I would not advise paying in cash. Checks should be used and a 1099 should be issued at year's end to the sitter. Payment in cash is sometimes a request among sitters and therefore may not appear to count as income and self employment taxes. If your parents require Medicaid assistance for nursing home care in the future (within 60 months), such checks from their account(s) when no 1099 is issued will appear to Medicaid as gifts and will incur a penalty. Contact a local attorney that specializes in elder law for further consultation and clarification.