Paying Relatives for Care

Many families needing in home care for a parent use children or other relatives to provide that care. The family members often feel they should do that care without compensation, out of love and loyalty. But if they cannot afford to go without pay, that can cause much financial harm and distress for them. It is often a difficult subject to discuss if that elderly family member needs help with bathing, dressing, toileting or transferring from bed or chair to another place.

Assume that the family has a member who can give that care, but needs to be paid because it requires them to give up their job. Also assume that someday Medicaid (Title 19) may be needed to pay for care when the money runs out. The wise step to take is to create a caretaker agreement that the state will accept if a Medicaid application is needed. The contract should be in writing, and it cannot be retroactive, so the start date cannot be before the contract is signed. It should spell out the services to be provided which are personal care, help with bathing or dressing or
eating, transportation to doctors appointments, giving medications and all other services. The timing of services should also be listed. Is it every day, all day, and nighttime also? Is it at the elder’s home or the caretaker’s home? It should specify how many weeks or months the care will be given. It is advisable to specify when the caretaker could terminate the contract, and how to amend it, if needed.

A key part is the amount of compensation. State of Connecticut Medicaid regulations have over the years been interpreted to allow a rate of pay equal to the minimum average cost of homecare services for a home health aide. That increases over time, but is currently accepted as $23 per hour.

In addition to the contract, the caregiver should keep a log of the time spent, and the services provided, as the Department of Social Services may request such information. It is best to have a form where the services provided can be checked off, along with the hours given. Since a live in provided by a company in the caregiver business will not be approved at over $257 per day, that is currently the maximum allowed. Both the caregiver and the person cared for should sign the
contract.

Through the years we have seen many families deal with the satisfaction and the challenges of giving full time care to a loved one. Often it is not easy and can be draining on the caregiver, to the point where the caregiver suffers illness, or caregiver burnout. The important point to internalize is that it does no good for the elder if the caregiver gets to the point of exhaustion and can no longer give effective care. A wife once came to us, and she had lost over 25 pounds and barely weighed 115 pounds. It was obvious she was killing herself to take care of her husband, and she eventually realized some outside care was needed, for the sake of both of them.

If your family has a family member that has the time and stamina to give care, that is wonderful. And if money can be paid under the Medicaid rules, that may benefit everyone, emotionally and financially.