Disclaimer: The following is based on consumer-directed-services rules for the State of Texas and is not intended to: (1) provide specifics on rules elsewhere; (2) guarantee up-to-date information on every law/regulation anywhere; (3) provide instructions on qualifying for Medicaid or any other financial aid; or (4) offer legal advice. If you need help with any of the above, please consult a professional directly.
Qualifying for a Medicaid waiver means, among other things, extra money toward hiring professional caregivers. Unfortunately, it doesn’t guarantee that you’ll get the right caregivers—especially if nobody in your household has met them before they report for work. Suppose that:
- A family member who hates everything unfamiliar takes months to adjust to a new caregiver—and, just when things finally seem stable, the caregiver leaves and you all have to go through that again.
- A caregiver proves unsatisfactory for any reason—and getting the agency to assign a new caregiver takes weeks of leaving messages and working through red tape.
You Mean I Can Choose My Own Caregivers?
Often, the solution is avoiding agencies altogether. There’s an alternative: consumer-directed services (CDS), under which the Medicaid recipient (or their guardian) is also the legal employer. It takes extra paperwork and training, plus an understanding of “employer” duties, but it frees you to choose your own caregivers according to your own criteria. You can hire a caregiver for attributes rarely considered by agencies:
- Understanding of specific disabilities
- Shared interests with the person receiving care
- Convenience to your home
- Ease of coordinating schedules
Best of all, you can hire caregivers you know personally, who already understand your family’s routines and get along with the care recipient. These people are often close friends or relatives, which can mean the best of both worlds: you know they won’t run out on you at the first higher-paying offer, and they get paid for helping those they love.
(Note: a paid CDS caregiver cannot be a legal guardian or spouse of the care recipient, but any other family or extended-family member is eligible.)
Points to Consider
However, it’s vital to understand how a professional relationship might affect your personal relationship. Before you offer the job to your mother/cousin/lifelong BFF, consider:
- Are you thinking of hiring a parent, or any older relative/family friend? Be very careful here. While your mother may seem the perfect choice to care for her own grandchild, can she handle the role reversal of having you as her boss, after she spent two decades supervising you?
- Will your friend’s/relative’s caregiver duties be similar to things they’re already doing for you? And if so, how might they react to the addition of not only a paycheck, but timesheets, tax documents, and “show up on the dot” requirements?
- If your friend/family member doesn’t understand their duties, or makes a mistake, how comfortable will they feel admitting this to you?
- How reliable is this person, really? People can be fun to spend time with, perfect allies in a crisis—and still chronically late or forgetful when it comes to everyday duties.
- Can you face the possibility of correcting a close friend/relative for duties poorly performed? Or of having to tell them their services aren’t working out? Even with someone you’ve known intimately for years, don’t assume it can’t happen. (It’s less likely to happen—or to destroy the personal relationship—if you make an advance plan together, clearly defining everything that’s expected. Include a trial period and performance reviews.)
- Finally: What might happen if you ask someone who doesn’t want (or can’t do) the job, but would feel guilty about saying no?
All that said, friends and family can and often do prove the best caregivers. If you know just the right person, you have our blessing. Your CDS relationship may well make your personal relationship stronger than ever.
This article was adapted from BridgingApps’ Consumer Directed Services Help Guide. For a copy of the full Guide, and in-depth details on all things CDS, see our Consumer Directed Services Resource page. For an overview of the basics on becoming a CDS employer, see this article’s companion post, “Consumer-Directed Services: Are You Ready to Hire Your Own Caregivers?”