Tri-Valley Adult Family Care (AFC) Program: A Paid Caregiving Option Through MassHealth (AFC)

What Is Adult Family Care (AFC) and How Is It Different?

Adult Family Care (AFC) is a MassHealth-funded program that provides an alternative to nursing home placement for elders and adults (16+) with disabilities who can no longer live alone. Instead of moving into an institutional setting, the participant lives with an approved caregiver who provides 24-hour support in a family home. Tri-Valley, Inc. administers the AFC program across its service area in Central Massachusetts.

AFC is structurally different from other in-home programs like the Frail Elder Waiver (FEW) or Consumer Directed Care. In those models, the participant remains in their own home and receives hourly visits from aides. AFC requires the participant to move into the caregiver's home, where the caregiver provides room, board, meals, and assistance with daily personal care. This 24-hour living arrangement makes AFC suitable for individuals who need more consistent support than hourly visits can provide but do not require the medical supervision of a skilled nursing facility.

For a broader understanding of where AFC fits in the care continuum, see our guide on Senior Care Options: Home Care, Assisted Living, or Nursing Home. For context on Tri-Valley's role as an Aging Services Access Point (ASAP), read What Is Tri-Valley Elder Services?.

How AFC Works: The Living Arrangement and Daily Support

The core of the AFC model is a shared household. A MassHealth-eligible participant moves into the home of an approved caregiver who provides:

• Room and board — a private or shared bedroom and access to common living spaces
• Meals — nutritious, prepared meals that accommodate dietary needs
• Assistance with daily personal care — help with bathing, dressing, toileting, transferring, and eating
• 24-hour supervision — the caregiver is present and available to respond to the participant's needs at any time
• Transportation to medical appointments and community activities, as needed

Tri-Valley carefully screens both participants and caregivers before matching them. The matching process considers the participant's care needs, personality, and preferences alongside the caregiver's skills, home environment, and interests. This is not a random placement — it is a deliberate pairing designed to create a stable, supportive household.

Once matched, an AFC nurse and Care Manager provide ongoing supervision, training, and support to the caregiver. This professional oversight ensures the participant's needs are met and the caregiver is not left isolated.

Who Is Eligible for AFC? Participant Requirements

To qualify for the AFC program, the participant must meet several criteria established by MassHealth and administered by Tri-Valley:

• Age 16 or older
• Enrolled in a MassHealth plan — Standard, CommonHealth, Senior Care Options (SCO), or One Care
• A medical diagnosis that requires daily personal care assistance
• Physician approval confirming the need for 24-hour support
• Not a danger to themselves or others

The program is designed for individuals who can no longer live alone safely but do not require the level of medical care provided in a skilled nursing facility. Common conditions that lead to AFC eligibility include advanced dementia, physical disabilities from stroke or injury, chronic conditions requiring daily monitoring, and developmental disabilities in adults.

Who Can Be a Paid Caregiver? (And Who Cannot)

One of the most attractive features of the AFC program is that family members can be paid for caregiving — but there are important exclusions. The following individuals are eligible to serve as paid caregivers:

• Relatives (excluding spouse, parent of a minor child, or legal guardian)
• Friends
• Non-related individuals

The exclusions exist for good reason. A spouse is already legally and financially responsible for their partner's care, so paying them through AFC would create a conflict of interest. Similarly, a parent of a minor child is already obligated to provide care, and a legal guardian has a fiduciary duty that cannot be compensated through this program.

For many family caregivers, the idea of being paid to care for a loved one can feel uncomfortable. There is often guilt attached to accepting money for something that feels like a natural family responsibility. But the AFC program is designed to recognize the real economic value of caregiving — the time, energy, and resources that a caregiver invests. The stipend is not a salary; it is compensation that allows a caregiver to reduce work hours, cover household expenses, and provide stable, long-term care without financial ruin.

If you are struggling with the emotional side of accepting help, our article on When Is It Time for In-Home Help? Recognizing the Signs and Overcoming Caregiver Guilt addresses these feelings directly.

Caregiver Screening and Approval Process

Becoming an approved AFC caregiver involves a thorough screening process designed to ensure the safety and well-being of the participant. The steps include:

• Reference checks — personal and professional references to verify character and reliability
• Criminal Offender Record Information (CORI) check — a background check required by MassHealth
• Home assessment — a Tri-Valley staff member visits the home to evaluate safety, accessibility, and suitability for the participant
• Matching process — the caregiver's skills, interests, and home environment are matched with a participant's needs and preferences

The home assessment is particularly important. The home must be safe, clean, and accessible for the participant. This may involve checking for fall hazards, ensuring adequate space for mobility aids, and verifying that the home can accommodate the participant's specific needs. Tri-Valley does not require a perfect home, but it must meet basic safety standards.

The matching process is not automatic. Tri-Valley considers the participant's medical needs, personality, daily routines, and preferences, then looks for a caregiver whose home environment, schedule, and caregiving style align. This deliberate matching reduces the risk of placement breakdown and increases the likelihood of a successful long-term arrangement.

Financial Details: Tax-Free Stipend and Paid Relief

The financial structure of the AFC program is one of its most compelling features for family caregivers. Caregivers receive a tax-free daily stipend that can total up to $18,000 per year. This stipend is not considered taxable income by the IRS, which means it does not affect Social Security benefits, Medicaid eligibility, or other income-based programs.

In addition to the stipend, caregivers receive two weeks of paid alternate care relief each year. This means that if the caregiver needs a vacation, is ill, or simply needs a break, Tri-Valley arranges for a qualified substitute caregiver and the original caregiver continues to receive their stipend during that time. This built-in respite is a critical feature that prevents caregiver burnout.

For a broader look at financial assistance options for family caregivers, including other MassHealth programs and tax credits, see our guide on The Hidden $7,200 Gap: A Practical Guide to Finding Financial Help When Caring for Aging Parents.

NCQA Accreditation: What It Means for Quality

In April 2025, Tri-Valley's Adult Family Care program earned a two-year accreditation from the National Committee for Quality Assurance (NCQA) in Case Management for Long-Term Services and Supports (LTSS). This accreditation is a significant quality marker. NCQA accreditation means that Tri-Valley's AFC program meets rigorous national standards for case management, including care coordination, participant assessment, care planning, and ongoing monitoring.

For caregivers and families, this accreditation provides reassurance that the program is well-managed, that participants receive appropriate oversight, and that the agency is committed to continuous quality improvement. It is not a guarantee of a perfect experience, but it signals that Tri-Valley has invested in the infrastructure and training necessary to run a professional, accountable program.

Ongoing Care Management and Support

Once a participant is placed, the relationship with Tri-Valley does not end. AFC nurses and Care Managers provide regular supervision, training, and support to caregivers. This ongoing professional involvement serves several purposes:

• Ensuring the participant's care needs are being met appropriately
• Providing training to the caregiver on specific care tasks (e.g., transferring, medication management, wound care)
• Monitoring the participant's health status and adjusting the care plan as needed
• Offering emotional support and connecting caregivers to additional resources
• Conducting regular home visits to assess safety and quality of care

This ongoing support is one of the key advantages of the AFC program over informal family caregiving. When a family member provides care without agency involvement, they are often isolated, untrained, and at high risk of burnout. The AFC structure ensures that caregivers have a professional team they can call on for guidance, training, and backup.

How to Get Started: Contacting Tri-Valley

If you are interested in the AFC program — either as a potential participant or as a caregiver — the first step is to contact Tri-Valley's Information & Resource (I&R) Department. This department serves as the single entry point for all Tri-Valley programs.

• Phone: 508-949-6640 or 1-800-286-6640 (toll-free within Massachusetts)
• Hours: Weekdays, 8:30 a.m. to 5:00 p.m.
• Online: Use the Information Request Form on Tri-Valley's website
• Email: [email protected]

Certified I&R Specialists will listen to your situation, answer your questions, and guide you through the next steps. They can explain the eligibility requirements in detail, help you determine whether AFC is the right option, and walk you through the application process.

The AFC program is one of the most underutilized resources in Massachusetts long-term care. For families in Central Massachusetts who have a MassHealth-eligible elder or disabled adult and the ability to provide a home, it offers a rare combination: a paid caregiving role that keeps a loved out of institutional care, supported by professional oversight and a tax-free stipend. It is not the right fit for every family, but for those who qualify, it can be transformative.