Do You Need Certification to Be a Paid Family Caregiver?

The program paying a family caregiver sets the training: most Washington paid family caregivers complete 35 hours, and in Texas's consumer-directed option the person you care for trains you.1,2 If you hope to be paid to care for a parent, ask that program what training you need before you buy a certification course. Some training costs nothing, like VA's free Building Better Caregivers workshop for caregivers of veterans.3

In This Guide

• Key Takeaways
• Do Paid Family Caregivers Need Certification?
• Where the 75 Hours Comes From
• If You're Paid Through Self-Direction, the Person You Care For Can Train You
• Paid Family Caregiver Training Requirements by Route
• Four States, Four Different Answers
• Who Pays for the Training?
• Free and Low-Cost Family Caregiver Training
• Programs Worth Knowing by Name
• What to Do This Week
• Frequently Asked Questions
• Learn More

Do Paid Family Caregivers Need Certification?

You may have started caring for a parent long before anyone offered to pay you. Then a caseworker mentions a paid caregiver program, you search for what comes next, and the results fill up with "caregiver certification" courses and career pages for home health aides. It's hard to tell which, if any, apply to you.

So, do you need certification to be a paid family caregiver? The useful question is narrower: what does the program paying you require? A paid family caregiver is paid through a specific route, such as a state Medicaid program, an agency that program contracts with, or a VA program. Each route writes its own training rule. Some name hours, some name tests, and some leave the training to the person receiving care.

A certificate you buy online is only worth something if the program that pays you accepts it. The rules in this guide describe their requirements in their own terms, so the safest move is to ask your program for its training requirement in writing before you spend money on a course.

Where the 75 Hours Comes From

If you've seen "75 hours" attached to caregiver training, here's where it comes from. The 75-hour home health aide training rule is a condition of participation for Medicare home health agencies. Under federal law, a home health agency may not use anyone as a home health aide unless that person has completed a training and competency evaluation program, or a competency evaluation program, meeting federal minimum standards.4

The standard, 42 CFR 484.80, requires at least 75 hours of classroom and supervised practical training, with at least 16 hours of classroom training before at least 16 hours of supervised practical training. A home health aide may furnish services for the agency only after passing a competency evaluation, and must receive at least 12 hours of in-service training in each 12-month period.4 Centers for Medicare & Medicaid Services (CMS) guidance for surveyors says online course material is an acceptable way to deliver the classroom part.4

That rule is written for the aides a Medicare home health agency uses. A state can also adopt it by reference: Ohio requires the 42 CFR 484.80 trainings of a Structured Family Caregiving caregiver whose provider is a Medicare-certified home health agency.10 If the program paying you points to this rule, the 75 hours applies to you. If it points somewhere else, follow what it names.

If You're Paid Through Self-Direction, the Person You Care For Can Train You

If you're paid through Medicaid self-direction, the person receiving care (or their representative) directs the services and the workers. Under the Section 1915(j) self-directed personal assistance option, the participant's decision-making authority includes recruiting, hiring, training and supervising workers and specifying worker qualifications. Whether a relative can be the paid worker is a state option, so check your state's program rules.5

Community First Choice, the Section 1915(k) option some states offer, works the same way. Under 42 CFR 441.565, the person receiving care keeps the right to train attendants in the specific areas of care they need, to set additional staff qualifications, and to reach other training offered by or through the state. In the self-directed model with a service budget, family members can provide services if they meet the qualifications the person sets, including additional training.11

When CMS wrote the Community First Choice rule in 2012, commenters asked it to require states to mandate training for attendants. CMS declined, saying that "would remove the authority vested in the individuals to train their providers."11 That doesn't mean no training is ever required. In the agency-provider model, the state must define provider qualifications in writing, and the state programs below set real requirements.11

One limit matters for families doing hands-on care. CMS reads the right to train as covering non-skilled activities, and a health-related task must be delegated within the state's practice act for the professional delegating it, such as a nurse, to be reimbursed.11 If your mother needs wound care or injections, ask her program who must teach and sign off on those tasks.

Paid Family Caregiver Training Requirements by Route

Here's how the main routes compare, drawn from the federal rules for home health aides, self-direction, Community First Choice and VA's stipend program.4,5,11,6 Your state's program rules fill in the details.

The VA route has a deadline worth knowing. Under VA's Program of Comprehensive Assistance for Family Caregivers, if the evaluations, training and initial home-care assessment aren't finished within 90 days of VA receiving the joint application, the application is denied and a new one is required, though VA may extend the 90 days when the delay is solely VA's.6 If you're applying, clear time on your calendar for the training as soon as VA reaches out.

Four States, Four Different Answers

If you've been told "it depends on your state," that's frustrating, but it's also true. These four states are examples, not a complete list, and each links to that state's paid caregiver guide. Here's what each rule means for you.

Washington. To be paid as an Individual Provider through Washington's Department of Social and Health Services (DSHS), most paid family caregivers must complete 35 hours of training within 120 days of hire, and you complete five hours of Orientation and Safety training during hiring. DSHS notes the requirement varies with your relationship to the person you care for. Washington Home Care Aides, by contrast, complete 75 hours and need Washington Department of Health certification.1 More in the Washington paid caregiver guide.

Texas. In the Consumer Directed Services (CDS) option run by the Texas Health and Human Services Commission (HHSC), your parent, or their legally authorized representative, is the employer and your trainer. Texas rule 26 TAC 264.233 has the employer train you when you start, along the way and every year, on the topics listed on an HHSC form (Form 1732) plus the program's own addendum to Form 1735. You both sign Form 1732, and a copy goes to the financial management services agency within 30 calendar days of signing. A Texas CDS employer must also show you how to clock in and out for electronic visit verification, and keep your CPR certification current if the program requires it.2 More in the Texas paid caregiver guide.

Ohio. In Ohio Structured Family Caregiving, available to adults on the MyCare Ohio, Ohio Home Care and PASSPORT waivers, the training depends on the provider agency. With an agency certified by the Ohio Department of Aging (ODA) or otherwise accredited, the caregiver completes at least eight hours of initial training that the person receiving care decides they need, by the deadline that person sets. For an Ohio Structured Family Caregiving caregiver with an ODA-certified provider, Ohio's rules also accept the initial personal care aide qualifications in place of the eight-hour initial training. With a Medicare-certified home health agency, the caregiver meets the 42 CFR 484.80 trainings. So in Ohio, the agency you sign on with decides which rule you follow.10 More in the Ohio paid caregiver guide.

Arizona. For workers employed through a direct care worker agency in the Arizona Long Term Care System, Arizona Health Care Cost Containment System (AHCCCS) Medical Policy 1240-A requires Level I training of all direct care workers, family caregivers included. A worker caring only for a family member is exempt from the Level II modules. Passing knowledge and skills tests is mandatory, while taking a course is recommended. Every Arizona agency direct care worker needs CPR and first aid certification before providing care. An Arizona direct care worker agency has 90 days from hire to train and test, but a worker with no comparable experience in the past two years must pass both tests before providing services. Policy 1240-A's training and testing requirements don't apply under Self-Directed Attendant Care, where the member is the legal employer and AHCCCS points to its own policy (AMPM 1320-A) for that option's service requirements.12 More in the Arizona paid caregiver guide.

The timing differs as much as the hours do.1,2,10,12

Who Pays for the Training?

This is a fair question when money is already tight. The answer is clearest in Texas: a CDS budget's employer support services can buy job-specific, CPR and first-aid training for employees, within a cap of $600 a year, or $50 a month when budgeting for less than 12 months.2

In Ohio Structured Family Caregiving, the provider agency must make sure the caregiver gets structured training tailored to the person's needs and must employ coaching staff, such as a registered nurse or licensed social worker, who make monthly contact with no more than 60 days between in-person visits.10

Outside those examples, who pays for required training, and whether your training hours are paid, depends on your state and program. Ask your caseworker or the agency that would employ you before you enroll in anything.

Free and Low-Cost Family Caregiver Training

Even when no program requires training, you might want it. Learning to move someone safely or manage difficult behaviors can make the work feel less frightening. Here are three public routes and what each one costs.

Your Area Agency on Aging

The National Family Caregiver Support Program, funded under Title III-E of the Older Americans Act, pays for five kinds of caregiver services, one of which is "individual counseling, organization of support groups, and caregiver training." Those services come through your Area Agency on Aging or an organization it contracts with. Under the National Family Caregiver Support Program, eligible caregivers include adult family members caring for someone 60 or older, or for someone of any age with Alzheimer's disease or a related disorder.7

No Older Americans Act service may be denied because of income or failure to pay, and any contribution you're asked for is voluntary.8 Under the Older Americans Act, a state may choose income-based sliding-scale cost sharing for some services, and caregiver training isn't among the services the Act shields from it. Even so, a state can't impose Older Americans Act cost sharing on an older person whose income is at or below the federal poverty line, and it can't count their savings.8 To find your local agency, use the Eldercare Locator at eldercare.acl.gov or call 1-800-677-1116.13

Medicare caregiver training services

Since 2024, Medicare has covered caregiver training services under Part B when a provider decides it's appropriate for the patient's treatment plan. The caregiver can attend individual or group sessions without the patient present. Medicare.gov says the training must help the patient meet the goals they set with their provider, and the patient must need a caregiver's help for treatment to succeed. Topics include giving medications, helping with daily tasks, moving the patient safely, and preventing bedsores and infections.9

Doctors, nurse practitioners, physician assistants, clinical psychologists, and physical, occupational and speech therapists are among the providers who can offer Medicare caregiver training services. CMS defines the caregiver for Medicare caregiver training services as someone giving unpaid help, and the patient (or their representative) must consent, with that consent documented in the medical record. Medicare caregiver training falls under the patient's Part B: 20% of the Medicare-approved amount after the Part B deductible.9 CMS sets no limit on how often the training can be billed, but medical necessity governs how much is given.14 If your father's physical therapist is already seeing him, ask whether caregiver training could be part of his plan.

VA's general caregiver program

If the person you care for is a veteran enrolled in VA health care, the Program of General Caregiver Support Services offers skills training, coaching and online programs, with no formal application. You don't have to be related to the veteran or live with them. Call VA's Caregiver Support Line at 1-855-260-3274 to connect with the caregiver support team at the local VA.3 Under 38 CFR 71.40(a), General Caregivers receive continued instruction, preparation, training and technical support.6

Programs Worth Knowing by Name

A few programs come up again and again. Here's what each one is, and what the evidence says.

• Building Better Caregivers is VA's free online six-week workshop for caregivers enrolled in either VA caregiver program.3
• Caregivers FIRST is VA's skills training program for caregivers of veterans, delivered as four virtual group classes covering self-care, health system navigation and hands-on clinical skills.3
• REACH II, a 12-session dementia caregiver program, was tested in a randomized trial in which caregivers in the program reported lower depression afterward than the control group (12.6% vs. 22.7%). VA's version, REACH VA, usually runs four sessions over two to three months and is open only to caregivers enrolled in VA's Caregiver Support Program.15
• Powerful Tools for Caregivers is a six-week group program led by two trained lay leaders and listed by NCOA as evidence-based. Its published evaluation reported gains in caregivers' self-care behaviors and self-efficacy, but it had no control group, and its authors wrote that the results "must be interpreted with caution."16

What to Do This Week

Learn More

Find personalized help working out the training your paid caregiver program requires at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.