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Friday, April 21, 2023

How to Pay a Caregiver (Even if That’s You)

Caregiving can help seniors age in place. A variety of programs may be able to help with the cost, even if that care is given by a family member.

Unpaid care is provided by 41.8 million Americans to adults over age 50 according to a recent survey. That amounts to almost 17% of the population. This puts a tremendous strain on these caregivers, who must bear a financial, physical, and emotional burden for their toil. But overwhelmingly, older adults want to age in place. We checked for programs that could help provide payment for this crucial service. 


You  must be homebound and under a doctor’s care to get home health services under Medicare. An example would be after hip surgery. Medicare Advantage plans are required to provide the same level of home health care coverage as Original Medicare, however that may come with different rules, restrictions, and costs. Certain Medicare Advantage plans offer additional limited help at home under defined circumstances. Be sure to comb through your plan carefully to determine what benefits you may qualify for. 

Beware Medicaid “Estate Recovery” Programs  

Federal law mandates all states to have “estate recovery” programs that seek to reimburse Medicaid for expenses, such as those paid out to caregivers. But states have leeway regarding whom they bill and what assets they'll go after. Some use a private contractor to recoup money from the estate of Medicaid participants. For more on the estate recovery program, go here. For a story on what happened to one family affected by estate recovery, read this. Before you elect to use Medicaid’s waiver program, it’s a good idea to check how aggressive your state is about clawbacks and what assets that may affect. The lookback period is five years in most states, so do your planning well in advance of when it will be needed.  


Medicaid is a joint federal and state health insurance program that mostly serves individuals with low incomes or disabilities. Medicaid’s Home and Community Based Services waivers can pay for homemaking, personal care, adult day health services and more. It may pay a family member to provide care. Check here for a complete list of covered services. However, be aware that many states actively claw back these payments after the death of the Medicaid recipient. 

Area Agency on Aging

Connect with your local Area Agency on Aging by going here. Caregivers may be able to obtain respite care (a break from their duties), education and training, information and assistance, counseling and support groups, and supplemental services through the National Family Caregiver Support Program. It’s available for people 60 and above, or less than 60 with a diagnosis of Alzheimer’s disease or related disorders. 


The VA has considerably more leeway than many government programs. If the person receiving care is a veteran, it is crucial that you check out what benefits he or she may qualify for. Caregivers of veterans may be able to get paid through the Veteran Directed Care program or Veteran Aid & Attendance Pension Benefit.

State-by-State Resource Guide

The Family Caregiver Alliance has a wonderful state-by-state guide to help you find resources where you live. For instance, your state Department of Human Services may have a program which would pay caregivers. Make sure to access this tool for resources you may otherwise miss. 

Other Options for Family Caregivers

Some long-term care policies allow payments to go to a family caregiver. Check your policy benefits to see if this is an option. The insurance company or agent should be able to help you find the information you need. 

It’s possible that a relative could take a leave from their job to care for you and continue to get paid. They’ll need to check with their human resources department to see if this is an option. 

Finally, family members may be willing to pay a member or outside caregiver for in-home services. This may be a viable option, especially when compared with the cost of moving a loved one to a care facility.