What Matters to Me Workbook
March 2, 2021
My favorite topic!
If you have been reading these newsletters, then you know that the subject that I return to over and over again (and again and again) is the health care proxy and the importance of advance care planning. If you are ever in a situation where you are unable to make your own health care decisions, then your trusted decision makers will be able to speak for you only if you give them the authority to do so (that’s the health care proxy you signed). But also, they will need to know what matters most to you, which turns on you knowing and conveying what matters most.
Well, you are in luck, because the good folks at Ariadne labs (that’s Atul Gawande’s lab – if you haven’t read Being Mortal, pick it up and start reading it now!) and the Conversation Project (remember Ellen Goodman from the Globe? She’s been busy since “retirement) are here to help. They have done the field research and reviewed the data, and they used these to develop a fabulous new workbook that helps you both think through what matters most to you and also to convey your thoughts to the people who matter most.
The new workbook is called “What Matters to Me.” You can download it here, or contact our office and we will print one out and mail it to you.
Please take the time to complete the workbook, and then pat yourself on the back for a job well done.
– Alexis
E-Newsletter: Useful Info During COVID
April 2, 2020
Following is the text of our recent e-newsletter. If you would like us to add you to our e-newsletter mailing list, please visit our homepage.
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Dear Friends,
This is our second newsletter during these interesting COVID times. The first newsletter offered legal information. This one shares useful info, plus something beautiful. You can revisit our first newsletter here.
We begin with a reminder:
Keep your Health Care Proxy, HIPAA Statement, and medication list at your fingertips.
(a) If you are a client of ours, then we enrolled you in DocuBank. Take five minutes now to update your medication list. (Really. Five minutes. I updated mine recently, it was very easy.)
(b) Keep copies on your phone. You can save the documents to your Google Drive, you can simply keep them attached to an email, whatever you like, so long as they are accessible to you on your phone. If you would like us to email PDFs of your signed documents to you, or to someone important to you, please call us or email us (doreen@alexislevitt.com).
(c) Keep copies on the back of your front door or on your refrigerator. Many first responders will look in these places for emergency medical papers.
(d) If you do not have a health care proxy, download one today from Honoring Choices. You will need to witnesses – perhaps your neighbors can watch you sign through your glass door or window.
We move on to community offerings:
The Wonder Duo of Two Sisters Senior Living Advisors, Michelle and Alyson, are bringing you free, professional chair yoga every Tuesday and Thursday morning! More info here (scroll down the page). Mark your calendars!
The Alzheimer’s Association 24/7 Helpline is open. If you are feeling at the end of your rope, or even if you are well before that point, call them. They can help.
The Alzheimer’s Association is also hosting a slew of webinars online. They have even found a way to continue with their support groups. Check it out. There is no need to go this alone.
Remember that your local Council on Aging is a bastion of information and resources! If you need anything, call them and they will either solve your problem or refer you to someone who can. Yes, your local senior is open for phone calls! (But not walk-ins.)
Now for Community Requests:
South Shore Hospital is requesting the following:
Financial donations
Homemade masks (attention people who love to sew!)
Supplies so that the hospital can make their own masks
Gift cards for employees in need
N95 masks, gowns, goggles, other PPE
Norwell VNA & Hospice is requesting N95 masks, gowns, goggles, and other PPE.
And, Something Beautiful:
There is a national movement to plaster our neighborhoods with hearts, in support of our health care workers who are on the front lines. In our neighborhood, teacher Kathleen Malone and her kids took the lead, and now we all have lovely homemade hearts on our doors. The ones with the Red Cross symbols were given to the nurses in our neighborhood, and they have told us that this makes them feel supported and loved. Pull out some art supplies and bring the same to your street!
And Remember:
Our office is open. We are working from home, but if you need anything at all, just call or email, and we will get right back to you.
Hang in there, and get outside for plenty of fresh air and sunshine. And wash your hands!!
– Alexis & Doreen
E-Newsletter: If You Are Hospitalized During the State of Emergency
March 30, 2020
Following is the text of our recent e-newsletter. If you would like us to add you to our e-newsletter mailing list, please visit our homepage.
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Dear Friends,
I hope you are all staying home (unless you are an essential worker). I want to share some important points to keep in mind if you are hospitalized during the state of emergency. These apply whether you are hospitalized for COVID-19 specifically, or for any other reason.
1. Keep your Health Care Proxy, HIPAA Statement, and medication list at your fingertips.
(a) If you are a client of ours, then we enrolled you in DocuBank. Take five minutes now to update your medication list. (Really. Five minutes. I updated mine recently, it was very easy.)
(b) Keep copies on your phone. You can save the documents to your Google Drive, you can simply keep them attached to an email, whatever you like, so long as they are accessible to you on your phone. If you would like us to email PDFs of your signed documents to you, or to someone important to you, please call us or email us (doreen@alexislevitt.com).
(c) Keep copies on the back of your front door or on your refrigerator. Many first responders will look in these places for emergency medical papers.
2. Advocate to be coded as “inpatient” rather than “under observation.” If you are in the hospital and then transferred to a rehab, how you were coded at the hospital will make a big difference in payment source for the rehab stay.
3. If you are transferred to rehab and told that you will be paying privately, call us. Under the State of Emergency, some of the usual coverage triggers for payment for rehab have changed. Nursing home billing offices could be – quite understandably – overwhelmed and perhaps not updated on the temporary changes. We can help.
4. Call us if you need a guardianship or conservatorship. For anyone who has not signed a health care proxy or a power of attorney, the hospital (or rehab) may tell you that you need a guardian or conservator. This is a court proceeding handled by an attorney.
(a) It’s possible that the hospital or rehab attorney will handle the guardianship and/or conservatorship for you, for free. If that is the case, be sure to check in with them as to who they are naming to act as the guardian or conservator, and, if you are not happy with their choice, advocate for naming someone you prefer.
(b) If the hospital or rehab tells you that you need to find your own attorney (or if you are not comfortable using their attorney), then please call our office. This is something that we can handle for you.
5. Our office is open. We are working from home, but if you need anything at all, just call or email, and we will get right back to you.
Hang in there, and get outside for plenty of fresh air and sunshine.
– Alexis & Doreen
Paying Your Caregiver Under the Table
September 20, 2018
Hiring a caregiver is an expense, no question about it. Some families are lucky enough to be able to find the perfect caregiver among their circle of close family and friends. When finding a caregiver on their own rather than through an agency, lots of families prefer to pay the caregiver under the table because it’s cheaper than using payroll. And lots of caregivers prefer direct payments because they make more that way – wouldn’t we all prefer to make more money?
But here’s the problem with this arrangement. Or more precisely, several problems:
- Both the employer and the caregiver are committing tax fraud. You really don’t want to be caught for this.
- The caregiver, by not using payroll to pay into her Social Security history, is setting herself up for a lower Social Security payment upon retirement. This will make things a lot harder on her in what are supposed to be her golden years.
- The caregiver is not covered by worker’s compensation in the event of injury. That leaves her in a lurch if she gets hurt on the job. Or, it leaves the family in a lurch, as she can try to sue the employer to recover for her injuries.
- The caregiver is not covered by state unemployment benefits when the job ends.
No one wants to pay taxes, and payroll costs add to the employer’s financial commitment and reduce the caregiver’s take-home pay. But if you run the numbers to see exactly how much the cost changes would be for both the employer and the caregiver, hopefully you will decide that the cost is not as much as you expected, and the protections will be worth it.
As the employer, once you decide to start using payroll, you have options for how to manage that. If you are an organized person and don’t mind or maybe even enjoy “HR” type of work, you can run payroll on your own and submit the required periodic filings to the employee and the government. You can use QuickBooks or similar programs to help. If you don’t have the patience or stomach to do it yourself (I don’t), you can use any payroll agency that works with small employers. Care.com caters specifically to home-based employers. (I’ve never used them but love that they are a Massachusetts company.)
If you would like help determining the best way to manage payments to your caregiver, please call us.
Elder Care Workshop Series at Norwell Public Library
March 7, 2017
Are You Caring for Someone Who Wanders?
December 22, 2016
CMS (the agency that manages Medicare and Medicaid) recently put out this interesting FAQ piece on wandering. The piece is aimed at managers of day programs and assisted livings, but there are a lot of useful nuggets in here for people who are caring for loved ones still at home who tend to wander.
Open Your Home and Grow Your Family
December 1, 2016
The South Shore ARC is looking for families who would like to host under the Shared Living program. This is a state program that matches up adults with developmental disabilities with “host families.”
If you would like to open your home and your heart, please visit the ARC’s Shared Living page.
The Globe Made It Sound Like All of Our Seniors are Living Like the 1% and That Ticked Me Off
June 13, 2016
The Boston Globe Magazine wrote in its 1/31/16 issue of a Massachusetts building boom of senior care communities targeted essentially at the “1%.” You can see that article here.
I was ticked off at the tone of the article, to say the least. The author talks about the high-end senior living communities that developers are building in Eastern Massachusetts, because, well, some seniors through a combination of work and luck have accumulated that kind of wealth. The fact is, most Massachusetts seniors are patching together a network of care and services and doing their best to stay at home. The Globe Magazine published my comment, which you can read here.
The country needs a more comprehensive network of services for seniors, and Massachusetts needs to lead the way.
Michelle Singletary – She’s Done It Again
May 7, 2014
I love her columns, I really do. A few weekends ago, she nailed it once again. Read her column here where she tells older parents why they need to talk to their adult children about the care they would like as they age. Keep in mind that the cost figures she cites are national averages – and so, you guessed it, Massachusetts $$ numbers are higher.
I haven’t read the book she is suggesting, but if Michelle Singletary likes it, I’m sure it’s good.
Caregiver Contracts – Tax Benefits
April 30, 2014
If you would like to care for your parents full-time, or close to it, and your parents want to pay you for this, then there are some tax issues that you need to be aware of.
Most importantly, if you are providing hands-on care, making meals, doing the shopping, taking your parents to doctors’ appointments, etc., then you are an employee (as opposed to an independent contractor). And if you are an employee, then there are some rules that you need to comply with.
First, you and your parents need to report your income. Second, you and your parents need to pay taxes (they pay employer taxes, you pay income taxes). Now before you throw something at your computer screen, consider this: You want to pay payroll taxes. Why? Because FICA earnings will translate down the road into your own retirement Social Security check. Spending years working but not contributing to FICA can result in a lower Social Security check when you eventually retire. Same goes for Social Security Disability (SSDI) if you become disabled before 65.
Also consider this: Your parents can recapture part of the employer taxes they are paying in the form of a tax deduction – If they spend more than 7.5% of their AGI (adjusted gross income) on health care, then they can deduct health care costs. If they are paying for your many hours of care, in addition to other out-of-pocket health care costs, it is quite likely that they are spending over 7.5% AGI on those costs.
The payroll requirements for an employer are detailed. Rather than asking your parents to try to keep the records and handle the reporting to the IRS and DOR themselves, it is exponentially easier to hire a payroll company to take care of all the details for you. One payroll company working exclusively for home care situations is Care.com/homepay. I haven’t worked with them, but I think they are the only payroll company focusing on home care.
You can read here about what goes into a caregiver contract, and you can read here about how your parents can end up in big trouble later with MassHealth if they pay you without a caregiver contract in place.
