In southeast Michigan, a voucher program allows caregivers to take a break

• The Caregiver Respite Voucher Program provides informal and family caregiver a voucher worth up to $575 to pay for respite care
• The issue is resonating as Michigan ages; the voucher similar to several other programs
• Voucher available to those who live in Livingston, Macomb, Monroe, Oakland, St. Clair and Washtenaw counties

Christina Pineau cares for her husband of 57 years as if he is a child, constantly watching his every move. 

Her husband, 80, has frontal lobe dementia, and Henry has difficulty reading, walking and he easily gets lost. Sometimes, he doesn’t recognize his grandchildren.

The 76-year-old caregiver from Sterling Heights feels like a “hamster in a wheel.” The days are rife with stress, exhaustion and limited movement. 

She doesn’t take extended grocery store trips and leaves the house only for a few hours to visit the bank or get a haircut. 

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“I’m worried something will happen,” she says. “There’s no one there. And if something goes wrong, he’s not going to know what to do.” 

“You just don’t think clearly when you’re under that kind of stress,” she says. “It’s just sad.” 

That’s why she applied for a new program supporting caregivers in southeast Michigan, hoping to find somebody she can trust to take care of her husband, even if it’s for a short time.

In October, nonprofit Area Agency on Aging 1-B launched the Caregiver Respite Voucher Program, which provides informal and family caregivers  a voucher worth up to $575 to pay for respite care, or temporary relief from caregiving responsibilities. 

The program offers caregivers the flexibility to choose who they’ll hire to provide care, says Katie Wendel, the agency’s director of planning and advocacy. Hiring a familiar face within the caregiver’s trusted circle may be less disruptive for people with Alzheimer’s or other dementia. 

But the program is limited to eligible caregivers of older adults living within the agency’s service region in southeast Michigan, and the voucher just covers short-term respite care. 

There is no program in the city of Detroit, but similar efforts exist nationwide. The Alzheimer’s Association-Michigan Chapter offers respite care scholarships that may be used for adult day programs, in-home care or overnight care. In Nebraska, a respite care subsidy provides relief for family caregivers living below the poverty line. In New York, $600 respite vouchers are available for informal, family caregivers of children under 18 years old and adults with long-term chronic conditions.  

“The demands of caregiving don’t stop. People have continuous needs,” Wendel adds. “To take a break, they need to have some support in place.” 

The voucher program comes as Michigan’s older adult population is rapidly growing. Meanwhile, a shortage of direct care workers persists, making professional respite care difficult to access. 

The cost of care services varies and may depend on the caregiver’s source of income. In Michigan, the average daily cost of a home health aide is $29 per hour, according to a 2021 Genworth survey. The online platform Care.com lists the state’s average cost of a professional caregiver between $17 and $27 per hour. Based on these figures, the voucher covers less than a week of full-time care.

The program aims to reduce the stress caregivers feel, Wendel says. The program is funded through a two-year $327,000 grant from the Michigan Health Endowment Fund and the Ralph C. Wilson Jr. Foundation and modeled after the Lifespan Respite Care Program. (Editor’s note: The Ralph C. Wilson Jr. Foundation funds the New York & Michigan Solutions Journalism Collaborative as well as Bridge Michigan.)  

To be eligible for a voucher, caregivers must live within the six-county region the agency serves, which includes Livingston, Macomb, Monroe, Oakland, St. Clair and Washtenaw. They must provide unpaid care for an adult 60 or older for at least two hours a week and have a professional referral, from a doctor, nurse, social worker, or nonprofit staffer.

Applicants use CareLinx, an online platform that connects clients to professional caregivers, to manage and pay for care. They can hire a family member, friend, neighbor, or a professional caregiver with guidance from a care adviser. Anyone hired must undergo a background check. 

As of late December, the agency had received 71 referrals for the 175 available vouchers. Forty-six applicants are interviewing potential caregivers or have hired one. Once accepted into the program, the caregiver must use the voucher within the year issued.  Caregivers can apply for a voucher in the second year, but new applicants will get priority.

To help spread the word about the relief opportunity, the agency has reached out to doctor’s offices, hospital systems, aging networks and nonprofits. Those healthcare providers can also help caregivers recognize what they do as work worthy of support, which isn’t always the case.  

Pamela Viviano heard about the voucher program from a social worker at Jewish Family Services. The 62-year-old caregiver is always searching for resources and quickly applied. 

Viviano looks after her 93-year-old mother, Joanne, in their Southfield home. Over the years, her mother has undergone a cognitive decline, no longer able to volunteer at a museum or usher at a theater. She would do things such as forget which coat belonged to her or where she placed her belongings, gradually losing some independence. 

Stepping into the role of a caregiver late in life has been a journey of learning and adaptation. The intense nature of caregiving frays Viviano's nerves.  

“It’s scary. I’m responsible for keeping her alive,” she says.  

Viviano is trying to broaden her social life again. She plans to study interactive web design next year, so the voucher could open up time for schoolwork. She’ll likely hire someone she knows and trusts.

In the past, respite care has been hard to pin down, mainly because home healthcare companies required a minimum of hours for their employees, she says.

“It was looking to be a challenge because I didn't know if I would need someone regularly for a minimum amount of time a week. Those are the parameters,” she says. 

Viviano likes the voucher program’s flexibility. 

Yet an obstacle has emerged: her mother’s resistance.

“My mom is not wild about having someone that she doesn't know” take care of her, Viviano says. “She’s just kind of holding on until I get home.”

For Pineau, she’s chosen to hire a professional caregiver. Friends were unwilling to go through the lengthy background check process the program requires. 

With the voucher, she’ll be able to get some care for her husband inside their home.  She might even have time for a haircut.

Her husband is not fully sold on the prospect of another caregiver, making Pineau’s search for a proper match crucial. She likes having ownership over the selection process. She’s never used respite care, and admits to long neglecting her needs. 

Pineau can’t carry the burden of caregiving alone anymore. She doesn’t want to always worry about her husband.

“The main thing is you don't want the caregiver to get sick. Depression runs,” she says. “I’ve been doing this for a long time. It’s just getting worse. I finally realized I really do need help.”