Caregiver Compensation Agreements Benefit Elders AND Caregivers
September 1, 2010
Caring for an aging relative is hard work. Many of the people who serve as caregivers admit that they often feel as if they have two jobs—their day job, and the part-to-full-time job of caregiver. If you consider that in our fast-paced society time is money, then most of these caregivers are not only giving up their time, but also their potential income. Caregivers need to know that it doesn’t have to be this way; caregivers can be compensated according to mutually agreed upon terms of a Caregiver Agreement, or Personal-Care Contract.
Elder law attorneys have known about Caregiver Agreements for a long time, but a recent article in the Wall Street Journal will hopefully raise caregiver awareness of this useful contract; especially, as the article mentions, given the “still-fragile” state of the economy. A Caregiver (or Employment) Agreement “should document a caregiver’s responsibilities and hours and set a rate of pay that’s in line with local practices. Both the caregiver and care recipient should sign the contract and disclose it to the rest of the family.”
An agreement of this sort can be useful not only for the care-giver and the cared-for; it also comes in handy if you think you may need to rely on Medi-Cal (known as Medicaid in other states) to cover nursing home costs sometime in the near future.
According to the article, “Before Medicaid will pick up the tab for nursing-home costs, it requires applicants to recoup certain payments made to relatives over the previous five years — and use the money to pay the nursing home… But if payments to relatives are made under the terms of a written employment agreement, often called a personal-care contract, the law allows it.” While the recoupmement term is different in California, the point is well-taken.
But remember, “to pass muster with Medicaid, it’s important to have such a contract in place before the services are rendered.”
This is why it is extremely important to talk to an attorney who is well-versed in elder law and Caregiver Agreements before any contracts are signed or money changes hands.
Will Long-Term Care Living Arrangements Prevent You from Leaving an Inheritance?
August 16, 2010
In our last post we wrote about what matters most when choosing a long-term care living situation, suggesting that it’s not always the place that matters most, but the mind-set of the elderly person who will be living there, and how involved that person is in the decision-making process. However, this does not mean that the quality of each living place doesn’t matter at all. In fact, according to the Wall Street Journal great care should still be taken when selecting a long-term care living situation… especially if you’re considering a Continuing Care Retirement Community (CCRC).
If you are considering a CCRC for yourself or an elderly loved one, you may want to read this article in the WSJ, which mentions that although more and more older Americans are drawn to the benefits offered by a Continuing Care Retirement Community, those benefits “often come at a steep price and ‘considerable risk.’”
The article goes on to mention that “So-called CCRCs—which typically offer fine dining, health clubs and on-site long-term care—have grown in popularity along with the aging of the population, particularly among the upper-middle class and affluent,” but that “the economic downturn is making it tougher for potential new residents to sell their existing homes and fill openings in new and expanded communities, which are generally regulated by state governments. As a result, low occupancy levels are challenging the industry’s financial models.”
We mention this because many of our clients are at a time in their lives when they or their elderly parents are looking into long-term care living situations, and we see how difficult it is to sort through all the choices and find a place that fits. Not only is quality of life an important factor (maybe the most important factor), but for many people the cost of the place they choose may mean the difference between leaving their children an inheritance and dying penniless.
We urge any of our readers who are in the market for long-term care living arrangements to look carefully at all their options; ask questions, do the research, and don’t be afraid to ask for help or a second opinion.
What Matters Most When Choosing a Long-Term Care Living Situation?
August 11, 2010
Elderly people and their families can spend months—sometimes years—looking for the perfect long-term care living arrangement. Most families try to avoid the nursing home option to the very end, believing that assisted living or small residential care homes provide a better quality of life. But is this fact or fiction?
Paula Span in her article on the NY Times New Old Age Blog suggests that “what variety of facility an older person lives in may matter less than we’ve assumed. And that the characteristics adult children look for when they begin the search aren’t necessarily what makes a difference to the people who move in.”
Span’s suggestion is based on (among other things) a recent study published in The Journal of Applied Gerontology, which found that among 150 Connecticut residents living in various long-term care situations (assisted living, nursing homes, residential care homes), the type of living situation itself made little difference in the resident’s emotional well-being. Rather, happiness and contentment was more a matter of “the characteristics of the specific environment they’re in, combined with their own personal characteristics — how healthy they feel they are, their age and marital status.”
Logically enough, a resident of a long-term care facility of any kind is more likely to report satisfaction and comfort if they had a hand in choosing their living situation, if they were part of the decision making process. In fact, it is the process itself—researching options, visiting facilities, considering current and future social and physical needs and how they will be met—that is the beginning of acclimatization.
Whatever your choice, you’ll want to know that you have options for paying for your long-term care living situation. Medicare.gov has published a chart summarizing and comparing the various options for long-term care financing. We find that the chart falls short, however, in the way it outlines the features of “Medicaid”, called Medi-Cal in California, as it does not address planning options that are currently available to qualify for the subsidy and protect your home and other assets. For more on this topic, see our “Consumer’s Guide to Medi-Cal Planning”.
The Next Step In Elderly Home Care
August 6, 2010
Many adult children of an aging parent get to a point in their parent’s care where they feel they have only two options: move their parent in with them so that they (or their spouse) can provide around-the-clock care, or move their parent into a nursing home. Reaching this point can be a very emotional time for both parent and child; with the parent feeling anger and frustration at the loss of independence, and the child feeling that they have somehow failed their parent.
Improving technology may never be able to remove the need for this decision entirely, but it may be able to postpone it a little. A recent article in the New York Times describes some new technologies that help adult children monitor their aging parent right inside the home, therefore removing the need (or at least delaying the need) for physical around-the-clock supervision.
One of the new technologies mentioned in the article (called GrandCare) “allows families to place movement sensors throughout a house. Information — about when doors were opened, what time a person got into and out of bed, whether there’s been any movement in a room for a certain time period — is sent out via e-mail, text message or voice mail.” It is this kind of in-home monitoring that may allow seniors to remain in their homes longer.
Some seniors have reservations about these new technologies, however, something that they consider to be an invasion of privacy. Nancy Schlossberg is quoted in the article as comparing these new technologies to nanny-cams, “Big Brother is watching you — there’s something about it that’s very offensive.” Some seniors may agree with her, but if it comes down to a choice between technological monitoring or moving to a nursing home they may find that “Big Brother” is the lesser of two evils.
Falling Through the Cracks
July 23, 2010
Our country may be facing a simultaneous growth and recession… unfortunately, according to journalist John Leland, the two seem to be at odds. What we are referring to is the growth of the elderly population and the recession of funds available to help this aging community pay for the care they need.
The economic downturn of the past few years has hit the elderly with a double-whammy. Many of them lost close to all of their savings when the stock market bottomed out, and now budget cuts to state-funded home-care services threaten to force many of them out of their homes and into hospitals or nursing facilities.
“’I’m not getting a cost-of-living adjustment, and now I’m not getting food,’ said Joyce Plennert, 83, who is on a waiting list for Meals on Wheels in Palatine, Ill. ‘Now I’m worried my home services will be cut. Without that, I’d be in a nursing home, if I could find one with room.’”
According to the above-mentioned NY Times article, a number of states have already made cuts to home-care services, including Alabama, Arizona, California, Colorado, Florida, Kansas, Mississippi, Missouri, Nevada, New Jersey, New York and Texas. “The situation is grim, and it’s safe to say that present trends are expected to continue,”
These budget cuts impact more than just senior citizens—they affect the professional caregivers and home aides who lose their jobs when state programs are cancelled, as well as the families of the elderly. When these seniors lose their ability to live at home it’s their families who will have to pick up the slack either by contributing to the costs of care or more often by becoming the caregivers themselves.
If you or a loved one is facing a loss of benefits due to budget cuts don’t be afraid to explore your options. Geriatric care managers can help families through confusing times, and other advisors such as elder lawyers, estate planners, financial planners and others can offer valuable advice when creating your plan for the future.
Is Medicare Headed for a Crisis?
July 17, 2010
If you are among the wave of Baby Boomers about to begin enrolling in Medicare you may be in for some tough times. Recent stories in Financial-Planning.com and USA Today report that the number of doctors refusing new Medicare patients is reaching a record high—and it’s not expected to improve anytime soon, especially since last month “Congress failed to stop an automatic 21% cut in payments that doctors already regard as too low.” Doctors simply feel they cannot afford to treat Medicare patients anymore.
Here are some of the distressing details you’ll find in the USA Today article:
- The American Academy of Family Physicians says 13% of respondents didn’t participate in Medicare last year, up from 8% in 2008 and 6% in 2004.
- The American Osteopathic Association says 15% of its members don’t participate in Medicare and 19% don’t accept new Medicare patients. If the cut is not reversed, it says, the numbers will double.
- The American Medical Association says 17% of more than 9,000 doctors surveyed restrict the number of Medicare patients in their practice. Among primary care physicians, the rate is 31%.
What this means for seniors is that although you may be able to qualify for Medicare you may not necessarily be able to count on it. But you can take action to ensure that a crisis for Medicare doesn’t mean a crisis for you. Your financial advisor or estate planner can help you determine what options you have regarding long-term care, asset protection, and even using alternate strategies in conjunction with Medicare. For example: it may be possible to re-design your trust and estate plan to facilitate access to a nursing home subsidy from the government in the event of future need. See our articles, “Spousal Protection Planning: Creating A Plan for Each Other”, and “Developing a Plan for An Incapacitated Spouse“
The days of being able to count on the government to take care of you in your old age may be coming to an end. It’s time to make your own luck and plan for your own future. Our firm may be able to help.
How to Tell If Your Loved One Needs In-Home Care (And What to Do About It)
July 12, 2010
It’s not always easy to know—or to admit—that a loved one is unable to fully care for themselves anymore. The signs develop gradually, and aren’t always easy to pick up on if you see your loved one on a daily or weekly basis. Often it’s the son or daughter who has moved away and comes home for a visit who notices (what is to them) the “sudden decline” in mom or dad’s ability to perform the most basic of tasks.
If you suspect (but aren’t sure) that your loved one may need in-home care, there are a few signs you can look for to help you decide. The “Right at Home” website has an article listing ten signs that home care could benefit your loved one, and Responsive Home Health has a 3 page questionnaire to help you determine whether or not mom or dad is still just fine at home alone. The signs you’ll want to look for include:
- Inability to prepare own meals
- Frequent falls
- Inability to keep up with basic hygiene such as bathing and brushing teeth
- Depression
- Sudden isolation
- And more…
Once you know for certain that your loved one needs in-home care you’ll have to face the sometimes daunting task of finding (and figuring out how to pay for) the right service. A recent article in the Wall Street Journal provides some excellent information on how to find the right kind and level of care for your loved one. For example: does your parent need just a little bit of help with cooking and housekeeping, or is more comprehensive care (such as daily help with bathing, grooming, mobility and medication) necessary? The level of care your loved one needs, as well as what financial resources you have available, will help narrow down your choice of agency or aide.
Always remember, you don’t have to go through any of this alone. There are a number of dedicated professionals who can help you along the way—including our office. Don’t hesitate to seek out help from these professionals. Remember, all of us are here to help.
Should A Bank Help You Care for Your Elderly Parents?
July 8, 2010
The influential Baby Boomer generation is aging, which means more and more of them are taking on the responsibility of caring for their elderly parents, and the Boomers are beginning to face up to the fact that they will need caregiving themselves in the not-so-distant future.
Large banks are not immune to this trend—and the potential to increase their client base by offering financial elder-care services. The question is, how effective can a bank be at helping you care for your elderly relatives?
According to this article in the Wall Street Journal banks can be helpful with certain financial issues such as helping to “sort out medical bills, hire in-home care or even manage the sale of a home.” Some of the larger banks are even beginning to offer more in-depth services such as “estate planning and setting up powers of attorney… crisis management (triggered, say, by a broken hip or a car accident); health and home assessments; Medicare-coverage selection and claims management; and evaluating retirement communities and long-term-care facilities.”
All of this sounds great, but before you get too excited our firm would like to caution you to be as careful about hiring a bank to do your estate or elder care planning as you would be with engaging any other attorney or professional advisor. After all, as the WSJ article says, “banks and trust companies aren’t doing this solely out of the goodness of their hearts. Providing extra services targeted at the elderly and their family caregivers can bump up the asset-management fees that clients pay each year. . . [or] persuade a few clients to move assets to an institution to meet its minimum deposit requirements.”
So we urge you, before you jump into anything—whether it be with a bank, an attorney, a CPA or other important advisor—do the research and ask all the questions you need to ask in order to find out whether this advisor truly knows their stuff; knows the ins and outs of the law and the care-giving industry; and most important of all, make sure the person or institution you hire will be working for you, will be your advocate and your ally during difficult and confusing times. Further, to the extent your loved one needs legal services to plan for incapacity, to implement asset preservation strategies, to design an estate plan or to plan for Medi-Cal or other public benefits, our strong recommendation is to first seek the advice and guidance of an Elder Law attorney knowledgeable in the field. In our opinion, acquiring these skills takes years of study, practice and experience.
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