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My sister-in-law lives at home with her mother and is receiving Medicare assistance for mental deficiency in the home.

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tacy is correct. You need to establish a separate contract with the agency for the mother's care. They evaluate, you sign, you pay.
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No, the caregiver is paid to help your SIL. Liability wise, an agency will not allow the aide to help your MIL due to a potential fall or injury and they will not assume the risk.
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