Can we pay my sibling to care for Mom?

A fellow caregiver asked...

Mom had a stroke and is now unable to live alone. She wants to stay at home she must have 24/7 help. If this is one of the siblings is it appropriate to pay them (as we would a service) to live with her under a personal care agreement? If she then depletes her money and has to "spend down" will the money paid for her care have to be paid back? Paying a sibling would be much less than 24/7 care through an agency and more trustworthy and reliable.

Expert Answer

Paying an adult child to care for a parent is a perfectly legitimate use of a parent's funds, as long as the parent agrees. In order for the payment to be considered legitimate by Medicaid -- if your mother someday applies for Medicaid benefits -- the care must be legitimately performed and the rate of pay must be in line with what private caregivers are paid in the area where your mother lives. If your mother agrees to this arrangement, it would be a very good idea for her and the sibling who'll be providing the care to draw up a personal care agreement that sets out the terms of the arrangement, including the duties and amount of care, regular hours, and pay.

This written personal care agreement can help in a number of ways. It can make and keep things clear between your mother and the sibling who's providing the care, about what the sibling is supposed to do, and how often. This can also reduce conflict between siblings, who can sometimes squabble about which ones are and are not spending time and energy providing care. The agreement can also provide the evidence your mother may need, if and when she runs out of funds and applies for Medicaid coverage of home care, that she has spent her money on care from the sibling and not merely given it as a gift. If Medicaid is satisfied that your mother "spent down" her assets on legitimate care, that money will not be counted as part of your mother's assets when Medicaid determines her eligibility. (By the way, Medicaid can deny someone's eligibility for awhile if Medicaid believes the person has given money away just to qualify for Medicaid benefits, but Medicaid has no authority to order the person who now has the money to pay the money back.)