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Paid Family Caregiving in Colorado

May 30, 2023

Family Connections with Pediatrics blog 

The healthcare workforce is in crisis, and that is especially true for pediatric home healthcare. There is a shortage of home healthcare workers because of poor pay, lack of training, and hiring challenges. This often translates into care that is not reliable or of good quality, causing families to take on unpaid care roles, job loss, and stress.1-5 In this month’s Pediatrics an article, “Paid Family Caregiving for Children with Medical Complexity,” by Brittan et al studies a model of paying families to provide home healthcare in Colorado (10.1542/peds.2022-060198).

What is the family CNA model in Colorado? 

Colorado built a model, funded by Medicaid, to address the lack of reliable, quality home care.  They allow parents and/or relatives to be employed as certified nursing assistants (CNA) for their own children with medically complexity. Family members are trained and licensed as CNAs and then hired by a home health agency to provide care. The article reports that as of 2021 almost 90% of pediatric home CNA care is provided by family caregivers. 

How did they study family CNA in Colorado? 

The authors interviewed English and Spanish speaking family CNAs, primary care providers, and home health administrators. They asked about the benefits, drawbacks, and effects of the program on the child and family quality of life. 

What did they learn about the family CNA program? 

The article outlines and discusses 4 key benefits: 

  • helps fulfill desire to be a good parent 
  • provides stable and high-quality home healthcare 
  • benefits the child’s health and wellbeing 
  • helps with family financial stability

The article also outlines and discusses some drawbacks and ways to improve the program: 

  • family CNAs can have burnout 
  • difficult access for some community members, such as those in rural areas or those needing language access, because of a lack of appropriate training sites and a complex process to enroll 
  • extra training requirements, such as focus on elder care or varied time of training 
  • people don’t know about the program 

Overall, the study found that the family CNA program is very important and helpful, and yet there are ways to improve it. 

What can you do with this article? 

  1. If you would like to learn more about this program, read more from the Colorado Department of Human Services or in this Pediatrics Family Partnerships article. 
  2. If you would like to learn about some paid family caregiving models in other states, check out this National Association of State Health Policy (NASHP) brief. 
  3. If you want to know if such a program is exists in your state or is being built in your state, reach out to your state Family-to-Family Health Information Center or ask your child’s doctor. 


  1. Foster CC, Agrawal RK, Davis MM. Home Health Care For Children With Medical Complexity: Workforce Gaps, Policy, And Future Directions. Health Aff (Millwood). 2019;38:987-93 
  2. Foster CC, Chorniy A, Kwon S, Kan K, Heard-Garris N, Davis MM. Children With Special Health Care Needs and Forgone Family Employment. Pediatrics. 2021;148 
  3. Boss RD, Raisanen JC, Detwiler K, et al. Lived Experience of Pediatric Home Health Care Among Families of Children With Medical Complexity. Clin Pediatr (Phila). 2020;59:178-87 
  4. LeGrow K, Cohen E, Espin S. Relational Aspects of Parent and Home Health Care Provider Care Practices for Children With Complex Care Needs Receiving Health Care Services in the Home: A Narrative Review. Acad Pediatr. 2022;22:196-202 
  5. Thomson J, Shah SS, Simmons JM, et al. Financial and Social Hardships in Families of Children with Medical Complexity. J Pediatr. 2016;172:187-93 e1 
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