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Ask the Aging Expert

"Can I be paid to be a caregiver?"

This may seem like a simple question, but the fact is, the answer is yes and no. The answer is no, there isn’t a program that guarantees that all caregivers can be paid for caring for a loved one in the state of Utah. But at the same time, the answer could be yes depending on the program your loved one qualifies for. Some programs allow for paid family caregivers, but it will not replace a full-time job and it is considered income, so you will be taxed on it.   Your loved one has to not only qualify for the program, but they need to have the assessed need for the service to be provided, and you will not be paid for anything that State Plan Medicaid can provide.  

Application for 1915(c) HCBS Waiver: UT.0247.R06.00 - Jul 01, 2020 Page 74 :

Participant-directed services method: The individual or another duly appointed party, under applicable laws of the State, exercises control over specified staffing decisions relating to his or her personal attendant, including control over the selection and retention of the personal attendant, supervision of the attendant’s activities and verification of the personal attendant’s time sheet. Providers of Personal Attendant Services may include agency-employed staff when the agency agrees to support the individual’s control over specified staffing decisions relating to his or her personal attendant provided by the agency in keeping with the participant-directed services method.

 In the case of an individual who cannot direct his or her own personal attendant, another person may be appointed as the decision-maker in accordance with applicable State law. The appointed person must perform supervisory activities at a frequency and intensity specified in the Designation of Personal Representative Agreement form. The individual or appointed person may also train the attendant to perform assigned activities. 

Waiver enrollees determined to need the types of services provided by the Personal Attendant Services category will be informed of the opportunity to receive the service through the participant-directed services method. Information will include the option to directly employ the personal attendant or to utilize an agency-employed personal attendant, and the scope and nature of the Fiscal Management Agency that is used when the personal attendant is directly employed.

 A case file notation will be made regarding the adequacy of the services provided, any training or retraining necessary, and the continued appropriateness and feasibility of the attendant providing services. The Case Manager will arrange with provider agencies for all training needs of the personal attendants.

 In certain cases, an individual may be deemed unable to adequately perform necessary supervisory activities when circumstances render the Personal Representative incapable of performing the supervisory activities that are in the best interest of the participant. In the event it is determined that the individual is unable to adequately perform necessary supervisory activities and has no qualified appointed person to direct the personal attendant, alternative waiver services will be arranged by the local/regional non-state entities utilizing appropriate agencies. Persons having case management involvement with the individual may not serve as surrogates responsible for directing the activities of the personal attendant. Payment will not be made for services furnished by the individual’s spouse or other individuals who have a legal responsibility to furnish the services.

If your loved one qualifies for a program that can pay a caregiver, one of the things that will be monitored is, as the attendant, if you live in home are these activities that you really do for the client not yourself and other family members.  In the Assessment you will be asked how meals are prepared, who is in the home, and if it is something that is covered by the state plan and are state plan benefits at the maximum level.   In-home services, whether they are from The Alternatives Program, or a Waiver, are the service of last resort. The case manager will look at Medicare Services, Medicaid State plan services, community resources and natural supports.   Bathing assistance is one thing that is done by the state plan and is typically not a reimbursable service.   The average hours given is approximately 10 hours weekly, so not a full-time employment opportunity or replacement of full-time income.  

 Most aging and in-home services programs are run at a state level. What that means is that just because another state paid for caregiving it is not automatic and may not be possible based on the rules in other states.    All programs have intakes and qualifiers both financial (meaning they look at the income and assets for the care receiver) and medical (meaning they look at the care receiver’s physical abilities and limitations).   Consumers will be asked for verification of income and assets, including a five-year lookback for some programs. This look back up is to make sure assets have not been given away.   After an intake screening you may be placed on a waiting list.   Some waiting lists are managed by the State of Utah and others are managed locally.  Due to the immediate growth in our area, we do have waiting-lists for our programs.    

So being a paid caregiver is limited, and the care receiver will need to qualify for the programs with apply for assistance and being an assessed need for the service. Caregivers, on most programs will submit to a background check on past criminal activity.

Tracy HeavyRunner is our Home and Community Based Program Director.

She has been with AAA-Five County since 1996. Tracy graduated from Southern Utah University and is a Social Service Worker. Additionally, she is a certified caregiver coach through the Rosalyn Carter Institute and a Master Trainer for the Chronic Disease, Diabetes and Pain Self-Management Programs.

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