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How much should Mom pay my sister for care?

I am the youngest of four sisters. We live in four different states and the one who lives in the same state as our mother, is two hours away. Our mother has serious dementia and can no longer handle ANY of her normal living matters. On this, we all agree. Up until about three weeks ago, we thought she was going to be able to live alone in an apartment near the sister who lives in the same state. That is no longer an option. Our oldest sister (Sister #1) - the one who has the least amount of annual income - has agreed to move mom in with her and her husband (she is the only sister willing/able to do so). On this, we all also agree. She acknowledges that she does not want to be involved in the financial decisions (she never was a very good money manager). She is leaving that up to us three. We just need to let her know what she has to work with. Here's the question. How do you decide how much to pay the sister (from mom's small monthly income) for the room, board, transportation, housekeeping, utilities (etc., etc., etc.) AND the compassionate care she provides? I believe that for the services my sister will provide, an assisted living facility would be paid upwards of $5,000 per month. There is no way our mother could afford that amount, nor can my sisters and I afford to contribute to pay that amount. But, of course, that would be an outside, for-profit company. Our sister is family. Some of us believe that sister #1 should be paid the absolute maximum mom can afford - even if that means drawing from her small 401(k). Some of us believe that as family, she should be paid only the amount that mom might otherwise have paid for an apartment. I'm sure that somewhere between "what a for-profit company would charge" and "nothing, because she's mom" there is an amount we can all live with. Does anyone have any ideas or formulas that might help us come up with this number? Mom's monthly income is just shy of $2000 and she has about $20,000 in all bank accounts (including her 401(k)). Keeping the same monthly income of $2000, her savings should last a little more than three years. Then her income would drop to about $1500 per month - period - for the rest of her life. So far, we've discussed three different monthly distribution areas: Basic room and board ($1000 - some feel this is just right, others feel this is not enough); Mom's personal allowance ($?? - maybe $200 for grooming, small gifts/cards she might want to purchase); and Respite/Relief help for Sister #1 ($???). Then, of course, there are her medical/RX expenses as well. Are we on the right track? How do others figure this out? How do you decide the limits of "family should do just because"? How do you handle hurt feelings when one sister thinks the other is taking advantage?
Status: Open    May 28, 2015 - 08:19 AM

Finance, Caregiving

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Sep 16, 2015 - 02:15 PM

Your sister can be paid. I’d suggest you check with local agencies to see what they charge for the services your sister is providing, then have yoiur sister charge that. This agreement should also be in writing – a Care Contract. Your sister should also claim these payments as income.
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By dsu44 on Aug 13, 2016 - 07:36 AM | Like (0)  |  Report

I am an accountant who just figured this out for my sister. I would suggest that the monthly expenses for living such as rent, food , utilities, be and expense for all and then you pay a stipend for your sister based upon what she needs. If everybody is living in the home and if the sister and husband works then their income can be apart of the contribution and ensure they are saving for life after your mother. Do a budget on the living expenses and include their contribution for the expenses of living and you pay your sister what your mother can afford because you don't want to tap into the savings unless you need to because of possible medical bills or a vehicle is needed. You also must understand that 401K is for retirement so why hold on to it when you have reached that point in her life. Just do a simple budget for the living expenses and include all contributing income and work it out with your sister what she needs based upon the income available from your mother's income. I hope this helps you!!!

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Sep 16, 2015 - 02:28 PM

I agree with Sarah Mitchell. She has a good answer. I would state it this way: She can be paid fair market price for her work. That will be less than a service provides because a service usually has people who are trained and bonded. That means if the paid care giver breaks anything in the person's home, injures the person by accident or is injured while providing care the patient is covered. Also a service schedules someone to be there everyday. If someone is sick you are not called the service is and someone else is sent.
I think you are on the right track. My suggestion would be that mother pays to sister all her income less the $200 personal needs and average monthly medication expenses. I would then pay respite help and other expenses out of the 401k money. That will have to be spent if she has to go to a nursing home. So use some now and keep her with family as long as possible. A Place for Mom can assist in finding respite workers. If sister gets used up in 6 months it is not a benefit to your mother. It will be stressful for her to care for your mother is she is at a point she cannot live alone. Be sure to support and assist her.
Pay sister monthly with a check. Same amount each month.
The service she is providing will be worth far more than the $1,500 or so she is paid for room and board but it will assist your mother and extend her time with family. Also consider using the 401k to purchase preneed burial arrangments. That is allowed by Medicaid.
This answer is based on Alabama law and being prepared in case Medicaid benefits are needed later.

Sep 17, 2015 - 10:18 AM

You can always call several local private agency or registry that provides that service and find out their hourly rate. It also depends on the level of service and the number of hours your mother depends on your sister for care. Some dementia patient need minimal attention with medicine management and reminder to take meals and can be left along for a few hours per day. While some patients need more care and cannot be left home alone.

Source: Sophia Lopez, Esq.

Sep 18, 2015 - 02:02 PM

If your mother is the widow of a veteran who served during a time of war, she may be eligible for the VA Aid & Attendance pension. Check the aplaceformom resources and contact a VA Accredited Claims Agent or a local VSO. The pension could be close $1,200/month if your mom qualifies. Your mom is allowed to create a Personal Care Contract which should help her validate that her cost of care exceeds her income. This could increase the amount of income available to pay the at home sister.

Sep 30, 2015 - 12:33 PM

I’d suggest you check with local agencies to see what the going rate is for the services that will be performed. Then charge that rate.

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Jul 21, 2015 - 04:19 PM

BRAVO on working together to come up with a solution! Your mother is VERY lucky to have you!

A few numbers that may be helpful. There are smaller residential care homes, depending on what state or are you live in, are often less expensive than the larger assisted living. At last check the national average was around $2500-3000/month depending on where you live. A Place for Mom has a great cost of living calculator your can use at : You may also find this article helpful:

The national average for in-home care starts around $20/hour and often is less for a 24-hour round the clock care, about $275/day, but even then the caregiver is allotted an 8 hour uninterrupted sleep time to recharge their own batteries.

Have you contacted your Area Agency on Aging where your sister lives? Programs vary from one state to the next. Some states offer a respite program, and some have grant funded one for families who qualify, to help with caregiver breaks/respite care. You can find the local office near your sister at this url

I hope that is helpful.
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By anneamore on Aug 16, 2016 - 05:10 PM | Like (0)  |  Report

Oh such a sorry story…did Mom ask to be paid when you were all babies? Now its time to take care of her. Sisters offer what you can afford,,, add up what expenses there are and pay them…Yes the sister doing the work should be compensated. Buy her what she may need..if she needs…somehow this just doesn't feel like the heart is making the rules…we all come to this eventually…you will lose her and that happens eventually too.

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Nov 08, 2015 - 10:50 AM

Someone voiced an opinion that the widow of a war veteran is entitled to veterans benefits. I beg to differ, I tried for six months last year to get my mothers benefits, but to no avail. I got absolutely no help from the veterans association even going up to the veterans hospital in Palo Alto California supposedly one of the best VA hospitals. I was given the runaround told to contact the American Legion blah blah blah and after filling out all the paperwork myself she was roundly rejected. If anybody knows the magic loop over dealing with the veterans Association I'd appreciate it because if she's entitled to that money I want her to have it. I am the main caretaker for my 92-year-old mother and I'm dealing with exactly the same issues, although my sisters don't think I need to be paid anything.


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By betty4677 on Aug 13, 2016 - 07:06 AM | Like (0)  |  Report

From my experience, I think it may depend on how the VA Aid & Assistance paperwork is filled out. It was a daunting task to me and I asked for help from a friend. I truly believe that it was her help in how to word things that was the magic trick. I had been told that it could be rejected and have to re-apply repeatedly so was prepared for that. Imagine my shock when the application was approved the FIRST time it was submitted! It seems like it did take a few months later before the first check was received - which included pmt for all those months at one fell swoop. Now the check comes once a month at the regular rate. Hope this helps.

By lldschick on Aug 13, 2016 - 08:39 PM | Like (0)  |  Report

In my area, the Veteran Service Office is the most helpful.

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Dec 06, 2015 - 11:46 AM

Contact Vetangels. They are wonderful and compassionate people and WILL help you.


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