Finding care for a loved one is often an emotional process and can be a long one as you navigate the many nuances to choosing, vetting, onboarding, and paying for care options.

First, evaluate your loved one’s needs. What will work best for them? Do they need to stay at home to receive care based on equipment or medical needs? Or would they benefit from the socialization and change of scenery gained through out-of-home care?

From there, research and compare different care options that meet those needs while keeping in mind cost and reimbursements. Speak with your insurance company and any relevant government agencies to understand what will be covered and what will not.

Once you’ve narrowed down your options, dive deeper. Read online reviews, check into the status of licenses and insurance and run necessary background checks to ensure the safety and dependability of the caregiver you choose.

The process may require trying an option or two before you find the perfect fit for you and your loved one. Reach out to the many resources available to assist in these types of searches. For example, the Eldercare Locator through the U.S. Administration on Aging.

Every situation, whether you are caring for a parent with dementia, a child with autism, or another medically complex loved one, requires different care options. In general, care options fall into two main categories – in-home and outside the home.

There are several in-home, individualized caregiving options. You can hire a licensed medical professional or care companion through your own research or through an agency that specializes in placing certified caregivers.

If you are interested in continuing to serve as a primary caregiver but cannot do so while maintaining another job, in many cases, it is possible to establish your own caregiving role as a paid position. However, there are specific parameters by state, as well as tax implications to be considered.

Alternatively, there are out-of-home options, both short and long-term, including children and adult day services, as well as assisted living and skilled nursing facilities.

Not matter the path you choose, there are resources to help find the right caregiving option (or mix of options) for your loved one. For example, the Eldercare Locator through the U.S. Administration on Aging.

Both Medicaid and Medicare cover home healthcare in some form for qualifying individuals with specific coverage and eligibility differing by state.

Medicaid serves as the primary payer across the nation for long-term care services. Under Federal law, every state Medicaid program is required to cover home health services.

However, Medicare does not cover long-term care.

Medicare Parts A and B both have provisions to cover home health services, including nursing care or home health aide care, PT, OT, a portion of medical equipment and supplies and more. Under Medicare, covered care is only “part-time” or “intermittent”, defined as “care you need or get less than 7 days each week or less than 8 hours each day over a period of 21 days (or less) with some exceptions in special circumstances.”

More details on home health services coverage can be found at Medicaid.gov and Medicare.gov.

There are multiple government and private insurance programs available offering payment to loved ones caring for a relative or friend who needs additional assistance. State Medicaid programs, long-term care insurance and veterans programs all offer options for caregiver compensation based on different eligibility criteria.

For instance, in many states, Medicaid offers a consumer-directed personal assistance program to allow a friend or family member to serve as a paid caregiver, allowing participants more active control over how care is received.

In 2000, Congress created the National Family Caregiver Support Program (NFCSP) to provide states and territories grants to help support care for aging adults in their homes for as long as possible. Each state’s policies and funding differ, but resources are available to help caregivers understand the support available.

Within the U.S. Department of Health and Human Services, Administration for Community Living’s 2022 National Strategy to Support Family Caregivers includes an Inventory of Federal Caregiver Support Programs and Initiatives with a detailed overview of myriad financial and care options sourced through federal agencies.

Respite care provides a temporary break to care companions by offering an alternate form of care for a certain amount of time.

Caregivers can access respite care options to help supplement their loved one’s care and give themselves a well-deserved break, knowing that their loved one is well cared for. Respite care can be delivered in-home, out-of-home, or both, as it is not limited to one option of alternative care.

Though respite care is available in emergency situations, it is best to establish alternate means of care before it becomes critically necessary to help avoid care provider burnout and the stress of finding care under urgent circumstances. This can include having your care recipient attend a day camp once a week so that you can run some errands or spend some alone time. Or you can ease your mind by having a trusted network of potential caregivers on speed dial to come to your home if you need to leave unexpectedly.

According to AARP, the average family caregiver spends more than $7,200 a year on costs related to caring for a loved one. There are federal tax credits and deductions that can be used to offset these costs.

The 2017 federal tax law changes introduced a Credit for Other Dependents up to $500. The IRS offers a tool to determine eligibility. There are also opportunities to deduct a dependent’s medical expenses and up to $3,000 in tax credits for one qualifying individual under the Child and Dependent Care Credit.

Keeping close records of your expenses and payments to nurses, companions and other types of caregivers, as well as consulting with your accountant and financial professionals, will help ensure you can maximize your available credit each year.

Yes, an LLC can have a 401(k) retirement plan. Any type of business can start a 401(k) plan, including corporations, partnerships, sole proprietors, and LLCs.

Under the Fair Labor Standards Act (FLSA),  workers must generally be paid for any time they are providing services or are required to be  available to provide services, if needed.

For example, even if the care recipient spends 6 hours of the care provider’s 12-hour shift sleeping, the care provider should be l paid for the entire shift since they had to be present for the entire duration.

However, if the caregiver works a 24-hour shift with 8 hours allocated for their own sleep, they would only need to be paid for the 16 waking hours.

Given these complexities, it is important to have an accurate method of timekeeping – whether digital or analog – to track your care-giving employee’s time on the job, pay them appropriately and comply with all applicable federal and state wage and hour and tax laws.

Many care recipients and their loved ones find their caregivers through an agency. There are benefits to this approach, as sourcing through an agency can provide peace of mind that the care provider has been vetted by a third party. It can also relieve the time it takes to find, interview, background check, and many other aspects of onboarding a caregiver.

Additionally, agencies come backed with a full bench of fully trained caregivers who can support you in a pinch if your primary provider is unable to make a shift. If you’ve hired your own caregiver, you may be left in the lurch if they are sick or on vacation and you don’t have access to a backup provider.

On the flip side, depending on the agency, sometimes there are additional fees associated with paying a caregiver. These fees may mean that only half of what you are paying is actually going to the care provider’s paycheck while the rest is kept by the agency as part of their services.

Additionally, it is not always the case that the agency provides payroll services for its nurses, companions and other caregivers; and it may not fall under the agency’s responsibility to communicate payment and tax requirements for the employee they are providing.

Tax requirements still apply whether a caregiver is providing care for two years or two weeks. The threshold is not dependent on time but rather on the amount paid. According to the IRS, in 2023, if you paid your caregiver $2,600 or more, you are required as their employer to withhold social security and Medicare taxes.

Under that thinking, it is also irrelevant here if you consider your caregiver full-time or part-time – both types of employees fall under this guidance.

Additional tax laws may apply based on your state or municipality and based on the classification of the employee (including if the care provider is a family member of the care recipient), so it is imperative to familiarize yourself with all applicable laws to avoid fines and penalties associated with noncompliance.

No matter what your caregiving situation – whether you serve as a primary caregiver, hire a care companion through an agency, leverage an out-of-home adult day service, or any combination of these or other care services – it’s important that you keep detailed records for tax and auditing services.

As previously mentioned, if your household employee is making more than $2,600 in 2023, you will be required to withhold certain payroll taxes as a result. It’s important to consider those withholdings when negotiating the caregiver’s preferred rate of pay.

These conversations should be had in the context of net pay vs. gross pay before deductions. For example, currently, social security and Medicare taxes amount to 15.3% of employee wages withheld – 7.65% coming from the employer and 7.65% from the employee. If you agree to an hourly wage of $15.00 for your caregiver, when you subtract Medicare and social security taxes alone, their take-home pay will be closer to $12.71/hour.

If you are being compensated (even more than $2,600/year) to care for a family member (either from a state agency or insurance company), these employment taxes may not apply. You must still report your wages earned on your Form 1040, according to the IRS, and in some cases – if you are “engaged in a trade or business of providing care services” – you may owe self-employment taxes.

Care providers can also work with accountants, lawyers and other trusted financial partners to ensure the financial aspect of caregiving is in compliance with all federal, state and local laws, lightening the burden of payroll, benefits, taxes and more.

While these types of relationships and record-keeping may require an investment of time upfront, they typically pay off (for example during tax season) and help prevent you from incurring costly fees associated with noncompliance.