How home care agencies that hire family members work
Home care agencies that hire family members do exactly what the name says: they put you on staff as an aide and assign you to one client — your relative. Your relative's Medicaid program pays the agency for the approved hours, and the agency pays you.
It's still home care by family member — you give the care, in their home or yours — but the paperwork and the employer are the agency's. This is the classic family home care agency model, and it predates the self-directed programs most families hear about today.
- Your relative qualifies for Medicaid home care and gets an assessment of their hours.
- They choose (or are assigned) an agency that accepts family caregivers.
- The agency hires you, runs a background check and provides any required training.
- You provide the care; the agency supervises, logs visits and pays you.
Agencies that pay family caregivers vs. self-direction
Most states offer at least one self-directed option, where your relative is the employer and a payroll company (fiscal intermediary) just cuts the checks. Agencies that pay family caregivers are the other route. Here's how they compare.
| Self-direction | Agency route | |
|---|---|---|
| Who employs you | Your relative (or their representative) | The agency |
| Training | Usually minimal | May require aide training — often paid for |
| Supervision | Your relative directs the care | A nurse or care manager checks in |
| Pay | Often higher share of the Medicaid rate | Agency keeps part of the rate |
| Paperwork for your family | More — you manage the schedule and timesheets | Less — the agency handles it |
| Backup if you're sick | You arrange it | The agency may send another aide |
Neither is better for everyone. If you want the most control, choose consumer-directed care. If you want support and a single employer, the agency route is reasonable. We go deeper in agency care vs. a paid family caregiver.
Which states use family home care agencies?
Some programs run only through agencies. These are the ones families meet most often, based on each state's published rules:
| State | Program | How the agency fits in |
|---|---|---|
| Indiana | Structured Family Caregiving | Live-in caregiver enrolls with an approved SFC agency, which supervises and pays a daily stipend. |
| Georgia | Structured Family Caregiving | Live-in caregiver enrolls through a licensed SFC provider agency. |
| Ohio | Structured Family Caregiving | Runs through an SFC agency; parents of minors on the Home Care Waiver must be agency-employed. |
| South Dakota | Structured Family Caregiving (HOPE Waiver) | An approved SFC provider agency pays the live-in caregiver. |
| Missouri | Structured Family Caregiving Waiver | Caregiver is employed and paid by a DSS-enrolled SFC agency. |
| Louisiana | Monitored In-Home Caregiving | An enrolled MIHC agency provides nurse support and pays the stipend. |
| Illinois | Community Care Program | Caregiver must be hired and supervised by a contracted in-home services agency. |
| Maryland | Community First Choice | Caregiver enrolls through a Medicaid personal assistance agency. |
| Connecticut | Adult Family Living | A sponsoring agency supports and pays the live-in caregiver. |
| Massachusetts | Adult Foster Care | Caregiver goes through a MassHealth-contracted AFC provider. |
| Colorado | IHSS and Family CNA | Routes through a licensed IHSS or home health agency. |
| New Mexico | Agency-Based Community Benefit | Caregiver becomes an employee of a home health agency. |
Many of these states also have a self-directed option, so the agency route is a choice, not the only door. Mississippi is a warning in the other direction: its Elderly & Disabled Waiver is agency-delivered and family can't be hired there, though its Independent Living Waiver allows some relatives. See the Mississippi caregiver program.
For a full state list, the programs that pay family by state table covers all 51.
Family home health care vs. family home care
People use "home care" and "home health" as if they were the same. They aren't, and it matters when you look for an agency.
- Family home care is non-medical help — bathing, dressing, meals, getting around, reminders. It's what most paid family caregivers do, and it's what Medicaid personal care programs pay for. See non-medical home care.
- Family home health care is skilled care ordered by a doctor — nursing, therapy and home health aide visits. Medicare-certified home health agencies deliver it. Medicare doesn't pay relatives, but some Medicaid programs let a certified family member work as the aide. See home health vs. home care.
So when you search for home health care for family members or home health care family caregivers, you're usually looking for a Medicaid personal care agency, not a Medicare one. In home health care for family member needs that are truly skilled — wound care, injections — is normally done by a nurse, not by a relative on payroll. Families sometimes blur the two as family care home health; the agency's license tells you which it is.
Home care for a family member: who can be hired
Agencies generally follow the program's relationship rules. Home care for a family member by an adult child, grandchild, sibling, niece or nephew is allowed almost everywhere. Spouses and parents of minor children are where the rules tighten.
Some agencies also hire close friends — the family and friends home care model — when the program allows it. And if you're a family member home care provider already working for one agency, you can usually move to another that pays better, as long as your relative agrees to switch.
For relationship rules by state, see spouse rules and paid parent caregivers; for example, Texas spousal caregiver rules or Pennsylvania spousal caregiver rules.
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What family care agencies pay
A family care agency pays you out of the Medicaid rate it receives. Some states require a minimum share to reach the caregiver in stipend programs:
| State program | Rule the agency must follow |
|---|---|
| Indiana SFC | At least 60% of the daily rate goes to the caregiver — roughly $46–$80 a day. |
| South Dakota SFC | At least 50% of the per-diem goes to the caregiver. |
| Nevada SFC | The caregiver receives at least 65% of the Medicaid per-diem rate. |
In hourly agency programs, the agency sets your wage within what the state pays it. Illinois reports Community Care Program aides earn about $18–$20 an hour through contracted agencies. Compare every state in family caregiver pay rates.
What to ask a home care agency before you sign up
Not every agency hires relatives, and the ones that do vary a lot. Ask:
- Do you hire family members as aides for their own relative? Spouses? Parents?
- What's the hourly wage or daily stipend, and how often do you pay?
- Do I need aide training or certification, and do you pay for it?
- How are hours logged — an app, phone call or paper timesheet?
- Who supervises, and how often will a nurse or care manager visit?
- What happens if I'm sick or need a break? Is respite covered?
- Can my relative switch agencies later without losing hours?
Our general guide to choosing a home care agency has more questions, and local home care agencies compared explains how national and local agencies differ.
National companies that pay family caregivers
Several national companies advertise that they pay families. They're not all the same kind of business: some are fiscal intermediaries for self-direction, some are home care agencies, some run structured family caregiving. Read our independent comparisons before choosing: FreedomCare, Help at Home, Caregiver Homes, Caregivers of America and PPL (Public Partnerships).
Sunroom Care isn't an agency and doesn't employ caregivers. We help families find the right program — self-directed or agency — and handle the enrollment paperwork, paid by the program.
Family taking care of family: when the agency route makes sense
Family taking care of family is the oldest kind of care there is. The agency route formalizes it. It tends to fit best when:
- Your relative's program only allows agency care, or your state bars you from self-direction (for instance, Indiana bars legally responsible relatives from self-directed attendant care).
- You live with your relative and a stipend program like Structured Family Caregiving pays more than hourly care would.
- You want a nurse checking in and someone else handling payroll.
- You'd like aide training and a credential you can use later — see caregiver jobs.
If none of those apply, self-direction is often simpler and pays a bigger share of the rate. Either way it's home care for family, and your relative keeps the person they trust.
Being an in-home family caregiver through an agency: day to day
As an in home family caregiver on an agency's payroll, your days look like most family care: help with morning routines, meals, medication reminders, errands and appointments. What changes is the structure around it.
- Care plan: the agency writes one from your relative's assessment. Your tasks and hours follow it.
- Visit logging: Medicaid requires electronic visit verification for personal care, so you'll usually clock in and out on a phone app. See caregiver apps.
- Supervision: a nurse or care manager visits periodically.
- Training: some agencies require annual refreshers.
That's family in home care with a safety net. For in home care for family member needs that may grow to around-the-clock, read 24-hour home care and live-in caregivers.
Finding home health care for family near you
Start with your relative's program, not an agency search. The program decides whether an agency is required and keeps the list of approved agencies. Your state page lists them:
Then ask two or three approved agencies the questions above. For general home health care for family searches, home care near me explains how to compare what's local. Or check eligibility and we'll point you to the right program.
Where to go next
Frequently asked questions
Do home care agencies hire family members?
Many do, when the relative's Medicaid program allows it. The agency employs you and assigns you to your own relative, paid from their home care benefit.
Is it better to go through an agency or self-direct?
Self-direction usually pays a bigger share of the rate and gives more control. The agency route gives supervision, backup and less paperwork. Some programs only allow one or the other.
Do I need to be certified to work for an agency caring for my relative?
Sometimes. Some agencies and programs require aide training, and many agencies pay for it. Stipend programs like Structured Family Caregiving usually require a short orientation instead.
How much do agencies pay family caregivers?
It depends on the state and program. Some stipend programs require agencies to pass a minimum share to the caregiver, such as at least 60 percent in Indiana's Structured Family Caregiving.
Can a spouse be hired by an agency to care for their husband or wife?
In some states and programs, yes. Spouses are legally responsible relatives, so rules vary. Check your state's spousal caregiver page.
Should I pay an agency to hire me?
No. Legitimate agencies are paid by the Medicaid program. Never pay an upfront fee to be hired as a caregiver.
Does Medicare pay agencies to use family caregivers?
No. Medicare home health covers short-term skilled care from agency staff, not ongoing care from a relative. Medicaid is the program that pays family caregivers.
Sources: Medicaid.gov: self-directed services · Medicaid.gov: electronic visit verification · IRS: certain Medicaid waiver payments may be excludable from income (Notice 2014-7) · Medicare.gov: home health services · Each state's published Medicaid program rules. Program rules and rates change — always confirm with the program. Reviewed September 30, 2026.