paid to care for a family member


Caring for a family member can not only drain your emotions, but the time-consuming tasks of caring for a loved one can also drain your bank account. AARP estimates that “[a]bout 48 million Americans provide care without pay to an adult family member or friend, and they do so for an average of nearly 24 hours per week.” Furthermore, “family caregivers regularly incur out-of-pocket costs caring for a loved one, with the average annual expenditure topping $7,200.”

Although you are most likely to get paid if you are caring for a family member who is a military veteran or is eligible for Medicaid, other possibilities exist.


All 50 states and the District of Columbia offer self-directed Medicaid services for long-term care which allows qualified individuals to manage their own long-term home-care services. In Nebraska Personal Assistance Services (PAS) are offered to applicants eligible for Medicaid who have a chronic medical condition or disability and need assistance with daily activities in their own homes. This program permits family members to be paid caregivers as long as they are not legally responsible for the participant. Spouses or parents of a minor child cannot be hired to provide care. Similarly, in Iowa a relative may be eligible for compensation as a caregiver unless they are a spouse, a parent of minor child, or a legally liable relative. As you would expect, with any government program, there are detailed rules, stipulations, and limitations. Contact your state Medicaid program to ask about its options or to start the sign-up process.


The U.S. Department of Veterans Affairs (VA) has four programs that allow for self-direction of care for veterans who are aged, disabled, or have Alzheimer’s disease or another type of dementia. Through these options, veterans are given a flexible budget (or cash allowance) that allows them to hire their own caregivers, including relatives, adult children, and even spouses. These programs have different eligibility criteria for those receiving care and giving care. In brief, here are the VA programs:

Aid & Attendance Pension Benefit

The Aid & Attendance (A&A) benefit is a cash benefit for veterans and surviving spouses who require long-term in-home care, assisted living, or nursing home care. These funds can be used as the veteran or surviving spouse sees fit, including using them to pay an adult child, grandchild, or another family member to provide them with in-home care.

Because A&A is an add-on benefit, you must first be eligible for the basic VA pension or the basic survivor pension. In addition to meeting eligibility requirements for a basic pension, one must meet a disability requirement in order to be eligible for the A&A pension.

Housebound Pension Benefit

The Housebound benefit is a monthly monetary benefit for veterans and surviving spouses who are permanently disabled, and due to the disability, are mostly unable to leave their homes. Like with the A&A benefit, financial assistance via the Housebound benefit can be used to hire a relative or friend to provide personal care assistance and homemaker services, but not spouses. However, other relatives, such as adult children, nieces and nephews, and grandchildren, can be paid to be caregivers. Like with the Aid & Attendance pension benefit, the Housebound pension benefit is available as an additional cash benefit to the basic veteran’s pension or the basic survivor’s pension, but you cannot receive both housebound and A&A benefits at the same time.

Program of Comprehensive Assistance for Family Caregivers

The Program of Comprehensive Assistance for Family Caregivers (PCAFC) provides monthly cash benefits to family caregivers of veterans. In addition to cash payments, family caregivers are eligible for education, training, and counseling. The caretaker must be 18 or older and a spouse, child, parent, stepfamily member, extended family member or full-time housemate of the veteran.

This program is for veterans who were critically hurt or suffered a serious illness in the line of duty on or prior to May 7, 1975 or on or after September 11, 2001. Veterans must be enrolled in the VA’s health care program and must require care assistance with at least one of their activities of daily living. On October 1, 2022 this program will be expanded to include veterans who were critically injured or had a serious illness in the line of duty between the dates of May 8, 1975 and September 10, 2001.

Veteran Directed Home & Community Based Care

For veterans of all ages who are enrolled in the VA’s medical benefits package, this consumer- directed option serves veterans who require skilled services and assistance with daily living activities, such as bathing, grooming, dressing, preparation of meals, and medication management. Recipients are given an individualized budget to obtain the assistance they require. Veteran Directed Care, which can be thought of as a nursing home diversion program, is a pilot program and is currently available in only 41 states. As of now it is available in Iowa, but not in Nebraska. However, with time, this program should be available nationwide.

For more information on help for military caregivers, visit: or call the VA caregiver hotline at 855-260-3274.

Paying a family member

If the person needing care assistance has the means and is mentally competent, they can, of course, opt to pay a family member instead of a professional home health care worker. If you and a family member are considering this option, offers this advice:

  • “Put aside any awkward feelings about discussing what you both need.
  • Draw up a personal care agreement that will serve as a contract between the caregiver and the care recipient.
  • Consult an elder care lawyer to review your contract to make sure it meets tax requirements and deals with inheritances.
  • Beware of emotional pitfalls.
  • Keep professional records.“


Sean D. Cuddigan
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SSA and VA Disability Attorney in Omaha, Nebraska
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