I see the work that my friends put in, managing a parent’s health and financial affairs. I see the home modifications my sister made to make it a safe place for our dad to live. Caring for our elders eats up time and money. And still, a lot of family caregivers feel uncomfortable with the idea of getting paid for the vital role we play—even though the hours we dedicate to caring for our aging loved ones lead to better health outcomes for them and reduce the strain on our healthcare system. 

Recognizing the Value of Elder Care

I understand why getting paid to be a caregiver for an aging family member can feel awkward. “They’re my parents. They cared for me when I was young. Now it’s my turn to care for them.” 

But let me ask you this: Do you think the hard work of raising children is valuable? If so, what would you value it at? Is it worth at least the cost of a roof over your head, clothes on your back, and food in your stomach? That’s the trade-off a lot of married Americans make when they decide that one of them will be a stay-at-home parent. Add up a year’s worth of rent ($15,840) or mortgage payments ($27,804), groceries ($9,363), and clothes ($1,185). Divide it by 2. You’ll see that most couples who choose this arrangement agree that caring for children is worth, on average, between $13K and $19K annually. I imagine anyone who has actually raised a child will tell you that it’s worth a lot more than that. 

For couples who choose/need to keep both jobs and outsource their childcare, 40-50 hours of childcare/week comes to an average of $10-12K annually. And they still have to provide the other 125+/- hours of care each week.  

Clearly, there’s a dollar value that can be—and is—assigned to caring for someone we love. So then, why balk at the notion of family caregiver compensation? If it’s starting to make more sense to you now, here are a few other reasons that family caregivers deserve to be paid. And they’re big ones.

1. Healthcare continues to shift toward a "hospital-at-home" model of care

During the pandemic, health systems started leaning into the hospital-at-home model. This means they’re sending patients home as soon as they’re stabilized, and prescribing visits by nurses, physical therapists, and occupational therapists in the home, instead of providing these services in the hospital setting. 

And they’re counting on the unpaid work of one or more family members to ensure that the patient follows the discharge instructions and continues to improve in a safe and supportive environment. When that support was provided by nurses at the hospital, no one balked at paying for it. Everyone saw its value. 

Family caregivers should also be paid for this work. Especially since research shows that the rate of hospital readmission is lower for people under hospital-at-home care than it is for those who remain in the hospital and receive the same care. And compared with patients in a hospital setting, patients in hospital-at-home had better clinical outcomes. So family members aren’t just doing the work of health care workers, we’re doing it…dare I say…more effectively.

But at what cost? Providing in-home care often requires family caregivers to take time away from paid employment. Only 11 states plus Washington, D.C. currently have paid family leave laws. So most family caregivers have to forfeit income when they take time off to care for a loved one. And because the care needs of an aging parent can be intense and continue for years—especially if they have Alzheimer’s or other dementia—even the most generous family leave laws aren’t enough to support a full-time family caregiver. This is why so many of us are forced to leave our jobs entirely. Often, during our most crucial earning years. 

Returning to work once our caregiving duties aren’t needed anymore is no easy task. That employment gap can result in a significantly lower wage. Beyond the immediate loss of income, future earning potential is greatly compromised. And remember, we’re also not contributing to Social Security or a 401(k) when we’re unemployed.

What else happens when family caregivers have to reduce hours or leave their jobs? Our out-of-pocket spending increases. Trips to doctor appointments mean added gas and parking costs. Having another mouth to feed adds to the grocery bills. Prescription co-pays can be numerous and astronomical. Caregiving supplies (like bed pads and incontinence products) and durable medical equipment (like walkers, bed alarms, wheelchairs, and shower seats) eat up more money. Some of us, like my sister, have to cover the costs of home improvements to make a bathroom or entryway safe and accessible. And we can’t always be there. Sometimes we need to hire a paid caregiver to step in and provide respite care for us so we can tend to our own health and wellbeing.

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Should family caregivers be paid to offset these costs and be rewarded for their work? Some institutions think so. See #2 below.

2. Some people are already getting paid to be a caregiver for a family member

Medicaid, some long-term care insurance (LTCI) plans, the Department of Veterans Affairs (VA), and some state programs ways for family caregivers to get paid. Why? Family caregivers save them money. 

Remember those better health outcomes mentioned above? That’s due to family caregivers being more likely to follow doctors’ recommendations and medication schedules for their loved ones. Other benefits of family caregiving include increased safety and delayed institutionalization.

Unfortunately, not everyone can take advantage of these programs.

Medicaid

Medicaid is only available to people who have no more money of their own left to pay for care. So for us to qualify for Medicaid payments, our older family member has to spend down almost all of their assets. In other words, they have to go broke first. There are some loopholes that allow us to place some of those assets in an irrevocable trust. But the money we put in there won’t be accessible to the beneficiaries until after our loved one passes away. So it won’t help with current expenses.

To learn more about your state Medicaid programs, Medicaid eligibility requirements, or to apply for coverage, visit the Medicaid.gov website. On that same page, you can find contact info for your state’s Medicaid office. Ask them about their policy on paying family caregivers. 

Long Term Care Insurance

Some Long term care insurance policies may pay a family caregiver who provides necessary help with activities of daily living. Some of those policies require us to get licensed as an in-home caregiver first, which isn’t too time-consuming and provides valuable education. But some LTCI policies will only pay a professional in-home caregiver; and some only pay a professional caregiver who works for an established home care agency.

If your loved one has an LTCI policy, contact their insurance broker or the insurance provider to ask if the policy allows a family member to get paid to be a caregiver.

Veterans Affairs

The Department of Veterans Affairs pays family caregivers via its Veteran Directed Care program. The program is for veterans who need personal care services and help with activities of daily living, like bathing, dressing, fixing meals, etc. It’s also for Veterans who don’t live near a professional home care provider, or whose caregiver is experiencing a burden that prevents them from providing care.

This pilot program, currently available in 42 states, gives the care recipient a budget they can spend on home care services. The budget is managed by the Veteran or the Veteran’s representative (eg: a family member). With the help of a counselor, the Veteran hires their own workers to meet their daily needs while they continue to live at home or in their community. They can hire adult children, siblings, grandchildren, or their spouse to provide that care.

You can learn more about Veteran Directed Care and other VA programs that pay some family caregivers of veterans and their surviving spouses on the VA website.

State Programs

Some states have enacted paid family leave laws that cover a portion of a family caregiver’s income for 6-12 weeks per 12-month period:

• California
• Colorado
• Connecticut
• Massachusetts
• New Hampshire
• New Jersey
• New York
• Oregon
• Rhode Island
• Vermont
• Washington
• Washington, D.C.

Four more states will join this list in 2025 and 2026:

• Delaware
• Hawaii
• Maine
• Minnesota

Some states have made this coverage available via a new payroll tax dedication, while others offer it as low-cost insurance that even self-employed residents can opt into. You can find out about your state's family leave laws on our Family Leave resource.

3. Pharmaceutical and insurance companies benefit from the work of family caregivers

Caring for an aging family member often means keeping track of multiple medications and varying dosage schedules. Without our assistance, imagine how many doses they would miss by mistake.

When family caregivers ensure all meds are taken on schedule, the pharma manufacturers sell more pills every month. And our loved ones are likely to stay alive longer, so the pharma companies sell those pills to us for a longer time. Multiply this by the 53 million family caregivers in the country and it’s clear that we’re making a direct and very positive impact on pharma’s bottom line.

Health insurance providers win, too. Because our care and attention help keep their aging members from incurring costly hospital stays or ER visits. Collectively, family caregivers save insurers millions—possibly billions—every year. 

It’s not out of the question for us to expect some compensation from these companies we’re helping to keep profitable. 

4. There’s a growing shortage of professional caregivers and home health aides 

We’re in the midst of a caregiving crisis. There simply aren’t enough healthcare workers to care for our sick and injured. And as our aging population continues to grow, that shortage will become all the more apparent. And it won’t just impact older adults. It will impact all of us. 

Family caregivers ease the strain on our stretched health system, so we all can get the care we need. Our society owes this vital workforce compensation for freeing up doctors, nurses, and hospital beds so we can stay healthy. Also, the hands-on experience family caregivers gain can be transferable to future work as much-needed professional caregivers.

At the end of the day, caring for family is most often motivated by love. But that doesn't mean it’s not valuable. Paid family caregiving is already happening. It's time to embrace it as both a practical solution and an ethical option for families. 

At RubyWell, we’re paving a path to financial stability for all family caregivers. Our Family Leave Finder provides state-by-sate info on family leave laws. Soon, family caregivers will be able to make the most of a loved one’s health insurance benefits with our Medicare Advantage Benefits Navigator. And ultimately, we're developing compensation solutions so that every family caregiver can be a paid caregiver. If you’d like to be among the first to hear about future products, join our waiting list.
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Was this story helpful for you? Share it with family or friends who are caring for an older family member and deserve to be compensated for their labor of love.

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