Sibieanne Martinez helps her husband Antonio Martinez get his shoes on. Spouses who provide basic health-care services to ill or disabled partners can now be compensated through AHCCCS under a program that went into effect in October. Antonio is disabled from a severe strain of valley fever that got into his spine and left him debilitated.

A.E. Araiza / arizona daily star

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Arizona families now have another option for taking care of ill loved ones.

Just in time for National Family Caregivers Month, spouses can now be paid to provide basic health care for husbands or wives in the Arizona Long Term Care System, the state's Medicaid program for the elderly and disabled.

The change, which took effect in October after the state received a waiver from the federal government, is already making a difference in the lives of Pima County residents Sibieanne and Antonio Martinez.

"No one can love your family like you can and no one is invested in your family like you are," said Sibieanne, 52.

She found herself Antonio's full-time caregiver when he went through a vicious bout with valley fever in late 2005. The infection triggered pneumonia, then spread from his lungs to his spine, requiring surgery. Doctors had to induce a coma to help Antonio's ravaged body heal.

He had to learn again how to speak, how to swallow, how to walk. He continues to have trouble breathing. At 55, he walks with a cane. Bending over is a marathon event.

Sibieanne, who has a background in early child care, was plunged suddenly into a role she never thought she'd have to play for her strapping, "he-man" soulmate who previously worked as a security guard.

Although he lost 80 pounds over his three-month ordeal, she still found herself hoisting a 6-foot-1 man weighing 180 pounds.

"I was sent home without a clue really about how to care for him," she said. "I just used to pray all the time for God to please help me."

There have been a host of famous spouses who stood by their partners during draining times: Dana Reeve, who cared for her actor husband, Christopher, paralyzed in a horseback riding accident; Nancy Reagan, who cared for the former president as Alzheimer's disease gradually stole him; and Meredith Vieira, whose husband has multiple sclerosis.

But while the emotional trauma may be comparable, famous people typically don't share the same financial realities as real-world mortals. In the Martinezes' case, Sibieanne pared back her hours and worked from home as much as she could.

With Antonio no longer drawing a salary and with her own hours cut, she began relying more heavily on credit cards. She's behind in her house payment but things have started to stabilize now that Antonio gets disability payments and she is compensated for 14.5 hours each week for the care she gives her husband. It's not much, she said, but the $200 or so she gets every few weeks helps pay the utility bills.

"There are a lot of people in our situation or in worse situations," she said. "I think it's great that this is available for families because it's crazy to pay a stranger to take care of your loved one if you can do it yourself."

That's the idea behind the change, said Rainey Daye Holloway, a spokeswoman for the Arizona Health Care Cost Containment System, or AHCCCS, the state's medical program for the indigent population.

Holloway said that when health officials continued to hear from frustrated spouses trying to care for their ailing partners while holding down a regular job, they pushed to allow compensation for basic care such as bathing, meal preparation and household chores. "It's a win-win situation," Holloway said.

First of all, she noted, it costs less money to care for someone in-home than in a facility. Secondly, she added, studies show people respond better to treatment in their own homes. Finally, with the state facing a critical shortage in health-care workers, it's a clever way to alleviate the strain on the system.

There are some controls built in. People can't just declare that they want to be paid to take care of a spouse. Spouses must be members of the state's long-term-care system and have to agree that they want their partners as caregivers.

The caregiver has to go through some formal training on basic services, covering areas from CPR to getting a person in and out of bed safely. A case manager has to sign off on the plan, and compensation is restricted to 40 hours a week.

Compensation is based on local caregiving rates, which typically hover around $10 an hour.

Although it is too early to say how many people will sign up for the program change, there are 10,000 elderly or physically disabled people in the state who are getting home and community-based services.

Surprise resident Sandy Ritter, 50, is caring for her husband, Jim, who was paralyzed in a logging accident years ago. "Before, when someone else was caring for Jim in the morning, we found that it was a real intrusion on our privacy. I always felt a little resentful of it," she said. "We have an extremely normal life together, but that took our normalcy away. Our time is our time now."

The financial situation also got better. Although she was doing some odd jobs from home to help make ends meet, the program change occurred just as she was gearing up to re-enter the job market. "He literally would almost panic thinking about that happening, so this is a really important thing for the person getting care."

Families considering this option should think carefully about the implications, said Susan Blommer, a caregiver specialist at the Pima Council on Aging. Blommer said caregivers too often try to do it all.

"They've taken such good care of their spouse but at an expense of their own health — they miss doctors' appointments, they don't get exercise, they aren't eating well."

Caregivers should not feel guilty about asking for help, either through a formal respite program or by asking grown children or even neighbors to step in, Blommer said. They should also be prepared for the emotional toll that caregiving can take, Blommer added, recommending they try to carve out some time to visit one of the many support groups in town.

Sibieanne Martinez, who boasts she comes from "strong stock," found out the hard way that sheer strength isn't enough. The stress and long hours contributed to spikes in her diabetes.

And then there were the emotional changes. Antonio, who is still dealing with memory loss and cognitive deficits, has to work to stave off depression and frustration surrounding his reduced independence.

Their children and six grandchildren, with another on the way, give them both strength.

Sibieanne figures she's earned her vanity plate. It reads "chispita" — Spanish for "spark."