The part most families never reach.
When a contractor comes home injured, the care usually falls to whoever is there. A wife. A husband. A grown son who moved back in. The days fill with bathing, dressing, medications, appointments, and the hundred small things nobody writes down.
Under the Defense Base Act, when a treating physician prescribes attendant care, that care is owed. And the person providing it does not have to be a stranger. A family member can frequently be employed through a licensed home care agency to do the work they are already doing.
What being employed actually means here.
This is not a check from the insurance company for being a spouse. It is a job, with the structure a job has:
- You are trained for the tasks in the care plan — safe transfers, skin checks, what to watch for and when to escalate.
- You are supervised by a nurse, who builds the plan of care and stays responsible for it.
- You are on payroll, with hours documented the way any employee’s hours are documented.
The training is not a formality. Most family caregivers have been improvising for years, and a transfer done the wrong way is how a spouse ends up injured too.
Why it goes through an agency.
The Act pays for prescribed, authorized care. An agency is what turns care into something that can be authorized and billed correctly: a nurse writes the plan, hours are recorded against it, and the carrier receives documentation that matches what was authorized.
Care that is not documented against a written authorization is care nobody has to pay for. That is the whole reason the paperwork exists, and it is the reason we staff only on written authorization. The complete Defense Base Act guide →
What has to happen first.
- The claim is accepted and medical benefits are open.
- The treating physician prescribes attendant care, naming the tasks and the hours.
- The carrier authorizes it in writing.
- The agency hires, trains, and supervises the caregiver — who can be the family member.
Step two is where most families are stuck without knowing it. Doctors write what they are asked to write. If nobody has asked your physician to describe the daily help you need, the prescription usually says something general, and general prescriptions do not turn into authorized hours.
What it does not change.
Being paid does not make you a professional caregiver instead of a spouse. It does not mean you do it alone, and it does not mean you are on duty every hour of the day. Many families use a mix: the family member takes the hours that need someone familiar, and agency staff take the rest.
It also does not change who is in charge of the care plan. A nurse is responsible for it, which is a relief to most families rather than an imposition. You stop guessing.
The honest limits.
Not every case supports it. The care has to be prescribed, and the carrier has to authorize it. Some carriers authorize fewer hours than the physician asked for. Some cases involve skilled nursing that a family member is not the right person to provide.
We will tell you which of those you are looking at before anyone signs anything. If the answer is no, you should hear it from a nurse early, not discover it three months in.
Where Alara fits.
In Las Vegas and Southern Nevada we hire, train, and supervise family caregivers for DBA patients directly. Anywhere else in the country, benefit guidance is free — what your prescription should say, what the authorization should cover, and what to ask.
If you are not certain the Defense Base Act is your program, or whether another one also applies, start with a few questions about your work and your care.
Common questions.
Can my spouse be paid to take care of me under the Defense Base Act?
Often, yes. When attendant care is prescribed, a family member can frequently be employed through a licensed home care agency — trained, supervised by a nurse, and paid for the care they already provide.
Does the insurance company pay my family member directly?
Typically the care is delivered and billed through a licensed agency that employs the family member, so that a nurse writes the plan of care and the hours are documented against the written authorization.
Do I need training to be paid as a family caregiver?
Yes, and it is worth having. The agency trains the caregiver for the tasks in the plan of care, including safe transfers and what to watch for, and a nurse supervises the care.
What has to happen before a family member can be paid?
The claim must be accepted with medical benefits open, the treating physician must prescribe attendant care naming the tasks and hours, and the carrier must authorize it in writing.
Sources: U.S. Department of Labor, Longshore and Defense Base Act.