October 31, 2011 § Leave a comment
For many, the only option to receive regular in-home care is to rely on a family member to provide the needed services. Whether the reason is financial or personal preference, it is essential to have a contract between all parties involved if there are any type of wages paid to the caregiver.
The basic caregiver contract should be signed and dated by the parties involved and describe the services that are to be provided as well as the wage that will be paid to the caregiver. A well written contract will help eliminate confusion about what is expected from the caregiver and the care recipient. The contract is especially important and needs to be carefully prepared if the person being cared for ever needs to qualify for Medicaid coverage.
Important aspects to consider in order for a contract to be Medicaid eligible are:
- Fairmarket Reimbursement Rates – Some states have a maximum wage that can be paid to a caregiver
- Proper Documentation – After the wage is agreed upon, carefully document all payroll checks and payroll taxes
- No Pre-Payments – Wages can only be paid after services are rendered. No money can be paid for future services
- Prescribed Services – Some states require that caregiver services be prescribed by a physician
- Maximum Payments – The total amount allowed for services rendered can also vary state to state
- Think Ahead – The agreement cannot be a last minute deal among family members
Attorney John L Roberts, in his article titled “Caregiver Contracts that Protect Elders and Their Family Members” states:
“A written Caregiver Contract is a good idea for every family that wants to protect family harmony, and make sure everyone in the family understands how care is being provided to an elder.
The family member who provides care can save an elder from needing nursing home services, and may also protect assets if nursing home care is needed in the future. Elders who want to cover all of these bases must have a written Caregiver Contract. Whenever adult children and other family members are providing valuable care, only a written agreement will protect assets from nursing home care costs and qualify the elder for Medicaid.”
In many cases, it may be necessary to consult an elder law attorney to help navigate preparing a contract that follows all of your state’s regulations while also considering Medicaid rules for eligibility. A well prepared contract can help protect your family member’s assests especially if they wind up requiring nursing home care in the future.
If you have any questions about creating a caregiver contract for a family member, please contact the Law Office of Dawn M. Weekly, PC. The law firm located in Sandwich, Illinois and focuses on elder law and Life Care Planning for clients. Their office may be reached by calling 815-570-2334.
October 24, 2011 § 2 Comments
As the number of family members providing care for aging parents increases, the solutions to find help with loss of income because of time off from employment for caregiving has become a major concern for many.
The demands on caregivers’ time and energy can make it impossible to maintain a full time job and take care of their loved one full time. There are several programs available to help caregivers either financially or through other methods of support.
A few examples of available programs and/or benefits are:
- National Family Caregiver Support Program
- Medicaid Cash & Counseling Program
- Veterans Aid and Attendance Pension Benefit
- Long Term Care Insurance Benefit
Below we have listed a brief description of each of these programs and how you can find out more about each topic.
National Family Caregiver Support Program
The federal government’s Agency on Aging created the National Family Caregiver Support Program in order to give support to family caregivers. The program offers support on a state and community level and provides a variety of services, which are listed below. To find an area Agency on Aging in your area and learn more about the program click here.
Services provided by the National Family Caregiver Support Program include:
- General information about available services
- Assistance to help caregivers gain access to supportive services
- Individual counseling and organization of support groups
- Training to assist caregivers in making decisions and solving problems
- Respite care to enable caregivers to be temporarily relieved from their responsibilities Supplemental services, on a limited basis, to complement the care provided by family caregivers
Medicaid Cash & Counseling Program
A Medicaid approved assistance program called Cash & Counseling may be used to provide funds to hire personal care aides as well as purchase items or services, including home modifications that help people live independently.
The PayingForSeniorCare.com website gives the following information about the program:
“For Medicaid eligible seniors, the process begins with an assessment in the home to determine the senior’s home care needs; this includes interviews with caregivers and possibly the senior’s physicians. A determination of how many monthly care hours are required is made. The benefit amount is calculated using that determination and cost of care for that geographic area. This amount can be increased or decreased as the senior’s needs change. A family care giver may need to qualify as a home health aid by the state to receive these funds.”
This program is executed by each individual state Area on Aging Services division. The program is relatively new and is not yet available in all states. Check with your state Area on Aging Services department for more information. To find an area Agency on Aging in your area click here.
Using the Veterans Aid and Attendance Pension Benefit
A totally overlooked source of money to pay family caregivers is the Aid and Attendance Pension Benefit. This money is available to veterans who served during a period of war. Pension money is also available to the widows of these veterans. This benefit, under the right circumstances, can provide up to $1,949 a month in additional income to pay family members to provide care at home.
Receiving the benefit can be difficult because there must be a caregiver contract in place, a medical evaluation must be performed by a physician, income and asset qualifications must be met and proof of medical expenses provided. Submitting the correct forms and documentation can easily be accomplished with the help of a VA Accredited Consultant who understands the process.
Long-Term Care Insurance Benefit
If the senior being cared for has a long-term care insurance policy that covers home care, payment to the caregiver from this source could be arranged. Some policies require the care provider to be from a licensed home care agency. Other policies will pay for certified individual aides, which require the family caregiver to take some training courses. There are also policies that will pay a daily amount to the insured to use for their care. Check with a long-term care insurance professional about the differences in policies.
For questions concerning any of the above programs, contact the Law Office of Dawn M. Weekly, PC. The law firm located in Sandwich, Illinois and focuses on elder law and Life Care Planning for clients. Their office may be reached by calling 815-570-2334.
October 17, 2011 § Leave a comment
This summer the FDA approved the 2011-2012 influenza vaccine formulation that will be produced and distributed this flu season. The vaccines will target 3 different strains of the influenza virus that the public health community believes will cause the most illness this year.
While several different manufacturers produce the vaccine under many different brand names, one new vaccine of particular interest is the Fluzone High-Dose vaccine. This flu shot was formulated specifically for people 65 years of age and older. « Read the rest of this entry »
October 10, 2011 § Leave a comment
In the first century of our country’s history there was no such thing as nursing homes or assisted living. Society was mostly rural and people lived in their own homes. Families cared for their loved ones at home until death took them. In the latter part of the 1800s, because of an increasingly urban society, many families were often unable to care for loved ones due to lack of space, or because all family members including children were employed six days a week for 12 hours a day. During this period many unfortunate people needing care were housed in County poor houses or in facilities for the mentally ill. Conditions were deplorable. In the early 1900s, home visiting nurses started reversing this trend of institutionalizing and allowed many care recipients to remain in their homes. Nursing homes or so-called rest homes were also being built with public donations or government funds. With the advent of Social Security in 1936, a nursing home per diem stipend was included in the Social Security retirement income and this government subsidy spurred the construction of nursing homes all across the country.
By the end of the 1950s it was apparent that Social Security beneficiaries were living longer and that the nursing home subsidy could eventually bankrupt Social Security. But in order to protect the thousands and thousands of existing nursing homes Congress had to find a way to provide a subsidy but remove it as an entitlement under Social Security. In 1965 Medicare and Medicaid were created through an amendment to the Social Security Act. Under Medicare, nursing homes were only reimbursed on behalf of Social Security beneficiaries for short-term rehabilitation. Under Medicaid, nursing homes were reimbursed for impoverished disabled Americans and impoverished aged Americans over the age of 65. It has never been the intent of Congress to pay for nursing home care for all Americans. The nursing home entitlement for all aged Americans was now gone.
Over the last 40 years, there has been a gradual change away from the use of nursing homes for long-term care, toward the use of home care and community living arrangements that also provide in-house care.
With Proper Planning People Could Remain in Their Homes for the Rest of Their Lives
We are seeing a trend toward working conditions like those in urban America in the early 1900s where both husband and wife are working and putting in longer hours. We are also seeing a return of the trend in the early part of the 20th century where outside visitor caregivers are becoming available to replace working caregivers and allow the elderly to receive long-term care in their homes. In addition, there is a significant trend in the past few years for Medicaid and Medicare to pay for long-term care in the home instead of in nursing homes.
Given enough money for paid providers or government funding for the same, a person would never have to leave his home to receive long-term care. All services could be received in the home. Adequate long-term care planning or having substantial income can allow this to happen.
We only need to look at wealthy celebrities to recognize this fact. Christopher Reeve, the movie star, was totally disabled but he had enough money to buy care services and remain in his home. President Ronald Reagan suffered from Alzheimer’s for many years but received care at his California ranch. He was also wealthy enough to pay for care when needed. Or what about Annette Funicello or Richard Pryor? Income from their movie careers allowed them to receive care with their multiple sclerosis at home. We will be willing to bet that Mohammed Ali, who is severely disabled with Parkinson’s disease, will probably never see the inside of a care facility, unless he chooses to go there to die. With the proper planning and the money it provides, most of us could remain in our homes to receive long-term care and we would never have to go to an institution or a hospital.
The Popularity of Home Care
Most of those receiving long-term care and most caregivers prefer a home environment. Out of an estimated 8 million older Americans receiving care, about 5.4 million or 67% are in their own home or the home of a family member or friend. Most older people prefer their home over the unfamiliar proposition of living in a care facility. Family or friends attempt to accommodate the wishes of loved ones even though caregiving needs might warrant a different environment. Those needing care feel comfortable and secure in familiar surroundings and a home is usually the best setting for that support.
Often the decision to stay in the home is dictated by funds available. It is much cheaper for a wife to care for her husband at home than to pay out $2,000 to $4,000 a month for care in a facility. Likewise, it’s much less costly and more loving for a daughter to have her widowed mother move in to the daughter’s home than to liquidate mom’s assets and put her in a nursing home. Besides, taking care of our parents or spouses is an obligation most of us feel very strongly about.
For many long-term care recipients the home is an ideal environment. These people may be confined to the home but continue to lead active lives engaging in church service, entertaining grandchildren, writing histories, corresponding, pursuing hobbies or doing handwork activities. Their care needs might not be that demanding and might include occasional help with house cleaning and shopping as well as help with getting out of bed, dressing and bathing. Most of the time these people don’t need the supervision of a 24/7 caregiver. There are, however, some care situations that make it difficult to provide long-term care in the home.
Please note from the first graph below that a great amount of home care revolves around providing help with activities of daily living. Note from the second graph below that the average care recipient has need for help with multiple activities of daily living. Finally, it should be noted from the second graph that well over half of home care recipients are cognitively impaired. This typically means they need supervision to make sure they are not a danger to themselves or to others. In many cases, this supervision may be required on a 24-hour basis. (Graphs were derived from the 1999 national caregivers survey, courtesy http://www.longtermcarelink.net.)
It is precisely the ongoing and escalating need for help with activities of daily living or the need for extended supervision that often makes it impossible for a caregiver to provide help in the home. Either the physical demands for help with activities of daily living or the time demand for supervision can overwhelm an informal caregiver. This untenable situation usually leads to finding another care setting for the loved one. On the other hand if there are funds to hire paid providers to come into the home, there would be no need for finding another care setting.
Problems That May Prevent Home Care from Being an Option
Caregivers face many challenges providing care at home. A wife caring for her husband may risk injury trying to move him or help him bathe or use the toilet. Another situation may be the challenge of keeping constant surveillance on a spouse with advanced dementia. Or a son may live 500 miles from his disabled parents and find himself constantly traveling to and from his home, trying to manage a job and his own family as well taking care of the parents. Some caregivers simply don’t have the time to watch over loved ones and those needing care are sometimes neglected.
The problems with maintaining home care are mainly due to the inadequacies or lack of resources with informal caregivers, but they may also be caused by incompetent formal caregivers. These problems center on five issues:
- Inadequate care provided to a loved one
- Lack of training for caregivers
- Lack of social stimulation for care recipients
- Informal caregivers unable to handle the challenge
- Depression and physical ailments from caregiver burnout
In order to make sure home care is a feasible option and can be sustained for a period of time, caregivers must recognize these problems, deal with them and correct them. The responsibility for recognizing these problems and solving them is another function of the long-term care planning process and the team of specialists and advisers involved.
Adequate Funding Solves Most Problems Associated with Providing Home Care
None of the problems discussed in this article would be an obstacle if there were enough money to pay for professional services in the home. These services would be used to overcome the problems discussed in the previous section. If someone desires to remain in the home the rest of his or her life, adequate preplanning could provide the solution.
This planning ideally occurs prior to retirement, but planning can still be done up to the time that a care need begins. The most obvious way to provide sufficient funds for home care is to buy a long-term care insurance policy when someone is younger, healthy and able to afford the lower premiums. If insurance is not an option, then money must be put aside early in life to pay for care in the future. The only other option is to be rich.
Unfortunately, very few people address the issue of needing long-term care when they are older. This leads to a lack of planning and in turn leads to fewer options for elder care when the time comes. Lack of planning means most people do not have the luxury of remaining in their homes and must rely on Medicaid support in a nursing home to finish out the rest of their lives.
To find out if you’ve sufficiently planned for long term care, or to start the planning process, give our office a call and schedule a consultation. 815-570-2334.
October 3, 2011 § Leave a comment
Many elderly people rely entirely on family or other trusted individuals to help them. Whether it is for physical needs or emotional needs, as people grow older they tend to need more and more help from others. This dependence on caregivers or family members makes an older person more vulnerable for abuse.
For example, an older person relying on her children to provide meals and transportation and help her with financial decisions finds it difficult to complain when one of her children takes advantage of her. If, for instance, the child takes her money, hits her or neglects her care, the parent may be threatened with loss of support from the child if the parent complains. The child may also use threats of violence to keep the parent in line.
It is estimated that 5% to 10% of elderly Americans are suffering abuse. According to the National Committee for the Prevention of Elder Abuse,
Spiraling rates of elder mistreatment are reported by both practitioners and researchers. In a recent national study of Adult Protective Services (APS), typically the agency of first report concerning elder abuse, there were 253,421 reports of abuse of adults age 60+ or 832.6 reports for every 100,000 people over the age of 60 (Teaster, Dugar, Otto, Mendiondo, Abner & Cecil, 2006). The National Elder Abuse Incidence Study (National Center on Elder Abuse, 1998) found that more than 500,000 persons aged 60+ were victims of domestic abuse and that an estimated 84% of incidents are not reported to authorities, denying victims the protection and support they need.
Much attention has been focused on abuse in nursing homes but most of the elder abuse in this country is at the hands of family members or other caregivers in the home.
In 2004, Utah Adult Protective Services workers investigated approximately 2,400 allegations of abuse, neglect or exploitation of vulnerable adults. In Utah, a vulnerable adult is defined as an elder adult (65 years of age or older) or an adult (18 years of age or older) who has a mental or physical impairment, which substantially affects that person’s ability to protect or provide for themselves. The majority of the victims were females between the ages of 60-89 and 60% of the perpetrators were family members/relatives, while 24% were non-related paid caregivers.
The protective needs identified were as follows:
- self-neglect 31%
- physical abuse 16%
- exploitation 19%
- caretaker neglect 12%
- emotional abuse 19%
- sexual abuse 3%
In conducting the investigations, it was not uncommon to find that adults who were self-neglecting were also being exploited or abused. As stated previously, these statistics are based on approximately 2,400 cases, thus, if only one in ten cases are ever reported, it is possible that there were actually 24,000 or more cases in Utah that year. We suspect nine out of ten is close to the actual ratio of unreported versus reported cases in Utah.
We also believe that Utah’s lack of reporting elder abuse is not unlike other states in the country. We suspect all the states are experiencing close to the same ratios of underreporting as in Utah.
There are a number of reasons why incidents of abuse, neglect, or exploitation are not reported to Adult Protective Services or other authorities. One of the most common reasons is the victim’s fear of losing support. Many of the perpetrators area family members and the victim fears that reporting the crime will result in removal of the caregiver, as the perpetrator may ace incarceration or may discontinue relations with the victim once accused, charged, or convicted. Many of these victims fear that by reporting abuse they will be left alone and expected to care for themselves or they will be forced to live in a nursing home.
Many states have implemented mandatory reporting laws to assist in the prevention of abuse, neglect or exploitation of vulnerable adults. Utah is one of the many states to have a mandatory reporting law (U.C.A. § 76-5-111). Utah law states that any person who has reason to believe that a vulnerable adult has been the subject of abuse, neglect, or exploitation shall immediately notify Adult Protective Services or the nearest law enforcement agency. Anyone who makes the report in good faith is immune from civil liability in connection with the report; however, any person who willfully fails to report is guilty of a class B misdemeanor.
It is important to note that the anonymity of the person or persons making the initial report and any other persons involved in the subsequent investigation shall be preserved and may only be released in accordance with the rules of the division (U.C.A. § 62A-3-311). In addition, all investigation information is confidential.
The following is a list of indicators of abuse, neglect or exploitation. It is important to note that the following list is merely of indicators and may not always be violations.
Signs of abuse
- Unexplained bruises, welts, fractures, abrasions or lacerations
- Multiple bruises in various stages of healing
- Multiple/repeat injuries
- Low self-esteem or loss of self determination
- Withdrawn, passive
- Depressed, hopeless
- Soiled linen or clothing
- Social Isolation
- Inappropriate or soiled clothing
- Over/under medicated
- Deserted, abandoned or unattended
- Lack of medical necessities or assistive devices
- Unclean environment
- Social Isolation
- Missing/”disappearing” property
- Inadequate living environment
- Frequent/recent property title changes or will changes
- Excessive home repair bills
- Forced to sign over control of finances
- No/limited money for food, clothes and other amenities