How to Become an AFC Caregiver in Massachusetts

If you’re looking for a full overview of what AFC is and who qualifies as a member, start with our guide: What Is AFC & Who Qualifies?.
Here, we’ll shift the focus to you—the caregiver: what it takes to qualify, how to apply, the training you’ll receive, your daily responsibilities, and the benefits you can expect.

A Quick Snapshot

AFC = Adult Foster Care (MassHealth program). Care happens at home with a live-in caregiver.
Who the caregiver is: Often a family member or trusted friend (not a spouse or legal guardian).
What you get: Ongoing nurse & care manager support, training, and a non-taxable monthly stipend (difficulty-of-care).
Top line: If you already help a loved one daily, AFC organizes that care and supports you with a team.

Caregiver Eligibility (Simple Checklist)

To serve as an AFC caregiver in Massachusetts, you should:

Live full-time with the member in a private home (AFC is not a drop-in service).
Be 18+ and capable of consistent daily support.
Not be the member’s spouse or legal guardian.
Complete background/safety checks and agency onboarding.
Be able to follow a care plan, keep brief daily notes, and collaborate with the nurse/care manager.
Have basic documents ready for stipend setup (photo ID, SSN/ITIN, direct-deposit info).
Maintain a safe home setting (clear walkways, safe bathroom setup, medication storage, posted emergency plan).

Note: Member eligibility (MassHealth coverage, ADL needs, PCP order, etc.) is detailed in your other article: link it above and keep this page focused on the caregiver path.

Step-by-Step: How to Become an AFC Caregiver

Step 1 — Book a free consultation with an AFC provider agency (e.g., Clare Senior Care).

Schedule a quick screening to discuss the member’s daily needs and your living arrangement.
Bring the member’s MassHealth info and PCP contact if available.
check eligibility and start the AFC process.
They’ll guide you through caregiver intake, assessments, and Prior Authorization (PA).

Step 2 — Caregiver intake & checks

Provide ID, SSN/ITIN (for stipend), direct-deposit info, emergency contacts.
Complete background checks and sign program agreements (privacy, safety, backup plan).

Step 3 — Home & clinical assessments

A nurse and care manager visit your home to:
- Evaluate the member’s ADLs and medical needs.
- Review home safety (bathroom aids, lighting, exits, medication lockbox).
- Draft a care plan that matches real daily routines.

Step 4 — PCP order + documentation

The agency coordinates with the Primary Care Provider to obtain the AFC order.
Your team compiles the clinical packet to demonstrate medical necessity.

Step 5 — Prior Authorization (PA)

The agency submits the PA to MassHealth.
The approval confirms program eligibility and assigns AFC Level I or II.

Step 6 — Onboarding & start of care

You’ll get a clear start date, visit schedule, and daily notes template.
The nurse/care manager will coach you on safe care techniques and documentation.

Typical timeline: Many families move from consult to start within 2–4 weeks, depending on how fast documents return and PCP scheduling.

Your Core Duties (Day-to-Day)

ADL Assistance

Help with bathing, dressing, grooming, toileting, eating, and mobility/transfers—as needed for safety.
Encourage hydration, nutrition, and the member’s preferred routine.

Medication Reminders & Health Monitoring

Provide timely reminders (not nursing administration unless licensed).
Watch for changes (pain, confusion, falls, skin issues) and notify the nurse promptly.

Safety & Environment

Keep walkways clear; dry bathroom floors; use non-slip mats, night lights, and grab bars if recommended.
Ensure a posted emergency plan and a backup caregiver contact.

Documentation & Communication

Keep brief daily notes (1–3 lines) showing what you helped with and any changes.
Attend monthly visits and collaborate on updates to the plan of care.

Respect & Dignity

Preserve privacy, support independence, and follow cultural preferences and language needs.

Quick daily notes template (example):
“9/15 AM: Assisted with shower & dressing; reminded morning meds; breakfast ok; walked 15 min in hallway; no pain; slight dizziness on standing—will monitor.”

Caregiver Benefits

1) Non-Taxable Monthly Stipend (Difficulty-of-Care)

Caregivers receive a monthly stipend via the AFC agency, generally excluded from federal income tax as difficulty-of-care.
Depending on level and days covered, caregivers can earn up to about $18,000 per year.

Stipend short disclaimer: Actual amounts vary by AFC level (I/II), days of service, MassHealth rules, and agency policies. Not financial/tax advice—consult a professional.

2) Ongoing Clinical Support

You’re backed by a nurse and a care manager who visit monthly (Level I: alternating; Level II: both each month).
You get practical coaching on safe transfers, fall prevention, dementia cues, and community resources.

3) Training & Tools That Make Care Easier

Step-by-step onboarding, plain-English handouts, and quick checklists.
Guidance on medication reminders, infection control, documentation, and emergency readiness.

4) Whole-Family Relief

With an organized plan and direct access to clinicians, families report less stress, fewer ER trips for avoidable issues, and more confidence at home.

Training for Caregivers (What You’ll Learn)

Onboarding Topics

Understanding ADL support and energy-saving techniques.
Safe transfers, gait belts, and fall prevention.
Medication reminders, side-effect awareness, and safe storage.
Infection control, hygiene, and household safety.
Documentation: simple daily notes, what to call the nurse about, incident tips.
Program rules: live-in requirement, non-duplication of services, privacy & rights.

Ongoing Coaching

Monthly visits are supportive, not punitive—bring your questions.
Your team will flag changes early and update the plan so care stays realistic.

What Makes a Strong AFC Home?

Environment

Clean paths, good lighting, non-slip bathroom setup, sturdy seating, easy-reach items.
Medication lock box if advised; posted emergency contacts.

Routine

Predictable wake/sleep, consistent meals, hydration reminders, gentle movement.
Calendar/labels for memory support; phone alarms for reminders.

Communication

A small notebook or app for daily notes.
One “medical folder” with the member’s ID, MassHealth card, medication list, and PCP info.

Backup Plan

Name at least one backup caregiver and review the emergency plan together.
Keep a bag ready (ID, meds list, clothes) for urgent visits.

FAQ: Common Questions (Fast Answers)

Can a spouse be the caregiver?
No. Spouses and legal guardians aren’t eligible AFC caregivers.

Do I have to quit my job?
Not necessarily. AFC requires live-in status and daily support. Some caregivers keep part-time work while ensuring 24/7 reliability (with a backup plan).

Is the stipend taxable?
In most cases it’s non-taxable under federal difficulty-of-care guidance. Individual tax situations vary—check with a professional.

What if the member is in the hospital for a few days?
Notify your care manager; your agency will advise on coverage and documentation during transitions.

What equipment do we need?
Often low-cost items: shower chair, non-slip mats, grab bars, raised toilet seat, night lights. The nurse will tailor suggestions.

How often are visits?

Level I: At least monthly (nurse and care manager alternate).
Level II: Nurse and care manager monthly.

How long to get approved?
Many families start within 2–4 weeks, depending on PCP response and paperwork timing.

Avoiding Delays (Pro Tips)

Have documents ready: ID, SSN/ITIN, direct-deposit, proof of residence, PCP info.
Be specific about ADLs: Describe what help the member needs and how often.
Live-in confirmed: AFC requires co-residence—plan your move-in if not already together.
Return calls fast: Nurses/PCPs may use different numbers; pick up or call back quickly.
Report other services: Tell the nurse about PCA hours or home-care services to prevent duplication.

Your First 30 Days: What It Looks Like

Week 1: Intake screening, caregiver paperwork, home safety walk-through.
Week 2: Nursing assessment, ADL review, PCP order requested.
Week 3: PA submitted; you practice daily notes and finalize emergency plan.
Week 4: Approval, start date, and first monthly visit cadence set.

From there, you’ll keep short daily notes, follow the care plan, and call the team if anything changes.

Ready to Start? (Free Consultation)

Becoming an AFC caregiver is a practical, compassionate way to keep your loved one safe at home—with clinical backup and a monthly non-taxable stipend recognizing your work.

👉 Book a free consultation to check eligibility and join the AFC program.
Prefer to talk first? Call our team and we’ll walk you through each step.
Already helping daily? You might be closer than you think—start today.

Program Disclaimer

This article is for general information only and does not replace medical, legal, or tax advice. AFC requirements (eligibility, levels, visit cadence), MassHealth rules, and stipend policies can change and may vary by individual case and provider agency. Confirm current rules with your AFC provider, the member’s medical team, and MassHealth.

Stipend note: Earnings depend on AFC level, approved days, and program rules. “Up to $18,000/year” is an estimate, not a guarantee. Consult your provider and a tax professional about your situation.

ref: https://www.mass.gov/lists/adult-foster-care-manual-for-masshealth-providers

AFC & GAFC Programs, MassHealth Guidance