Taking Care Of Elderly Parents At Home And Getting Paid
Watching an aging parent get sick and lose independence can be challenging. Many adult children want to care for their elderly parents. They want their parents to be as independent as possible and to be able to stay at home.
The financial reality is that not many families can afford this arrangement. Family caregivers do billions of dollars of unpaid work every year, many forgoing a job and an income. If you provide home care for a parent and are currently unpaid, these resources can help you earn an income while caring for your loved one.
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Option 1: Medicaid
Medicaid is a federally funded entitlement program that provides healthcare for low-income Americans. Each state administers its own Medicaid program, which has specific eligibility requirements and benefits.
Although each state program is different, they all offer ways for family members to get paid to provide personal care services for a loved one. Contact your state agency that administers Medicaid to determine if your loved one is eligible for services.
Home & Community-Based Services
Medicaid traditionally paid for long term care in nursing homes and other residential facilities. To reduce the number of people transitioning to nursing homes, Medicaid introduced Home and Community-Based Services (HCBS) waivers.
The waivers allow states to expand human services available to Medicaid recipients. They allow states to cover personal care services in the home or community instead of only in nursing homes.
The types of waivers available vary by state program but generally cover homemaker services, home health aides, adult day care, personal care services, and respite care.
Self-Directed Care
Medicaid also introduced self-directed care. This is a philosophy of care designed to give care recipients more agency. It allows them to make more choices about their care services. They can choose who becomes their Medicaid-paid caregiver. This includes family members and allows adult children to become paid caregivers of their elderly parents.
Structured Family Caregiving
Another option for being paid as a family caregiver is the Structured Family Caregiving (SFC) program. It’s currently available in only eleven states: Connecticut, Georgia, Indiana, Louisiana, Massachusetts, Missouri, Nevada, North Carolina, Ohio, Rhode Island, and South Dakota.
SFC is a program specifically designed to provide compensation to family caregivers. The program provides qualifying participants with a tax-free monthly stipend for homemaker services, supervision, and personal care assistance. The program also offers caregiver training.
Option 2: U.S. Department Of Veterans Affairs Benefits
If your parent is a veteran, you could be eligible to be a paid caregiver using Department of Veterans Affairs (VA) benefits. Several options may apply to you and your care recipient.
Program Of Comprehensive Assistance For Family Caregivers
The VA’s Program of Comprehensive Assistance for Family Caregivers (PCAFC) offers support and financial assistance for veterans with significant disabilities. Qualified veterans have a disability rating of at least 70% and need home care.
The PCAFC allows a veteran to choose one primary and up to two secondary caregivers, who can be family members. The primary caregiver receives a monthly stipend from the VA and access to health care. Both primary and secondary caregivers can access mental health care, travel benefits, and respite care.
Veteran Directed Care
Veterans who need in-home personal care for activities of daily living can choose their care provider. To qualify, veterans must also be enrolled in VA health care. If eligible, your parent will receive a monthly budget to pay for their care needs. This payment can be used to pay a family caregiver.
Aid And Attendance & Housebound Benefits
The VA offers two types of benefits in addition to standard pensions that could help you be a paid family caregiver.
Aid and Attendance is for pension recipients who need help with personal care and activities of daily living or must stay in bed for long periods due to illness.
The Housebound benefit is for pension recipients who have permanent disabilities, which keep them home most of the time. These benefits provide a stipend in addition to the veteran’s monthly pension. They can use the stipend to pay a family caregiver.
Veterans cannot use both Aid and Attendance and Housebound benefits at the same time.
Respite Care
VA respite care does not pay family caregivers. However, it does allow caregivers to take time off without the expense of paying for an additional caregiver. The VA pays for in-home or nursing home respite care for qualified veterans. As with other programs, this benefit is for veterans who need assistance with activities of daily living and personal care.
Option 3: Paid Family Leave
Depending on where you live and care for an elderly parent, you may be eligible to receive paid family leave. Washington, D.C., and several states have paid family leave laws and programs:
- California
- Colorado
- Connecticut
- Massachusetts
- New Hampshire
- New Jersey
- New York
- Oregon
- Rhode Island
- Vermont
- Washington
The programs vary by state. They all offer a way for caregivers to take time off work while still receiving some payment. The amount of payment and the maximum time you can receive payment depend on the state program. Some additional states are expected to implement paid family leave soon: Delaware, Maine, Maryland, and Minnesota.
The Family and Medical Leave Act (FMLA) is a federal law that applies in all states. It does not include paid leave but allows workers to take time off to provide care without losing their jobs. The eligibility requirements for FMLA are that:
- The employee have worked for their employer for 12 months or more
- The employer has at least 50 employees
The eligibility requirements for states’ paid family leave programs are similar.
Option 4: Long Term Care Insurance
Private insurance policies can also be sources of payment for family caregivers. Some private health plans include long term care insurance.
This benefit covers the costs of nursing home care, home health care, in-home personal care, and homemaker services. It may also cover hospice care and adult day care. The exact types of coverage depend on the individual policy.
One of the benefits of this type of insurance is that it’s flexible. It has far fewer restrictions and limits than federal programs like Medicaid.
If your elderly parent has private health insurance, check their policy for long term care coverage. You can also call the insurance company to learn more about the policy and what is included. If the older adult has this coverage, they can use the benefit to pay you for personal care services in the home.
Option 5: Life Insurance
Another insurance option that can help you become a paid family caregiver is your aging parent’s life insurance policy. With their agreement, you can use it as an asset for financial support.
For instance, many policies include an accelerated death benefit. If your parent has a terminal illness, the policy allows them to access their benefits. This can be used to pay you for care services.
Not all life insurance policies have an accelerated death benefit. Another option is to liquidate the policy by selling it. Settlement companies facilitate the sales of life insurance policies.
The downside, of course, is that the original beneficiary receives no compensation when the policyholder dies. Also, the policyholder will not get the full value of the policy. However, this option offers an immediate way to access cash and pay for a caregiver.
Option 6: Personal Care Agreement
If your parents have the means to pay for a caregiver, they can simply pay you directly for your services. With family, this can get a little complicated. Using a personal care agreement is a great way to turn an informal arrangement into a formal agreement. It helps eliminate any future disagreements or conflicts.
A personal care agreement is a legally binding document that you and your parent agree to and sign. It names:
- One or more caregivers
- Their specific roles in providing care
- Hhow much caregivers will be paid
- When the care recipient will pay them
A document like this takes a lot of stress out of the caregiver and care recipient relationship, especially with family involved. It can also be a useful way to show proof that your loved one has paid down assets to qualify for Medicaid.
Medicaid has income limits for eligibility. Eligibility also depends on available assets. If your parent has too many assets, they won’t qualify. They can use those assets to pay for care. Once they get to the limit, they can apply for Medicaid. The record of your personal agreement and care service payments shows proof of how they used their assets.
Option 7: National Family Caregiver Support Program
The National Family Caregiver Support Program (NFCSP) is a federal program that supplies grants to fund state-level caregiver support services. It does not directly pay caregivers, but it can guide you to resources that do.
The programs that NFCSP funds work alongside other state and community programs to meet the unique and diverse needs of individual caregivers and elder care recipients. NFCSP-funded programs provide:
- Caregiver information and resources about available services
- Access to available services and resources
- Caregiver counseling, training, and support groups
- Respite care
- Supplemental caregiving services
Eligible recipients include informal caregivers of care recipients 60 or older or with dementia at any age. While the NFCSP programs do not pay caregivers, they can connect you to and help you access the programs that do.
Another good resource for finding financial assistance by state is the Family Caregiver Alliance. It offers a searchable online database of state-level services. You can find respite services, your local Area Agency on Aging, eldercare locators, and additional resources to help you find ways to get paid.
Option 8: Tax Credits
Tax credits don’t directly pay family caregivers but provide a way to save money. There are a few federal tax credits that might apply to you and your care recipient. There is also a new bill making its way through the legislature, which, if voted into law, would provide informal caregivers with up to $5,000 in tax credits.
Right now, you might qualify for the:
- Dependent or child and dependent care credits. The dependent care credit may apply if your aging parent is completely disabled and qualifies as your dependent.
- The child and dependent care credit can also provide a credit for qualifying caregivers and their care recipients.
- The head-of-household tax credit. If you pay more than half of the cost of the household that you share with your parent, you could qualify for the head-of-household tax credit.
Option 9: Respite Care
Respite care is another resource that doesn’t pay family caregivers. But, it’s still a valuable resource. Many family caregivers have little time to take a break. They struggle to find time to enjoy a vacation or even to engage in healthy lifestyle habits, like exercising or getting enough sleep.
Respite care services offer a temporary caregiver to take your place. This can be done in the home, nursing, or other residential facility. Care can also be provided in an adult day care center for very short-term respite.
You might never enjoy respite because you cannot afford to pay an additional caregiver. Resources are available to help you get free or low-cost respite care. Medicaid offers respite for qualifying beneficiaries. Medicare provides paid respite for care recipients in hospice care. The VA also has a respite care program for veterans and their caregivers.
The ARCH National Respite Network is a great resource for finding respite services and ways to pay for them. The National Family Caregiver Support Program in most states offers respite care to qualifying families. State Respite Coalitions are local grassroots organizations that support caregivers. Many have opportunities for caregivers to receive respite vouchers for financial assistance.
Working as an unpaid caregiver, even for a beloved parent, can be a financial burden. To avoid the transition to assisted living or a nursing home, use these resources to find a way to become a paid caregiver and to stay with your parent longer.
Don’t forget to check if you have free access to Trualta for more caregiving resources, support groups, caregiver forums, and more.
References
- Medicaid.gov. (n.d.). Home and community-based services 1915(c). U.S. Centers for Medicare & Medicaid Services.
- U.S. Department of Veterans Affairs. (n.d.). VA Caregiver Support Program.
- National Conference of State Legislatures. (n.d.). State family and medical leave laws.
- Family Caregiver Alliance. (n.d.). Family Caregiver Services by State.
