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Personal benefits of paid caregiving - why do I work as a paid caregiver?

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Personal benefits of paid caregiving - why do I work as a paid caregiver?

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10 Benefits of Becoming a Paid Caregiver for Your Loved One | Dada Home Care

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Caring for a loved one is a profound and rewarding experience. Here, we explore the numerous benefits of becoming a caregiver through this program.

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In this article: Step 1: Determine Your Eligibility for Medicaid's Self-Directed Services Programs
Step 2: Enroll in a Home and Community-Based Services (HCBS) Program
Step 3: Determine Whether Your Loved One Is Eligible for Veterans Aid
Step 4: Determine Whether Your Loved One Has a Long-Term Care Insurance Policy That Provides for Caregiver Compensation
Step 5: Determine Whether Your Company Offers Paid Leave for Caregivers
Step 6: Determine Whether Your Family is Willing to Pay You for Your Caregiving Time
Steps to Obtaining Financial Assistance for Caregivers by State
Serving as a caregiver can be an extremely rewarding experience. Not only do you get to spend time with the person you care for, but you also have the opportunity to ensure that they receive the best quality care. And as a family caregiver, you can surround your loved one by creating a support network that provides the attentiveness that your family member deserves, but also helps you so you don't have to shoulder this journey alone.

Being a caregiver for a family member sometimes comes at a cost. Caregivers often must significantly reduce their number of hours working outside the home or leave their jobs entirely to provide quality care for their loved one. This means that caregivers are spending hours of uncompensated time assisting loved ones with daily tasks, cooking meals, going to appointments, ensuring their safety and well-being, and providing companionship.

The 2020 AARP Report, Caregiving in the U.S., highlighted that 1 in 5 caregivers report high financial strain as a result of caregiving. 3 in 10 have stopped saving, and 1 in 4 have taken on more debt. Adding to this, as some caregivers find they need to reduce their work schedules, they may lose a great deal of income while oftentimes shouldering some of caregiving expenses out of their own pockets. A 2023 AARP Report, Valuing the Invaluable, revealed that family caregivers spend roughly a quarter of their incomes on costs and activities associated with caregiving.

Family caregivers need to know that there may be financial assistance available to them while taking care of their loved ones. If you're wondering, "how much do family members get paid for caregiving," here are steps to determine eligibility:

1. Determine your eligibility for Medicaid's Self-Directed Services.

2. Opt into a home and community-based services program.

3. Determine whether your loved one is eligible for Veterans Aid.

4. Determine whether your loved one has a long-term care insurance policy that provides for caregiver compensation.

5. Determine whether your company offers paid leave for caregivers.

6. Determine whether your family is willing to pay you for your caregiving time.

Step 1: Determine Your Eligibility for Medicaid's Self-Directed Services Programs

If your loved one is eligible for Medicaid, you may be able to receive financial aid from the Self-Directed Medicaid Services programs. According to Medicaid.gov, states have several options for providing Medicaid enrollees with the option to self-direct Medicaid services under the state plan and waiver programs. Fortunately, this option is available in some form in most states. It is important to note that the names of self-directed services programs vary from state to state.

Self-directed services programs provide people with disabilities and older adult citizens the option to manage a budget and determine how to use their money to pay for goods and services directly relating to their personal care needs. When enrolled in one of these waiver programs or other self-directed options, program participants may use their allotted budget to hire and pay for caregivers. To determine your family member's eligibility for self-directed services available in your state, contact your local Medicaid office.

Step 2: Enroll in a Home and Community-Based Services (HCBS) Program

If you are providing care to a family member or friend who needs help with daily activities like eating, walking, or getting out of a chair, you may be eligible to enroll in a Home and Community-Based Services (HCBS) program. Through the HCBS program, you could receive a tax-free stipend, a personal caregiver coach to guide and support you, and access to other resources. The guidance and payments from these programs help reduce financial stress for caregivers like you and help you to provide the best care possible to your loved one. These programs are usually available for people who receive in-home care and are enrolled in Medicaid.

Step 3: Determine Whether Your Loved One Is Eligible for Veterans Aid

In the United States, some veterans can enroll in a Veteran Directed Care Program (previously known as Veteran-Directed Home and Community Based Services programs). This program empowers veterans to manage their own care, which may include hiring and paying for in-home caregivers. Another option for veterans who require in-home care is a benefit known as VA Aid and Attendance. VA Aid and Attendance or Housebound benefits may be used to cover assisted living, nursing home, and in-home care costs including paying family caregivers.

In many cases, to qualify, your loved one must need assistance with activities of daily living and align with income and asset guidelines. If you need more assistance in determining your loved one's eligibility for these veteran benefits, contact your local Veterans Affairs office or your local veterans service organization.

Step 4: Determine Whether Your Loved One Has a Long-Term Care Insurance Policy That Provides for Caregiver Compensation

According to the Family Caregiver Alliance, some long-term care insurance policies do include provisions for paying a family member who provides care. If you can determine whether your loved one has such a policy, you need to find out if caregiver payment is among the benefits. If you need clarification about your loved one's long-term health insurance policy, contact the agent or the insurance company and ask about the caregiver payment benefit.

Step 5: Determine Whether Your Company Offers Paid Leave for Caregivers

As more families require at least one member to serve as a caregiver for relatives or aging parents, companies are realizing the need to assist employees with paid leave. If you find yourself serving as a caregiver to a family member while you are employed, your company may offer an elder care program or benefit. Some companies are allowing up to 8-16 weeks of paid leave for caregiving employees. However, the Bureau of Labor Statistics found in 2023 that just 27% of private industry workers had access to paid family leave through their employers, and 89% had access to unpaid family leave.

Step 6: Determine Whether Your Family is Willing to Pay You for Your Caregiving Time

Considering the amount of money that you are saving your loved one and the rest of the family by serving as the primary caregiver, you are well within your rights to ask your loved one or other family members if they will compensate you for your time. Chances are, the family would be paying out of pocket for a home health aide, which the Genworth Cost of Care Survey reports carries a monthly median cost of $4,576 per month. To protect yourself and your family, meet with an attorney to draft a contract to explicitly state your work and payment schedule. This contract may be used later in the event your loved one needs to apply for Medicaid or enter an assisted living facility or nursing home.
Summary: How to obtain financial assistance for caregivers in Alabama
It's vital that you know your loved one's eligibility for various government programs, insurance policy benefits, employee benefits, and family payment options if you hope to become a paid caregiver for a family member. To help you navigate the options available to you, we've put together a step-by-step, state-by-state guide to help you obtain financial assistance for caregiving services.

The programs that compensate family caregivers differ by state, and in some cases, from county to county.

Note that not all states make this option available, and some have restrictions on the family members who can become paid caregivers. Included here are helpful resources to find your local Aging and Disability Resource Center or local Area Agency on Aging to get in touch with community experts for further guidance. Information on the states that offer Veteran Directed Care (VDC), is also provided as well as links to the state Veterans Administration to make it easy for you to get in touch with the right representatives for the help you need. Click on a state below to go directly to the information for your state:

Alabama offers the Alabama CARES Program, which is administered under the Alabama Department of Senior Services (ADSS) through the 13 Area Agencies on Aging (AAA). This program offers assistance to caregivers including training, individual advice, information, and support (such as personal care, limited homemaker services, and adult day care. Based on the county you live in, you will need to contact your local area agency on aging for more information and eligibility requirements.
Summary: How to obtain financial assistance for caregivers in Alaska
Several Medicaid Waiver Programs are offered that aim to help prevent nursing home placements where possible. Each has its own eligibility criteria, including income and asset qualifications. Below are some general details about Medicaid Waiver Programs that may be relevant to your situation:

The Alabama Medicaid Elderly and Disabled Waiver is designed to provide support services to older adults and persons with disabilities that enable them to live safely in their own homes. Services may include case management, personal care, homemaker services, respite care, companion services, adult day care, and home-delivered frozen meals.

The Personal Choices program enables Alabama older adults to select and manage their own care providers and is available to individuals enrolled in a Home and Community Based Waiver Services program such as the State of Alabama Independent Living (SAIL) program.

The Alabama Community Transition (ACT) Program provides individuals with disabilities or long-term illnesses living in a nursing facility and who wish to transition back to a home or community setting the opportunity to do so by providing plan of care and case management services. To qualify, the individual must have been in the nursing facility for 90 days or more. They must also move into the community within 180 days.

The Technical Assisted Waiver (TAW) Program provides plan of care and case management services to enable ventilator-dependent adults or those with a tracheostomy who would otherwise need institutional care to remain in the community.

If you would like more information about any of the Medicaid Waiver Programs, you can contact your local Area Agency on Aging (AAA) and Aging and Disability Resource Center (ADRC) at 1-800-AGE-LINE (1-800-243-5463).
Summary: How to obtain financial assistance for caregivers in Arizona
Under the Veteran Directed Care Program (VDC), eligible veterans manage a flexible budget and determine the mix of goods and services that meet their needs to enable them to continue living in their homes and engage in their communities rather than risk placement in a long-term care facility. Under this program, veterans hire and supervise their own workers, while receiving assessment and care planning assistance, help securing financial management services, and ongoing counseling support for themselves, their family members, and their caregivers from an options counselor.

1. Review Medicaid eligibility requirements. If eligible, you may apply for Medicaid in Alabama online or by contacting one of Alabama's Medicaid District Offices for assistance.

2. Contact the Alabama Department of Senior Services.

3. Complete the Application for a §1915(c) Home and Community-Based Services Waiver.

4. Evaluate other waiver program options in Alabama, including:

1. Contact the Alabama Department of Rehabilitative Services at 1-844-602-7275 for information on the SAIL Waiver, including information on how to apply. For information on the ACT or Elderly and Disabled waiver, contact your local Area Agency on Aging at 1-877-425-2243.

2. Contact your local Area Agency on Aging (AAA) and Aging and Disability Resource Center (ADRC) by calling 1-800-AGELINE (1-800-243-5463) for more information on local programs, including Alabama CARES, and assistance with determining program eligibility and accessing programs.

3. Contact the Alabama VA Healthcare System of your choice for information on the Veteran Directed Care Program if your loved one is a veteran. (See above for links to the three Alabama VA Health System locations approved as qualified providers for VDC).

The state of Alaska offers a Personal Care Services (PCS) program, which provides assistance with activities of daily living (ADLs) such as bathing, dressing, toileting, and eating, as well as instrumental activities of daily living (IADLs) such as shopping, laundry, and light housework, for eligible older adults. The program operates in two primary ways:

Agency-Based PCA Program (ABPCA): An agency will oversee, manage, and supervise the care services of participants.

Consumer-Directed PCA Program (CDPCA): Participants manage their own care services and may hire friends or certain family members to provide care; however, parents of minor children, spouses, most legal guardians, and a sole power of attorney or a joint/dual power of attorney are restricted from serving as a paid PCA.

The Community First Choice (CFC) is a program under the Medicaid reform initiative, 1915(k). The CFC program offers personal care services and other supportive services to enable eligible recipients to receive services in their homes as an alternative to institutional care. Recipients may receive a Personal Emergency Response System (PERS) as part of the program, and as well as skills training to help them learn to perform activities with greater independence. The number of hours of personal care services a recipient is eligible to receive each week is determined by an assessment conducted by the Division of Senior and Disabilities Services.

Alaska's Veteran Directed Care Program is offered through the Alaska VA Health System.
Summary: How to obtain financial assistance for caregivers in Arkansas

Evaluate Alaska's Senior Benefits services to determine eligibility.

1. Apply for the Personal Care Services (PCS) program if eligible.

2. Apply for one or more of Alaska's Home and Community Based Waiver programs.

3. Evaluate Alaska's grant programs to determine eligibility and apply for grants you're eligible for.

4. Contact your local Area Agency on Aging and Aging and Disability Resource Center (ADRC) for more information on local programs and assistance with determining program eligibility and accessing programs.

5. Contact the Alaska VA Healthcare System for information on the Veteran Directed Care Program if your loved one is a veteran.

The Arizona Long Term Care System (ALTCS), Arizona's Health Care Cost Containment System (AHCCCS) (the state's Medicaid program) is the only agency that offers such a program. ALTCS is "health insurance for individuals who are age 65 or older, or who have a disability, and who require nursing facility level of care."

In order to be eligible for ALTCS, individuals must a) be in need of a nursing home level of care as determined by AHCCCS, b) be a citizen or qualified immigrant, c) have a Social Security Number (SSN) or apply for one, d) be an Arizona resident, e) apply for all cash benefits that you may be entitled to, such as Pensions or VA benefits, and f) live in an approved living arrangement. There are also certain financial eligibility requirements that must be met.

ALTCS offers Member-Directed Options, which empower members who qualify with more control over how certain services are provided, such as attendant care, personal care, and homemaker services. One notable Member-Directed option is 'Self Directed Attendant Care (SDAC).' Under SDAC, the member's legal guardian serves as the legal employer of the paid caregiver. In this role, they assume all employer-based responsibilities and are supported by a Fiscal Employer Agent that takes care of the taxes, payroll withholding, and paychecks for the caregiver.
Summary: How to obtain financial assistance for caregivers in California
Arizona's Agency with Choice (AWC) program allows ALTCS members to share employer-based responsibilities for paid caregivers in relationship with a provider agency. Under this program, the provider agency maintains hiring and firing authority over caregivers and arranges for required minimum training for caregivers. Members may choose to recruit and select their own caregivers, dismiss caregivers, manage caregivers, including their duties and schedules, supervise caregivers, and identify special training needs and conduct caregiver training.

Arizona's Veteran Directed Care Program is offered through the Southern Arizona VA Health Care System.

1. Determine Medicaid eligibility and follow the application process if your loved one meets the criteria.

2. Contact your local ALTCS office. You may also get in touch with the AHCCCS/ALTCS program by calling 602-417-6600.

3. Visit Arizona's Family Caregiver Support Program (FCSP) for more information on caregiver support services in your area.

4. Get in touch with your local Area Agency on Aging (AAA) for information on the Home and Community Based Waiver program, including eligibility criteria and application information, as well as information on accessing FCSP programs.

5. Visit Arizona's Aging and Disability Services (ADS) website for more information on programs for older adults in Arizona.

6. If your loved one is a veteran, contact the Southern Arizona VA Health Care System for information on the VDC program.

The Arkansas Department of Human Services, Division of Aging, Adult & Behavioral Health Services, administers the ARChoices in Homecare Medicaid waiver program. Under the ARChoices program, eligible recipients can receive services that provide help with activities of daily living and instrumental activities of daily living such as bathing, dressing, meal preparation, and household chores. Benefits also include adult day care services, respite care, and home modifications. ARChoices represents a combination of two prior Medicaid waivers: Alternatives for Adults with Physical Disabilities (AAPD) and ElderChoices.
Summary: How to obtain financial assistance for caregivers in Colorado
The Living Choices Assisted Living Waiver (ALW) is another Arkansas Medicaid waiver program. This program covers the cost of services received at an assisted living facility but does not cover the cost of room and board. Services may include medication monitoring, attendant care, and nursing evaluation, among others.
Find out how you can get a tax-free stipend and free caregiving coaching and support.

Arkansas also offers the Arkansas Independent Choices (IC) program. This is a member-directed option that allows the client to be in charge of "hiring, training, and supervising his or her in-home workers from Medicaid funds the client or his/her representative control."

The Program of All-Inclusive Care for the Elderly (PACE) is a joint Medicare-Medicaid program for people age 55 and older that also emphasizes consumer-directed care. You can find a PACE plan near you by searching here.
Summary: How to obtain financial assistance for caregivers in Connecticut
Arkansas offers a Veteran Directed Care program through the Central Arkansas VA Medical Center and Fayetteville VA Medical Center.

1. Determine Medicaid eligibility and find out how to apply by visiting the Arkansas Department of Human Services.

2. Get in touch with your local Area Agency on Aging (AAA) for information on local programs, eligibility, and application information.

3. Evaluate grant program options and eligibility. Contact Palco for information on the Arkansas Independent Choices Program at 1-866-710-0456. If you currently receive ARChoices services, contact the DAAS RN who conducts your assessments.

4. Visit the Division of Aging, Adult, & Behavioral Health Services for more information on programs for the older adult and disabled in Arkansas.

5. Veterans should contact the Arkansas Department of Veterans Affairs for information on the Veteran Directed Care program.

California's Department of Aging offers a Family Caregiver Services program with funding from the U.S. Administration on Aging through the state's 33 Area Agencies on Aging (AAAs). The AAAs coordinate local programs to assist family caregivers who are caring for an older adult. Services include information for caregivers, help with gaining access to services, training, counseling, respite care, and limited supplemental services aiming to complement the care provided by a family caregiver. These services are provided either directly by AAA staff or through partnerships with public or private agencies.
Summary: How to obtain financial assistance for caregivers in Delaware
Additionally, California's Medicaid program offers an In-Home Supportive Services (IHSS) Program that pays for services provided to qualifying older adults to enable them to remain in their own homes, such as housekeeping, meal preparation, laundry, grocery shopping, and personal care services. The recipient is responsible for hiring, training, and supervising their individual provider. The IHSS Program consists of four programs: IHSS-Residual (IHSS-R), Personal Care Services Program (PCSP), IHSS Plus Option (IPO), and Community First Choice Option (CFCO). Spouses may receive compensation for providing caregiving services under the program in some situations.

California's Veteran Directed Care program is offered through the San Diego VA Health Center.

1. Apply for Medi-Cal (California's Medicaid program) by calling 1-800-433-2611, through your local county assistance office.

2. Contact the AAA's Information & Assistance program for information about local programs and services, eligibility criteria, and application information by calling 1-800-510-2020.

3. Visit the California Department of Social Services for contact information for your local Social Services office.

4. Complete an IHSS application and submit it to your local IHSS office. A complete list of local IHSS offices can be found here.

5. Get in touch with your local Area Agency on Aging (AAA) for information on programs and services offered in your area.

6. Evaluate relevant Home & Community-Based Services Waiver options and eligibility.

7. Veterans should contact the California Department of Veterans Affairs for information on the Veteran Directed Care program.

The Colorado State Unit on Aging is part of the Department of Human Services, overseeing a variety of programs and services for older adults including caregiver support, nutrition services, legal services, and aging and disability resources. The National Family Caregiver Support Program (NFCSP) provides information, respite care, counseling, assistance for caregivers who need help gaining access to available services, and limited supplemental services such as home modifications, assistive technologies, emergency response systems, and other equipment and supplies.

The Consumer-Directed Attendant Support Services (CDASS) program allows eligible recipients to hire, train, and manage their own personal care providers, including adult children and spouses. It's not technically a waiver program, but it is available for older adults residing in Colorado who are receiving services under the EBD waiver program or are qualified to receive services under the EBD program and other Colorado waiver programs. Under the CDASS program, recipients can manage their own Health First Colorado funds and use the funds to pay their chosen personal care provider.
Summary: How to obtain financial assistance for caregivers in Florida
The Colorado VD-HCBS program is available through the Western Colorado VA Medical Center and Eastern Colorado VA Medical Center.
Find out how you can get a tax-free stipend and free caregiving coaching and support.

1. Determine eligibility for Medicaid by visiting Health First Colorado and applying for benefits.

2. Contact a Single Entry Point (SEP) Agency to apply for the Elderly, Blind, and Disabled Waiver (EBD) through Colorado's In-Home Support Services program. The Complementary and Integrative Health Waiver (CIH) and the Children's Home and Community-Based Services Waiver (CHCBS) can also be applied for via your local SEP agency.

3. Contact your SEP or Community Centered Board (CCB) for information on eligibility for the CDASS program.

4. Determine eligibility for the Programs of All-Inclusive Care for the Elderly (PACE) (a joint Medicare-Medicaid program) and inquire about services available. You may also inquire about PACE through a Single Point of Entry Agency. You must apply for PACE through a local PACE organization, which can be found here.

5. Contact your local ARDC office by calling 1-844-COL.ADRC (1-844-265-2372) for information on programs and services.

6. Get in touch with your local Area Agency on Aging (AAA) for information on the NFCSP and other programs and services available in your local area, eligibility criteria, and application information.

7. Veterans should contact the Colorado Division of Military and Veterans Affairs for information on the Veteran Directed Care program.

Community First Choice is a program provided by the Department of Social Services as part of the Affordable Care Act. It enables participants to receive support and services in their home while giving them control over what services they obtain and the responsibility of managing those services. Participants are permitted to hire certain family members and friends.
Summary: How to obtain financial assistance for caregivers in Georgia
Various Home and Community Based Services Medicaid waivers are available in the state of Connecticut. The Personal Care Assistance (PCA) Medicaid Waiver Program allows individuals with a physical disability who require hands-on help with at least two activities of daily living (ADLs) to receive a personal care assistant. Examples of activities of daily living include bathing, dressing, eating, incontinence, transferring, and toileting. Under this program, a Personal Care Assistant is an employee of the participant, and the participant is responsible for hiring, training, supervising, and terminating them. Wages that the Personal Care Assistant receives are based on negotiation with the participant. Anyone who meets the program requirements may be a Personal Care Assistant; however, a conservator may not be a Personal Care Assistant. More information is available here.

For veterans, the VDC program in Connecticut is offered through VA Connecticut Health Care System.

1. Contact your local Department of Social Services office for information on applying for a Personal Care Assistance (PCA) waiver.

2. Get in touch with Careforth in Connecticut to learn more about the Adult Family Living program, eligibility criteria, and how to apply.

3. Contact your local Area Agency on Aging (AAA) to learn more about programs in your area, eligibility criteria, and how to apply.

4. Veterans should contact the Connecticut Department of Veterans Affairs for information on the VDC program, offered through the VA Connecticut Health Care System West Haven Campus.

Delaware's Diamond State Health Plan - Plus (DSHP-Plus) is Delaware Medicaid's managed long-term care program , which includes a Long Term Care Community Services (LTCCS) Program that allows for certain consumer-directed services such as personal care assistance. Under this program, some family members can receive payments for providing caregiving services, including spouses and adult children.

Delaware does not currently offer a VDC program.

1. Visit Delaware ASSIST to review eligibility requirements and apply for Delaware Medicaid benefits.

2. Contact the Delaware Aging and Disability Resource Center (DADRC) Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) at 1-800-223-9074 or visit the DADRC website here for information on caregiver support programs and how to apply for these services.

3. Inquire about the Attendant Services Program through the DADRC.

4. Contact the Division of Medicaid and Medical Assistance for information on the Diamond State Health Plan - Plus and the Long-Term Care Community Services program.

Florida's Department of Elder Affairs administers the National Family Caregiver Support Program, which provides information and assistance to caregivers of frail older adult relatives or other loved ones. Florida's Home Care for the Older adult (HCE) program provides support for Florida residents aged 60 and older who are living in family-type living arrangements as an alternative to nursing homes or other long-term care settings. In some cases, subsidies may be provided for services or supplies, although a basic subsidy (which averages $160 per month) is provided for all participants.
Summary: How to obtain financial assistance for caregivers in Hawaii
The Community Care for the Older adult (CCE) program "provides community-based services organized in a continuum of care to help functionally impaired older adults live in the least restrictive yet most cost-effective environment suitable to their needs." Under this program, clients receive a range of services including adult day services, personal care, shopping assistance, respite care, and more. The Department of Elder Affairs also provides several other services for older adult Floridians.

Florida's Statewide Medicaid Managed Care Long-Term Care Program (SMMC LTC) includes a Participant Directed Option (PDO) that allows older adult Floridians or their designated representatives to hire, train, and manage care providers, and spouses and adult children may be hired and receive compensation for caregiving services under this program.

Florida offers a VDC program through VA Medical Centers in several locations including Bay Pines, Lake City, Tampa, Gainesville, Orlando, Miami, and West Palm Beach.
Summary: How to obtain financial assistance for caregivers in Idaho

1. Contact your local Aging and Disability Resource Center for information on applying for the HCE program.

2. Veterans should contact the Florida Department of Veterans Affairs for information on the VDC program.

Non-Medicaid-funded services are offered through the Home and Community Based Services Program (HCBS). The Division of Aging Services contracts with Georgia's 13 Area Agencies on Aging to administer the HCBS program, which consists of services such as home-delivered meals, older adult recreation, emergency response services, home modifications, personal care assistance, and more. HCBS also includes services for caregivers including education and support groups, adult day services, mobile day care, and kinship care programs.

Georgia's other Medicaid waiver program is called Service Options Using Resources in a Community Environment, or SOURCE for short.

1. Get in touch with Careforth in Georgia to learn more about our Structured Family Caregiving program, eligibility criteria, and how to apply.

2. Make a toll-free call to 1-866-552-4464 to connect with your local Area Agency on Aging in Georgia or visit this page to find contact information for the location nearest to you.

3. Inquire with your local AAA about eligibility for CCSP or HCBS and how to apply.

Under the Hawaii Department of Human Services, the State of Hawaii Med-QUEST Division (MQD) administers the state's Medicaid program. The state does not offer any Medicaid waivers, as equivalent services are available through Med-QUEST, which centralizes administration of beneficiaries' health and personal care services. Med-QUEST offers funding for home health care, adult day care, personal care, and respite care, although only personal care and respite care are eligible for consumer-directed care. Under the consumer-directed care model, some family members and friends can be compensated for providing caregiving services.

The State of Hawaii Department of Health, Executive Office of Aging (EOA) administers the Family Caregiver Support Program, which provides caregiver support services to caregivers of eligible care recipients, with the goal of enabling recipients to remain in their home environment.
Summary: How to obtain financial assistance for caregivers in Illinois
Four non-Medicaid-funded assistance programs are available. The Kupuna Caregivers Program, administered by the Older adult Affairs Division of the Hawaii Aging and Disability Resource Center, provides participants in the city and county of Honolulu with up to $210 per day to cover the adult day care services. Payments are made directly to the service provider. To qualify, a primary caregiver must be employed at least 30 hours per week.
Find out how you can get a tax-free stipend and free caregiving coaching and support.
Additionally, the Chore Services Program is a non-Medicaid-funded program managed by the Department of Human Services' Adult Protective and Community Services Branch, providing assistance to older adults or Hawaii residents with disabilities with household tasks and assistance with activities of daily living (ADLs). Participants are able to choose their own care providers, including certain family members, friends, and neighbors, who may be compensated. Information is sparse on the Department's website, so it is advisable to contact them directly for more information.

The Hawaii Community Living Program (CLP) is a self-directed program, allowing recipients to determine the mix of services and supports that best meet their needs and hire and manage their own service providers. The CLP program is only available in certain areas at the time of writing (Kauai, Maui, and Hawaii counties). Reach out to the ADRC for more information.

Hawaii offers a VDC through the VA Pacific Islands Health Care System.
Summary: How to obtain financial assistance for caregivers in Indiana
Under Idaho's Medicaid for Elderly or Adults with Disabilities, older adults as well as those with disabilities can access a variety of Home and Community Based Services (HCBS). These services may include adult day health services, personal care, case management, respite care, and more.

Idaho uniquely offers a self-directed program as an option under the Developmental Disabilities Waiver called My Voice, My Choice. This program gives participants greater choice and control over the Medicaid funds for the services and supports they receive to ensure they fit their needs. Participants can hire and manage their own workers, and even hire people they know.

Idaho offers a VDC program through the Boise VA Medical Center.

1. Contact your regional Idaho Department of Health and Welfare office for information on Medicaid eligibility and application information.

2. Inquire about the My Voice, My Choice program if you are caring for a person with a developmental disability. In order to be eligible for Developmental Disability (DD) services like My Voice, my Choice, they will need to submit an Eligibility Application for Adults with Developmental Disabilities.

3. Veterans should contact the Idaho Division of Veterans Services for information on the VDC program.

Summary: How to obtain financial assistance for caregivers in Iowa
Illinois has two managed care health plans relevant to those caring for an older adult or an individual with a disability.

Illinois HealthChoice is a managed care program that provides numerous long-term care services. It is mandatory for Medicare/Medicaid enrolled older adults or individuals with a disability who get waiver services to join. Medicare-Medicaid Alignment Initiative represents a "joint effort to reform the way care is delivered to clients eligible for both Medicare and Medicaid Services."

There is currently no non-Medicaid-funded or Medicare-funded participant-directed caregiving program in the state of Illinois. However, older adults may be eligible for the Community Care Program, a Medicaid-funded waiver program managed by the Illinois Department on Aging. These services were formerly offered under the My Choices Program, which was terminated in 2016.
Summary: How to obtain financial assistance for caregivers in Kansas
Under the Community Care Program, a variety of supports, services, and technologies are provided to eligible participants who are at risk of being placed in a Medicaid-funded nursing home in order to enable them to remain in their own homes. This program is offered through the Home and Community Based Services Waiver.

Services offered under the Community Care Program include adult day services, homemaker services, medication management, transportation, and more. The former My Choices Program offered more flexibility in choosing a care provider, and the Community Care Program is a bit more restrictive. Care providers must offer services in the client's geographic area of residence and must be part of the Illinois Department on Aging's network.

1. Visit the Illinois Department of Healthcare and Family Services for information about Medicaid eligibility in Illinois.

2. If eligible, apply for Illinois Medicaid coverage. Once you have Medicaid coverage, look into joining Illinois HealthChoice.

3. Contact your local Community Care Program Care Coordination Unit (CCU) to apply for the HCBS Waiver and the Community Care Program.

4. Contact the Senior Helpline at 1-800-252-8966 or get in touch with your local Illinois Area Agency on Aging for information on other services and programs for caregivers in Illinois.

5. Veterans should contact the Illinois Department of Veterans Affairs for information on the VDC program.

Under the Consumer-Directed Attendant Care Service, participants may hire and manage their own care providers, including friends and certain family members (but not spouses), at an hourly rate determined by the state of Indiana. As this is a Medicaid-funded program, participants must be eligible for Medicaid in order to take advantage of these services.
Summary: How to obtain financial assistance for caregivers in Kentucky
Indiana also has a Program of All-Inclusive Care for the Elderly (PACE®) program that provides services such as home health care and personal care, social services, adult day care, medical care, and other services for participants who are deemed eligible for nursing home care.

The Structured Family Caregiving service from Careforth provides financial and support services for caregivers, including a tax-free daily stipend and coaching from a professional care team. The program is a benefit under Indiana's Aged and Disability Medicaid Waiver or Indiana Programs of All-Inclusive Care for the Older adult (PACE). Family members, including spouses in some cases, can become paid caregivers under this program. Benefits include up to 15 days of non-skilled respite care services per year and regular supportive visits from a case manager and registered nurse. The paid caregiver is responsible for providing the recipient's care, including assistance with activities of daily living, housekeeping, transportation, and other personal care needs. Care recipients may receive other services simultaneously through the Aged and Disabled Waiver, such as adult day care and transportation services.

1. Determine eligibility for Indiana Medicaid and, if eligible, apply for benefits. Visit the Division of Family Resources for more information.

2. Contact your local Area Agency on Aging and Aging and Disability Resource Center to learn more about the Aging and Disabled HCBS Waiver and how to apply.

3. Get in touch with Careforth in Indiana to learn more about the Structured Family Caregiving program, eligibility criteria, and how to apply.

4. Contact your local Area Agency on Aging and Aging and Disability Resource Center for more information on caregiver support services and other programs you may be eligible for.

Summary: How to obtain financial assistance for caregivers in Louisiana
Veterans should contact the Indiana Department of Veterans Affairs for information on the VDC program.

Iowa's Area Agencies on Aging (AAAs) provide a case management service that is "designed to promote and support the independent living of older Iowans by helping them coordinate the home and community-based services and supports they need."

If your loved one is a veteran, the Iowa Veteran-Directed Home and Community Based Services program may be a good option.

1. Get information on the HCBS Waiver programs in Iowa. Download the Elderly Waiver Information Packet for information on eligibility and how to apply.

2. Caregivers must apply as an individual CDAC provider.

3. Get in touch with your local Iowa Area Agency on Aging to find out more about case management services..

4. If your loved one is a veteran, apply for the Iowa Veteran-Directed Home and Community Based Services program, if eligible.

Older adults in Kansas who qualify for Medicaid may receive similar services through the Kansas Medicaid (KanCare) HCBS Frail Elderly Waiver. KanCare, the state's Medicaid program, is a managed care program administered by the Kansas Department for Aging and Disability Services (KDADS) and the Kansas Department of Health and Environment (KDHE). Some services provided through this program may be consumer-directed, although in most cases, spouses and legal representatives cannot be hired to provide caregiving services. There are some exceptions in rare circumstances, however.
Summary: How to obtain financial assistance for caregivers in Maine
Kansas does not currently offer a Veteran Directed Care program.

1. Determine eligibility for KanCare, and if eligible, submit an application for benefits.

2. Contact the Frail Elderly Program Manager at 785-296-4983 for information on applying for the Frail Elderly HCBS Waiver program. Or, you can contact your local Aging and Disability Resource Center or call 855-200-2372.

3. If not Medicaid-eligible, find your local Kansas Area Agency on Aging or call 855-200-2372 to speak to an options counselor from the Aging and Disability Resource Center (ADRC).

Non-Medicaid-funded options include the Kentucky Hart-Supported Living Program and the Kentucky Personal Care Attendant Program (PCAP). The Hart-Supported Living Program offers grants to eligible older adults to help them remain in their own homes or the home of a loved one. This program is entirely self-directed, meaning that recipients are responsible for determining the services and supports they need as well as the provider of those services. Spouses and other family members may be paid for caregiving services through the Hart-Supported Living Program, which is a state-funded program designed for Kentucky residents with disabilities, regardless of age.

PCAP is also a state-funded program for Kentucky residents who are 18 years of age or older and have a functional loss of two or more limbs. It's a consumer-directed program, allowing beneficiaries to choose and manage their own personal care attendant to assist with day-to-day activities including housekeeping, personal care, and meal preparation.

The state of Kentucky offers VDC programs through the Lexington VA Medical Center and the Louisville VA Medical Center.

1. Apply for Medicaid and/or Medicaid Waivers online using the kynect benefits portal.

2. Contact your local office of the Cabinet for Health and Family Services (CHFS) for more information or assistance applying for the HCBS Waiver program or call 844-784-5614. You can also email the Department of Medicaid Services (DMS) at 1915cwaiverhelpdesk@ky.gov.

3. Get in touch with your regional Hart-Supported Living Coordinator for information on eligibility requirements and how to apply for the program.

4. If eligible for the PCAP program, contact your local Area Agencies on Aging and Independent Living for guidance with the application process.

5. If your loved one is a veteran, contact the Kentucky Department of Veterans Affairs for information on veterans benefits and how to apply for services.

Find out how you can get a tax-free stipend and free caregiving coaching and support.

Louisiana also offers a Veteran-Directed HCBS Waiver program, which is administered from the Shreveport VA Medical Center (Overton Brooks).

1. Determine eligibility for Louisiana Medicaid. If eligible, apply for benefits.

2. Call the Louisiana Options in Long Term Care Help Line at 1-877-456-1146 for information on the Community Choices Waiver program, how to apply for benefits, and how to register as a care provider.

3. Get in touch with Careforth in Louisiana to learn more about the Monitored In-Home Caregiving (MIHC), eligibility criteria, and how to apply.

4. If your loved one is a veteran, contact the Louisiana Department of Veterans Affairs or the Shreveport VA Medical Center for information on the VD-HCBS program and how to apply for services.

Summary: How to obtain financial assistance for caregivers in Maryland
The Consumer-Directed Home Based Care (CDHBC) Program, administered by Maine's Office of Aging and Disability Services (OADS), is a non-Medicaid-funded program offering consumer-directed personal assistance services. Services include nursing services and personal care assistance in addition to funding for assistive technology (i.e. personal emergency response services). These services are typically limited to essential services required to avoid placement in a residential care facility. For more information, contact the Office of Aging & Disability Services at 207-287-9200 or 1-800-262-2232.
Find out how you can get a tax-free stipend and free caregiving and support.
Those eligible for MaineCare (Maine Medicaid) have two options: the MaineCare Consumer Directed Attendant Services (CDAS) Program and the MaineCare Older Adults and Adults with Disabilities Waiver. The CDAS Program allows consumers to choose and hire their own care providers who may be paid for their caregiving services. This may include adult children who are not also the legal representative of the care recipient. Spouses and parents are currently not able to be hired to provide services; however, adult children of aging parents are eligible as long as they are not also their parent's legal representative.

The MaineCare Older adult and Adults with Disabilities Waiver is administered by Maine's Department of Health and Human Services' Office of Aging and Disability Services. The program includes a Participant-Directed Option under which consumers can hire their preferred care provider, including adult children, other family members, and friends in some circumstances. Spouses are not eligible to receive compensation for providing caregiving services through the program. Participants are required to use a third-party financial management company to facilitate payroll and taxes.

The Maine VA Medical Center offers a VDC waiver program for eligible veterans.

1. Contact your local Aging and Disability Resource Center for information on applying for the Older adult and Adults with Disabilities Waiver.

2. Contact the Office of Aging and Disability Services for information on the CDHBC program, eligibility criteria, and how to apply. You may also reach the agency by calling 207-287-3707.

3. If your loved one is a veteran, contact the Maine Department of Veterans Affairs for information on the VDC program, eligibility, and how to apply.

Summary: How to obtain financial assistance for caregivers in Massachusetts
The Maryland Attendant Care Program (ACP) is a non-Medicaid-funded program offering assistance in the form of financial reimbursement for attendant care services provided to adult residents with severe physical disabilities age 64 and younger. Administered by the Maryland Department of Disabilities, this is a consumer-directed program in which qualified family members over age 18 are eligible to receive compensation for providing care. Spouses, however, are not eligible.

For Medicaid-eligible care recipients, there are several Medicaid-funded programs available, including the Maryland Community Pathways Waiver, the Maryland Community First Choice Program, and Maryland's Community Personal Assistance Services. The Maryland Community Pathways Waiver is intended for Maryland residents with a physical and/or mental impairment. Funding is provided by Maryland's Developmental Disabilities Administration (DDA) under the Department of Health. A self-directed option is available, although spouses may not be hired to provide caregiving services under this program.
Summary: How to obtain financial assistance for caregivers in Michigan
Maryland Medicaid's Community First Choice (CFC) program is for older adult and disabled Maryland residents who would otherwise require institutional care. Services may be provided in the home setting, in a loved one's home, or in a foster care home. The specific level of assistance provided is based on individual needs but typically includes assistance with activities of daily living and instrumental activities of daily living such as meal preparation. The program emphasizes self-directed care and with a few exceptions, family members may be hired to provide caregiving services.

The Maryland Attendant Care Program (ACP) is a non-Medicaid-funded program offering assistance in the form of financial reimbursement for attendant care services provided to adult residents with severe physical disabilities age 64 and younger. Administered by the Maryland Department of Disabilities, this is a consumer-directed program in which qualified family members over age 18 are eligible to receive compensation for providing care. Spouses, however, are not eligible.

For Medicaid-eligible care recipients, there are several Medicaid-funded programs available, including the Maryland Community Pathways Waiver, the Maryland Community First Choice Program, and Maryland's Community Personal Assistance Services. The Maryland Community Pathways Waiver is intended for Maryland residents with a physical and/or mental impairment. Funding is provided by Maryland's Developmental Disabilities Administration (DDA) under the Department of Health. A self-directed option is available, although spouses may not be hired to provide caregiving services under this program.

Maryland Medicaid's Community First Choice (CFC) program is for older adult and disabled Maryland residents who would otherwise require institutional care. Services may be provided in the home setting, in a loved one's home, or in a foster care home. The specific level of assistance provided is based on individual needs but typically includes assistance with activities of daily living and instrumental activities of daily living such as meal preparation. The program emphasizes self-directed care and with a few exceptions, family members may be hired to provide caregiving services.

Maryland's Community Personal Assistance Services, formerly known as Medical Assistance Personal Care, is another Medicaid-funded program under which participants may opt to select their own care providers. Administered on a county-by-county basis, the Community Personal Assistance Services program requires caregivers to be approved, certified in first aid and CPR, and supervised by a nurse monitor.

Maryland also offers a VDC program, with services available through the Maryland VA Medical Center.

1. Submit an application for Maryland Medicaid if eligible for benefits.

2. Contact your local Area Agency on Aging for information on the CFC program and how to apply. You may also contact Maryland Health Care Commission about Medicaid's Long Term Care and Waiver Services at 410-764-3460.

3. Contact your county's Health Department office to inquire about the Community Personal Assistance Services program. Or, to apply by phone or locate your nearest office, you may call Maryland Access Point at 1-844-627-5465.

4. If eligible, contact Maryland Developmental Disabilities Administration (DDA) to discuss the Community Pathways Waiver. Your local coordinator will advise you when funding is available and let you know when to complete an application for services.

5. Veterans should get in touch with the Maryland Department of Veterans Affairs to find the nearest office and get information on services and benefits.

Massachusetts offers a Home Care Program (HCP) and an Enhanced Community Options Program (ECOP) for older adult residents through its In-Home Services, both of which provide services aimed at helping older adults remain in their own homes in the community. ECOP is designed for older adults with greater care needs. Benefits may include home delivered meals, adult day care services, medication assistance, chore services, and more. Services may be free of charge to recipients, or they may require a co-pay, depending on the recipient's income. Both programs allow for consumer self-direction of personal care, home care, and homemaker services, and family members can be paid to provide these services if the paid family member is not also the recipient's legal guardian or surrogate. Both programs are managed by the Executive Office of Elder Affairs.

Massachusetts Medicaid, known as MassHealth, administers the Medicaid-funded option, the Personal Care Attendant (PCA) program, which provides services for older adult and disabled Massachusetts residents. Consumers are provided with funds for self-directed care, and friends, neighbors, and certain family members (including adult children and former spouses) may be hired and paid as care providers. Current spouses and legal guardians, however, are not eligible to receive compensation for providing services.

Adult Foster Care is another Medicaid-funded option available in Massachusetts, through which the state pays caregivers (including family members) for providing 24-hour care. The Enhanced Adult Foster Care program available through Careforth in Massachusetts provides caregivers with support services from a professional care team along with a daily tax-free stipend.
Summary: How to obtain financial assistance for caregivers in Minnesota
VDC is available for veterans in Massachusetts through the VA Medical Centers located in Boston and Bedford.

1. Determine eligibility for MassHealth and, if eligible, apply for benefits. For assistance, contact Careforth Medicaid Support Specialist who can screen you, and direct you & support you through this process.

2. Contact the Executive Office of Elder Affairs at 617-727-7750 or 1-800-243-4636 for information on HCP and ECOP programs, or visit the In-Home Services website for application information and eligibility criteria.

3. Contact the MassHealth Customer Service Center at 1-800-841-2900 (TTY: 1-800-497-4648) for information on the PCA program, including how to apply for services.

4. Get in touch with Careforth in Massachusetts to learn more about Enhanced Adult Foster Care, eligibility criteria, and how to apply.

5. If your loved one is a veteran, contact the Massachusetts Department of Veterans Services for information on the VDC program or inquire directly at the Boston or Bedford VA Medical Centers.

6. Contact your local ASAP (Aging Services Access Point) for assistance with MassHealth application, and/or Frail Elder Waiver for community services.

The Michigan Choice Older adult and Disabled Waiver is one of two Medicaid-funded options in the state. The MI Choice Waiver Program gives participants the option of having the state manage their care or self-directing their care, including hiring and managing the caregivers of their choice. This option is known as Self Determination in Long-Term Care (LTC). Family members including adult children may be hired, although spouses and legal guardians are ineligible to receive payment for providing caregiving services in most cases.

1. Determine Medicare eligibility here (required to participate in the MI Health Link Program).

2. Contact your local MDHHS County office for Medicaid eligibility and application information, as well as information on the Home Help program and how to apply for benefits.

3. Determine eligibility for MI Health Link and, if eligible, apply for benefits.

4. Contact your local Area Agency on Aging to inquire about the HCBS/ED program.

5. Contact the Michigan Veterans Affairs Agency for information on benefits available to veterans in the state.

The Minnesota Alternative Care (AC) Program is the non-Medicaid-funded program available to eligible Minnesota residents. The program serves Minnesota residents aged 65 and older who "require the level of care provided in a nursing home, choose to live in the community and are not yet financially eligible for Medical Assistance."

Some of the services received through the AC program may be self-directed under a service option known as Consumer Directed Community Supports (CDCS). Family members, including adult children, may be hired to provide caregiving services. While spouses may also be hired under this program, the services provided by a spouse are limited to personal assistance services. Any family member participating in the program must be registered with the state as a care provider, and participants are required to use a third-party financial management company as an intermediary to facilitate payments. The AC program can also assist with home modifications such as wheelchair ramps.

The program also offers a few services not covered by the Older adult Waiver (discussed further below), including conversion case management for transition from a nursing home, discretionary services, nutrition services, and a relative hardship waiver.
Summary: How to obtain financial assistance for caregivers in Mississippi
The Minnesota Consumer Support Grant (CSG) Program is another state-funded program which provides a monthly cash grant to eligible recipients in place of in-home services. In 2018, participants received an average monthly grant of $938. This program is designed to be an alternative to services covered by Medicaid such as a home health aide, personal care assistance, and/or private duty nursing. The funds may be used for care support as well as services such as home modifications, transportation assistance, and meal delivery services. Based on the self-directed services model for Medicaid service delivery, this flexible grant program allows recipients to choose a mix of services and supports that best meet their needs. Under the CSG program, recipients can hire family members as paid caregivers, including spouses, adult children, and other relatives, in addition to employees of traditional home health care agencies. The CSG program is not available statewide at the time of this writing. More information about this grant can be found in this fact sheet.
Get paid to care for a parent or loved one. Find out how you can get a tax-free stipend and free caregiving coaching and support.
The Minnesota Essential Community Supports (ECS) Program is another state-funded option. It's designed for older adults who do not require a nursing home level of care but do require assistance to continue living independently in their homes. There are financial eligibility requirements, although eligible participants are financially outside the Minnesota Medicaid limits. Administered by the Minnesota Department of Human Services, the ECS program offers up to $424 per month towards essential services such as homemaker services, adult day care services, and home meal delivery, as of 2021. Eligibility for the ECS program must be reevaluated each year.

Those who are Medicaid eligible have several program options administered by the Minnesota Department of Human Services. In Minnesota, the state's Medicaid program is referred to as Medical Assistance (MA). Examples of relevant programs include:

The Elderly Waiver (EW) Program is a waiver program that funds both home and community-based services for people age 65 and older who wish to live in the community but require the level of care provided in a nursing home. It includes a self-directed option, under the Consumer Directed Community Supports (CDCS) service option, that allows participants the flexibility to choose their own care providers. The Minnesota Personal Care Assistance Program (PCA) is also a self-directed program, allowing family members and adult children to receive compensation for caregiving services.
Summary: How to obtain financial assistance for caregivers in Missouri
Spouses and parents of minor children may also be able to receive compensation for caregiving services, provided that they meet eligibility criteria. The Community Access for Disability Inclusion (CADI) Waiver is a similar program that offers assistance for people with disabilities and includes Consumer Directed Community Supports (CDCS) as a service option. More information can be found in this fact sheet.

Minnesota does not currently offer a VDC program.

1. If eligible for Minnesota Medicaid (Medical Assistance), apply for benefits.

2. Contact Minnesota's Department of Human Services for information on the Consumer Support Grant, availability in your area, and application information, as well as information on the PCA program and the CADI Waiver for those with disabilities under the age of 65.

3. If you're not eligible for Medicaid, determine eligibility for the AC program by completing the Alternative Care Program Eligibility Worksheet (click here for the worksheet for unmarried individuals and here for those with a community spouse).

4. For information on the AC program, or to find out if the CSG program is available in your area, contact your local Long-Term Care Consultation Contactor call the Senior LinkAge Line at 1-800-333-2433.

5. For information on the ECS program, including how to apply, contact the Senior LinkAge Line at 1-800-333-2433 or Disability Hub MN at 1-866-333-2466.

The Mississippi Division of Medicaid offers three Medicaid waiver programs that focus on supporting the needs of older adult and/or disabled individuals. The Office of Long Term Care is responsible for ensuring that providers of these home and community based waiver services meet enrollment requirements.

The Mississippi Independent Living Waiver (IL) is available to anyone who 16 years of age or older who has neurological and/or orthopedic impairments. There are several diagnoses that would qualify an older adult Mississippi resident for this program, including Alzheimer's disease, Parkinson's disease, Lewy Body Dementia, osteoarthritis or arthritis, and joint fractures.
Summary: How to obtain financial assistance for caregivers in Montana
The Mississippi Independent Living Waiver allows participant direction through the Personal Care Attendant (PCA) service option. Participants may select their own PCA, as long as the PCA meets basic competencies, including educational and functional requirements. More information about this waiver can be found in the Independent Living Waiver brochure.

Another waiver that provides participation direction via the Personal Care Attendant (PCA) service option is the Traumatic Brain Injury/Spinal Cord Injury (TBI/SCI) Waiver. More information about this waiver can be found in the TBI/SCI Waiver brochure.

Mississippi's other two Medicaid waiver options relevant to older adult and/or disabled individuals include the Mississippi Older adult and Disabled (E&D) Medicaid Waiver and the Mississippi Assisted Living Waiver. Unfortunately, neither of these waivers allow for consumer directed care.

Mississippi offers the VDC program through the Gulf Coast Veterans Health Care System and the G.V. (Sonny) Montgomery VA Medical Center.

1. Determine eligibility for Mississippi Medicaid.

2. Contact the Mississippi Department of Rehabilitation Services for information on eligibility for the IL Waiver program. You can apply with this form. Find your local office here.

3. Contact your local Area Agency on Aging for information on other relevant services you or the person you are caring for may be eligible for.

4. If your loved one is a veteran, contact the Gulf Coast Veterans Health Care System or the G.V. (Sonny) Montgomery VA Medical Center for information on the Veteran Directed Care program.

Through the Personal Care Assistance services program, services may be consumer-directed. Family members other than spouses and legal guardians may be hired and compensated for providing care services. Care providers must register as CDS providers with the Missouri Medicaid Audit and Compliance Unit (part of the Department of Social Services).

Personal care assistance is also self-directed through the I ndependent L iving Waiver program. Spouses and legal guardians are ineligible to receive compensation for providing care, although other family members may be hired. Payments and other financial matters are handled through Financial Management Services. Other Medicaid waiver programs include the Missouri Medicaid Aged and Disabled Waiver and the Nursing Home Coverage program. Neither of these waiver programs offer consumer directed care options.
Summary: How to obtain financial assistance for caregivers in Nebraska
The Missouri Medicaid Care Options program offers assistance with activities of daily living such as bathing and dressing, companion care services to relieve family caregivers, assistance with tasks such as housekeeping, laundry, and meal preparation, nursing care, and adult day care services. This program does not allow participant direction of services.

1. Apply for MO HealthNet if eligible for Medicaid. You can also call 1-855-373-4636 toll-free to speak with a representative from the MO HealthNet Service Center.

2. Contact the Department of Health and Older adult Services at 573-751-6400 for more information about the IL Waiver program.

3. Referrals for the Division of Older adult and Disability's Home and Community Based Services can be called in by phone at 1-866-835-3505 or through the Online HCBS Referral Form. You can also find your local Missouri Department of Social Services office here.

4. If your loved one is a veteran, contact the Missouri Veterans Commission for information on the VDC waiver program, eligibility, and how to apply for services.

Montana doesn't offer a non-Medicaid-funded option for older adult care services, although it does offer the Montana Big Sky Rx Program, a no-cost program funded by the state that can help with the cost of Medicare-approved prescription drug insurance premiums.

For those who are Medicaid-eligible, there are two programs: the Montana Medicaid Home and Community Based Services Waiver ( Big Sky Waiver) and Montana Community First Choice / Personal Assistance Programs ( CFC / PAS). The Big Sky Waiver is administered by Montana's Older adult and Long Term Care Division (part of the Department of Public Health & Human Services). It's also known as the Older adult/Physically Disabled Waiver. Consumer-directed care is an option under this program, and certain family members (provided they are qualified to provide care) may be hired as care providers - subject to approval by the state of Montana. Spouses are typically excluded, but may be hired under certain circumstances. Adult children may be hired as caregivers, with services limited to personal care or homemaker services.
Summary: How to obtain financial assistance for caregivers in Nevada
The CFC/PAS program also includes a self-directed option. Spouses, parents, and legal guardians are ineligible to be hired, while adult children of aging parents and ex-spouses are eligible to receive compensation for providing services. The recipient is responsible for approving timesheets, and timesheets are reviewed and payments issued to caregivers by the state.

Montana's VDC program is offered through the Fort Harrison, MT VA Medical Center.

1. Apply for Montana Medicaid if eligible.

2. Contact Mountain Pacific Quality Health (MPQH-Montana) on at 1-800-497-8232 to determine eligibility for the Big Sky Waiver program.

3. Contact your local Montana Department of Public Health and Human Services (DPHHS), Division of Older adult and Long Term Care field office for information on the CFC/PAS program, eligibility, and how to apply.

4. If your loved one is a veteran, contact the Montana VA Medical System for information on the VDC program, eligibility criteria, and how to apply.

The Nebraska Disabled Persons and Family Support (DPFS) Program serves the needs of older adults and disabled Nebraska residents who are not Medicaid-eligible. The program is a self-directed model, allowing participants to select their own care providers, including relatives. A legal contract between the care provider and recipient is required, and providers must meet state regulations. The maximum monthly spend amount is $300. Under this program, the state may also provide funding for certain home modifications that support the individual's independence, such as wheelchair ramps and handicapped-accessible bathroom modifications. The program is managed by the Nebraska Department of Health and Human Services, Office of Medicaid and Long-Term Care.

The SSAD program provides services ranging from housekeeping and meal delivery to food preparation, adult day care services, and limited personal care services. There is no consumer-directed option under the SSAD program.

The AABD program offers a cash stipend and medical coverage to eligible Nebraska residents who are blind or disabled based on Social Security rules but are not eligible to receive Supplemental Security Income (SSI) due to a disability that is expected to last less than 12 months.
Summary: How to obtain financial assistance for caregivers in New Hampshire
The Lifespan Respite Program offers a monthly stipend of $125 to eligible recipients to be applied towards respite care services. While respite care services may be provided in the home or in a location such as an adult day care center or older adult center, respite care providers must be chosen from an approved provider list.

There are two additional programs available to Medicaid-eligible Nebraska residents: the Nebraska Aged & Disabled Medicaid Waiver and the Nebraska Medicaid Personal Assistance Services (PAS) program. The PAS program includes a self-directed option, allowing recipients to choose their care provider as well as the types of services provided. Family members, other than spouses and those who are legally responsible for the care recipient, may be hired to provide services. The PAS program is administered by the Special Services for Children and Adults Division, Office of Aging and Disability Services within the Nebraska Department of Health and Human Services.

Nebraska does not currently offer a VDC program.

1. If not Medicaid-eligible, download an application for the DPFS Program here. You can contact the
Disabled Persons & Family Support Program office at 402-471-9188. You can also reach the Office of Medicaid and Long-Term Care for more information and assistance by calling 1-800-358-8802.

2. If Medicaid eligible, apply for Nebraska Medicaid.

3. Contact your local Department of Health and Human Services Public Assistance Office for information on the PAS program and how to apply. Care providers must also pass the state's approval process.

4. If not eligible for PAS, you may inquire about the Aged & Disabled Waiver program; however, keep in mind that this program does not allow for self-direction of services at this time.

5. Reach out to the Nebraska Aging and Disability Resources Center (ADRC) for information on other programs and services serving the Nebraska aging population.

Older adults in Nevada who are not eligible for Medicaid may qualify for Nevada's Community Options Program for the Elderly (COPE). Administered by Nevada's Aging and Disability Services Division and funded by the state, COPE provides non-medical services such as adult day care, personal care, and homemaker services, and some services are self-directed. Care providers, which may include certain family members, must be approved by the state, and the hourly rate is regulated.

Under Personal Care Services, however, it is possible to hire any qualified caregiver of the participant's choosing. Financial aspects such as payments are handled by an Intermediary Service Organization (ISO). Siblings and adult children may be hired as caregivers, provided they are not the legal representative of the care recipient. Spouses and anyone legally responsible for the recipient are not eligible to receive compensation for providing services.
Summary: How to obtain financial assistance for caregivers in New Jersey
Nevada's VDC program is offered through the Las Vegas, NV VA Medical Center and the Sierra Nevada Health Care System in Reno, NV.

1. Contact your local Nevada Aging and Disability Services Regional Office for information on the COPE program, how to apply, and how to register as a care provider. You can also contact your local Aging & Disability Services Office.

2. If eligible for Medicaid, apply for Nevada Medicaid benefits.

3. Call 1-800-525-2395 (option 1 and then option 4) to submit an initial request for services under the PCS program. Provider enrollment contact information can be found here.

4. Contact your Aging and Disability Services Resource Center for information on the HCBW-FE program and how to apply.

5. If your loved one has a physical disability, contact the Division of Health Care Financing and Policy for information on the HCBW-PD program and how to apply.

6. Contact the Nevada Department of Veterans Services for information on the VDC program and how to apply if your loved one is a veteran.

While New Hampshire doesn't have a non-Medicaid-funded program, those who are Medicaid-eligible may qualify for New Hampshire's Choices for Independence Waiver. Formerly known as the Older adult and Chronically Ill Waiver, the Choices for Independence Waiver provides services for those who are clinically eligible for nursing home placement but prefer to remain in their own homes in the community.

The Choices for Independence Waiver provides support and services as long as the costs of those services don't exceed a certain percentage as similar services provided in a nursing home setting would cost. There is some level of consumer direction offered under this program, which applies mostly to non-skilled and custodial care services. Family members, however, are not able to be hired to provide services under this program.
Summary: How to obtain financial assistance for caregivers in New Mexico
New Hampshire also offers a Social Services Block Grant (SSBG), funded under Title XX of the Social Security Act, which provides home and community-based services for older adults age 60 and older as well as residents between the ages of 18 and 60 who have a chronic illness or disability. It does not appear as though the SSBG includes a self-directed option, but services include adult in-home care, adult medical day services, home delivered meals, homemaker services, and more.
Summary: How to obtain financial assistance for caregivers in New York
Another Medicaid-funded option is the Personal Care Attendant Services (PCAS) program. It's primarily designed for those who are wheelchair-bound most of the time and intended to enable disabled residents to remain independent and postpone nursing home placement. Recipients may self-direct their care by interviewing, selecting, training, managing, supervising, and dismissing their Personal Care Attendant (PCA). PCAs must be a "qualified nonfamily member," so relatives may not be hired to provide caregiving services under the PCAS program.
Find out how you can get a tax-free stipend and free caregiving coaching and support.
The Manchester, NH VA Medical Center offers the state's VDC program.

1. Unfortunately, there is no program offered presently in New Hampshire that enables family caregivers to receive compensation for providing care to a loved one.

2. However, if your loved one is a veteran, you may inquire with the New Hampshire State Office of Veterans Services for information on the VD-HCBS program, eligibility criteria, and how to apply for services.

3. Determine Medicaid eligibility and apply for New Hampshire Medicaid benefits if eligible.

4. To inquire about Choices for Independence, call 1-866-634-9412. Keep in mind that while Choices for Independence provides services that can help your loved one continue living independently, family members may not be compensated for providing services. You may also inquire about SSBG at the same contact number.

5. Check to see if your loved one is eligible for any other Home and Community Based Services (HCBS) Waivers.

6. If your loved one is already on Medicaid and is wheelchair-bound the majority of the time, contact Granite State Independent Living at 603-228-9680 or 1-800-826-3700 for more information on the PCAS program and how to apply.

There are a variety of options for getting assistance with personal care services in New Jersey. Non-Medicaid-funded programs include New Jersey Assistance for Community Caregiving (JACC), New Jersey Family Leave Insurance, and New Jersey Statewide Respite Care. Under JACC, family members and friends who meet the program's requirements may be hired to provide services such as attendant care, household chores, or transportation assistance. Spouses and adult children are also eligible to receive compensation for providing these services in New Jersey, and minor home modifications that support independence, such as wheelchair ramps, may also be offered under this program.

New Jersey's Family Leave Insurance (FLI) program provides up to six weeks of paid time off for caring for a family member with a serious illness. It can be used in conjunction with the federal Family Medical Leave Act (FMLA), which requires employers to hold an employee's job and continue to provide healthcare benefits during this time off. Administered by the New Jersey Department of Labor and Workforce Development, the FLI program is funded by employee wage deductions.
Summary: How to obtain financial assistance for caregivers in North Carolina
The New Jersey Statewide Respite Care Program (SRCP) offers respite services for unpaid caregivers with the aim of avoiding unnecessary nursing home placement. The SRCP program is managed locally by Aging and Disability Resource Centers and is administered by the New Jersey Department of Health and Older adult Services. Caregivers utilizing this program are able to select the agency or individual of their choosing to provide respite care services.

The New Jersey Medicaid Personal Preference Program (PPP) is the state's Medicaid program, which distributes a budget to recipients that would otherwise be spent on the provision of services. Participants may choose their own care providers, including friends and family members who are 18 years of age or older.

New Jersey's VDC program is offered through the Lyons, NJ VA Medical Center.

1. Determine eligibility for New Jersey Medicaid (NJ Family Care), and apply if eligible.

2. Apply for the PPP through the New Jersey Division of Medical Assistance and Health Services. If you are enrolled in a NJ FamilyCare Managed Care Organization (MCO), contact your MCO to request a PCA assessment for enrollment into PPP. Contact information for MCOs can be found on this page. If you're not enrolled in a MCO, call the NJ Division of Disability Services at 1-888-285-3036 for assistance.

3. To apply for JACC, contact your local Area Agency on Aging/ADRC by calling 1-877-222-3737. You can find a list of local offices and contact information here.

4. To apply for FLI, you must notify your employer in advance. Begin your application for benefits with the state after your leave begins by calling the Department of Labor and Workforce Development's Temporary Disability Insurance Information General Information hotline at 609-292-7060. You can also visit the New Jersey Department of Labor and Workforce Development for more information.

5. For SRCP, contact the Statewide Respite Care Program in your county by calling the Aging & Disability Resource Connection (ADRC) at 1-877-222-3737.

6. Contact the New Jersey Department of Military and Veterans Affairs for information on the VD-HCBS program if your loved one is a veteran.

There is no state-funded, non-Medicaid program offering support for family caregivers in New Mexico, although older adults and their caregivers may receive some services offered through local Area Agencies on Aging via the Older Americans Act, such as adult day care services, in-home respite care services, transportation assistance, and homemaker services.
Summary: How to obtain financial assistance for caregivers in North Dakota
Those who are Medicaid-eligible can receive services through NM Centennial Care, the state's Medicaid program under the Community Benefit program. This program focuses on enabling older adults to remain living in their own homes in the community. Services include adult day care, respite care, and personal care services such as assistance with ADLs. It includes a Self-Directed Community Benefit (SDCB) option, allowing participants to select their preferred care providers. Family members and friends may be hired for non-skilled services (including personal care services), although the managed care organization (MCO) makes determinations on whether the selected provider is qualified. New Mexico's MCOs include Molina Health Care of New Mexico, Blue Cross Blue Shield of New Mexico, Presbyterian Healthcare Services, and United Healthcare.
Find out how you can get a tax-free stipend and free caregiving coaching and support.
New Mexico offers a VDC program through the New Mexico VA Health Care System.

Those who are eligible for Medicaid may be able to utilize New York's Consumer-Directed Personal Assistance Program (CDPAP), offered through NY Managed Medicaid Long Term Care and the Community First Choice programs. Participants work with a county caseworker and a medical professional to determine their required level of care and create a personalized care plan, which includes the number of hours of assistance they require each week. Participants are then able to hire their own caregivers to provide services up to the specified number of hours each week. Spouses and legal guardians are ineligible to be paid caregivers; however, ex-spouses, adult children, and siblings may receive compensation for providing services. A third-party financial management agency oversees payment processing and timesheet approvals.

1. Apply for New York Medicaid if eligible.

2. Contact your local Area Agency on Aging for information on availability and how to apply for the EISEP program.

3. To apply for CDPAP, contact your local Department of Social Services.

4. To apply for paid family leave under the PFLBL, you must notify your employer at least 30 days in advance. You must also submit paperwork and supporting documentation of your relationship to the care recipients and their care needs. Learn more about how to apply here.

5. Veterans should contact the New York State Division of Veterans' Services for information on the VD-HCBS program and how to apply.

North Carolina In-Home Aide Services is a program available in North Carolina for residents who are not eligible for Medicaid. This program was previously known as Chore, Homemaker, Homemaker-Home Health Aide, Respite, and Personal Care Services. Services are provided to older adults and caregivers to enable participants to avoid nursing home placement. Personal care and chore services are among the broad range of services offered, and these services may be provided by relatives, including adult children and spouses, if the participant chooses. Care providers must be at least 18 years of age, and they must have given up other employment in order to provide care for their loved one. A health care professional and a case manager will screen applicants to determine eligibility and define the services to be provided.

The North Carolina Community Alternatives Program for Disabled Adults Waiver (CAP/DA) is a Medicaid-funded program that offers similar services. The program also covers minor home modifications to support independence in addition to personal care and other services. This program offers consumer directed services, which allows the participant to freely choose who will provide care to meet medical and functional needs. They can hire an employee (personal assistant) of their choice and independently set their pay rate. Coordinated Caregiving from Careforth is another option for live-in family caregivers under this waiver. In addition to a tax-free stipend, the service includes ongoing support from a professional care coach.

The State/County Special Assistance In-Home Program for Adults (SA/IH) program provides a monthly cash stipend to help older adults remain independent who would otherwise require adult care home placement. The funds provided can be used for rent, food, daily necessities, and clothing. The amount of the stipend will vary from participant to participant. This is not a consumer-directed program. A case manager from the county's Department of Social Services conducts a comprehensive assessment to identify the factors that would impact the recipient's ability to live independently, determine if the recipient could remain safely independently in their home, and what services would be needed. Case managers work with recipients to determine the amount of the payment and how the funds will be used. Other programs are offered by the state of North Carolina, such as Project C.A.R.E. (Caregiver Alternatives to Running on Empty), which provides respite care services for unpaid caregivers for those with Alzheimer's or dementia. Dementia information and training for caregivers is also provided.

The Fayetteville VA Medical Center and Durham, NC VA Medical Center offer North Carolina's VDC waiver program.
Summary: How to obtain financial assistance for caregivers in Ohio

1. North Carolina In-Home Aide Services are administered on the county level, so get in touch with your local social services agency to apply. You can find a list of county offices here. Your local social services agency can offer information on other state-funded programs, as well.

2. Apply for North Carolina Medicaid if eligible.

3. Get in touch with Careforth in North Carolina to learn more about the Coordinated Caregiving program available through Medicaid.

4. Contact NC Medicaid Clinical Section at 919-855-4340 for information on the CAP/DA program and the Consumer Directed Services option

5. If your loved one is a veteran, contact the North Carolina Department of Military & Veterans Affairs for information on the VDC program and how to apply.

North Dakota Service Payments for the Elderly and Disabled ( SPED and Ex-SPED) Programs are available to state residents who do not qualify for Medicaid benefits. This program includes two levels of services with different eligibility requirements, with SPED serving those who are more functionally impaired. Both programs offer services to enable older adults and people with disabilities to remain in their own homes, including adult foster care. Both programs allow for self-direction via the Family Home Care service option. Family Home Care "reimburses a family caregiver who meets the relationship requirements defined by state law and resides in a client's home 24-hours per day."

Medicaid-eligible North Dakota residents are served through the North Dakota Medicaid State Plan Personal Care Services (MSP-PC) program. Services may be provided in several settings, including their own home, the home of a loved one, or in adult foster care or assisted living communities. Services are not provided to residents in nursing homes, hospitals, or intermediate care communities.
Summary: How to obtain financial assistance for caregivers in Oklahoma
This program includes three service levels (Level A, Level B, and Level C) with different eligibility criteria. The number of hours of care available varies based on the participant's service level. It is consumer-directed, and care providers, who are called Qualified Service Providers, may include a family member, neighbor, or friend who has met the standards set by the North Dakota Department of Human Services (DHS). Payment is at a Medicaid-approved hourly rate.

North Dakota does not currently offer a VDC program.

1. To apply for the SPED program, contact your local Human Service Zone (previously known as County Social Service Offices). Alternatively, you can visit the Aging and Disability Resource-LINK (ADRL) website here or call 1-855-GO2-LINK (1-855-462-5465) toll-free. One may also find additional information about SPED here or Ex-SPED here.

2. If eligible, apply for North Dakota Medicaid.

3. Call your local Department of Human Services to apply for the Personal Care Services program, or call 1-800-472-2622 to get in touch with your local county office. A caseworker will conduct an initial assessment to determine eligibility and care needs, and an annual assessment is conducted thereafter.

4. Call the Aging & Disability Resource-LINK at 1-855-462 5465, visit https://carechoice.nd.assistguide.net/, or contact the local Human Service Zone in your area for additional information and assistance related to the Personal Care Services program and other programs and services in your area.

Ohioans who are not eligible for Medicaid may qualify for services through the Ohio Elder Services Program (ESP). The program allows for consumer direction of some services, and family members may be hired in some cases to provide caregiving services if they work for the provider organization and are qualified to provide the necessary services. ESP is only available in Butler, Clinton, Hamilton, and Warren counties presently. The program is funded by a county tax levy and administered by the Ohio Council on Aging (COA).

Ohio's Medicaid PASSPORT (Pre-Admission Screening System Providing Options & Resources Today) Waiver is a Medicaid-funded program offering similar services, although the cost of in-home services provided must not exceed 60% of the cost of the same care if it were provided in a nursing home setting. PASSPORT Consumer-Directed Service Options allow participants to hire their own direct service workers. They can be hired from a Choices-Home Care Attendant Service (C-HCAS), in which the participant trains the worker and also negotiates their hourly pay rate with care manager input. Or, they can be hired from a Personal Care Service if the worker is certified as an STNA, HHA, or has completed an annual a 60-hour ODA-approved training program and 12 hours of continuing education. If the worker is hired via a Personal Care Service, they will be paid a state-contracted hourly pay rate.
Summary: How to obtain financial assistance for caregivers in Oregon
Note that dual Medicare/Medicaid-eligible residents are unable to receive services through PASSPORT; however, those who live in a county with the Integrated Care Delivery System (ICDS) can receive the same services through MyCare Ohio, which is Ohio's mandatory managed care program. This program is called the MyCare Ohio Plan (MCOP), or Managed Medicaid Program for Elder Care.

Medicaid-eligible Ohioans with developmental disabilities may also qualify for a HCBS waiver. The Individual Options Waiver is the most comprehensive of the three waivers Ohio offers.

For caregivers who are legal guardians of adults with intellectual or developmental disabilities, Shared Living (formerly Adult Foster Care or Adult Family Living) from Careforth in Ohio may be an option. The program provides a tax-free stipend for caregiving expenses along with support and coaching from a professional care team.

Other services and support programs are available through the Ohio Department of Aging. An example of one service that may prove useful is the Golden Buckeye program. Under this program, businesses provide participants with special savings, such as discounts, waived fees, free products or services, and more.

Ohio offers a VDC waiver program through its Chillico the, Cincinnati, Cleveland, Columbus, and Dayton, OH VA Medical Centers.

1. If you reside in one of the four counties in which the ESP program is offered and you are not Medicaid-eligible, you can find relevant contact details here.

2. Clermont county residents should contact Clermont Older adult Services or call 513-724-1255 for information on in-home services available in your area.

3. Get in touch with Careforth in Ohio for information on eligibility for Shared Living and how to apply.

4. Apply for Medicaid if eligible.

5. Call the Ohio Medicaid Consumer Hotline at 1-800-324-8680 or enroll online here for MyCare Ohio.

6. Veterans should get in touch with the Ohio Department of Veterans Services for information on the VDC waiver program.

Summary: How to obtain financial assistance for caregivers in Pennsylvania
Another option is the Oklahoma's ADvantage Program Waiver, in which participants may opt to self-direct their care, choosing their own care providers which may include family members. In some cases, spouses and legal guardians may be hired to provide services. This is known as the CD-PASS option. ADvantage is managed by the Aging Services Division of the Oklahoma Department of Human Services and replaces the former My Life, My Choice and Sooner Seniors programs.
Find out how you can get a tax-free stipend and free caregiving coaching and support.
Oklahoma offers a VDC program through the Jack C. Montgomery VA Medical Center in Muskogee, OK.

There are several options serving Medicaid-eligible residents: the Oregon Client-Employed Provider Program, Oregon Independent Choices Program, Oregon Spousal Pay Program, and Oregon K Plan.

The Client-Employed Provider Program (CEP) is a self-directed program allowing participants to hire friends, neighbors, and family members of their choosing to provide services. This includes adult children and spouses. However, an individual who is also serving as the recipient's Durable Power of Attorney or official representative may not be hired to provide caregiving services. Recipients do not receive cash to compensate their caregivers; they authorize the state to make payments on their behalf under this program.

The Spousal Pay Program, administered by the Oregon Department of Human Services, is similar, but focuses on the spouse as primary caregiver. Through this program, the spouse becomes an official Homecare Worker and joins the Homecare Workers Union. The spouse receives a salary, is taxed on earnings, pays union fees, and is eligible for unemployment insurance.

The Oregon Independent Choices Program (ICP) is also similar in nature to the CEP program. Also a self-directed program, individuals receiving services may hire friends, neighbors, and family members - including adult children and spouses - to provide caregiving services. Under this program, participants receive cash benefits from the state and handle paying their caregivers without the state or another agency serving as an intermediary. Legal guardians are not able to be hired as care providers, however. Participants are also able to negotiate hourly rates with care providers.
Summary: How to obtain financial assistance for caregivers in Rhode Island
The Oregon K Plan - Community First Choice Medicaid Program also offers in-home support services to Medicaid-eligible recipients as an alternative to long-term home and community based Medicaid waivers, which have limited enrollment. The CFC program, by contrast, is an entitlement program and available to any eligible resident who requires services.

1. Apply for Oregon Medicaid if eligible.

2. To apply for the CEP program, Spousal Pay Program, and Independent Choices Program, contact your local Seniors and Persons with Disabilities / Area Agency on Aging office.

3. For information on the Oregon K Plan, contact your local Seniors & Peoples with Physical Disabilities Office.

4. Contact your local Area Agency on Aging for more information about the OPI program and how to apply.

5. Veterans should contact the Oregon Department of Veterans Affairs for information on the VDC program.

6. Get in touch with your local Aging and Disability Resources Center for information on other programs and services available in your area. You can also call 1-855-673-2372 for assistance.

Pennsylvania's OPTIONS Program is a non-Medicaid-funded program that provides assistance to older adults and family members who are caring for aging loved ones at home. The OPTIONS program funds some assistance services through block grants (Aging Block Grants or ABG) provided through local Area Agencies on Aging. Recipients cannot also be receiving services through the Pennsylvania Department of Aging Medicaid Waiver, but those who are not eligible for Medicaid may be able to receive some free or low-priced services through other funding avenues. Some services provided through the OPTIONS program may be self-directed, allowing participants to choose their own service providers, although family members are typically not eligible to be paid for providing services through this program.

Medicaid-funded programs in Pennsylvania include the Community HealthChoices Program (CHC) and Pennsylvania Services My Way. The CHC program began in January 2018 and rolled out in phases. Those who were previously enrolled in the Pennsylvania Aging Waiver (PDA) were automatically enrolled in CHC as it became available in their area. The Community HealthChoices Program is a Medicaid managed care program serving adults 21 years of age and older who are dual-eligible (eligible for both Medicare and Medicaid), or individuals who require skilled nursing care (and would otherwise qualify for nursing home placement).

CHC provides older adults and physically disabled individuals with medical benefits, as well as long-term support services to promote independent living and prevent unnecessary nursing home placements. Benefits include personal care services, such as assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADL), like bathing, meal preparation, and medication management. Enrollment in this program is mandatory for those who meet the eligibility requirements. Careforth offers a support program, known as CarePlus, for family caregivers enrolled in the CHC program.

The Pennsylvania Services My Way (SMW) Program allows recipients to choose their own care providers, and while it's not technically a distinct Medicaid waiver, it is a program that provides another way for waiver recipients to receive services. Through the SMW program, certain family members may receive compensation for providing services. Participants work with a state case manager to determine care needs and a budget, resulting in an Individual Services Plan - from there, participants can choose providers for obtaining the required goods and services. Adult children, neighbors, and other family members may be hired, although spouses and legal guardians are ineligible for compensation for providing services. An Employer Agent, a fiscal intermediary, handles payments to care providers.

The Pennsylvania Domiciliary Care program, also known as Dom Care, is a state-funded program that offers an alternative to assisted living by allowing care recipients to receive care in the home of a caregiver. Providers are screened by the PA Area Agencies on Aging and may care for up to three recipients in their homes, although most providers care for a single resident or married couple. Care recipients cannot move into the home of a relative, but they may move into the home of a friend provided they're qualified to provide the required services and pass the background and safety screenings.
Summary: How to obtain financial assistance for caregivers in South Carolina

1. Contact your local Area Agency on Aging for information on the OPTIONS program, availability, and eligibility requirements. Your local AAA can also assist you with the application process.

2. Determine eligibility for Medicaid and apply if eligible. You can apply online using COMPASS.

3. Call the PA Department of Aging Resources Long Term Care Helpline at 1-866-286-3636 for information on the Services My Way Program or to start the application process.

4. Click here to learn more about Community HealthChoices (CHC) and visit Care Coordination to get in touch with a care coordinator to assist you in obtaining services.

5. Get in touch with Careforth of Pennsylvania to learn more about the caregiver coaching and support program, eligibility criteria, and how to apply.

6. Contact your local Area Agency on Aging for information on other programs and services that may be available, or your local county assistance office.

7. Veterans should contact the Pennsylvania Department of Military and Veterans Affairs for information on the VDC program.

Rhode Island Paid Family Leave, or the Temporary Caregiver Insurance (TCI) Program, is one option for family caregivers of loved ones who are not eligible for Medicaid. This program provides up to four weeks of paid benefits in a 12-month period to care for a loved one (such as an aging parent) who has a serious illness. Caregivers are paid up to a maximum of $852 per week as of 2019 under this program, and it requires employers to offer a comparable position to the employee following their leave. It is administered by the Rhode Island Department of Labor and Training. More information can be found here.

The Rhode Island Global Consumer Choice Compact Waiver is a Medicaid-funded option administered by the RI Department of Human Services (DHS), with many of the programs for the older adult administered by the RI Executive Office of Health and Human Services. The program is self-directed, enabling recipients to select their own care providers, which includes adult children and other relatives.

This global waiver now encompasses several former programs, including the Personal Choice Program, Home and Community Care Medicaid Waiver, and the Shared Living Program, and now aims to provide a comprehensive range of services under a single program. Additionally, the program offers some services to older adults who are not fully Medicaid-eligible.

Live-in family caregivers of Medicaid-eligible individuals should be aware of the RIte @ Home from Careforth in Rhode Island, which falls under the Shared Living program. RIte @ Home provides a tax-free stipend and coaching support from a professional local care team of nurses and social workers.

The Veterans Affairs Program of Comprehensive Assistance for Family Caregivers (PCAFC) offers "enhanced clinical support for caregivers of eligible veterans who are seriously injured." Benefits for eligible caregivers include a financial stipend, travel and per diem compensation (when traveling for a veteran's VA healthcare appointment) as well as respite care, mental health counseling, and more. There are seven eligibility requirements that must be met in order to qualify. More information can be found on this fact sheet.
Summary: How to obtain financial assistance for caregivers in South Dakota

1. Visit the Department of Labor and Training website for more information on the TCI program. You may also call 401-462-8420 for information and assistance.

2. Apply for Rhode Island Medicaid benefits if eligible.

3. Get in touch with Careforth in Rhode Island to learn more about the Rite @ Home program, eligibility criteria, and how to apply.

4. Contact the RI Executive Office of Health and Human Services at 401-462-5274 for information on the Rhode Island Global Consumer Choice Compact Waiver and how to apply.

5. Visit the Office of Healthy Aging website and the Rhode Island Division of Elderly Affairs for more information on additional programs and services available to older adults.

6. Visit the Rhode Island Office of Veterans Services to discover relevant support services and programs. To apply for the Veterans Affairs Program of Comprehensive Assistance for Family Caregivers (PCAFC) program, complete VA Form 10-10CG or apply in person through a local Veterans Affairs Medical Center (VAMC) Caregiver Support Coordinator. For more information, you can contact a Caregiver Support Coordinator or call the Caregiver Support Line toll-free at 1-855-260-3274.

South Carolina's Medicaid program is also known as Healthy Connections, although it is sometimes called South Carolina Community Long Term Care or CLTC. Healthy Connections is administered by the South Carolina Department of Health and Human Services (SCDHHS).

Healthy Connections offers two Medicaid-funded programs to support older adults in the community and family caregivers: the South Carolina Community Supports Waiver and South Carolina Community Choices. The South Carolina Community Choices Medicaid Waiver is also called the Older adult and Disabled Waiver. Under this program, the cost of care provided in the community setting cannot exceed a certain percentage of the cost of comparable services provided in the nursing home setting.

Participant direction is possible for some services, including personal assistance, respite care, and companion services, allowing recipients to select their own care providers. Certain family members are eligible to receive compensation for services, including adult children of aging parents. Care providers are required to pass the state's background checks and receive approval from the state. Home modifications and some medical equipment and supplies, as well as adult day care, may also be covered through this program.
How to obtain financial assistance for caregivers in Tennessee:
The South Carolina Community Supports Waiver is intended for individuals with intellectual disabilities or a related disability (ID/RD) of any age who are eligible for Medicaid. It's a self-directed program, and family members may be hired to provide care services - other than spouses or legal guardians.

Under the Older Americans Act, older adults can receive non-Medicaid services such as respite care, home-delivered meals, and home living support. The services offered are region-dependent, so check with your local Area Agency on Aging for more information.

South Carolina offers a VDC waiver program through its Charleston and Columbia, SC VA Medical Centers.

Find out how you can get a tax-free stipend and free caregiving coaching and support.
Summary: How to obtain financial assistance for caregivers in Texas
The Home & Community-Based Options and Person Centered Excellence (HOPE) Waiver serves older adults (age 65 and older), or those age 18 and older with disabilities. It does not appear that the HOPE Waiver includes self-directed service options, however.

For those who are not eligible for the state Medicaid program and the Home and Community Based Services waiver programs, South Dakota offers a state-funded option called the South Dakota Division of Adult Services and Aging (ASA) In-Home Services program. Funded by the Division of Long Term Services and Supports, the program offers services to allow eligible recipients to remain in their homes rather than require nursing home care, such as assistance with daily activities such as bathing and grooming, grocery shopping, meal preparation, and other homemaker services, and more. This program does not appear to allow for consumer self-direction of services.

Structured Family Caregiving(SFC) is also available for Medicaid-eligible families. The SFC model is a caregiver support program designed for family and friends who are caring for a loved one at home. Under the SFC program, family caregivers receive financial and professional support to make in-home caregiving possible.

Caregivers in South Dakota can benefit from respite care and other supportive services offered through the Caregiver Support Program.

South Dakota offers a VDC program through the Sioux Falls VA Medical Center.
Summary: How to obtain financial assistance for caregivers in Utah

1. Get in touch with Careforth of South Dakota to learn more about the Structured Family Caregiving program, eligibility criteria, and how to apply.

2. Reach out to the your local Long Term Services and Supports Field Office to reach a Long Term Services and Supports Specialist. Specialists can help older adult and/or disabled individuals "decide which available long-term services and supports can assist them to continue residing in their home and/or community."

3. You can also inquire about other in-home services and local programs that may be available in your area. Keep in mind, however, that the state does not appear to currently offer consumer-directed options for personal care services, other than the program available to veterans through the VA Medical Center in Sioux Falls.

4. Contact the South Dakota Department of Veterans Affairs for information on the VDC program if your loved one is a veteran.

Tennessee residents who are eligible for Medicaid may qualify for the TennCare CHOICES in Long-Term Care Program. This is the only Medicaid waiver for older adults. Services are provided for older adults and/or residents with disabilities who would otherwise require nursing home placement. Services are offered in a multitude of settings such as the recipient's home, a loved one's or caregiver's home, an adult foster care home, or an assisted living community. In addition to personal care services, the program offers assistive technology, personal emergency response services, and minor home modifications to support independent living.

Some services in the CHOICES program are self-directed. Adult children of aging parents may be hired as caregivers through the CHOICES program, as well as other friends, neighbors, and certain family members, excluding spouses and legal guardians or anyone who has a Power of Attorney for the care recipient.

The state-funded (non-Medicaid) program providing in-home services and supports to older adults is the Tennessee OPTIONS for Community Living program. Services include personal assistance, meals, and homemaker services. The program allows for self-direction of care, allowing recipients to choose their own care providers, including family members. However, spouses may not be paid to provide caregiving services under the OPTIONS program.

1. If eligible, apply for TennCare Medicaid (Tennessee's Medicaid program) through Healthcare.gov.

2. Contact your local Area Agency on Aging and Disability or visit the TennCare CHOICES website for information and how to apply for the CHOICES program. You can also call 1-866-836-6678 for assistance.

3. Contact your local Tennessee Area Agency on Aging and Disability for information on the OPTIONS program and other programs and services that may be available to you. You can also call the statewide assistance line at 1-866-836-6678.

4. Contact the Tennessee Department of Veterans Services to inquire about the VDC program.

Summary: How to obtain financial assistance for caregivers in Vermont
The Community Attendant Services (CAS) program allows certain family members to be hired as caregivers, with the exception of close relatives and legal guardians. The CAS program requires the use of a financial management agency to serve as an intermediary to facilitate the transfer of funds.

The Texas Community Care for Aged/Disabled (CCAD): Non-Medicaid Services for the Elderly program offers a similar suite of services, but it does not appear as though self-directed care is an option via this program.

STAR+PLUS is a managed Medicare program, with services provided by a managed care organization (MCO). The CFC program is a consumer-directed program, allowing participants to choose their own care providers, including family members with the exception of spouses.

1. Contact your local Texas Health and Human Services (HHS) office to apply for the CAS program.

2. For information on the CCAD program, contact your local Aging and Disability Resource Center.

3. Visit Independent Living Services for information on in-home support services for older adults and those with disabilities.

4. Apply for Texas Medicaid if eligible through the Your Texas Benefits website. (You must have Medicaid in order to apply for the STAR+PLUS program).

5. Apply online for the CFC program.

6. Read the Case Worker Community Care for Aged and Disabled Handbook for more information about relevant services.

7. Veterans should contact the Texas Veterans Commission for information on the VDC program.

The Utah State Plan Medicaid Personal Care Services program is an entitlement program, meaning there are never wait lists to receive services. It's not clear whether consumer direction is an option through this program.
Summary: How to obtain financial assistance for caregivers in Virginia
This Utah Medicaid Waiver for Individuals Age 65 or Older or the Aging Waiver is a Medicaid Home and Community Based Services (HCBS) waiver that allows for consumer direction of services. Participants are able to hire friends or relatives, with the exception of spouses and legal guardians, to provide caregiving services. Support is also provided for in-home medical equipment, personal emergency response services, and home modifications necessary to support independence, as well as medication reminder systems, respite care, and adult day services. Payments for caregivers are handled by a financial management agency. The Aging Waiver is managed by the Utah Department of Health.

Utah's New Choices Waiver (NCW) is a Medicaid program provides services designed to enable individuals to move from an assisted living community, nursing home, or health care facility back to their own home or into the home of a loved one or caregiver. The NCW provides funds for support services including homemaker services, home modifications required for accessibility, home delivered meals, non-medical transportation, and other services such as attendant care and adult day services. It allows for consumer direction of services, including the option to hire friends or relatives, with the exception of spouses or legal guardians. An open enrollment period applies to this program, and it's only available for those who are currently residing in a care facility and want to transition back into the community.

Utah's VDC program is offered through the Salt Lake City VA Medical Center.
Summary: How to obtain financial assistance for caregivers in Washington

1. Contact your local Area Agency on Aging for information on the HCBA / Alternatives Program.

2. Apply for Utah Medicaid if eligible. You can contact Utah Medicaid using the details here.

3. Contact your local Department of Human Services office for information on the Utah State Plan Medicaid Personal Care Services program. Keep in mind that this program may not include self-directed services. You can also call 1-866-435-7414 for information and assistance.

4. Contact your local Area Agency on Aging for information on the Aging Waiver program and how to apply for services.

5. Veterans should contact the Utah Department of Veterans and Military Affairs for information on the VDC program.

There are a few programs available to Vermont residents who are eligible for Medicaid, including the Vermont Attendant Services Program and the Vermont Global Commitment to Health Waiver.

The Attendant Services Program (ASP) provides services to those with disabilities who require assistance with ADLs. It's a self-directed program, and participants are able to hire, train, and manage their own care providers, which includes certain family members such as adult children of aging parents. Spouses, civil union partners, and legal guardians are ineligible to be paid for providing services, however. The hourly rate is a Medicaid-approved rate typically between $14.75 and $18.75 per hour.

Other programs available in Vermont (without consumer-directed options) include the Vermont Home Sharing Program, which matches older adults requiring assistance with housemates who are able to offer the needed assistance, and the Vermont Home Access Program, which offers assistance with home modifications.

Vermont's VDC program is offered through the White River Junction VA Medical Center.

1. Apply for Vermont Medicaid if eligible.

2. Learn more about the ASP program from by visiting the Vermont Department of Disabilities, Aging & Independent Living website or reading this brochure. You can also contact an ASP program representative by calling 802-828-0610.

3. Contact Vermont Health Connect via their website or by phone at 1-855-899-9600 to apply for the GC waiver.

4. Contact your local Vermont Area Agency on Aging for more information on other programs and services that may be available to you.

5. Get in touch with the Office of Veterans Affairs for information on the VDC program.

Summary: How to obtain financial assistance for caregivers in West Virginia
The Virginia Elderly or Disabled with Consumer Direction (EDCD) Waiver was available to Virginia residents who are Medicaid-eligible, until July 2017, when the program merged with the Technology Assisted Medicaid Waiver into a single, comprehensive program called the Commonwealth Coordinated Care (CCC) Plus Medicaid Waiver.

The CCC Plus Medicaid Waiver rolled out statewide on January 1, 2018. Under the CCC Plus program, some family members may be compensated for providing care services, including adult children, although spouses and legal guardians cannot be hired to provide care. The CCC Plus Medicaid waiver is mandatory for all eligible Virginia residents.

Adult Services (AS) and Auxiliary Grant (AG) are Virginia's two state assistance programs for older adult residents. Adult Services Program supports adults with an impairment to remain as independent as possible, ideally in their own home. Services include homemaker services, adult foster care, and long-term care services and support (LTSS) screenings. The Auxiliary Grant is for low-income adults with a disability age 60 and older who are entering or already living in certain licensed or approved facilities that accept auxiliary grant payments, so it is not appropriate for those with loved ones still living at home. In any case, both of these programs do not offer an option for participant direction.

Virginia's VDC program is offered through the Richmond and Hampton VA Medical Centers.
Summary: How to obtain financial assistance for caregivers in Wisconsin
Medicaid-eligible Washington residents have several programs available to obtain support and services including Washington COPES, the Washington Medicaid Personal Care (MPC) Program, Washington Medically Needy In-Home Waiver, Washington New Freedom Program, and the Washington Community First Choice Option. In Washington, Medicaid is referred to as Apple Health.

COPES is a Washington State Medicaid (Apple Health) waiver program offers supports and services including personal care, home modifications, emergency response services, and transportation assistance. The program is administered by the Health Care Authority and the Washington State Department of Social and Health Services.

The Washington New Freedom Program is self-directed. After an individual budget and spending plan is created, based on assessed needs and preferences, the participant is able to use their budget to hire their own personal care attendants and purchase items and services that enable them to live independently. Blood relatives may be hired as a personal care attendant - but not spouses or legal guardians. The Washington Community First Choice Option offers similar services, although it's not clear if consumer direction is an option through this program.

1. Apply for Washington Medicaid (Apple Health) if eligible.

2. Residents in King County can call 1-800-346-9257 or 206-341-7750, while residents in Pierce County can call 1-800-442-5129 or 253-476-7200 for eligibility and enrollment information for the New Freedom Program. A self-assessment and other forms can be downloaded here.

3. Visit Washington Connection, a fast and simple way to apply for a variety of services.

4. Contact your local Area Agency on Aging for information on additional programs and services that may be available to you.

5. The Washington State Department of Veterans Affairs is the point of contact for veterans interested in the VDC program.

The West Virginia Ron Yost Personal Assistance Services program and the West Virginia Lighthouse Program are two options for West Virginia residents who are not eligible for Medicaid.

The Ron Yost Personal Assistance Services program (RYPAS) is modeled after the Medicaid Cash and Counseling model (although it is not a Medicaid-funded program). It is a consumer-directed program, allowing participants to hire friends, neighbors, and even spouses to provide caregiving services.
Summary: How to obtain financial assistance for caregivers in Wyoming
The Lighthouse Program offers four levels of support for older adults - age 60 and over - in their homes, including personal care services, nutrition, mobility assistance, and homemaker services. Like the RYPAS program, certain family members may be hired to provide services (though not in all counties) for a maximum of 60 hours per month. However, the specific hours of care permitted will be determined by the Plan of Care, developed by a county caseworker and a medical professional. Adult children may be hired as caregivers; spouses may not. Caregivers are hired and provided training by the county.

West Virginia's Aged and Disabled Waiver is a Medicaid-funded program offering services ranging from non-medical personal care assistance to non-medical transportation and homemaker services. Family members may receive payment for providing care services through this program, with the exception of legal guardians and spouses. The hourly rate is capped by Medicaid and as of 2020, the maximum is $17.00 per hour.

West Virginia does not currently offer a VDC program.

1. Apply for West Virginia Medicaid if eligible.

2. If ineligible for Medicaid-funded programs, apply for RYPAS here.

3. Contact the Bureau of Older adult Services or your local county aging provider for information on applying to the Lighthouse Program.

4. Contact the West Virginia Department of Older adult Services by calling 304-558-3317 or 1-877-987-3646 for information on the Aged and Disabled Waiver program.

Participants in the SDS program are provided with funds that would otherwise be spent on their care services in a residential setting such as a nursing home, which they may then utilize to pay for goods and services that support independent living. Participants may hire friends, neighbors, and certain family members as caregivers, which may include adult children but generally excludes spouses and legal guardians.

Wisconsin Medicaid offers the Include, Respect, I Self-Direct (IRIS) Program, a waiver program that includes self-directed care (Self Directed Personal Care or SDPC). After a Service and Support Plan is developed, the participant is provided with a budget that they may spend on any goods or services outlined in the plan. They may also select their own care providers, including family members (adult children, spouses, and other family members are eligible). However, family members cannot be hired to provide live-in caregiving services under this program. Caregivers must pass background checks and be qualified to provide the services. They are also taxed on their wages.

Wisconsin offers a VDC program through the state's VA Medical Centers located in Milwaukee and Tomah.

1. Apply for Wisconsin Medicaid if eligible.

2. Contact your local Aging and Disability Resource Center (ADRC) for information on the Family Care and Family Care Partnership programs, including how to apply.

3. Your local ADRC office can also assist with IRIS applications. You may also call 1-888-515-IRIS (4747) for information on the program.

4. Veterans should contact the Wisconsin Department of Veterans Affairs for information on the VDC program.

The Wyoming Community Choices Home & Community Based Services Medicaid Waiver (CCW) is a Medicaid-funded program offering services including personal care assistance, home meal delivery, adult day services, respite care, and other services to help individuals remain in their own homes and avoid nursing home placement.

Administered by the Wyoming Department of Health's Division of Healthcare Financing (DHCF), CCW offers an In-Home Participant Directed Option enabling participants to select their own care provider, called a direct service worker. Family members including adult children may be hired to provide caregiving services, although spouses, legal guardians, and anyone with a Power of Attorney for the care recipient are ineligible to receive compensation for services.

Caregivers are limited to a maximum of 40 hours per week and are paid at a rate typically ranging between $10.25 and $12.25 per hour. It is not an entitlement program, so there may be wait lists.

Wyoming state offers a single non-Medicaid based program called the Wyoming Home Services Program (WyHS). A number of services are provided by WyHS, including care coordination, personal and respite care, and homemaker services, to support qualified individuals who are at risk of premature institutionalization.

Wyoming does not currently offer a VDC program.

1. Apply for Wyoming Medicaid if eligible.

2. Contact the Division of Healthcare Financing Community Based Services Unit at 1-855-203-2823 for information on applying for the CCW program. You can also email the department with questions at ccw.waivers@wyo.gov.

3. An assessment will be arranged to determine eligibility. Applications are typically approved or denied within 45 days.

4. Contact your local Area Agency on Aging or the Wyoming Department of Health Aging Division for information on additional programs and services available in your area.

5. To find out more about the Wyoming Home Services Program (WyHS), call Jeanne Scheneman at 307-777-8566 or the toll-free number: 1-800-442-2766.

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How to Become a Paid Caregiver for a Family Member: 6 Steps to Uncovering Financial Assistance Options for Family Caregivers

# data[].attributes.attachment_link.description
Discover 6 steps to become a paid caregiver for family members and explore financial assistance options. Learn how to navigate caregiving finances.

# data[].attributes.headline
Arizona's Support Program for Caregivers

# data[].attributes.subject
Arizona's Support Program for Caregivers

# data[].attributes.attachment_link.readable_text
Family Caregivers provide most of the assistance that enables older Arizonans and those with disabilities to live independently in their homes and communities. Caregivers can also include grandparent raising grandchildren.

What is the Family Caregiver Support Program?

The program offers five direct services to Caregivers that best meet the range of their needs, including:

Information about available services.

Assistance in gaining access to supportive services.

Individual counseling, organization of support groups, and training to assist caregivers in making decisions and solving problems relating to their roles.

Respite care to enable caregivers to be temporarily relieved from their caregiving responsibilities.

Supplemental services, on a limited basis, to complement the care provided by caregivers.

Arizona Caregiver Resource Line:
888-737-7494
Speak with a trained volunteer who can provide a compassionate ear, information, assistance, local resources and support Monday through Friday from 9 a.m. - 4 p.m.
Caregiver Action Network Resource Line:
855-227-3640

Eligibility

A family caregiver is defined as:

An adult family member, or another individual, who is an informal provider of in-home and community care to an older individual or any individual with Alzheimer's disease or a related neurological disorder.

A grandparent or older individual who is a relative caregiver (defined as a grandparent or step-grandparent of a child, or a relative of a child by blood, marriage, or adoption, who is 55 years of age or older):

1. Lives with the child who is not more than 18 years of age or who is an adult child between 19 and 59 years of age with a disability. In the situation when it is an adult child with a disability, the caregiver cannot be the parent.

2. Is the primary caregiver of the child because the biological or adoptive parents are unable or unwilling to serve as the primary caregiver of the minor child.

3. Has a legal relationship to the child, such as legal custody or guardianship, or is raising the child informally.

Services, such as respite care and supplemental services, will only be provided to a family caregiver who is providing care to an older individual who has been determined unable to perform at least two Activities of Daily Living (ADLs) without substantial human assistance, including verbal reminding, physical cueing, or supervision.

Respite services shall only be provided to a family caregiver who is assessed to be at moderate or high risk as determined by an assessment tool designated by the Division of Aging and Adult Services.
Contact a local Area Agency on Aging

# data[].attributes.attachment_link.description
Family Caregivers provide most of the assistance that enables older Arizonans and those with disabilities to live independently in their homes and communities. Caregivers can also include grandparent raising grandchildren. The program offers five direct services to Caregivers that best meet the range of their needs, including: Information about available services.

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BMC Public Health 18, Article number: 53 (2018) Cite this article

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An Erratum to this article was published on 22 September 2017

Abstract

Background

Caregiving burden and depression in family caregivers have been investigated, but little is known about how they affect paid caregivers. The aim of this study was to investigate caregiving burden and depression in paid caregivers of hospitalized patients.

Methods

A cross-sectional survey study was conducted in a tertiary referral hospital (Chengdu, China) that enrolled 108 paid caregivers who worked in the inpatient department. The Caregiver Burden Inventory (CBI) and the Center for Epidemiologic Studies Depression (CES-D) scale were incorporated into a self-developed questionnaire to gather demographic information on the following four aspects: general, work, income, and family.

Results

The mean total CBI score was 29.7 ± 12.5. The time-dependence burden had the highest score of 15.3 ± 4.0, which was followed by the physical burden score of 6.5 ± 4.6, developmental burden score of 3.7 ± 4.0, social burden score of 3.2 ± 4.0, and emotional burden score of 2.4 ± 3.1. Multiple linear regression analysis showed that a higher CBI was associated with a longer time as a paid caregiver [β=7.041, 95% Confidence Interval (CI):1.935 to 12.974, p = 0.009], lower income satisfaction (β= − 6.573, 95% CI: -11.248 to −3.020, p = 0.001), and higher frequency of meeting with their relatives (β=7.125, 95% CI: 2.019 to 12.456, p = 0.006). The mean CES-D score was 11.9 ± 8.7, and significant depression was found in 28 (25.9%) paid caregivers according to the CES-D score ≥ 16 cut-off. There was a moderate positive correlation between the CBI and CES-D scores (Pearson's r = 0.452, p < 0.001).

Conclusions

A high caregiving burden was commonly observed in paid caregivers of hospitalized patients in China, as was a high prevalence of depression symptoms. Several associated factors were identified that could be areas for future interventions.

Peer Review reports

Background

Caregivers have been shown to suffer from high caregiving burden and depression; therefore, they are a group of vulnerable people or "invisible patients" who need attention or interventions from medical staff and social workers. [ 7, 8] However, most previous studies [ 1, 7, 8] have focused on the caregiving burden of family caregivers for patients who stayed at home and not on the growing population of paid caregivers who work in hospitals. According to published studies in Chinese journals, most paid caregivers are middle-aged women who were previously farmers from a rural area or laid-off workers from a city. [ 9, 10] Although psychological health and work pressure were investigated in paid caregivers in China, which were related to sleep disturbances, unstable income, and a lack of social respect and support, [ 11, 12] data are very limited on the caregiving burden in this population, especially by the use of designated inventories. Therefore, to provide information for developing practical interventions, a survey study was conducted to identify the prevalence of caregiving burden and depression symptoms as well as their associated factors from four categories, including general, work, income, and family characteristics.

Methods

Study design

This was a cross-sectional survey study in a tertiary referral hospital (Chengdu, China) performed with a self-developed questionnaire that is described in the "Instruments" section. Nurses participated in the design, distribution and return of the questionnaire.

Participants

Considering that caregiving burden could be affected by the working environment and patients of paid caregivers, the subjects were all paid caregivers who worked in four medical and four surgical wards (i.e., cardiology vs. cardiac surgery, respiratory medicine vs. thoracic surgery, gastrointestinal medicine vs. gastrointestinal surgery, and neurology vs. neurosurgery). The subjects were enrolled if they met the following criteria: (1) agreed to participate and signed the informed consent form and (2) could read and complete the questionnaire. Consequently, 120 of the 124 (96.8%) registered paid caregivers from the aforementioned wards were enrolled; four people did not fulfil the inclusion criteria as they refused to participate.

Instruments

The questionnaire was written in Chinese and consisted of three parts. In the first part, the baseline characteristics of the study subjects were collected; this included proposed factors associated with the caregiving burden or depression that were categorized into general, work, income, and family information. General information included the age, gender, education, and marital status. Work information included the ward in which they worked, number of years as a paid caregiver, and number of vacation days per month. For the income information, "income satisfaction" was a required field, while "income per month before and after becoming a paid caregiver" was optional. The number of dependents, frequency of meeting his/her own family, and housing status in Chengdu (owned or rental) were categorized as family information.

Five CBI factors and their scores. CBI, Caregiving Burden Inventory. The bar chart represents the means ± standard deviation, and the adjusted physical burden is the original score multiplied by 1.25 to give an equivalent score out of 20 for comparison. † p < 0.001 vs. the time-dependence burden and § p < 0.001 vs. the physical burden

The third part of the questionnaire assessed the depression symptoms of paid caregivers with the Chinese version of the Center for Epidemiologic Studies Depression Scale (CES-D), which has been validated and showed good reliability in a Chinese population. [ 17, 18, 19] The CES-D includes 20 items that cover affective, cognitive, behavioural, and somatic symptoms associated with depression. The subjects were asked to indicate the frequency of symptoms on the following 4-point scale from 0 (rarely or none of the time) to 3 (most or all of the time). The 4 positively formulated items (items 4, 8, 12, and 16) were recorded in reverse. Therefore, the total score of the CES-D ranged from 0 to 60, and a score of 16 or higher indicates the likely presence of clinically significant depression. [ 18, 20].

According to the study design, the copies of the questionnaire with inadequate quality were not entered into the final analysis, including those with an incomplete CBI or CES-D section, and a consistent lowest score (i.e. "0" score) or highest score (i.e. "4" score in the CBI section and "3" score in the CES-D section) for each item in either section. This extreme and unchangeable scoring situation was considered to indicate that the participant had not understood the survey or had not seriously considered it.

Statistics

The statistical analysis was performed using SPSS software, version 20.0 (SPSS, Chicago, IL, USA). A Kolmogorov-Smirnov test was performed to determine whether continuous parameters were normally distributed. T-tests, chi-square tests and Fisher's exact tests were used for univariate analyses. One-way ANOVA was used to test differences among the 5 factors of the CBI. Multiple linear regression was performed to identify factors associated with the CBI and CES-D scores. A Pearson correlation coefficient was used to analyse the correlations between the CBI and CES-D scores. A p-value <0.05 was considered statistically significant.

Results

During the study period, 120 copies of the survey were sent out and returned (100% response rate) by assigned ward nurses. However, several surveys were unsuitable for analysis (12/120, 10%), including nine that had an incomplete CBI or CES-D section and another three that had a consistent "0" score for each item in the CBI section.

Baseline characteristics

Data for the 4 domains are presented in Table 1. All paid caregivers were middle-aged, and most were female. The majority of the subjects achieved an educational level below high school. The number of years that each participant worked as a paid caregiver was categorized into five groups in the questionnaire (i.e., less than 1 year, 1 ~ 3 years, 3 ~ 5 years, 5 ~ 10 years, and more than 10 years); however, 73 (66.7%) paid caregivers worked in this field for more than 10 years.

Table 1 Baseline characteristics of the paid caregivers

Caregiving burden and depression scores in paid caregivers

The total CBI score was normally distributed among the study population with a mean value of 29.7 ± 12.5. There were some differences among the 5 factors of the CBI that were detected by the ANOVA (F ₍₄₅₃₅₎ = 194.207, P < 0.001) and post hoc analysis. The time-dependence burden factor had the highest score of 15.3 among the 5 factors; it was significantly higher than those of the remaining factors (all P < 0.001). It was followed by the physical burden score of 6.5, which was significantly higher than the emotional, developmental, and social burden scores (all P < 0.001). The scores of the last 3 factors were similar. (Fig. 1).

The CES-D score of the study participants also had a normal distribution with a mean value of 11.9 ± 8.7. Using the CES-D score ≥ 16 cut-off, depression was found in 28 (25.9%) paid caregivers. Moreover, the CBI score of the depression group (CES-D score ≥ 16) was significantly higher than that of the non-depression group (36.3 ± 14.3 vs. 27.4 ± 11.0, P = 0.001). The CBI score was positively correlated with the CES-D score ( r = 0.452, P < 0.001). (Fig. 2).

Correlation between the CES-D and CBI scores. CES-D, Center for Epidemiologic Studies Depression Scale. CBI, Caregiving Burden Inventory. The Pearson correlation coefficient is 0.452 ( P value <0.001)

Factors associated with a higher caregiving burden and depression

A multiple linear regression analysis was used to identify the factors that were related to higher CBI (Table 2) and CES-D (Table 3) scores. The parameters in Table 1 were all included as covariates in the model, where either the CBI or CES-D score was the dependent variable. Three independent variables were associated with a higher CBI score, which included a longer time as a paid caregiver ( P = 0.009), lower income satisfaction ( P = 0.001), and more frequent meeting with his/her own family ( P = 0.006). (Table 2) Similarly, a lower income satisfaction was found to be associated with a higher CES-D score ( P = 0.008). (Table 3).

Table 2 Variables associated with the likelihood of a higher CBI score

Table 3 Variables associated with the likelihood of a higher CES-D score

Discussion

In this survey, the majority of paid caregivers were married, middle-aged women with a low educational level. They suffered from a high caregiving burden that was related to the amount of time as a caregiver, income satisfaction and frequency of meeting with their own family. The depression rate of this group was higher than that of the general population, but it was lower than that of family caregivers; it was also positively correlated with caregiving burden.

High caregiving burden in paid caregivers

Factors associated with a higher caregiving burden

Previous studies showed that the risk factors for caregiving burden included female gender, [ 30] a low education, [ 31, 32] sleep deprivation, financial stress, [ 33] depression, [ 34] social isolation, [ 35] and time restrictions [ 36]. Because the paid caregivers in the current study worked on a 24-h schedule, we gathered the number of years they spent as paid caregivers rather than the number of hours per day spent performing their job and found the former to be associated with the CBI score. This association might be attributed to the self-perceived long-term time restrictions and deteriorating physical health of the paid caregivers. As previously reported, financial stress was a risk factor for caregiving burden [ 33], and poor payment for paid caregivers was a common issue. [ 37, 38] In China, most tertiary referral hospitals (as the study site) provide high-quality, specialized medical health care services to a number of districts that are located in urban areas; however, these areas also have the largest demand for paid caregivers. [ 39] In contrast, most paid caregivers are from the countryside and have moved to a city for a better living. Not surprisingly, lower income satisfaction was significantly associated with a higher caregiving burden, indicating a conflict among their actual payment, self-expectations and financial circumstances. However, this conflict cannot be resolved only by raising their salaries. It is possible that organized lectures and regular meetings could identify what paid caregivers need and think. More interestingly, it was observed in the study that paid caregivers who met with their own families more frequently had a higher CBI score. This phenomenon has not been previously identified, and its cause remains unexplored in the current study.

Correlation between depression and caregiving burden

Study limitations

The major limitations of this study include its cross-sectional nature and the absence of health consequence data, i.e. the result of coupling between the caregiving burden and the physical/emotional health of paid caregivers. Although some practical interventions to reduce the caregiving burden could be developed based on the results of the current study, their impact on the professional health of paid caregivers remains unclear. The relatively small sample size is another limitation.

Conclusions

Caregiving burden is high in paid caregivers of hospitalized patients in China, most of whom are middle-aged women from rural areas. It is associated with a prolonged working time, low income satisfaction and unexplained impact from their own families. In addition, the caregiver burden and depression are correlated, which is more prevalent in paid caregivers than in the general population.

Change history

22 September 2017

An erratum to this article has been published.

Abbreviations

CBI:

Caregiver Burden Inventory

CES-D:

Center for Epidemiologic Studies Depression Scale

References

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Acknowledgements

We appreciate Professor Rui Zhang (Department of Medical Administration, National Health and Family Planning Commission, P.R.C.) for providing us with the validated Chinese version of the CBI.

Funding

No funding supported this study.

Availability of data and materials

Data will be available upon request from the corresponding author.

Author information

Authors and Affiliations

1. Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China

Yao-Dan Liang, Ya-Li Wang, Zhi Li, Li He, Ying Xu, Qing Zhang & Gui-Ying You

2. Department of Nephrology, West China Hospital, Sichuan University, No. 37, Guo Xue Xiang, Chengdu, Sichuan, 610041, China

Xu-Hua Mi

Contributions

MXH designed this study and wrote the study protocol. LYD conducted the study and drafted the manuscript. YGY designed the questionnaire. WYL and LZ helped to finalize the questionnaire and recruited the paid caregivers in each ward. HL and XY were responsible for giving out and receiving the questionnaires, organizing the data, and performing the literature review. ZQ was responsible for performing the statistical analysis and revising the manuscript. All authors have read and approved the final manuscript.

Corresponding author

Correspondence to Xu-Hua Mi.

Ethics declarations

Ethics approval and consent to participate

The current study was an observational study that was approved by the ethics committee of the West China Hospital of Sichuan University. Written informed consent was obtained from each study participant.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher's Note

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Additional information

An erratum to this article is available at https://doi.org/10.1186/s12889-017-4709-6.

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Liang, YD., Wang, YL., Li, Z. et al. Caregiving burden and depression in paid caregivers of hospitalized patients: a pilot study in China. BMC Public Health 18, 53 (2018). https://doi.org/10.1186/s12889-017-4563-6
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Caregiving burden and depression in paid caregivers of hospitalized patients: a pilot study in China - BMC Public Health

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Background Caregiving burden and depression in family caregivers have been investigated, but little is known about how they affect paid caregivers. The aim of this study was to investigate caregiving burden and depression in paid caregivers of hospitalized patients.

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Theorizing about Family Caregiving: The Role of Responsibility on JSTOR

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Kathleen W. Piercy, Theorizing about Family Caregiving: The Role of Responsibility, Journal of Marriage and Family, Vol. 60, No. 1 (Feb., 1998), pp. 109-118