State program allows family caregiving at home


By Janice Masi

There is a wonderful resurgence of caregiving happening in families today. Years ago, it was common for three or more generations to live together in one home. When aging family members needed care, they had plenty of people willing to pitch in to help out. Choosing to send a parent or grandparent to a nursing home was a last resort.

Times changed and mobility became a way of life as people found it easy to relocate to new jobs or lifestyles. But the pendulum is swinging back as family members who once found it easy to live apart from one another — and often at great distances — are forming those multi-generational households once again.

Partly due to a suffering economy and job losses, more importantly driven by a belief that family comes first, about one in six people are now living in a multigenerational household. And nearly one in three people in the United States are caring for a family member or friend while the estimated value of these services that families provide is over $300 billion.

So how can the financial challenges of caregiving be addressed along with the desire of elders to live at home and in the community for as long as possible? Some states are addressing the needs of elders through programs that give them the option to be cared for by family members.

In 2007, the Commonwealth of Massachusetts introduced an Enhanced Adult Foster Care (AFC) program that compensates family members as caregivers. The current rates allow a family — or non-family — caregiver to be paid up to $18,000 a year, according to the client’s level of need. Spouses and legal guardians currently are not eligible to be paid as caregivers.

A professional team — registered nurse and care manager — through an approved agency provides caregivers with training and professional direction in managing care with the goals of maintaining health and safety in the home.

There are several organizations offering adult foster care in Massachusetts, and more information about this program can be found on the website. The organizations offering this service must comply with AFC regulations.

The first requirement is that the elder who needs care must be on, or eligible for MassHealth.

Once MassHealth requirements have been met, a registered nurse and care manager evaluate the elder’s health and care needs and establish a plan of care to be followed by the caregiver. The caregiver must be approved following a criminal background check, reference checks and interviews. And the home must meet safety criteria. The AFC services complement other community and health based programs, such as hospice, skilled home care and adult day health, to provide the elder with a comprehensive approach to promote daily functioning at home.

By including family caregivers in the Adult Foster Care model, Massachusetts has acknowledged that family can come first and that’s important for elders who want to have choices for care at home.

Janice Masi is the executive director of Caregiver Homes of Massachusetts. She can be reached at 866-797-2333, or at their website: Archives of articles from previous issues can be read at