It’s scary to think about having a medical emergency and not being able to speak to tell the EMT’s who to call. Well, if you carry a cell phone, one solution is to put the names and numbers of your emergency contacts in there. EMT’s, firefighters, and other first responders know to look there.  Just add those names to your address book as “ICE” - In Case of Emergency.

In my phone, I have a few people listed - I have ICE1, ICE2, and ICE3.

I’ve been writing a lot about caregiver contracts lately. That’s because they represent the ideal solution for so many families.

Many children become part-time or even full-time caregivers for their aging parents. Sometimes a child needs to be paid for this - usually that is the only way she can afford to leave her job in order to stay home and care for Mom. And in some families, the parent insists on paying the child, or at least contributing to groceries and utilities - because she doesn’t want to feel she is taking advantage of anyone or being a burden.

Earlier posts describe why a written caregiver contract is important to prepare for the possibility of a future MassHealth nursing home application, but here is something that would apply more immediately:  in addition to drafting a good contract, an elder law attorney will also set the family up with a payroll service that will make sure the child receives the benefits of an employee. Namely, the child will have two special protections.

The first is worker’s compensation coverage. Have you ever helped a frail elder with a shower? How easy is it to hurt your back? Very. With a proper caregiver contract arrangement, that child can collect worker’s comp from her injury.

The second protection is the unemployment benefit. Sometimes, no matter how good a job a child does of keeping Mom at home, there comes a time where the care Mom needs exceeds what the child can provide, and she must move to a nursing home. Now the child is unemployed.

For so many families, paying a child to care for the parent is the best solution. Having informal, unwritten understandings is typical, but leaves both the parent and child open to too many pitfalls. By working with an elder law attorney to craft a good caregiver contract and to set up a payroll service to take care of the deductions and taxes, both the parent and child will be much better protected in the long run.

On Veterans Day 2009, Governor Patrick signed into law a range of new or increased benefits for veterans. One component is additional “welcome home” bonuses for soldiers completing multiple tours of duty. Until now, they received a bonus only upon returning home from the first tour.

A forward-thinking provision is to allow veterans to use some of the education and training they received in the military to count towards state requirements when seeking certain state permits or certifications.

The law also allows the state to be more proactive in preventing veteran homelessness, by working with vets before they become homeless and by providing more housing.

Perhaps one of the most important provisions is increased social support to returning veterans and their families. Spotting needs due to mental health issues or physical impairments – and many of both can go undetected for some time – is critical to keeping vets and the families caring for them from unraveling. I hope that the state makes some real advances in social services and can become a model for other states.

The US Census, conducted every ten years, is underway. You can count on scammers to use the opportunity to try to rip people off.

A Census worker will be coming to your door. They will have an identification badge, a copy of the letter that was previously sent to you by the Census Bureau, a bag or laptop with the Census Bureau insignia, and a hand-held device.

They will ask you for your name so that they can verify your address.

Legitimate census workers will NOT ask for your Social Security number, your credit card number, bank account numbers, or any other confidential information.

If anyone does claim to be with the Census and asks you for your Social Security number, credit card, or bank information, ask them to leave.

Also note that the Census will not contact anyone by email. If you receive an email claiming to be from the Census, it is not legitimate.

Keep an eye on your neighborhood, especially the homes of elderly neighbors. Seniors are particularly susceptible to scam artists.

Most of my clients need a little extra help at home but aren’t sure how to pay for it. When we look at their savings and project how long those funds will work for them, the bottom line is usually this: if the client had just a little more cushion, they could stay at home, with the proper supports, for longer. But where to find the money?

For many of the Greatest Generation, the answer lies in Veterans Benefits. There is a fantastic program that few seniors and their families know about: Aid & Attendance. Once you qualify, the VA will send a monthly check that you use to pay caregivers, buy medical equipment, remodel a bathroom to be wheelchair accessible, pay rent at assisted living – whatever you decide is the best and most effective use of that money. This is the most logical, pragmatic long-term care program I know of. It helps seniors stay at home or in an assisted living – and out of a nursing home – for longer. All without limiting you to certain home health aide agencies, rolling deductibles, and a lot of the impediments that come with other support programs.

The application process for the A&A program is not for the faint of heart. There are reams of papers to fill out (of course), and it can take at least six months to receive approval. More to the point, the VA regulations are hard to find, and if you can find them, impossible to understand. More than almost any other government program, you will need an elder law attorney or a qualified veterans representative to walk you through the planning process. Without this help, it is very difficult to obtain the maximum benefits you are entitled to.

In order to assist you, an attorney must be “certified” by the VA and take requisite training. I have made it my business to become certified and receive the necessary education so that I can help my clients stay at home for longer.

I’ve been reading Howard Gleckman’s book, Caring for Our Parents, in which he examines the long-term care system of today and the future. Essentially, if we keep on doing things as we are now (expect people to use up their savings to stay at home or in assisted living, have Medicaid pay for nursing home – with a few other public programs thrown in here and there), then the elderly of the next few decades are in for quite a shock.

My conclusions are these:

1. Write a Health Care Proxy and a Medical Directive, or Living Will.  My version of this is to give clients Your Way, a fantastic workbook that helps you spell out to your family what care you would want in various end of life situations. Long-term care is astonishingly expensive, as you know if you are currently coordinating at-home care or other support for your parents. If you don’t want that kind of money spent on you – if you don’t want certain procedures done or decisions made – tell your family now. During an emotional crisis, it will be very difficult for them to turn down a medical option without you having previously given them that moral permission.

2. Get thee to a financial advisor. The current long-term care system depends in large part on the consumer paying her own way. The Boomers are notorious for not saving money. Work with an advisor to see what kind of cushion you can build up.

3. Get involved in politics at the grass-roots level. As currently structured, the Social Security, Medicare, Medicaid, and long-term care insurance systems are projected to crash in on themselves. Additionally, Boomers don’t have the numbers of children that their parents do to share the workload. Your parents will be OK – an elder law attorney can help them stretch out their assets to stay at home for as long as possible. But the Boomers will not be OK. The system needs to be overhauled, dramatically. I don’t have answers, but Gleckman outlines the models that some other countries use. I’m sure there are other brilliant policy makers in the US coming up with excellent ideas, as well. But ideas become law only if the Boomers use their sheer numbers to push the system to provide the care they expect. Without big change, the Boomers will be in for quite the surprise in their frail old age.

Last week I gave a presentation to Weymouth parents of special needs young adults, and from our conversation, it was clear that the school system was telling them that when a special needs child turns 18, the family must obtain a guardianship. As I’ve written elsewhere, this costs money, involves lawyers, and requires going to court. And for kids with developmental disabilities, there is the daunting clinical team report, which requires coordinating three different professionals.

Fortunately, guardianship (and its accompanying conservatorship) is not necessarily the answer for every family. For lots of kids, a Health Care Proxy and Durable Power of Attorney are the way to go. I don’t know why school special ed personnel are not educated on this, but the Health Care Proxy and Durable Power of Attorney are much more respectful of the young adult’s autonomy and cost significantly less – thousands of dollars less – with a fraction of the hassle.

To sign her Health Care Proxy and Durable Power of Attorney, the young adult needs to have a basic understanding of what she is appointing the named agents to do (usually her parents, but not necessarily – it’s up to her to decide whom to name). Ask yourself: Does she understand that money buys her things? That money must be saved and spent with care? Does she like to have someone help her manage money and make decisions? Does she like to have someone involved with her medical care? Would she like for someone to be able to tell doctors what to do if she can’t tell them herself?

If you think the answer to these questions is “yes,” then meet with a special needs attorney to discuss a Health Care Proxy and Durable Power of Attorney instead of guardianship and conservatorship. Technically speaking, the question of whether a person has the requisite mental capacity to sign these documents is a legal one, so the attorney will need to meet with the young adult alone – maybe more than once – to make that determination for herself.

And if the attorney decides that indeed this young adult can create and sign these documents, than the small investment you have made is more than outweighed by the savings of avoiding guardianship and conservatorship – in terms of the young adult’s autonomy and your family’s time, money, and emotional capital.

If as a parent and child, you have agreed that the child will care for her parent in exchange for compensation, you need to work with an elder law attorney to draft a caregiver contract, as discussed in earlier posts.

What will your attorney put into the contract? She will list details of the care to be provided, ranging from the hands-on care, meal preparation, shopping, laundry, to the right to a private room and evening quiet hours. Most likely, the attorney will bring in a geriatric care manager to develop a thorough care plan, and the attorney will incorporate the terms of that plan into the contract.

Rate of pay will be included. Can you just ask your parent to pay whatever salary you would like? No. The rate will be based on comparable work performed by professional agencies in your geographic area, such as home health care agencies.

The attorney will also help you arrange for the appropriate payroll deductions, such as Social Security and worker’s compensation.

Beware of trying to write a caregiver contract on your own – this contract will very likely be scrutinized in the future by MassHealth, Social Security, and the IRS. Avoid issues with these agencies later by working with an elder law attorney now to draft an appropriate contract.

Do you help someone manage their money? Perhaps you are a representative payee on the Social Security checks of an SSI recipient? Or maybe you are the trustee of a special needs trust?

Would the person whose money you manage – let’s call her the recipient – like to have some cash in her pocket for small purchases of her own?

There is an interesting new debit card that can give you the best of both worlds, the Mastercard Allow Card. The premise is that as the trustee or the representative payee, you would put some amount on the card every month, let’s say $200. You would also fill out a lengthy questionnaire, detailing what purchases can and cannot be made with the debit card.

So if, for example, you are managing Social Security funds for an SSI recipient, you know that her SSI checks are meant to be spent on food and shelter. You would allow the debit card to be used for those purchases, but you would, perhaps, block it from being used for buying video games or cigarettes.

Likewise, if you are the trusee of a special needs trust, you know that those funds are not to be used for food or shelter. You would set up the card to reject any attempted purchases of snacks or groceries. And you would allow the card to accept purchases of books, movie tickets, etc.

As the person filling out the questionnaire, you have discretion to set up the purchasing rules as you feel is appropriate. And at the same time, it gives the recipient the independence, satisfaction, and pride of knowing that she can walk into a store and take care of herself.

There are fees associated with both cards, you will need to investigate both and see if this is the right for your situation. Special thanks to Jack Longert of the Wisconsin Pooled and Community Trusts for teaching me about this.

As they need more help with daily tasks, many parents prefer to have their kids helping them rather than hiring an aide. And many children want to be helping their parents, if only they could afford to quit their job.

One solution is for the parent to hire the child. I discuss some of the nuts and bolts of how to draft a caregiver contract in another post. I also previously discussed the advantages of caregiver contract in a down economy.

The message for this post is that if you plan to hire your child, or if you plan to work for your parents, everything must be in writing. If the parent eventually needs to apply for MassHealth, your chances of having the application approved significantly increase if the agreement was in writing during all those years that the child provided care. If it is not in writing, MassHealth may well declare that any money passing from the parent to the child was a gift – and a gift disqualifies a person from receiving MassHealth assistance.

Working with an elder law attorney will improve your chances of having the agreement approved by MassHealth, because an elder law attorney understands what needs to be in the contract not only to satisfy MassHealth, but also to help you comply with Social Security laws, income tax regulations, and employment laws.