Can a Spouse Also be a Caregiver, please?

Are spouses considered family?  The answer is “no” at Beacon Hill, at least if the discussion is about providing compensation for in-home caregivers.

It’s an exception that directly contradicts several of the core concepts behind the Adult Family Care (AFC) program, and something we’d like to see changed.


Founded on the principal of giving people the option of living in a family setting, AFC supports and financially assists in-home caregivers, who are often friends or family.

AFC provides a tax-free stipend for caregivers of eligible elders or adults with disabilities. But this state-funded program remains unavailable for spouses, despite several efforts by legislators in recent years to change that.

Common arguments against allowing spouses as caregivers include concern over spiking demand, cost, and the cultural assumption that spouses should be motivated by love—not compensation.

Al Norman of Mass Home Care deftly addressed the concerns in testimony submitted for the legislature in 2015, and his arguments still stand. He noted a 2012 study in the “Gerontologist,” which evaluated the spouse-as-caregiver program in California which found the program posted “no financial disadvantage to Medicaid” and actually offered “some quality and cost advantages.”

The study also pointed out that people with spouse caregivers generally had better outcomes and had a higher level of satisfaction.  Perhaps more importantly, it showed no dramatic spike in demand, because the program doesn’t allow spouses to be paid for general household maintenance tasks.

Understanding the needs of AFC clients is key here—the program requires caregivers who meet specific needs on a daily basis, with considerable investment of time. In a very real sense, the stipend is to help offset sacrifices that must be made elsewhere when meeting daily home care needs.

Considered in that context, does it really make sense without support from a dedicated spouse, when it would be given to a sibling, aunt, or parent? We don’t think that it does—and more than a dozen states agree with us, allowing spouses to receive compensation for providing adult caregiver services.

Massachusetts likes to think of itself as a leader on social issues, but that doesn’t seem to be the case here.

That could change in 2016: lawmakers are once again considering a bill (S.372) that would extend the AFC program to spouses, and it recently received a favorable recommendation from the legislature’s Joint Committee on Elder Affairs.

We’re hopeful, but only time will tell if lawmakers will be able to remove this arbitrary barrier to home care.

Adult Family Care is a non-profit program at Somerville-Cambridge Elder Services that supports in-home caregivers across the Greater Boston, North Shore, and Merrimack Valley areas. For more information, call 617-628-2601.