Caregiving and help at home
Help at home is paid for by a different system than hospital care, and the main door is Medicaid home and community-based services, which in most states can pay a family member to provide that care. Other doors include PACE, which wraps all your care into one program, the National Family Caregiver Support Program for respite, and the GUIDE model for families living with dementia. Every one of these is decided state by state.
Written and checked by Jason Burns, Editorial Steward · Checked August 25, 2026
Medicare pays for very little long-term help at home
This surprises almost everyone. Medicare pays for short-term skilled care after an illness or hospital stay. It does not pay for ongoing help with bathing, dressing, meals or supervision. That kind of help, called personal care or custodial care, is paid for by Medicaid, by long-term care insurance, by the Department of Veterans Affairs for some veterans, or out of pocket.
Medicaid waivers, and the option to pay a family member
A home and community-based services waiver lets a state use Medicaid money for care at home instead of care in a nursing home. Most states also offer a self-directed option, sometimes called consumer-directed care, where the person needing care picks their own worker and that worker can be an adult child, a grandchild, a friend, or in some states a spouse. Rules on who can be paid, and how many hours, differ in every state.
PACE bundles everything
PACE, the Program of All-Inclusive Care for the Elderly, provides medical care, therapy, meals, transportation and adult day services through one team, for people 55 and older who need a nursing home level of care but can live safely at home. It exists only where a PACE organization operates.
Support for the caregiver, not just the patient
The National Family Caregiver Support Program funds counseling, training, and respite so a caregiver can rest. The GUIDE model, run by Medicare's innovation center, gives families living with dementia a care navigator and, at participating organizations, respite services.
Questions people ask
How do I get financial help for my aging parents?
Start by calling your parent's local Area Agency on Aging through the Eldercare Locator at 1-800-677-1116 and asking for a benefits check-up, which screens them at once for a Medicare Savings Program, Extra Help, SNAP, energy assistance, and home care — the five that most families miss.
Can I get paid to care for my mother?
In many states you can be paid to care for your mother through a Medicaid self-directed home care program, where she is approved for home care hours and chooses you as the paid worker — the approval is based on her income and care needs, not on yours.
What help is there if I'm caring for someone with dementia?
Dementia caregivers can get paid respite care, training, and a care navigator through the National Family Caregiver Support Program, and if the person you care for has Original Medicare, a practice enrolled in the GUIDE model can provide 24-hour caregiver support and respite at no cost to you.
Who helps if I can't manage at home anymore?
Call your Area Agency on Aging at 1-800-677-1116 and ask for a home care assessment, because most people who feel they cannot manage anymore can stay home with paid help through a Medicaid home and community based services waiver or, in some areas, through PACE, which coordinates all care and can prevent a nursing home move.
Can a family member get paid to take care of me?
Often yes — most states let Medicaid pay a family member to provide your personal care at home through a self-directed option inside a home and community-based services waiver, but the rules on who may be hired, how many hours are approved, and whether a spouse counts are set by each state, so the answer depends on where you live.
What is a Medicaid HCBS waiver?
A Medicaid HCBS waiver is a state program that uses Medicaid money to pay for long-term care in your own home or community rather than in a nursing home, where HCBS stands for home and community-based services and waiver means the state has federal permission to bend some ordinary Medicaid rules to make that possible.
What is PACE and how is it different from Pennsylvania PACE?
Federal PACE, the Program of All-Inclusive Care for the Elderly, is a Medicare and Medicaid program that provides a person's entire medical and long-term care through one team so they can keep living at home, while Pennsylvania PACE is a completely unrelated state program that only helps Pennsylvania residents pay for prescription drugs, and the two share nothing but a name.
What is the National Family Caregiver Support Program?
The National Family Caregiver Support Program is federal Older Americans Act funding that pays your local Area Agency on Aging to support unpaid family caregivers with counseling, training, support groups, help finding services, and respite care so the caregiver can rest.
What is the GUIDE dementia model?
GUIDE is a Medicare program in which participating provider organizations give people living with dementia and their unpaid caregivers a dedicated care navigator, a 24-hour support line, caregiver training, and access to respite services, with the goal of helping the person stay at home longer.
Programs covered in this guide
- Medicaid Home and Community-Based Services, Including Paying a Family CaregiverMedicaid can pay for help at home instead of a nursing home, and in most states it can pay your own family member to give that help.
- PACE: Program of All-Inclusive Care for the ElderlyOne program that becomes your entire medical and home care team so you can stay out of a nursing home.
- Pennsylvania PACE and PACENET Prescription AssistancePennsylvania's state prescription program for residents 65 and older. Not the same thing as federal PACE.
- National Family Caregiver Support ProgramRespite, training, counseling, and sometimes small grants for the family member doing the caring.
- GUIDE Model for Dementia CareA Medicare program for people with dementia that assigns a care navigator and pays for respite.
Sources
- Home and Community-Based Services · Centers for Medicare & Medicaid Services
- National Family Caregiver Support Program · Administration for Community Living
Every program on this site is free to apply for. Anyone who asks you to pay to apply, or to “unlock” a government benefit, is a scam — hang up and call Senior Medicare Patrol or 211.
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Checked August 25, 2026. Licensed under the Citation License 1.0. © 2026 Adolicious LLC.