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February 13, 2017

The Case for Family as Paid Caregivers


One of the more polarizing debates in the human services field is whether or not family (parents in particular) should be paid caregivers for their adult children. This debate has come to the forefront as states try to move to more community based services and seek to eliminate or at least significantly reduce the usage of state institutions. Services like sponsored residential placement have seen a significant increase in requests my by parents and other family members willing to provide residential care and be reimbursed by the state/sponsor agency.

Many feel that parents and other family members should never get paid for caring for their own family. One of the primary arguments is that why get paid for something you should do anyway and have been doing for free since the family member was born. Those who are against this option seem to be fixated on the money aspect of these types of services. However, these services are seen as a viable option, especially in rural areas where service providers are limited. There are situations when there are severe medical and behavioral concerns that are best managed by a family member.

As with any program like this, there will be some that will try to take advantage of the system. Unfortunately, this makes it difficult for the families that are actually good candidates and will utilize the program the way it was intended.  This has led to more stringent requirements for family members as opposed to non-related caregivers.

Then there is what I like to call the “bait and switch” which always raises a red flag when families requested to become paid caregivers. This is when the family says that they can no longer care for their loved one and need residential placement. Then after they are approved for funding, the family member requests to become the residential sponsor and caregiver. All of a sudden they become capable of caring…. for pay. I do believe this is more of the exception than the norm.  In general, I support this option and I list a few reasons why this can be a good alternative for providing care.
                                                                                  
The Advantages of Family as Paid Caregivers

Consistency in support staff- The family can provide consistent support instead of a different support staff every day. Residential facilities traditionally have high turnover rates and the residents have to constantly get used to new support staff. Constant turnover can also have an impact on the overall level of care since they will have to be trained on how to provide care and get a chance to develop a rapport with the resident.

More flexibility- This option provides more flexibility for the family and the primary caregiver. Constant medical appointments, therapy sessions, and health issues make it extremely difficult for the parent to maintain employment. The reimbursement is meant to offset the difficulty of maintaining stable employment. Some parents are forced to take early retirement or sacrifice their careers to care for their loved ones.  So I personally think it’s an insult to the family to suggest that they are purely doing this for the money. There are human service professionals that actually believe this. In my conversations with parents and other family members, they are not living some lavish lifestyle by caring for their family. It’s a 24 hour 7 day a week job that never ends.

More one on one attention- This option provides an opportunity to for the staff to dedicate more hands on attention. Group homes and other facilities may have one staff responsible for up 3-4 residents. The staff to client ratio can restrict opportunities for community activities. If a resident is sick or is having a behavioral issue, It can limit the activities of others if there is not enough staff to stay at home with those who can’t participate.

Family can provide more freedom to travel and be involved in community activities.  Family members also tend to have a closer connection than staff in a typical residential facility. For them it’s more than a job. Family can provide opportunities that group homes just cannot provide. They can go on vacation and use relief staff or provide support themselves. This option allows the individual to have experiences that they normally wouldn’t have under other circumstances.

Family members also tend to have a higher attention to detail and can often detect illnesses and treat them before they become more serious. In residential settings illnesses may not be detected immediately due to the care required by the other residents.


Generally more cost-effective- The reimbursement rates and the overall costs of staying at home is usually less than residential placement. Parents/family tend to charge less for rent than group homes that usually take a large portion of the residents SSI benefits to cover the room and board. This of course leaves the individual with less money to spend on community activities and other wants and needs. 

So not only does allowing families the option to become paid caregivers enhance the overall well-being of the individual, it is also often the most cost-effective method to provide the least restrictive residential services. I think we as service coordinators should focus less on families “getting paid” and focus on the happiness of the people we serve. 

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