You can be paid to care for them. You should not have to do all of it.
Most home care agencies in Northern Virginia offer one arrangement: they send an aide. If you want a family member to be the paid caregiver instead, they will tell you to look elsewhere.
Millennium is enrolled with Virginia Medicaid for both models. Agency-directed, where we employ and schedule the caregiver. Consumer-directed, where your family hires and directs the attendant, including a relative. And the arrangement most families end up wanting once they understand it exists, which is a share of each.
Who Virginia allows to be paid
Under consumer-directed care the person receiving care chooses their own attendant, and that attendant can be family. In Virginia that includes a spouse, an adult child, a sibling, a niece or nephew, and a grandchild.
A spouse, and a parent of a child under 18, are what Virginia calls legally responsible individuals. Extra rules apply to them and only to them: the care has to go beyond what that person is already expected to provide, payment is capped at 40 hours a week, and a services facilitator has to be involved. We will walk you through which of this applies to your household before you commit to anything.
The problem nobody warns you about
Families arrive at consumer-directed care relieved. The daughter or the husband who has been doing this unpaid for a year can finally be paid for it. That is real, and it matters.
Then month four arrives.
Being your mother’s paid caregiver does not stop you being her daughter. Forty hours a week of bathing, lifting, toileting and medication, on top of that relationship, on top of your own job and your own children, is not a job you clock out of. There is no evening. There is no sick day. When you get the flu, the care does not stop.
This is the point where home care arrangements break. Not because the family stopped caring. Because one person was carrying something built for two or three, and eventually could not. What follows is usually a facility, which is the outcome everyone was trying to avoid.
The split
The family member stays the paid attendant for part of the week. Our aides cover the rest.
Nothing is taken away. The relative keeps the income and keeps the role. What changes is that there are now hours in the week that belong to them, on a schedule, with someone trained and background-checked covering the care.
What that buys, specifically
- A day off that exists on paper. Not “when I get a chance.” Tuesday and Thursday mornings, every week, booked.
- Cover for the days you cannot. Your own illness, a work deadline, a funeral, a trip home. Care continues.
- A second set of eyes. Our aides are supervised by a registered nurse. Changes get noticed by someone who is not too close and too tired to see them.
- The heavy hours handled. Many families keep the personal, private care with the relative and give us the physically hard parts, or the early mornings, or the nights.
- A working relationship before you need it. The week you end up in hospital yourself is a terrible week to start looking for an agency.
Who this tends to suit
- A spouse who is the main carer and is past the point of managing alone
- An adult child who moved back in, or moved a parent in, and has not had an uninterrupted night in months
- Families where the person receiving care will accept help with washing and toileting from a relative but not a stranger, or the exact reverse
- Households where several siblings share the load unevenly and it has started to cause arguments
- Anyone whose care plan depends entirely on one person staying well
What this does not mean
We will be straight with you, because this is where families get their hopes up.
- Being family does not by itself qualify anyone. The person needing care has to qualify, through a screening that decides whether they need help at the level a nursing facility would provide.
- Nobody at Millennium approves this. DMAS and your health plan decide, and we will tell you quickly if your situation does not look like it fits.
- Approved hours are set by an assessment, not by how much care you are giving day to day. Most families are giving more.
How it works
- We talk. Tell us what the week looks like now, honestly. Which hours are hardest, who is doing what, what has already been approved.
- Free in-home assessment. No cost, no obligation. We look at the care needed, not just the hours requested.
- We work out the split with you. Which hours stay with the family caregiver, which we cover. This is not fixed forever and it changes as things change.
- The paperwork. Consumer-directed care runs through a services facilitator and a state contracted payroll company. Agency-directed hours run through us. We explain both and tell you what each one needs.
- Care starts within 48 hours of everything being in place.
What it costs
For families on Virginia Medicaid, personal care and respite under the waiver are covered. There is no separate bill for the split. The hours come out of what the assessment approves, and how they are divided between a family attendant and our aides is a planning decision, not an extra cost.
Whether your family member qualifies is decided by the Virginia Department of Medical Assistance Services and your health plan, never by us and never by this page. Anyone who promises you approval before a screening is guessing.
We are contracted with Anthem HealthKeepers, Sentara, Humana and Aetna Better Health, and we are accepting new Medicaid clients now.
Common questions
Does the family member lose their pay if we add agency hours?
No. They are paid for the hours they work. The split changes how the approved hours are distributed, not whether the relative is paid for theirs.
Can a spouse be the paid one?
In some cases, yes. Virginia’s rules changed in November 2023 and were revised again in July 2025. A spouse may be paid for up to 40 hours a week where the care is beyond what a spouse would ordinarily provide, and where the file documents why. We wrote this up in detail: Can a spouse be paid as a caregiver in Virginia?
Do we have to decide the split now?
No, and most families do not get it right the first time. Start with the hours you are most worried about and adjust. Needs change, and so should the plan.
What if we only want a few hours?
That is a normal request and often the right one. Two mornings a week to sleep, or the Saturday, is enough to change whether an arrangement holds. You do not have to hand over the whole week to get help with part of it.
What if my mother does not want a stranger in the house?
Common, and worth taking seriously rather than arguing about. About ten of our twelve caregivers speak Amharic and three speak Tigrinya, so for many families the person who arrives is not culturally a stranger. Meals are cooked the way your family eats, including fasting days. We also start small on purpose, with short visits doing practical things, so trust is built before personal care is asked for.
Can we switch back to one arrangement later?
Yes. Families move between all three as circumstances change. That is the point of being enrolled for both.
If the names on the paperwork are confusing you
Cardinal Care, the CCC Plus Waiver and your health plan are three different things, and only one of them decides whether care at home is covered. We explain which is which here: Cardinal Care or CCC Plus? Both. Here is what the names mean.
If the hard part is the conversation, not the paperwork
Plenty of families call us before anyone has agreed to anything. How to tell a parent they need help at home is what tends to work, from families who have been through it.
Talk to a care coordinator
Tell us what the week looks like. We will explain which of the three arrangements fits and what it would take to set up. If your situation does not fit what we do, we will say so quickly rather than leave you waiting.
- Licensed by the Virginia Department of Health, license HCO-14982
- Enrolled Virginia Medicaid provider, NPI 1043640360
- Enrolled for both agency-directed and consumer-directed care
- Contracted with all four Cardinal Care plans
- Same-day response, care can start within 48 hours
- Caregivers speak Amharic, Tigrinya and English, with Spanish available
- Background-checked aides, supervised by a registered nurse
Call (703) 941-8412, Monday to Friday, 9:00 am to 5:00 pm, or ask for a free in-home assessment. Serving Annandale, Alexandria, Arlington, Falls Church, Fairfax and Springfield.
Millennium Home Health Care, 4200 Evergreen Lane, Suite 312, Annandale, VA 22003.