes.
State-funded programs, including Texas’ Community Care for Aged/Disabled (CCAD) program, is a non-Medicaid (state funded) option that will pay certain family members or other loved ones for providing certain types of care.
The Texas Community Care for the Aged / Disabled (CCAD) program is designed to allow seniors and disabled individuals who are at risk of nursing home placement to remain living at home, in the community, or in the home of a caregiver, and receive services and support in those locations.
In addition to helping low-income elderly or disabled individuals reside in their homes, the goal is to prevent costly Medicaid-funded nursing home institutionalization. To achieve that goal, the program offers a suite of different services (outlined below).
The program offers personal care at home, in foster care, or in assisted living residences. It also covers services that reduce the need for personal care or supervision, such as Personal Emergency Response Services (PERS).
The CCAD Program is also referred to as Non-Medicaid Services and, sometimes by its federal funding source, Title XX Social Services.
While the majority of the services available via CCAD are Title XX services, Community Attendant Services (CAS) is not. Rather, this is a Medicaid (Title XIX) funded program and is only available to Medicaid recipients.
- Veterans’ Programs
While programs for veterans are not relevant to all Texans, the state has a very large veteran population, at last census, estimated to be over 1.5 million.
- Long Term Care Insurance
If your loved one has long-term care insurance and if their policy meets certain requirements, it can be used to hire family members as caregivers.
All 50 states and the District of Columbia offer self-directed Medicaid services for long-term care.
These programs let states grant waivers that allow qualified individuals to manage their own long-term home-care services, as an alternative to the traditional model where services are managed by an agency. In some states, that can include hiring a family member to provide care.
Benefits, coverage, eligibility and rules differ from state to state.
Some programs pay family caregivers but exclude spouses and legal guardians. Others will pay care providers only if they do not live in the same house as the care recipient.
Program names also vary. What is called Consumer Directed Care in one state might be called Participant-Directed Services, In-Home Supportive Services or Cash and Counseling in another. Contact your state Medicaid program to ask about its options or to start the sign-up process.
Enrolling in self-directed care involves the following steps:
Your loved one — with assistance if desired or needed — is assessed for capacities, need, preferences, risks and strength as the Centers for Medicare & Medicaid Services requires.
Your family member and any chosen representatives create a written service plan detailing the daily living assistance required. Areas may include bathing, dressing, feeding, helping with light housekeeping and laundry, managing medications, moving from bed to wheelchair, preparing meals, shopping, supervising activities and transporting to appointments. Contingency plans should be available for coverage when the care provider is off and instructions for fill-in caregivers should address risks.
If the assessment shows need, a budget for goods and services will be provided.
When the care plan is set, the care recipient, or a surrogate if needed, chooses a caregiver.
For military veterans
VA medical centers determine eligibility and make referrals. Find and contact your nearest center for more information.
Similar to self-directed care under Medicaid, this Department of Veterans Affairs (VA) program allows qualified former service members to manage their own long-term services and supports. It is available in 42 states, the District of Columbia and Puerto Rico for veterans of all ages who are enrolled in the Veterans Health Administration health care system and need the level of care a nursing facility provides but want to live at home or the home of a loved one.
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, such as bathing, cooking, feeding, dressing, using the bathroom and adjusting prosthetic devices. The veteran chooses the caregiver and may pick any physically and mentally capable family member including a child, grandchild, sibling or spouse.
This program supplements a military pension to help cover the cost of a caregiver, who may be a family member. A&A benefits are available to veterans who qualify for VA pensions and meet at least one of the following criteria. The vet:
- 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 why a caregiver is needed, ideally including an attending doctor’s report.
Be specific about the disease or injury that caused physical or mental impairment, and explain on the form your typical day, noting how well you get around, any loss of coordination or any inability to manage basic daily needs without assistance. You can mail the form to the pension management center that serves your state or file in person at your regional VA benefits office.
Veterans who receive a military pension and are substantially confined to their immediate premises because of permanent disability can apply for a monthly pension supplement.
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.
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 on or before May 7, 1975, or on or after Sept. 11, 2001. (Benefits will be extended in October 2022 to veterans who suffered a service-related disability between those dates.)
The veteran must be enrolled in VA health services, have a disability rating (individual or combined) of 70 percent or higher, and need either personal care related to everyday activities or supervision or protection because of their condition. The caregiver must be 18 or older and a child, parent, spouse, stepfamily member, extended family member or full-time housemate of the veteran.
The stipends are based on federal pay rates for the region where an eligible veteran lives. The caregiver receives 62.5 percent or 100 percent of the pay rate, depending on the level of supervision and help with daily activities the veteran needs. A family caregiver in Dallas, for example, would receive $1,752 or $2,803 a month, according to a VA fact sheet on the program.
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.
For more information on help for military caregivers, visit the VA Caregiver Support page or call its hotline at 855-260-3274.
Getting paid by a family member
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, try these steps to establish a proactive employer-employee approach, which 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 and caregiver sick days will be handled.
- Draw up a personal care agreement that will serve as a contract between the caregiver and the care recipient. It should spell out wages, what services will be provided and when, and the length of the agreement, among other terms. Consider involving other members of the immediate family in working out terms so they are not surprised later.
- Consult an elder care lawyer to review your contract to make sure it meets tax requirements and deals with inheritances. All other interested parties, such as siblings, need to approve it.
- 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 elder care.
- Keep professional records. Specify services performed, dates of work and the amount paid. This paperwork is essential if your family member later applies for Medicaid. During the qualification process, a caseworker will examine records for the past five years.
- Report income. As with any paid job, caregivers are legally required to report wages as taxable income. If at a later date your family member becomes eligible for Medicaid but your taxes have not been paid, Medicaid will consider the money a gift — not an expense. This could prevent your loved one from qualifying for Medicaid. On the other hand, the Internal Revenue Service is clear: When services are provided, all money received is a wage, not a gift.
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.
These programs and qualifications are complex and vary by state.
Contact a benefits counselor by calling 211 or find information online by calling 211 or your local area agency on aging.
For information for states other than Texas, enter your state and this information into your search engine: “How can I get paid to be a caregiver for a family member?
If you don’t qualify for programs, another option is to consider respite (relief) care. While being a caregiver can be very rewarding, it can also be stressful and present health challenges for the caregiver. A recent survey found that about one in four caregivers say they have difficulty caring for their own health. Respite care, where someone else looks after your loved one while you take a break, is a great way for a caregiver to have some time for themselves. Respite provides caregivers with the ability to run errands and take care of other personal matters. Respite care can be provided in several different settings for a couple of hours or for a couple of days.
The HHS Take Time Texas website has several resources to help caregivers, including:
- A search function that finds respite providers in Texas
- Testimonials from families who use respite
- Links to national resources
- Resources for family caregivers
- Common myths about respite
- North Central Texas Area Agency on Aging, Dallas Area Agency on Aging Community Council of Greater Dallas and Texas Health & Human Services.
- AARP – You Can Get Paid as a Family Caregiver (funding may not apply to all states and community)
We hope this information is helpful to you in the important work you do as a family caregiver.
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