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My son has been living with Dad for a few years. Dad does not give son a check, but pays for things (like movies, restaurants), Son in turn, drives Dad to doctors, makes meals, cleans up, keeps him company. How will this affect Medicaid spend down? Should Dad be writing checks to son in stead? Do we need a contract of some sort? Thanks in advance.

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Having a contract may be a good thing if the amount is substantial. It needn't be complicated, however if the amount is quite large you may want to consult an attorney for a one-time visit. If it's just a small amount there may not be an issue, but I believe in covering the bases so that there aren't nasty surprises when you get to the Medicaid step.
Your son is earning this money in a very respectable way. Your dad would have to pay someone else to provide these services. So, why not make it a legal document so no one needs to worry. An attorney would know the right words to use.
Take care,
Carol
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