Tennessee Caregivers Guide: Pay, Respite, Programs (2026)

Tennessee caregivers, save this number first: 1-866-836-6678. If you are looking after an aging parent, spouse, or disabled adult child, that line is the Tennessee Department of Disability and Aging (DDA) Statewide Referral Line, and one call routes you by ZIP to your local Area Agency on Aging and Disability (AAAD), which can screen you for TennCare long-term care and respite in a single conversation. Most Tennesseans learn this system one frantic phone call at a time, after a hospital discharge or a fall or the slow realization that a parent's home has become unsafe. It does not have to be that way. Tennessee has spent the last two years rebuilding its caregiver infrastructure faster than almost any state in America: the DDA launched July 1, 2024; the Freedom for Family Caregiving Act removed the single biggest barrier to paid family caregiving on July 1, 2025; and the Caring for Caregivers Act, which reimburses dementia-caregiving families up to $6,000 a year, was signed into law on May 18, 2026. This guide walks you through the four questions every Tennessee caregiver asks, how do I get paid, how do I get a break, what programs exist, and who do I call, with a dedicated deep-dive behind each one.

How This Guide Is Organized

The four central caregiver questions in Tennessee map to four dedicated guides:

Read this overview first, then dive into the specific guide that matches your most-pressing question.

1. How Do I Get Paid as a Family Caregiver in Tennessee?

The dedicated guide: How to Get Paid to Care for a Family Member in Tennessee · TennCare Consumer Direction Deep-Dive

Tennessee is one of a growing number of states where more than one program pays family caregivers directly. If you are the one showing up every day, this is the section that can turn unpaid care into a paycheck. There are two primary direct-payment pathways through TennCare.

Consumer Direction (CD): The Family-Hired Pathway

Consumer Direction is available through CHOICES Group 1 (nursing facility), CHOICES Group 2 (home and community-based services), CHOICES Group 3 (At Risk), ECF CHOICES Groups 4 through 7, Katie Beckett Parts A and B, and the §1915(c) DD Waivers.

Here is how it works: the recipient (or their representative) becomes the employer of record for the worker. A TennCare-contracted Fiscal Employer Agent (FEA), Consumer Direct Care Network Tennessee (CDTN), handles payroll, tax withholding, and worker enrollment. The recipient's managed-care organization (MCO) Care Coordinator approves authorized weekly hours; the family hires the worker, the worker logs time through Electronic Visit Verification (EVV) on the CareAttend app, and the FEA pays the worker through W-2 employment.

On wages, the member sets each worker's pay up to a TennCare-approved maximum that varies by service. Under the CDTN CHOICES rate schedule (Rev. 07/30/2025), the Personal Care Visit rate averages $18.31 and tops out at $19.16 per hour, and Respite averages $16.36 and tops out at $18.93 per hour; Companion Care is paid as a daily rate (roughly $159 to $163 per 24/7 day). Verify the exact ceilings with CDTN before you hire, since CDTN routes by managed-care plan (UnitedHealthcare 1-888-444-3109; Wellpoint 1-888-398-0664; BlueCare Tennessee 1-888-450-3240).1

Read the CD exclusion list carefully, because it decides who in your family can be paid. Spouses cannot be paid CD workers. A member's CD representative, a court-appointed conservator, or a legal guardian generally cannot be the paid CD worker, because the supervisory role is a conflict of interest. Adult children, parents, siblings, in-laws, friends, neighbors, and unrelated providers can all be paid CD workers.

Agency-Employed Family Caregiver Pathway: Post-PC 182

The Freedom for Family Caregiving Act (Public Chapter 182 of 2025; HB 712 / SB 1178), signed by Governor Bill Lee on April 30, 2025 and effective July 1, 2025, prohibits TennCare and DDA from blocking provider agencies from hiring a family member as a Direct Support Worker based on:2

1. Family relationship
2. Shared residence
3. Age of the recipient
4. Parental or spousal status
5. Which TennCare program the recipient is enrolled in

This is a different mechanism from CD: the family member becomes a W-2 employee of a TennCare-contracted home care agency, instead of being hired by the family directly. The recipient still receives authorized care hours; the agency assigns the family caregiver to deliver them. Wages, taxes, supervision, and liability all run through the agency.

Families choose the agency route over CD for three reasons. Spouses are eligible, where CD bars them. Parents are eligible regardless of the recipient's age, because PC 182 prohibits blocking a hire based on the recipient's age or on parental status. And there is less administrative burden, because the agency handles payroll, supervision, and compliance while the family member simply shows up, delivers care, and gets a W-2.

The trade-off: agencies are not required to hire any specific family member, and court-appointed conservators and legal guardians remain excluded unless a court order explicitly permits employment. You will need to find a willing TennCare-contracted agency in your region. TennCare maintains a list of contracted home care agencies on the TennCare Provider-Agency Information page.

Veterans Affairs Caregiver Pathways

For TN veterans (or surviving spouses), three federal VA programs pay or compensate family caregivers:

1. Aid & Attendance Pension: a tax-free monthly pension that can compensate a family caregiver. VA publishes the 2026 A&A maximums (effective Dec 1, 2025 to Nov 30, 2026) as Maximum Annual Pension Rates: up to $29,093/year for a single veteran with A&A; up to $34,488/year for a veteran with one dependent; and up to $46,143/year for two veterans married to each other who both qualify for A&A. The net worth limit is $163,699; the assets counted exclude the primary residence, the car, and basic home items.3

2. Veteran-Directed Care (VDC): a veteran-controlled monthly budget set by the VA care team. The veteran chooses whom to hire, including family members. Confirm availability with your VA social worker.

3. PCAFC: a tax-free monthly stipend for caregivers of veterans with a single or combined service-connected disability rating of 70% or more who need in-person personal care for at least six continuous months. The stipend is the OPM GS-4 Step 1 annual rate for the veteran's locality divided by 12, times a factor set in 38 CFR 71.40(c)(4). In the current program that factor is 0.625, or 1.00 where VA determines the veteran is "unable to self-sustain in the community." A legacy participant or legacy applicant is on a separate schedule that lapses October 1, 2028, where the factor comes from the sum of the veteran's 2019 clinical ratings instead: 1.00 at 21 or higher, 0.625 at 13 to 20, 0.25 at 1 to 12, with no self-sustain determination required. A household qualifying under both is paid the higher amount, and a legacy participant's stipend cannot fall below what it was the day before October 1, 2020 while the veteran stays at the address on record.4 PCAFC also opens CHAMPVA health coverage, mental health services, and respite.5

One caution that saves families thousands: do not pay a private VA claims consultant. Tennessee's network of County Veterans Service Officers (CVSOs) files VA claims for free. Find your CVSO at tn.gov/veteran.

Tennessee Family and Medical Leave: Wage Protection, Not Direct Pay

Tennessee does not have a state-funded paid-family-leave program. TN families rely on the federal Family and Medical Leave Act (FMLA) for unpaid, job-protected leave for caregivers of seriously ill family members, up to 12 weeks per year for eligible employees. FMLA is wage protection, not wage replacement: it preserves the job, but it does not pay you for the caregiving work itself.

Read the full guide: How to Get Paid to Care for a Family Member in Tennessee.

2. How Do I Get a Break? Tennessee Respite Care for Family Caregivers

The dedicated guide: How to Find Respite Care in Tennessee

Respite is the most under-funded and most under-used category of caregiver support in America, and skipping it is how devoted caregivers burn out. Tennessee has rebuilt its respite infrastructure significantly since the DDA launched in 2024. Seven separate TN payors now fund respite, and most TN caregivers access two or more pathways at once:

The most important shift in thinking: do not ask which single respite program you are eligible for, ask which combination you can layer. A caregiver of a CHOICES Group 2 recipient with dementia can typically combine CHOICES authorized in-home respite hours, NFCSP supplementary respite through the local AAAD, and the Caring for Caregivers Act reimbursement for dementia-specific respite once DDA opens applications.

On private-pay cost, adult day services typically run roughly $70 to $95 per day in Tennessee, in line with the national median of about $95/day. In-home agency, residential assisted-living, memory-care, and nursing-facility short-stay rates vary by region and acuity, with skilled care priced substantially higher than companion-level care. Layering payors keeps almost all TN families well below the private-pay ceiling.6

Read the full guide: How to Find Respite Care in Tennessee.

3. What Programs Exist? The Tennessee Caregiver Programs Hub

The dedicated guide: Caregiver Programs in Tennessee: A Complete 2026 Directory

The programs hub catalogs all major Tennessee caregiver programs in a single Programs at a Glance table, with eligibility, cost, application process, and statutory authority for each. The breadth surprises most TN families:

1. TennCare CHOICES Consumer Direction, §1115 demonstration authority (functionally equivalent to federal Cash & Counseling self-direction)
2. ECF CHOICES Family Caregiver Stipend, MCO-paid; ECF Group 4 only (up to $500/mo when the member is a child under 18, up to $1,000/mo when the member is 18 or older)7
3. Katie Beckett Parts A & B, severe disability under age 18
4. §1915(c) DD Waivers, Self-Determination, Statewide, Comprehensive Aggregate Cap
5. PC 182 Agency-Employed Family Caregiver Pathway (effective 7/1/2025)
6. Caring for Caregivers Act (signed May 2026; up to $6,000/year for dementia caregivers)
7. VA Aid & Attendance, tax-free monthly pension
8. VA Veteran-Directed Care
9. VA PCAFC, a tax-free monthly stipend set by the veteran's locality pay area and by whether the household is paid on the current or the legacy schedule
10. NFCSP through 9 AAADs, federal Title III-E
11. OPTIONS for Community Living, TN state-funded; through AAADs
12. Medicare Hospice Respite, Medicare Part A; 5 days inpatient
13. FMLA / TN Family and Medical Leave, unpaid job-protected leave
14. TN Adult Day Services Network, TDHS-licensed adult day services centers

The hub also covers the federal tax framework that affects caregiver wages and the TN-specific 2024 through 2026 statutory landscape (DDA reorganization, PC 182, Caring for Caregivers Act).

The single most actionable framing is to layer the payors: Consumer Direction for daily care hours, AAAD/NFCSP for emergency respite and education, the federal live-in tax exclusion when it applies, and Medicare hospice respite when applicable. No single program is the answer; the combination is.

Read the full guide: Caregiver Programs in Tennessee: A Complete 2026 Directory.

4. Who Do I Call? Tennessee Caregiver Resources

A dedicated TN Caregiver Resources directory is in active development. In the meantime, these are the highest-leverage Tennessee caregiver phone numbers and websites. Start with the DDA Statewide Referral Line, since a single call routes you by ZIP to your local Area Agency on Aging and Disability, which administers NFCSP, OPTIONS for Community Living, TN Adult Protective Services referrals, and the state long-term-care ombudsman.8

For dementia-specific help, the Alzheimer's Association 24/7 Helpline (1-800-272-3900) and Alzheimer's Tennessee (1-888-326-9888) both take caregiver calls, and DDA's Dementia Navigators offer no-cost cognitive-screening referrals and care planning.9

The 9 Tennessee Area Agencies on Aging and Disability (AAADs) are your local front door for caregiver support, and all are reachable through the statewide line above:

1. First Tennessee AAAD, northeast TN, Johnson City headquarters
2. East Tennessee AAAD, Knoxville, serving the counties surrounding Knox
3. Southeast Tennessee AAAD, Chattanooga, serving Hamilton and surrounding counties
4. Upper Cumberland AAAD, Cookeville
5. Greater Nashville Regional Council AAAD, Nashville, serving Davidson and surrounding counties
6. South Central Tennessee AAAD, serving the south-central region
7. Northwest Tennessee AAAD, serving the northwest region
8. Southwest Tennessee AAAD, Jackson
9. Aging Commission of the Mid-South, Memphis, serving Shelby and surrounding counties

A full Tennessee Caregiver Resources directory, with website, hours, languages, and service-area scope for each entity, is on the Brevy editorial calendar.

The Tennessee Caregiving Landscape: Why It Looks Different From Other States

Tennessee's caregiver policy environment has changed dramatically in the last 24 months. Five framing facts every TN caregiver should know:

1. The Department of Disability and Aging (DDA) Launched July 1, 2024

Tennessee restructured aging and disability services on July 1, 2024, merging the former Tennessee Commission on Aging and Disability with the Department of Intellectual and Developmental Disabilities into a single Department of Disability and Aging (DDA). The reorganization unified administration of NFCSP, OPTIONS for Community Living, the §1915(c) DD Waivers, and the state long-term-care ombudsman program. The merger meaningfully reduces the inter-agency referral friction that used to bounce TN families from office to office.8

2. The Freedom for Family Caregiving Act (PC 182, 2025) Was the Most Significant Single Caregiver Statute in TN History

Public Chapter 182 of 2025, signed by Governor Bill Lee on April 30, 2025 with a Senate vote of 31-0 and a House vote of 94-0, removed the single biggest pre-2025 barrier to paid family caregiving in Tennessee: the prohibition on TennCare-contracted agencies hiring spouses, parents, or co-resident relatives as Direct Support Workers. It applies no matter which TennCare program the recipient is enrolled in, and it works through the agency-employed route, meaning a TennCare-contracted home care agency may now hire the family member as a W-2 employee to deliver the recipient's authorized care hours.2

The act does not override TennCare's Consumer Direction (CD) exclusions, so CD still bars spouses, conservators, and powers of attorney from being the paid CD worker. But the agency-employed pathway opened by PC 182 is now available as an alternative for families who could not previously qualify under CD.

3. The Caring for Caregivers Act Is the First Direct State Subsidy for Family Caregivers in Tennessee History

The Caring for Caregivers Act (HB 1443 / SB 1777), sponsored by Rep. Renea Jones (R-Unicoi) and Sen. Rusty Crowe (R-Johnson City), was signed into law by Governor Bill Lee on May 18, 2026 as Public Chapter 940 of 2026, after passing the House 92-3 and the Senate 30-0. It establishes a three-year pilot grant program administered by the DDA to support family caregivers of people with Alzheimer's disease or related dementias cared for in a private residence. Eligible caregivers may apply for up to $6,000/year to reimburse documented expenses including home modifications (grab bars, ramps, safety upgrades), durable medical equipment, and respite care. The first-year appropriation is $600,000, divided across the state's three regions (East, Middle, and West Tennessee), with priority given to lower-income households.10

It is a reimbursement, not a tax credit and not an hourly caregiver wage, so caregivers must front qualifying expenses and submit documentation. Because the program is newly enacted, watch the DDA news page for the application window and implementation guidance before relying on it.

4. Federal Tax Treatment Often Excludes Live-In Caregiver Wages

For Medicaid-funded caregivers who live in the same home as the recipient, the federal tax framework can exclude qualifying wages from federal gross income. Tennessee has no state income tax on wages, so the federal classification is the entire tax story for TN residents. Talk to a tax preparer familiar with Medicaid waiver wage exclusions before filing; the rules turn on residency, the type of payment, and the form the FEA issues. See our deep-dive in the How to Get Paid guide.

5. Tennessee Has No State Paid Family Leave, but the Federal FMLA Floor Applies

Unlike several other states that have stood up state-funded paid-family-leave or family-leave-insurance programs, Tennessee has not. TN caregivers rely on:

• Federal FMLA: 12 weeks per year of unpaid, job-protected leave for eligible employees of covered employers (generally those with 50 or more employees within 75 miles).
• Tennessee Maternity Leave Act: unpaid maternity leave for eligible employees, which does not cover caregiving for ailing relatives.
• Voluntary employer programs: a growing number of TN employers offer paid caregiver leave as a voluntary benefit. Check your benefits handbook.

There are active legislative proposals to create a state paid-family-leave program; none have passed both chambers. Watch the General Assembly tracker.

What This Pillar Does Not Yet Cover (Coming Updates)

Future pillar expansions in queue:

• Caregiver burnout assessment tools: the Zarit Burden Interview, Modified Caregiver Strain Index, and AARP Family Caregiver Quick Self-Assessment
• Kinship Caregivers Program deep-dive, for grandparents and relatives raising children through TN's Kinship Care program at DCS
• TN Caregiver Resources Directory, a comprehensive phone-and-URL guide
• Caring for Caregivers Act implementation guide, once DDA publishes the application window and rules
• TN County-by-County CHOICES Consumer Direction Guide, with wage rate, FEA contract, and authorized hours by region

Brevy is actively building these. Subscribe to our newsletter or check back monthly.

The Bottom Line

Tennessee has far more help available than most families are ever told about, and the hard part is not whether help exists but which programs fit your family and how to combine them. Three things carry most of the weight:

1. Save 1-866-836-6678. The TN DDA Statewide Referral / OPTIONS for Community Living line is your single front door: it routes to your local AAAD, which screens for NFCSP, OPTIONS, and TennCare long-term care in one call.
2. Pick your pay pathway deliberately. Consumer Direction lets the family hire and supervise but bars spouses, conservators, and POAs; the PC 182 agency route lets a contracted agency hire spouses and parents as W-2 employees. Different paperwork, different eligibility, different best fit.
3. Layer the payors, and use the new dementia grant. Combine CD or agency hours, NFCSP respite, the federal live-in tax exclusion, and, for dementia families, the Caring for Caregivers Act (signed May 18, 2026, up to $6,000/year); check the DDA news page for its application window.10

You are not alone. Tennessee spent the last two years rebuilding this infrastructure specifically so that no caregiver here should ever feel like they have nowhere to turn. The hardest part of using it is knowing it exists, and now you do. This pillar is the map; the four dedicated guides are the deep dives.

Tennessee Caregiver Pillar, Quick Navigation

Learn More

Tennessee's caregiver infrastructure has been rebuilt over the last 24 months: DDA reorganization in 2024, PC 182 in 2025, and the Caring for Caregivers Act enacted in 2026. Most TN families have not yet caught up to the changes. Read this overview first, bookmark the dedicated guides, and save 1-866-836-6678.

Find personalized help navigating Tennessee's caregiver programs 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.