Choosing a Relative as a Paid Caregiver in Pennsylvania: A Step-by-Step Guide

Your mother does not want a stranger. She wants you, and you have already cut your hours at work to make it possible. Somewhere in the last few months somebody has told you that in Pennsylvania a family member can be paid to do this, and you would like to know whether that is true, whether it applies to you, and what it actually involves before you build your life around it.

It is true, with rules. This is the step-by-step version for families in Allegheny County, written by an agency that employs family caregivers and would rather you knew the awkward parts now.

First, who can be paid

The money comes from Pennsylvania’s Community HealthChoices program, the Medicaid route for long-term care at home, so the person being cared for has to be enrolled in it first. That means being 21 or over, meeting the clinical test for a nursing-facility level of care, and passing the Medicaid financial test. If that has not happened yet, start with how Community HealthChoices works for family caregivers, because nothing below can begin until it has.

Once the person is enrolled and hours are authorized, the waiver’s rule on relatives is short. Family members can be paid to provide personal assistance and respite, except four people:

• the participant’s spouse;
• their legal guardian;
• anyone holding their power of attorney;
• their representative payee, the person who receives their Social Security on their behalf.

Everybody else is eligible: adult children, siblings, grandchildren, nieces and nephews, in-laws, and for that matter friends and neighbors. The exclusions are about legal roles, not blood. That produces a situation we see often: the adult daughter who has power of attorney and does all the caring is the one person in the family who cannot be paid for it, while her brother could be. Whether anything can or should be done about that is a question for an elder law attorney, not for an agency, and we would not advise anyone to change a legal arrangement just to qualify.

Two more rules. The paid relative has to be 18 or over and meet exactly the same standards as any other caregiver; there is no family discount on background checks or training. And if any one person provides more than 40 hours a week, the person’s CHC plan reviews the service plan and has to approve it.

The two routes, and what each means on a Tuesday

There are two ways a relative is paid under CHC. The difference is who the employer is, and it changes your week more than the paperwork suggests.

That last row catches families. In self-direction, the person who signs as employer is not allowed to be a paid worker, and neither is anyone appointed as the participant’s representative. If one adult child is doing everything, self-direction requires somebody else, often the parent themselves, to take the employer role. A spouse can be the employer even though a spouse cannot be paid.

Self-direction is a real choice and for some families the right one: more control over schedule and pay rate within the authorized budget, and the version called Services My Way adds a flexible spending plan. It is also a small business to run. The agency route means less control and more support. Neither is more “official” than the other; both are paid for by the same plan for the same hours.

A note on a phrase you will meet online: “Agency with Choice.” It is a model used by Pennsylvania’s Office of Developmental Programs for people with intellectual disabilities and autism. It is not offered under Community HealthChoices, so if an article promises it to you for an aging parent, that article is not about Pennsylvania’s program.

What getting hired by an agency actually involves

Home care agencies in Pennsylvania are licensed by the Department of Health under a set of regulations, Chapter 611, that say what has to happen before anyone provides care. They apply to a daughter exactly as they apply to a stranger. Expect all of this, in roughly this order:

1. An application and references. Two verifiable references who can speak to your reliability.
2. A criminal background check. If you have lived in Pennsylvania for the last two years, a Pennsylvania State Police record check. If not, an FBI fingerprint check as well. Certain convictions bar employment in home care under the Older Adults Protective Services Act, with no exceptions for family.
3. A child abuse clearance where the agency’s work requires it.
4. Training or a competency test covering confidentiality, daily living tasks, recognizing changes in condition, infection control, emergencies, documentation and abuse reporting, with hands-on personal care skills on top. Cyanjel runs its own training and re-certifies every caregiver annually.
5. A tuberculosis screening dated within the last year, repeated every twelve months.
6. Payroll paperwork: identity documents, tax forms, direct deposit.

At Cyanjel the whole of that is done online through the applicant portal, including the official application, and the office tells you what is missing rather than leaving you to guess. Realistically it takes a couple of weeks if you have your documents together, longer if a fingerprint appointment is needed.

Then the job starts, and it is a job. Every visit is clocked in and out through electronic visit verification, which Pennsylvania requires for Medicaid personal care; the plan does not pay for a visit that was not recorded. You are paid for the hours the service coordinator authorized, not the hours you actually spend, which for most family caregivers is fewer. You have a supervisor. If the care plan says personal care and meal preparation, that is what the hours are for.

The parts nobody tells you about

Do not resign from your job before hours are authorized. The CHC enrollment can take months, the hours authorized may be fewer than the hours you are already giving, and the pay is a caregiver’s wage. It is a genuine help; it is not a salary.

The relationship changes. Being paid formalizes something that used to be love and habit. Some parents dislike being “a client” of their own child. Some children find that being paid makes it easier to set limits. Talk about it before the first paid shift, not after.

You will still need a break. A paid family caregiver burns out on exactly the same schedule as an unpaid one. The advantage of the agency route is that respite is one phone call: another caregiver, already screened, already introduced. Plan it in from the start, and read what caregiver burnout looks like while you still have the energy to notice.

It ends. When a parent moves to a facility or dies, the employment ends with the care. Some family caregivers stop there. A good number discover they are good at this and want to keep working, and a trained, checked, experienced caregiver is somebody any agency, including ours, wants to keep.

How Cyanjel handles the family caregiver arrangement

A good number of the caregivers we employ are looking after their own relative, so this is not an exception we tolerate; it is part of what we do. The standards are the same as for everyone else, the training is the same, and the office relationship is the same: a real person in Pittsburgh who knows the plan, answers the phone Monday to Friday, and will say plainly when something is not going to be authorized. Where we differ from doing it yourself is the backup, the payroll, the visit verification and the billing, and the fact that if the arrangement stops working for the family, we can step in with a different caregiver rather than the care simply stopping.

If you would like to know whether you qualify, call (888) 772-5460 with the basics: who needs care, whether they are on Medicaid already, and what legal roles you hold. We will tell you honestly, and if the answer is that self-direction suits you better, we will tell you that too.