How to Prevent Caregivers from Becoming Unauthorized Occupants

Occasionally, a resident may ask you what steps need to be taken to allow a professional caregiver on site to assist him or her with activities of daily living. Typical duties of a caregiver might include taking care of someone who has a chronic illness or disease; managing medications or talking to doctors and nurses on someone’s behalf; helping to bathe or dress someone who is frail or disabled; or taking care of household chores, meals, or bills for someone who cannot do these things alone.

For assisted housing purposes, it’s important to know the difference between a live-in aide and a caregiver. A live-in aide is someone who lives on your site but is not a resident. And a caregiver may stay overnight in the resident’s apartment, but he or she is not considered a live-in aide.

We’ll go into the differences between the two classifications so that you’ll know if the resident is asking for permission to house a live-in aide when he or she needs additional help with day-to-day living. We’ll also give you a Model Form: Require Caregiver Registration to Prevent Misconduct, Unauthorized Live-Ins, that you can adapt and use at your site.

Live-in Aide vs. 24-Hour Caregiver Help

If around-the-clock care is needed, a resident may be considering the option of a live-in aide or 24-hour home care to ensure someone will be there throughout the day and night. A live-in aide situation involves one person. Use of caregivers usually means a team of caregivers taking shifts watching the resident. For example, two caregivers could be booked daily and work 12 hours each.

While caregivers may stay overnight in a resident’s unit, overnight stays do not necessarily mean the caregiver is a live-in aide. Caregivers have their own home, and the caregiver taking an overnight shift may not be the same person.

Live-In Aide Criteria

If the resident is really asking for permission to house a live-in aide, it’s important to verify both the need for the aide and the individual’s qualifications for serving as the aide. The reason these are such vital steps is that certain rules apply to households with qualified live-in aides. First, they are eligible for and can insist upon a larger unit to accommodate the aide. Second, the income of the aide cannot be factored into the household’s rent calculation.

HUD has certain criteria live-in aides must meet to be considered legitimate and qualified. A live-in aide is defined as a person who resides with one or more elderly persons, near-elderly persons, or persons with disabilities, and who:

• Is determined to be essential to the care and well-being of the person(s);
• Is not obligated for the support of the person(s); and
• Would not be living in the unit except to provide the necessary supportive services [HUD Handbook 4350.3, par. 3-6(E)(3)(a)(1)].

With regard to a live-in aide, the site owner or manager must:

Verify need for live-in aide. Verification that the live-in aide is needed to provide the necessary supportive services essential to the care and well-being of the person must be obtained from the person’s physician, psychiatrist, or other medical practitioner or health care provider [HUD Handbook 4350.3, par. 3-6(E)(3)(a)(2)(a)].

Approve live-in aide if needed as reasonable accommodation. In accordance with 24 CFR Part 8, an accommodation must be granted if needed to make the program accessible to and usable by the family member with a disability [HUD Handbook 4350.3, par. 3-6(E)(3)(a)(2)(a)]. You may verify whether the live-in aide is necessary only to the extent necessary to document that applicants or residents who have requested a live-in aide have a disability-related need for the requested accommodation. This may include verification from the person’s physician, psychiatrist, or other medical practitioner or health care provider. You may not require applicants or residents to provide access to confidential medical records or to submit to a physical examination.

The live-in aide qualifies for occupancy only as long as the individual needing support services requires the aide’s services and remains a resident [HUD Handbook 4350.3, par. 3-6(E)(3)(a)(2)(c)]. At a HUD site, the live-in aide must disclose and provide verification of his or her Social Security number (SSN) [HUD Handbook 4350.3, par. 3-6(E)(3)(a)(2)(e)]. In addition, the live-in aide may not qualify for continued occupancy as a remaining family member. The income of a live-in aide is excluded from the annual income of the household [HUD Handbook 4350.3, par. 3-6(E)(3)(a)(2)(d)].

Finally, relatives may be considered to be live-in aides if they meet applicable requirements, especially the stipulation that they would not be living in the unit except to provide the necessary supportive services [HUD Handbook 4350.3, par. 3-6(E)(3)(a)(3)].

Caregiver Rules

To curb housing assistance abuse and incentives for residents to claim unauthorized occupants as caregivers, you should establish a form, like our model form, with rules that provide caregiver guidelines. It’s a good idea to require residents to have the caregiver register his or her name and address and fill out a short questionnaire and submit the form to the site office. This can help caregivers from becoming residents without your knowledge. And you also will know their identities, in case they cause trouble while at the site.

Caregivers and residents who register by signing the form certify that they will abide by the rules and have provided accurate information. This form can help you keep track of caregivers and give you ammunition against residents whose caregivers cause trouble or become unauthorized live-ins; and it shows HUD that you’re making an effort to prevent unauthorized live-ins and subsidy abuse at your site. Your form, like ours, should also lay out how you will proceed if you start to suspect that the guest is no longer just a caregiver but has in fact moved in. It states that you will ask for verification of alternative residence. Also, the owner will request a meeting with the household head if the owner suspects that a registered service provider or caregiver should be classified as a resident.