Your reimbursement for the care you provide could come from any number of sources–a long-term care insurance policy, a community program, your care recipient, even other family members.
The devil really is in the details with this situation, isn’t it? It’s wonderful you can be compensated for providing care; it’s a luxury, really, that many family caregivers can’t enjoy. But, the details involved in can be daunting. And, the repercussions of such a decision can be far-reaching.
Any time money enters an equation, particularly an equation that involves relationships (with your care recipient, other family members, even yourself), you’ll want to take a few precautions.
1. Do your due diligence to determine a fair compensation. If your care recipient or other family members will reimburse you for care, you’ll want to be compensated for fair market value of services provided. Call local home care agencies to learn their rates for companions, homemakers and home health aides. Then, ask how rates vary depending on care provided. This will give you an idea of an appropriate rate for the duties you perform.
In addition, your compensation must be directly tied to your duties, rather than to the amount of your care recipient’s assets. When it comes to computing your compensation, it’s insignificant how much money your care recipient has, i.e., your compensation cannot be computed as a percentage of your care recipient’s estate, for instance, or compared to the amount you may expect to inherit.
Keep all documentation as it relates to how you finally determine your compensation. And, plan to review this compensation rate every year (perhaps every January). And, document all care that is provided each day.
If you are receiving pay from a long-term care insurance policy or from a community program, your rate of pay may be determined for you.
2. Ask, and answer, the What if? questions. What happens if your care recipient is hospitalized? And then needs short-term care in a nursing home? How will any changes in environment affect your reimbursement?
In addition, keep in mind how many years your care recipient can pay you to provide care and the impact that doing so may have on your care recipient’s future care needs. For instance, is it better to receive compensation but deplete your care recipeint’s assets at a faster rate? Or, is it better to preserve assets to ensure your care recipient will have the funds available for as long as possible to pay for care?
And, as the disease progresses, the time may come when your care recipient can no longer live at home, as care needs may be just too great. In this case, it’s critical that money has been budgeted and saved for nursing home care. Having few assets and then trying to find a good, quality nursing home can be a very difficult task. Money to pay for care in a nursing home for at least one year ensures you can choose the best nursing home for your care recipient.
3. Money can add such an awkward dimension to the caregiving experience. You’re smart to involve third-party professionals as you proceed. In addition to a good elderlaw attorney (who also can advise you about the necessary legal documents, such as a durable Power of Attorney for health care and finances for your care recipient) consider using the services of a financial planner. The financial planner can oversee your care recipient’s finances (and work to preserve them as long as possible) and provide an important objective presence. With a financial planner and elderlaw attorney overseeing your care recipient’s finances, you avoid any potential problems with family members. An uninvolved family member often becomes very involved after the will is read and after the expenses related to care are discovered. As you receive compensation for care provided, be sure a third-party (such as the financial planner) oversees the distribution. In addition, document all expenses and retain all receipts.
An elderlaw attorney also can create a contract for you detailing your reimbursement rate, plan of care, caregiving goals, and any other requirements you agree to.
4. Create a care plan that includes you, but is not exclusive to you. Some questions to consider: How do you best use care recipient’s money in order to ensure she receives (and can continue to receive) the care she needs? And, who are the best person (or persons) and community programs to provide that needed care?
Your community has services and programs, such as adult day centers, that may help you provide care. Your care recipient can attend an adult day program during the day, allowing you time to pursue other employment options, if appropriate. To find out about programs, call the ElderCare Locator at 1-800-677-1116; they’ll refer you to your local Area Agency on Aging, which can tell you about help that’s available. To remain your care recipient’s caregiver for the long haul, regular breaks are essential.
Perhaps an effective care plan would look like this: Your care recipient attends an adult day center three times a week; receives help from a home health aide one day a week; receives help from you three days a week and at night. Such a care plan may be the best way to use your care recipient’s money so she receives the care she needs. And, with such a care plan, you free up your time to increase the number of hours you work outside the home while still receiving compensation for the days (and nights, when appropriate) you provide care as well as the time you spend managing the overall care plan. You can hire a geriatric care manager who can work with you to create a plan of care that works best for you and your care recipient. To learn more about geriatric care managers, visit caremanager.org. (In this case, you would reduce your reimbursement to reflect only the days you provide care.)
5. Plan for your own future. How will you protect your own financial future? How will any sacrifices you make today affect tomorrow? For instance, if you quit a full-time job to be your care recipient’s full-time caregiver, how will your future be affected? Can you live with the impact?
If the impact seems too great, what adjustments can you make (finding a part-time job, for instance, or determining the length of time you can provide full-time care before returning to work) that offer compromises?
As you keep an eye toward your future, take small steps to ensure your future employability. Consider online classes, online volunteer opportunities, and classes at your local community college to keep your skills up-to-date.
Finally, consider setting up a team that helps and supports you, while also helping you stay true to your caregiving goals. Share your Caregiving Mission Statement with your team and ask them to keep you on the right path. And, keep your heart focused on the good in life because you have that–a good life.
Resources
National Academy of Elder Law Attorneys
American Bar Association Commission on Law and Aging
Who Will Mind Mom? Check Her Contract
Hello. My name is Lori and I am taking care of my mother. She has been diabetic for aprox 30 years. In Jan. 09 I was informed by my brother that she’s not able to do some things by herself anymore and that I needed to come and see. I was in a different state at the time. Well, we have since then learned of some conditions that we were unaware of. She was recently hospitalized for a seizure and at that time we found out the she has stage 4 cancer that has matastised to the brain. I have been here ever since. I am giving her 24 hour care. Shots, meds, breathing treatments, and cleanings. She is bedridden. I am finding it hard to make some of my bills so a friend informed me that she was being paid for taking care of her mom.Her mom drives and a lot more than my mom. I will take care of her no matter what but I was wondering if there was anything available for me. i know that I have more than enough spelling probs here, however I think you can tell what I am trying to say. Sorry about that. Any help would be greatly appreciated. Thank you and God Bless. Lori
Hi Lori,
Your local Area Agency on Aging can tell you about programs that may be available to help you. Call the ElderCare Locator at 1-800-677-1116 for a referral to the agency in your area. Also, have you spoken to your mom’s doctor about Hospice? Hospice is a great support service for you and your mom. I would highly recommend Hospice. Can you take a moment today to ask the doctor for a referral so you can gather more information? You sound like a wonderful, caring daughter and friend. Please let us know what happens…
I’m very happy that you wrote something about getting together with a qualified attorney. Paying a family member, even to help with care, can be considered “gifting” by the state, and can create horrible problems for the care recipient if they need to apply for medicaid – and statistics show that approximately 90% of people receiving at-home care will need skilled nursing care within 2-3 years. Make sure you visit an attorney who is well-versed in the Medicaid maze, or you could be putting your loved one in an incredibly bad spot. Great advice!
Hi Catherine–Thanks so much for sharing you insights. They are really helpful. You statistic (90% of people receiving at-home care will need skilled nursing care within 2-3 years) is really interesting. Do you know its source, by any chance? Glad to have you with us–look forward to hearing more from you.
Great website! I do have a question and it is related to others available on your site. Isn’t there a government program that reimburses a family member who provides full time care to a loved one at home? Thanks! Michelle
Hi Michelle–Some states participate in a program called Cash and Counseling; here’s the website: http://www.cashandcounseling.org/ If the care recipient qualifies for Medicaid (a federal- and state-funded insurance program for low-income individuals), then the care recipient can choose to use funding to reimburse the family member who provides care. In addition, some local programs do have fund to reimburse a family member who provides respite care. To find out more about programs in your area, call the ElderCare Locator at 1-800-677-1116. You also can search for programs that can help a care recipient at Benefits Checkup: http://www.benefitscheckup.org