If you are an adult child, a sibling, a grandchild, a niece, a nephew or a friend, yes. If you are the spouse, or the parent of a child under 18, no. That rule is the same whichever program you use.

Two MassHealth programs pay family caregivers and they want opposite things from you. The PCA program does not care where you live. Adult Foster Care requires that you live together.

Who is barred from being paid as a PCA?

• The member's spouse.
• The parent of a member under 18, including an adoptive or foster parent.
• Any legally responsible relative.
• The member's surrogate.

Everyone else is fair game, including relatives who live in the house. An adult daughter caring for her mother is the single most common paid arrangement in the program, and nothing about living under the same roof disqualifies her.

My mother was told she does not qualify for PCA because she only needs reminding. Is that the end of it?

No, and this is the most useful thing on this page. The PCA program pays for physical, hands on help and specifically excludes cueing, prompting and supervision. Adult Foster Care does not. Its criteria count hands on assistance or continuing supervision and prompting, and behaviors like wandering or resisting care are considered too.

It also asks for less. PCA generally requires physical help with two activities of daily living. Adult Foster Care requires need with at least one, plus a finding that the person cannot safely live alone. So the person turned away from PCA over cueing is often exactly the person Adult Foster Care is built for. If that is your situation, read what makes you ineligible for PCA hours and then ask about Adult Foster Care instead of giving up.

What does Adult Foster Care require that PCA does not?

That you live together, in a private home. Either you move in with her or she moves in with you. A rest home, an assisted living residence or a group home does not count, and no more than three participants can live in one home.

The caregiver has to be 18 or older, and the same people are excluded: a spouse or anyone legally responsible. A physician also has to sign an order form saying the services are needed.

How does the money work in each one?

They are structured completely differently, and this matters more than the rate.

• PCA. You are your mother's employee. She hires you, she schedules you, she approves your time. A fiscal intermediary runs payroll, withholds taxes and sends you a W-2. You clock in and out on an app. You are paid hourly for authorized hours only, and no PCA may work more than 60 hours in a week, with an authorization required above 50 for one consumer.
• Adult Foster Care. You are employed by an Adult Foster Care provider agency, not by her. The agency trains you, assigns a care manager and sends a registered nurse to check on things. You are paid a daily rate rather than by the hour, which is the real difference: it does not matter whether a Tuesday took four hours or nine.

Both are taxable income and both are real jobs with real paperwork. Neither is a benefit check.

Can I be paid and also be her surrogate?

No, you have to pick one. If your mother cannot manage the employer side of the PCA program herself she needs a surrogate, and her surrogate cannot be her paid attendant. In families where one person is doing everything, the usual answer is that the hands on caregiver takes the paid role and another relative becomes the surrogate. We go through that choice on whether you need a surrogate.

I am the spouse. Is there anything for me?

Not as the paid caregiver in either program, and nobody should pretend otherwise. What is available to you is help, not a paycheck: PCA hours worked by somebody else so you are not doing all of it, respite through your local Aging Services Access Point or Council on Aging, and caregiver support programs that exist specifically for spouses. If your husband or wife also has a diagnosis that qualifies for a waiver program, the rules there can differ, so it is worth asking rather than assuming.

What should I think about before taking the paid role?

Four things, honestly.

• The authorized hours are usually fewer than the hours you are already working. Getting paid for 20 does not mean the other 15 stop.
• Your mother becomes your employer on paper, which changes the relationship whether or not you want it to.
• If you are the only attendant and you get sick, there is nobody. Keeping a second person on the roster is worth doing even if they only work a few hours.
• It is income, so it affects your taxes and possibly your own benefits. Check before the first paycheck, not after.

Which one should we apply to?

If you do not live together and she needs physical help with at least two activities, start with PCA. If you already live together, or the need is supervision rather than hands on help, ask about Adult Foster Care. Neither application is quick, so start the one that fits rather than the one you heard about first.

Care Remedy is a personal care management agency serving eastern and central Massachusetts from offices in Woburn, Brockton and Springfield. We handle the PCA side, meaning the intake, the nurse and occupational therapist evaluation, the prior authorization and the skills training that teaches you the employer role. We do not run Adult Foster Care, but we will tell you if that is the better fit for your family and point you at who does. Call 781-957-8076 or email pcm@careremedy.com.

Eligibility rules for both programs are set by MassHealth and change from time to time. Confirm current requirements before making a decision.