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Many older Americans can live at home instead of in a nursing home, if they receive adequate caregiving services. “Consumer-directed care” programs in some states provide funds to pay for family caregivers. These programs can cost the state and federal government less money than long-term care facilities. Seniors get to continue living in the home they love. On the surface, this arrangement sounds perfect, yet the caregivers often experience surprising problems with other family members and the parents they are trying to help.

The adult child who serves as the primary caregiver frequently does so at great financial sacrifice, having to quit her job or work fewer hours to take the parent to doctor appointments and dress, groom, and feed the parent. Siblings of the caregiver sometimes resent the fact that the person providing the care gets paid by the government, even though it is a modest wage. Here are some tips on how your caregiver can get paid and treated fairly, while avoiding family conflict.

Communicate. The caregiver, care recipient and other family members should have a candid conversation about the arrangement before taking the leap. Once siblings realize the government red tape required and the small amount of compensation the caregiver will receive, they will be less likely to cause problems.

In some families, however, the existing dynamic is not a good fit for a paid caregiver arrangement. In these situations, the parent might treat the caregiver like a servant, damaging the parent-child relationship. Siblings might refuse to pitch in at all with helping the parents, even though the nominal salary is grossly inadequate to cover round-the-clock care. Some caregivers also might treat the parents or siblings unfairly, once they start collecting an income for providing care.

Decide if the caregiver salary is worth it. In some situations, the caregiver might find that the little bit of income is not worth the family squabbles and being treated like a second-class citizen. Some caregivers reach their breaking point and go back to their previous jobs that often paid more money and provided benefits. In these instances, the parent will likely have to move into a nursing home. Many families do not appreciate the caregiver’s work, until the situation gets to this level. By then it is too late to undo the harm.

This advice is a cautionary tale for older parents, whose children serve as their caregivers. Once the adult child starts getting paid for his work, the parent might start to mistreat him, barking orders and making unreasonable demands. Seniors should understand that the consequences of such actions can include being moved into a nursing home.

If your state has programs that pay family members to provide caregiving services, your parent might be able to delay the nursing home and the caregiver can get some respect and pay for doing these valuable activities. To make sure that everyone gets treated fairly, the family needs to have a family meeting, discuss the details openly and set clear boundaries and expectations.

You should talk with a nearby elder law attorney about whether your state’s regulations vary from the general law of this article.


AARP. “Getting Compensated for Caregiving Can Change Family Dynamics.” (accessed February 14, 2019)

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