Shirley Hirsch's mother, who suffered from Alzheimer's disease, lived for three years with Annie, a private caregiver who bathed her, cooked her meals and did housework. But when Ms. Hirsch and her four sisters moved their mom into a nursing home in 2000, they grappled with an often-awkward decision: how to give Annie the proper thank you.

"There was a lot of discussion on how to compensate Annie," says Ms. Hirsch, of Freehold, N.J. "She really became part of the family."

Ms. Hirsch says she and her siblings ultimately took Annie to dinner, and presented her with a Seiko gold watch and a week's additional salary, or about $500. "We wanted to give her a monetary gift," Ms. Hirsch recalls, "but we also wanted to give her something to remember us by."

When a caregiver spends three, five or even 10 years watching an elderly parent or a child, and then their services are no longer required, it's hard to know what sort of parting gift or bonus is appropriate, much less expected. Many caregivers make less than $15 or even $10 an hour, for a job that entails long hours and emotional distress.

But it's often more than that. Caregivers can become close friends to the person they are taking care of -- sometimes the only friend the person has for a long time. Families also may feel guilty about asking a caregiver to do something that the family isn't willing, or able, to do.

As a result, many families feel they should give something extra to compensate the caregivers for their efforts.

But what?

For certain, there is no blanket etiquette, such as tipping 15% or 20% for good service at a restaurant. The decision to provide a gift often becomes a last-minute decision with many shades of gray, such as the family or care recipient's relationship with the caregiver, the tenure of service and the family's financial situation. Some families don't provide a gift at all.

"It can be very, very tricky, because each relationship is so different," says Donna Schempp, program director for the Family Caregiver Alliance, a nonprofit in San Francisco devoted to families and friends providing long-term care at home. "It depends, I think, on how integrated that person has become with your family."

Most families with paid caregivers don't provide substantial farewell gifts unless the caregiver worked for at least a few years and provided extraordinary service, Ms. Schempp adds. In her experience, the most common gift is money, such as one week's or one month's salary. However, some families choose gift certificates or, in rare situations where the caregiver has become like family, a bequest from the care recipient's estate.

What follows are some things to consider when deciding how much to give a departing caregiver.

HOW THEY WERE HIRED

Complicating the decision for care recipients and their families is that there are all sorts of caregiving arrangements, sometimes with more than one caregiver.

Roughly two-thirds of professional elderly caregivers are hired privately by families, Ms. Schempp estimates. But an increasing number are contracted through private agencies, which sometimes restrict the types and value of gifts their caregivers can accept. So it's usually a good idea to check with an agency in advance, Ms. Schempp says.

John Major, owner of Right at Home, a home-care franchise in Chatham, N.J., says his office doesn't let employees accept gifts from their patients, in order to comply with elder-abuse laws and avoid potential misgivings about the gift. Instead, Mr. Major gives bonuses to some caregivers after they complete multiyear assignments with a client "where there's a very close relationship and the caregiver has gone above and beyond." The bonuses are usually about three weeks' salary, he says.

Visiting Angels, a home-care franchise with 275 offices nationwide, allows gifts to caregivers, but asks that they be made through the local office. "That way, there is no misunderstanding and no misrepresentation," says Patricia Drea, the company's vice president. She says about 10% of clients give a gift after an assignment ends.

Caregivers hired privately by families, however, are a different story. Many times they expect more payback for their work, because they may be more entwined with family affairs. Some may not receive traditional benefits such as health insurance.

A caregiver who has spent years with one family may even expect a piece of the estate. That obviously requires more discussion among family members as to what's the right gift. Moreover, if the care recipient is still alive when the caregiving ends, it could be a while before the caregiver receives his or her gift.

LENGTH OF EMPLOYMENT

How long the caregiver has worked for a family -- and how often -- is another big factor in the decision of what's appropriate to give.

"If somebody has been with you five years versus five weeks, there's probably going to be a difference in how you feel about them," says Liz de Nesnera, founder of CaregiverCommunity.com, an online community for caregivers.

Ms. de Nesnera lives with her mother, who has dementia, but pays two professional caregivers. One has worked with her for nine years and stays with her mom on weekdays while she works; the other spends overnights with her mother on an as-needed basis. Ms. de Nesnera says she hopes to give the longtime caregiver at least one month's salary as a departing bonus. The other one, who has worked for her sporadically for a few years, will likely get a smaller cash gift.

Moreover, some caregivers live with the person they're taking care of while others drop by daily or less often. Live-in caregivers particularly can have very intimate relationships with the person they're taking care of.

HOW MUCH YOU CAN AFFORD

The family's financial situation plays a big role in the decision. Some families can easily afford an extra month's salary for the caregiver, but it's a stretch for others.

Sometimes a caregiver's salary comes out of the trust fund or bank account of the person receiving care, but sometimes it's the family scraping together money for the care. "There's no mathematical formula," Ms. de Nesnera says. "You've just got to weigh how you feel about the person with what you have to give."

Ernestine Woods, a private caregiver in Hayward, Calif., specializing in home-based hospice care, says she has received two substantial parting gifts since starting her career in the early 1980s. One doctor's family gave her a week's salary and their mother's late-model Volvo when the mother, who suffered from Alzheimer's, moved out of state to be closer to her children. Another woman gave her $500 after her mother moved into a nursing home and her help was no longer needed. But Ms. Woods, who usually makes about $16 an hour, says it's more common that families give her a thank-you card or a small gift.

"Usually when they do [provide a gift] it's when they're in a position financially to do it," she says. "Some people might want to, but they can't" afford it.

WHEN IT'S FRIENDS OR FAMILY

About 80% of long-term care of Americans over age 50 is provided by a friend or family member. And when it's a relative or friend instead of a professional taking care of a loved one, thank-you gifts and bonuses aren't always appropriate or welcome, says Suzanne Mintz, president of the National Family Caregivers Association.

Family caregivers, she says, would generally rather receive help while they're providing care than a token gift afterward. That might mean relieving them of their duties for nights, weekends or vacations, or providing extra money to cover the considerable costs of taking care of a sick or disabled person at home. If family caregivers receive no help and then receive a gift afterward, "it's a slap in the face," Ms. Mintz says.

While family caregivers often aren't paid salary as a professional would be, there are other ways to pay them back for their sacrifice, says James Lange, a Pittsburgh estate lawyer. Some families, for instance, give the caregiver of Mom or Dad a larger chunk of the estate. But it's best that the siblings and other heirs discuss this in advance, so nobody gets angry after the parent dies. "An unspoken expectation of who's going to be left what can lead to some family fighting," Mr. Lange says.

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