Get in-home support services

For family members with disabilities who need extra help at home, there are two main options available for caregivers.

The options are adult family care or adult foster care (AFC) and a personal care attendant (PCA). Both programs help care for those who need hands-on help.

  • AFC is a program that will help pay for a caregiver to live with your family member in order to help them with activities of daily living (ADLs). AFC is a good option for a family member that cannot safely live alone.

  • A PCA is a caregiver that will come help your family member for a certain number of hours each week. A personal care management (PCM) agency will work with your family to find out how many hours a week are needed to help your family member. Most of the time you and your family member are able to choose who the PCA is.

Click the button below to read more about the types of tasks an AFC or PCA caregiver can help with.

Before MassHealth can approve a caregiver for your family member, they need proof that the extra help is medically necessary.

MassHealth may find that a caregiver is needed if your family member needs help with these tasks:

  • bathing (full-body bath or shower)

  • getting dressed, including clothes and undergarments (not just help with shoes, socks, buttons, snaps, or zippers)

  • toileting, if your family member is "incontinent" (can't control their bladder or bowel) or needs help on a regular basis with going to the bathroom, a catheter or colostomy care

  • moving from place to place, or "transferring"(if your family member needs help moving to another position)

  • unable to self-steer a wheelchair without help from someone else

  • eating, if your family member needs constant supervision and cueing during the entire meal, or physical help with a part or all of the meal

A personal care management (PCM) agency will work with you and your family member to figure out which caregiver option is best.


Source: MassHealth

Click the button below to read more about the differences between AFC and PCA.

What are the differences between the AFC (adult family care) and PCA (personal care attendant) programs? Under the AFC program: 1. Only one caregiver can be paid. 2. The family member must be living with the AFC caregiver. 3. The AFC caregiver is paid based on the level of needs of the family member. (For example, Level 1 means the family member needs help with one or two activities of daily living or ADLs; Level 2 means the family member needs help with three or more ADLs. 4. The AFC caregiver fills out a daily log. 5. A parent cannot be a paid caregiver if you are the legal guardian. 6. The family member is over the age of 16. 7. The family member needs daily hands-on help or help with supervision and cueing. Under the personal care attendant or PCA program: 1. There can be multiple PCAs as long as they are approved by MassHealth. 2. Masshealth will decide how many hours per week a PCA will work with your family member. 3. You and your family member play a role in the hiring (and firing) of a PCA. 4. The family member or parent fills out a time sheet for the PCA, and the PCA is paid by the hour. 5. If the family member is under age 18, the parent cannot be a PCA. A sibling or other relative who is not the legal guardian could be the PCA. Note: the legal guardian can never be the PCA, no matter how old the family member is. 6. The family member who needs a PCA can be any age. 7. The family member needs help with ADLs, but not help with supervision or cueing. Note: if it gets passed, an upcoming bill in Massachusetts may change the rules so that a PCA can help with supervision and cueing needs. Considering both programs, your personal care management or PCM agency will help you decide which option is best!

Sources: MassHealth, MA Council for Adult Foster Care, Cerebral Palsy of MA, MA Personal Care Attendant Workforce Council

Here's what you can do:

A service provider can help you decide which caregiver option is best for you and your family member. Some agencies offer both PCA and AFC programs. Click the links below to find a list of provider agencies:

Be sure to visit our Resource Directory for the most up-to-date information.


Sources: MA Council for Adult Foster Care, MassHealth, Rewarding Work Resources Inc.