Structured Family Caregiving vs Attendant Care in Indiana: Which One Fits Your Family?

If someone in your family needs daily help and qualifies for an Indiana Medicaid waiver, you will hear two terms again and again: Structured Family Caregiving and attendant care. Both can pay a family member to give care at home. They work in very different ways, and picking the wrong one can mean less support or less pay than your family could get.

The short answer on structured family caregiving vs attendant care: Structured Family Caregiving (SFC) pays a daily rate to a caregiver who lives with their loved one. Attendant care pays an hourly rate to a caregiver employed by an agency, who does not need to live in the home.

This guide compares the two programs side by side, explains who can be paid under each one in 2026, and walks through how to choose and apply. We are Vital Home Care, a family-owned agency in Fishers that provides both services and helps Central Indiana families sort out these choices every week.

What is the difference between structured family caregiving vs attendant care?

The main differences are how the caregiver is paid, whether they live with the person, and how much support the agency gives them.

	Structured Family Caregiving (SFC)	Attendant care
How it pays	A daily (per diem) rate in one of three levels, based on assessed need	An hourly rate for each approved hour of care
Live-in requirement	The caregiver and the participant live together	No live-in requirement
Who employs the caregiver	The SFC agency supports and pays the principal caregiver	The agency employs or contracts the attendant
Support for the caregiver	A caregiver coach, nurse oversight, home visits and yearly training	Agency training and supervision
Spouses and parents of minors	Can be paid when program rules are met	Only in limited extraordinary care cases
Waivers that offer it	PathWays for Aging, Health and Wellness, TBI	PathWays for Aging, Health and Wellness, TBI
Medical or skilled care	Not included	Not included

The Indiana Family and Social Services Administration (FSSA) publishes its own side-by-side comparison of SFC and attendant care if you want to see how the state describes structured family caregiving vs attendant care.

What is Structured Family Caregiving?

Structured Family Caregiving is a Medicaid waiver service that pays a live-in caregiver to provide daily care at home, with ongoing support from an approved agency.

The caregiver is usually a family member who lives in the same home and gives care every day. The state sets a daily rate in three levels. A case manager assesses how much help your loved one needs and assigns a level, and the agency pays the principal caregiver a share of that daily rate. The rest pays for the coaching, nurse visits and other support the agency must provide.

• Daily pay, not hourly: you do not log every hour. SFC recognizes that live-in care happens around the clock.
• A support team: a caregiver coach and a nurse check in regularly and help you solve problems.
• Training: caregivers receive training each year based on their loved one’s needs. No prior experience is required.
• Respite: SFC plans include time off for the principal caregiver, so you can rest without losing support.
• Backup planning: the agency helps you plan for emergencies or days you cannot give care.

Who can be an SFC caregiver?

Adult children, siblings, grandchildren, other relatives and legal guardians can be SFC caregivers when they live in the same home as the participant. Spouses and parents of minor children, whom the state calls legally responsible individuals, can also be paid through SFC when program rules are met. Our page on the paid family caregiver program explains how SFC works with Vital step by step.

What is attendant care?

Attendant care is a Medicaid waiver service that pays a trained attendant by the hour to help with daily activities such as bathing, dressing, meals and getting around the home.

The attendant is employed or contracted by a licensed agency. The number of hours is set in the participant’s service plan based on assessed needs. Because there is no live-in rule, attendant care works well when the family caregiver lives nearby but not in the same house, or when the person needs help at set times of day.

• Hourly pay: the attendant is paid for the hours approved in the service plan.
• Flexible location: the caregiver does not have to live with the participant.
• Agency employment: the agency handles payroll, training and supervision.
• One rate for all needs: the hourly rate does not change with the level of care.

Who can be paid for attendant care?

Adult children, siblings, other relatives and friends can be hired as attendants through an agency. Under the Health and Wellness waiver, relatives and legal guardians of adults can each be paid for up to 40 hours a week of attendant care. Additional approved hours are covered by other agency staff.

Can a spouse or parent be paid under either program?

A spouse or the parent of a minor child is usually paid through SFC, not attendant care.

Indiana stopped allowing spouses to provide attendant care in July 2024, as FSSA’s relationship guidance for paid family caregivers explains. Since January 1, 2026, a narrow exception lets spouses and parents of minors be paid for attendant care under an extraordinary care allowance. It applies only when the person has intensive nursing needs, such as ventilator or tracheostomy care, and all legally responsible caregivers together are limited to 40 hours a week. It cannot be used with self-directed care, and behavioral needs alone do not qualify.

For most married couples, SFC is the practical route. We explain the rules in more detail in our guide on how to get paid to care for a spouse in Indiana.

How much does each program pay?

On pay, structured family caregiving vs attendant care differs in one key way: SFC pays a daily rate that rises with the level of care. Attendant care pays an hourly rate times the approved hours.

Indiana sets both rates, and the state has adjusted them more than once since 2024. In SFC, the agency receives the daily rate and passes most of it to the caregiver. The share it keeps pays for the coach, nurse visits, training and respite. In attendant care, the agency pays the attendant an hourly wage for each approved hour.

Which pays more depends on your situation. A live-in caregiver for someone with high needs often does better with SFC because the daily rate covers the whole day. A relative who can only help a few hours a day may do better with attendant care. We share current rates during a free call, because they change and every plan is different.

A note on taxes: under IRS guidance on Medicaid waiver payments, many live-in caregivers can exclude these payments from federal income. Caregivers who do not live with the participant usually cannot. Check with a tax professional about your own case.

Which one is right for your family?

When you weigh structured family caregiving vs attendant care, choose SFC if you live with your loved one and give care throughout the day. Choose attendant care if you live apart or help at set times.

• You live together and help day and night: SFC is usually the better fit.
• You are the spouse: SFC is almost always the route, unless your spouse has intensive nursing needs.
• You live across town: attendant care lets you be paid without moving in.
• Several family members want to share care: attendant care can split hours between relatives. SFC has one principal caregiver.
• You want coaching and nurse support: SFC builds this into the program.

How do you apply for SFC or attendant care in Indiana?

Whichever side of structured family caregiving vs attendant care you choose, both services start with the same Medicaid waiver application. The service you choose is added to the service plan.

1. Make sure your loved one has Indiana Medicaid or is applying for it.
2. Apply for the right waiver. PathWays for Aging serves people 60 and older, and the Health and Wellness Waiver serves people 59 and younger.
3. Complete the level of care assessment to show a nursing facility level of care.
4. Tell your care manager or health plan which service you want and which agency you choose.
5. The agency completes its own intake, training and paperwork, and paid care begins once the service plan is approved.

Common questions about structured family caregiving vs attendant care

Can we switch from attendant care to SFC later?

Yes. If your living situation changes, ask your care manager to update the service plan. The agency can help with the paperwork.

Is either program medical care?

No. Both are non-medical services. Skilled nursing and therapy are covered separately. See our guide to home care vs home health in Indiana for the difference.

Do I need caregiving experience?

No. SFC caregivers get training and ongoing coaching, and agencies train attendants before they start.

Conclusion

When you compare structured family caregiving vs attendant care, start with one question: do you live with the person you care for? SFC pays a live-in caregiver a daily rate and adds a coach and nurse for support. Attendant care pays an hourly rate and works when you live apart or several relatives share the care. Spouses and parents of minors are generally limited to SFC, except in rare extraordinary care cases. Vital Home Care provides home care in Indianapolis and paid family caregiving across Fishers, Carmel, Noblesville, Westfield, Greenwood, Zionsville, Avon and Plainfield, and we can help you pick the option that fits.