The Importance of Caregiver Contracts
October 2, 2014
A goal that my clients bring up in meetings time after time is that they wish to stay in their own homes for as long as possible. Many people, however, find the cost of bringing help into their homes to be daunting. Elders are increasingly turning to their adult children for in-home care. As thanks, to reimburse the child for their time and expenses, or a combination of both, elders often wish to “pay” the child. But should the elder need nursing home care in the future, MassHealth will view informal payments as gifts, which could prevent the elder from receiving public assistance. So the question is, what is a family to do?
One solution is a “caregiver contract.” This is a written agreement between the elder(s) and their adult children, laying out tasks the child will perform and a rate of pay. Set up along with worker’s compensation and the usual payroll deductions, this provides an income stream to the caregiver while giving the parent what most elders want – being cared for by his or her own family.
Caregiver contracts benefit both parties. The caretaker child gets the benefit of worker’s compensation, in addition to reportable, reliable income for state and federal income tax purposes. (You may not think that’s a benefit – but paying taxes can be much better than the consequences of being discovered as delinquent!) The elder gets to remain in his or her home with a familiar caretaker, often at a rate much less expensive than those charged by home health agencies. Should the elder require MassHealth to pay for nursing home care, he or she can prove that the payments were just that – payments – and not gifts.
Only an elder law attorney familiar with the ever-changing MassHealth rules should draft a caregiver contract, so that it will protect the elder in the event he or she needs nursing home care in the future. If you believe a caregiver contract would be helpful to you, please do not hesitate to contact my office.
Thrown into the Deep End
May 18, 2010
Did you see Michelle Singletary’s column this weekend in the Boston Globe? I like her column, The Color of Money. She writes in a straight-forward, honest manner, with guidance targeted at “regular folks” like myself.
This weekend she wrote about essentially being thrown into the deep end of the pool of elder care. If you read her column, you saw that her feelings, questions, fears, and sense of being overwhelmed and without direction are those very same feelings that most children of seniors (or healthier spouses of seniors) are experiencing every day.
While I can’t make your parent or spouse healthier, and I can’t bring back their memory skills, I can make it easier for you to handle your new caretaking role. The elder law attorney’s job has many aspects – for one, I help elders stretch out their assets to stay at home for as long as possible.
How do I do this? We look at MassHealth benefits and Veterans Benefits as a way of bringing more help into the home. We look at selling the home and building an in-law apartment on a child’s house. We explore setting up a contract between parent and child that allows the child to quit her job and care for her parent but still earn some income. And if nursing home is a possibility, we explore ways to maintain a healthy spouse at home and also explore various methods of safely and legally transferring some assets to children.
But the elder law attorney’s role goes beyond this – my job is also to pull in other professionals who can help you become a better – and more sane – caregiver. I may invite in an Alzheimer’s coach to teach a family how to work with a family member who is changing before their eyes; a geriatric nurse to guide a thoughtful conversation on wishes for end of life care; a geriatric care manager to create and manage a schedule of home health aides – and more.
I can’t get you out of the deep end of the pool. Life takes our parents and spouses in certain directions. But I can teach you how to swim.
More Reasons to Write up a Caregiver Contract
November 13, 2009
Paying Your Children to Care for You? Put it in Writing.
August 30, 2009
Always Keep Time & Expense Records When Helping Another
August 6, 2009
So many children, nieces and nephews, and good neighbors pitch in to do heavy lifting for an aging or disabled family member or friend. You may be running errands, cleaning out a basement, doing weekly grocery trips. We do these things on a volunteer basis, usually receiving just reimbursement for purchases made. And when the hours pile up – like cleaning out a house or overseeing home remodeling – elders often insist on paying their helpers for their time.
If you are doing this sort of work for an elder or disabled person, it is imperative that the person you are helping (or you yourself, if she can’t), keep good records of expenses and time spent.
While this may feel wrong to you – afterall, you are doing this work out of kindness, it’s not a business arrangement – a lack of records can spell big trouble for the elder or disabled person later. If they will ever be turning to MassHealth (Medicaid) for care, whether at home, assisted living, or in a nursing home, MassHealth will examine the last 5 years of the applicant’s bank records. She will need to explain – and document – why she was paying you.
Without accurate records and receipts, MassHealth will likely reject the elder’s application. At that point, the only way for her to get the care she needs from MassHealth will be for you to return all the funds she paid you.
While it may feel awkward, do yourself and the person you are helping a favor and keep good time records and all receipts. And carry on with your good work.
Caregiver: Care for Yourself, Too
June 1, 2009
Caregiver burnout is a dangerous side-effect of dedicating your time and energies to the care of a loved one. All the physical activity, combined with the worry, isolation, and frustration, make for a dangerous recipe. Families frequently come to me when Mom got sick from the exhaustion of caring for Dad. Another common scenario is a child becomes worn down and finds herself spending lots of time in doctors’ offices for her own ailments, and the family asks me to make different arrangements for the parents’ care.
It’s hard work caring for another – physically, emotionally, mentally. If you are a caregiver, you must take time for yourself. Go for walks, take an art class, join a support group where you can let off steam and also get some ideas and encouragement from other souls in the same boat. To take time for ourselves, most of us need it to be compulsory: so sign up for an exercise class or a walking group, or find your own buddies to cycle with a few mornings a week. Whatever the activity, if you’ve scheduled a time and others are expecting you, it’s more likely you will follow through.
There are many places to look for support and ideas, just spend a few minutes online and you will find them. One good place to start is the Alzheimer’s Association Caregiver Stress Check. Joining a caregiver support group is an excellent thing to do and can often result in long-lasting friendships. Call your local senior center for a list.
Most importantly, get outside! It’s the perfect time of year for that. Take good care.
HBO’s The Alzheimer’s Project: Grandpa, Do You Know Who I Am?
May 19, 2009
This weekend I watched the film on grandchildren caring for grandparents with Alzheimer’s. I was floored by the patience and persistence these kids displayed.
One theme that the film highlighted with “staying in the moment.” This is something we all did as kids (remember focusing on a ladybug crawling up a blade of grass for minutes at a time, oblivious to anything else in the world?), but we lose as we mature. Turns out we end up back there towards the end of life.
Spending time with an Alzheimer’s patient sometimes means playing cards or other games, discussing what they see out the window at that moment – and not discussing what happened this morning or what you will be doing tonight.
This also touches on the theme of “fiblets” – the notion that you cannot change the reality of an Alzheimer’s patient, so you go with their reality instead. They are in their moment – go and join them there. My favorite Alzheimer’s coach, Beverly Moore, tells this story: It is about 3 p.m., and a woman she is working with is convinced that Johnny should be coming off the school bus any minute. There is no way to convince her that she is 85 and her little boy is a 60 year-old accomplished engineer. Instead, Beverly agrees and steers her into the kitchen to make tea while they “wait for the bus.”
It is a shift in the way we are used to interacting with people, but if you can force yourself to return to your childhood habits and “stay in the moment” you can turn what could have been a frustrating experience into some joyful time spent with your loved one.
HBO’s The Alzheimer’s Project: Caregivers
May 18, 2009
This weekend I watched the film Caregivers (don’t you just love On Demand?). One theme that jumped out was the isolation that caregivers suffer. Several of the film’s stars (I think that’s a good name for them) talked about how very quietly the invitations to events and gatherings stopped. Not only does this damage the patient, but even more so the caregiver who needs more than ever to maintain her connections to the world.
This happens with families with special needs children, as well. They lose their friends and even family as their child grows past the infant years.
It all comes down to lack of knowledge. Very few, if any, of us innately know how to interact with a person with mental deficits or behavioral issues. The good thing is, it’s not too hard to learn.
If you have a friend, neighbor, or family member who is caring for an individual with Alzheimer’s, another form of dementia, behavioral issues, mental retardation, Turret’s Syndrome, or any other type of disability that affects the mind, please – don’t shy away from them – they need you in their life. Just ask your friend – “I would love to spend the afternoon with you, please tell me what to expect from Vanessa, and please give me some tips on how to interact with her.” There are also so many books and websites devoted to various special needs and highlighting skills for interacting with the special needs person.
And if you are the caregiver and you have noticed that your friends and family invite you out less frequently – call them up, explain that you understand why they have backed off, and then ask if you could describe a few tips for how to spend time with your loved one.
All it takes is a little bit of knowledge, patience, and a willingness to try something new.
Is Your Home Care Agency Appropriate for Alzheimer’s Care?
February 25, 2009
We are lucky on the South Shore to have so many agencies supporting seniors who continue to live at home. Among these are home care agencies, which are the companies that provide home health aides and companions. If you are considering a home care agency to care for a loved one with Alzheimer’s, look for one that has put some time and effort into training its employees to work with this population.
North River Home Care is a family owned agency based in Norwell, and they are the only home care agency in our area to hire StilMee (a/k/a Sweet Grapes), the Alzheimer’s coaching company, to train staff. Sweet Grapes is another fantastic locally owned company, headed by the indefatigable Beverly Moore of Quincy. North River’s owner, Heather Kenney, has hired Beverly not only to train her 60 caregivers, but to provide weekly support and feedback to the caregivers who provide live-in care to Alzheimer’s patients – perhaps one of the toughest jobs an aide can have.
If you are looking for an agency to care for a family member with Alzheimer’s, be sure to ask what specific training and ongoing support the aides receive.
Caregiver Stress Check Quiz
December 9, 2008
If you are a caregiver for a person with Alzheimer’s or any other debilitating disease, take a look at the National Alzheimer’s Association’s Caregiver Stress Check. It’s very well done. Based on the issues you check off (ex., you feel like you are doing everything yourself with no backup, you think that your own health is suffering from the overload, etc.), the quiz takes you to different resources that can help you.
This quiz only takes a minute and can make a big difference to your own health and outlook, to your relationship with the person you care for, and to the quality of care you provide.
