Among the many words used to describe family caregivers—invisible, overwhelmed, heroic, to name just a few—one is often just assumed. That word is “unpaid.” Although family caregivers are often praised as a critical part of the elder care workforce, most don't get a paycheck.
Yet many caregivers need financial help. In addition to emotional and physical stress, caregiving often brings money worries. Paying for medical supplies and drugs not fully covered by insurance, transportation, home adaptations, home care, or any of the myriad other expenses may wreak havoc on a budget. It's no wonder many family caregivers ask, “Can I get paid for taking care of my mother?”
The short answer? It depends.
A longer answer would spell out the differences that determine eligibility: which state you live in, the age or condition of the person you are caring for, your relationship to that person, his or her income and assets, and more. It would also warn that not even the state and federal programs noted below will replace a full-time salary with benefits.
But for some caregivers, the extra resources would go a long way.
Seven Options for Caregiver Pay
Here are seven options worth exploring:
1. A long-term care insurance policy
If your family member has long-term care insurance that provides for in-home care, the policy may allow a family member to be paid. Some policies exclude people who live in the same household. Ask an insurance agent to explain the policy's benefits and conditions.
2. A private contract with a family member
If your family member has savings or other resources and wants to pay you, a private contract or personal care agreement may work out well for both of you. But this option can lead to family conflict and emotional and legal trouble. Make sure you consult an elder law attorney to draft a contract that spells out your wages and your responsibilities. Your wages should be consistent with prevailing local rates. Any impact on inheritances should be clear, too. Finally, all interested parties (siblings, other relatives) should understand and approve the arrangement.
3. Consumer-directed Medicaid programs
Every state but South Dakota has Medicaid programs that allow an eligible older adult to hire, fire, and train their home-care aides. These programs are often informally called Cash and Counseling, but each state has its own formal name and eligibility requirements. Family members or friends can be hired; only 12 states allow spouses to be paid, however.
Once the request is approved, the state Medicaid agency creates an individualized budget based on needs and available resources. In California, for example, under Medi-Cal's In-Home Supportive Services program, the value of the services cannot exceed $3,500 a month and generally averages around $2,200. The national average hourly wage for home-care service providers, including family, is around $11 an hour, although in some areas it may be as high as $15 to $17 an hour.
There is a lot of paperwork involved, and many participants use a financial management services agency to manage tax and other requirements. Your state Medicaid agency should be able to provide you with a list.
Some states have programs for individuals who are not eligible for Medicaid or who have specific conditions, such as traumatic brain injury. To find out what your state offers, contact your state Medicaid agency. Since many states do not have the word “Medicaid” in their agency's title, check with the state department of health or your local Area Agency on Aging, which you can access through Eldercare Locator, a service offered by a federal agency.
4. Paid family leave
The federal Family Medical Leave Act protects workers' employment when they take time off for the birth or adoption of a baby or to care for a serious ill family member, but it is unpaid leave. California, New Jersey, and Rhode Island, however, have programs that give employees the right to paid leave for these major life events; New York has a law that goes into effect in January 2018; the District of Columbia's law will be active in 2020. Washington state also passed a law but implementation has been delayed.
Each state's laws have different payment schedules and eligibility requirements.
5. Caregivers of veterans
The U.S. Department of Veterans Affairs (VA) has a number of caregiver support programs. For primary caregivers of veterans injured in military conflicts after 9/11, a 2010 law provides monthly stipends, the amount determined by a combination of hours and wages that would be paid to a home care aide. Other benefits to caregivers include travel expenses, access to health care insurance, mental health services, and 30 days of respite a year.
Caregivers of other veterans who require assistance and are housebound may be eligible for the VA's Aid and Attendance Pension Benefit. Some states have their own programs designated for veterans as well.
6. Vouchers for employed caregivers
In July 2017, Hawaii became the first state to provide financial assistance to full-time employed caregivers of older adults. The Kupuna Caregivers Act (kupuna means “grandparent” or “elder” in Hawaiian) provides up to $70 per day in vouchers for eligible caregivers that can be used to pay for services available through one of Hawaii's Aging and Disability Resource Centers.
Services include adult day care, case management, home-delivered meals, and transportation. The legislature has allocated start-up funds of $600,000 for this program, which must be renewed in 2018.
7. Tax credits
Almost half the states (23) have some form of tax credit for caregivers of dependent older adults. There are different requirements for eligibility and for types of allowable expenses. Tax credits are not refunds; they allow a person to deduct a dollar amount from their state tax bill, and sometimes a percentage of the amount on their federal tax return.
The federal Credit for Caring Act (H.R. 4808/S.2759) was introduced in May 2017; if passed, it would provide a federal tax credit of up to $3,000 for eligible employed family caregivers. Its prospects for passage are uncertain.
And Don't Forget—Other Sources of Support
Additional income for the family caregiver may not be the only solution to financial problems. Programs such as Supplemental Nutrition Assistance Program (SNAP) or Meals on Wheels may help provide food. Other programs pay for paratransit or homemaker services. Two places to start are Eldercare Locator and Benefits Checkup, provided by the National Council on Aging.
Finally, consider the future. Caregiving that lasts for a few months may be difficult financially but manageable. Caregiving that goes on for years presents financial challenges that require a comprehensive plan.
Reproduced with permission from Next Avenue