Often when I advise a client they need to enter into a caregiver agreement with a familiy member that is caring for them they balk at the idea.  I can understand why!  Why do familiy members need a contract for a child to care for an aging parent?  Yet months or years later when the elder requires long term care in a nursing home, the inevitable question is: "Sonny boy has been taking care of momma for years, can we pay him anything as part of the medicaid spenddown?"

And the answer is No.  You can only pay somenone for services they are presently providing and will provide in the future.  You cannot go back and pay after the fact. 

So, if you are caring for an aging relative, a caregiver agreement is a prudent idea.