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Are you one of the 48 million Americans who provide family caregiving to someone you love? In some cases, that caregiving can be basic – a quick check-in every few days, making sure the fridge is stocked, and ensuring that your loved one has all the things they need to stay safe and healthy in their own home.
But there are many caregivers who do much more than that. According to the Caregiving in the U.S. 2020 survey, millions of caregivers provide care for an average of 24 hours each week.1 That’s the equivalent of a part-time job!
That can be especially challenging for those of the sandwich generation, who are often raising children of their own while taking care of an elderly parent. These caregivers often have a whole calendar of responsibilities, including a full-time job, a household to run, and obligations to family and friends.
Just reading that is a little exhausting, isn’t it?
In addition to the problems of running out of time, there is also the issue of finances. A whopping 78% of family caregivers incur expenses directly related to the care of their loved one, spending an average of $7,200 each year.
Your expenses might not be too bad at first – you might plan some aging in place home modifications or choose a medical alert bracelet or wristband with an affordable monthly fee. But as your loved one gets older and their medical needs become more complex, you might find that you are spending more and more cash to keep up with those needs.
Getting paid for caregiving would help lessen the financial burden and make it easier to help the person who needs you. Fortunately, there are some programs that might offer payment for caregiving. Here are a few of those options.
Medicaid Recipients
Medicaid services are state-based, so the programs will vary from one state to another. They will also have different names, so take the time to go through your state’s Medicaid website to understand the terminology for your area.
All 50 US states and Washington, D.C. have the option of self-directed services for long-term care. This means that the states can grant waivers that allow families to manage long-term care, including hiring caregiving services.
Some states allow the person hired to be a spouse or other family member; other states require that a person be licensed as a home health aide or certified nursing assistant before they can be paid for caregiving. Still others will pay family caregivers, but spouses and legal guardians are excluded from the benefit.
How do you get self-directed care approved by Medicaid? The steps are straightforward but the process does take some time:
· Your loved one will be assessed on a wide variety of metrics, including their cognitive capacity, physical needs, risk of falls and other problems, strength, and even their preferences in care.
· If the assessment finds that your loved one needs long-term care, Medicaid will provide you with a budget that is meant to cover goods and services related to those needs.
· You will create and submit a service plan that explains which activities of daily living your loved one needs help with. This can include everything from bathing and dressing to basic housekeeping and transportation. You can even list the little things in your budget, like a medical alert system with fall detection or over-the-counter medications.
· Once a care plan and budget are set, it’s time to choose a caregiver. Fill out all the Medicaid paperwork appropriately and you may be approved to start receiving funds for the work you do with your loved one.
To learn more, contact your state Medicaid program.2
Assistance for Military Veterans
Those who were in the military might find that they have many options for paid caregiving. These options will vary depending upon the state as well as what the care recipient needs in their day-to-day assistance. Here are some of the options:
Veteran-Directed Care
Former service members who need assistance with daily living can manage their own long-term care service through this VA program. It’s currently available in 42 states, Washington D.C. and Puerto Rico. It’s for veterans of all ages who are assessed to need a level of care a skilled nursing facility can provide but want to live at home instead of in a nursing home.
Just as with self-directed Medicaid care, the government will conduct an assessment and then set a budget for an appropriate care plan. This budget can include anything from basic medical supplies to a personal alarm button to the cost of a regular caregiver. The VA allows any capable family member to hold that role, including a spouse, sibling, child, or even grandchild.
Aid & Attendance Benefits
Aid and Attendance Benefits are for former service members who qualify for a VA pension. It’s also available for the surviving spouses of service members. In addition to qualifying for a pension or being a military spouse, a person who qualifies for A&A benefits must demonstrate one of the following:
· They are confined to bed due to disability.
· They require help from someone else to perform the activities of daily living, including bathing or dressing.
· They are in a nursing home due to physical or cognitive problems.
· They have significantly limited eyesight, which is defined as less than 5/200 acuity in both eyes.
To qualify for this assistance, you will submit an application that explains the need for a caregiver, what a typical day looks like, and includes a doctor’s report on the medical status of your loved one. You can file this form via mail or in person at your regional VA benefits office.
Housebound Benefits
These benefits are available to those veterans who receive a pension and are substantially housebound. They must be confined to their home due to a permanent disability, whether service-related or not. These benefits are given as a monthly pension supplement, which can then be used to pay a family caregiver for providing home health care.
The application for housebound benefits is the same one as the A&A application. Just remember that you can’t receive A&A and housebound benefits at the same time; you must choose one.
Program of Comprehensive Assistance for Family Caregivers
This program specifically assists family caregivers with a monthly stipend. It’s for those who are taking care of a veteran who needs assistance with daily living due to a serious injury or illness sustained in the line of duty. The veteran must be enrolled in VA health services, have a disability rating of 70 or higher, and require caregiving for everyday activities.
The caregiver must be 18 years old or older. They can be a spouse, siblings, parent, child, or other extended family member or close friend. The amount of assistance depends upon where a person lives and the federal pay rates for that area. This fact sheet from the VA can guide you on how much you might receive.3
Some of the other benefits with this program are incredibly helpful for caregivers, including:
· Comprehensive training in caregiving practices
· Access to health insurance
· Access to mental health services
· Up to 30 days of respite care each year
· Lodging and travel reimbursement for a caregiver who accompanies a veteran as they travel to receive the proper care
Payments from Long-Term Care Insurance
Some long-term care insurance plans require a person to be housed in a skilled nursing facility or assisted living facility before they will pay anything. Others will cover the care of home health aides or registered nurses to allow an elderly person to stay home as they age.
A few of those will agree to cover the cost of a family caregiver. If they do, odds are they will cover someone who comes in from outside the home, which excludes spouses or other live-in family members. Check with the insurance company about your coverage and get a copy of the benefits information for reference.
Hiring a Family Member as a Caregiver
For those who have the financial means, hiring a professional caregiver makes sense. But what if you want to hire a family member to care for you instead?
This isn’t as easy as wiring money to their bank account every week. To hire a family member, you should treat the situation like a business transaction, where everything is written in a contract and agreed upon. Here are a few things to consider:
· Talk with an attorney who specializes in elder care. You will need them to look over any agreements or contracts you choose to draw up. They can make sure there are no problems with taxes, inheritance, and other legal and financial issues.
· Talk to a financial advisor. This is very important if you are going to be an employer for your caregiver. They can give you advice on how much pay is appropriate and guide you through the steps to getting them paid.
· Create a personal care agreement that spells out what your needs are, what services will be provided, the general number of hours they will work with you, how long the contract continues for, and more. Let the attorney and financial advisor both take a look.
· Keep meticulous records. Not only will the paperwork on dates of work, the amount paid, and the services provided help you see your increasing needs over time, it also provides you with a paper trail. You’ll need that if you apply for Medicaid, as you’ll need to hand over records for at least the past five years.
Getting paid for caregiving can greatly ease the financial burden. As your loved one ages and you find that more and more money is coming out of pocket, it’s time to look into the options that can help.
