Michelle Singletary – She’s Done It Again

May 7, 2014

Filed under: Financial,Living at Home,MassHealth — Alexis @ 10:42 AM

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

Filed under: Living at Home,MassHealth,Medicaid (MassHealth) — Alexis @ 10:28 AM

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.

Veterans: Are You Getting Older, Need Care, and Want to Stay at Home?

February 27, 2014

Filed under: Living at Home,Veterans Benefits — Alexis @ 11:10 AM

Good news! The VA has several programs designed to assist elderly and/or disabled veterans who want to stay at home for as long as possible. Listed below are some of these programs. They each have different eligibility tests regarding income and assets, minimum age, level of disability, service-connected rating, and geography. If you are interested in any specific program, talk to the outpatient social worker at the VA clinic that you use.

1. Three hours of home health aides per week.
2. Skilled care at home.
3. Adult Day Health – the VA has contracts with many local adult day health programs.
4. TeleHealth (a computer in your home permits a remote nurse to monitor basic health indicators on a daily basis).
5. Home-Based Primary Care. For the truly home-bound, veterans can receive home visits from a team consisting of the PCP, occupational therapist, physical therapist, social worker, and more.
6. Veterans Independence Plus Program (VIPP) provides a budget for a veteran to bring in the care he needs to stay at home, including home health aides, grocery delivery, snow shoveling, visiting nurses, etc.
7. Respite care, meaning that the caregiver can take a break while the veteran stays at the Brockton Community Living Center for 9, 16, 23, or 30 days.

These programs are available only to the veteran. If the spouse or widow of a veteran needs help staying at home, she should look into Aid & Attendance. If you would like further help exploring these programs or other resources to help you stay at home for as long as possible, please contact our office to schedule a Planning Session.

Aid & Attendance

February 20, 2014

Filed under: Living at Home,Veterans Benefits — Alexis @ 11:05 AM

Most of my clients need a little extra help around the house 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 can they 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 can 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 residence – 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.

For 2014, the figures are as follows: If the veteran needs assistance, the maximum amount that he or she can receive is $1,759 per month. If the spouse is the one who needs help at home, he or she can receive up to $1,380 per month. A widow can receive at most $1,130 per month. If you both need care, you can receive up to $2,085 per month. These funds can help supplement home care, and they can also be very useful if you move to assisted living.

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.

If you would like to explore whether A&A can help you pay for your care, please call our office.

Department of Public Health Survey on Health Needs for People with Disabilities

May 20, 2013

This landed in my inbox. It took about 5 minutes to fill it out. Due date is May 31. Here are the details:

Help influence health care in Massachusetts! The Health and Disability Program, part of Office of Health Equity at the MA Department of Public Health (DPH) is conducting a health needs survey for people with disabilities in Massachusetts. The Office of Health Equity promotes the health and well being of minority populations, including people with disabilities throughout the Commonwealth. Results from the survey will be used to determine how best to address the current public health needs of the disability community. To that end, first, please take a few moments to complete the health needs survey yourself here.

DPH would like to get a broad range of respondents representing all the facets of the disability community, please forward the link to your friends and colleagues in the disability community and ask them to complete.

Who should complete this survey?

Residents of Massachusetts, over the age of 18 who have disabilities
Caregivers or guardians of adults or children with disabilities
Disability advocates
Staff at community based organizations or state or local government offices that serve people with disabilities
Academic researchers
Healthcare providers
Public health officials or professionals
Health and wellness promotion specialists
Health administrators
Health policy experts
We also invite participation by anyone else who has an interest in the health of people living with disabilities in Massachusetts. Please forward as soon as possible, as the survey link will only remain active until May 31, 2013. We look forward to hearing from you!

This is a voluntary and anonymous survey. The responses are compiled and we do not have knowledge of individual respondents.

Prepare for the ASAP Nurse Screening Visit

March 23, 2012

Filed under: Living at Home — admin @ 12:10 PM

So you finally convinced your parent or spouse to let you call your local ASAP – around here, that’s South Shore Elder Services or Old Colony Elderly Services. You have a date for the nurse to come meet your spouse or parent. What do you do next?

First, make a list of everything you want to discuss with the nurse. That means all your loved one’s medical issues, medications, medical history, along with all the things you think she has trouble with and needs help doing. Ask other people to help you put together this list so that you don’t forget anything.

On the day of the visit, make sure that the primary caregiver is at the home. That may be you, it may be another family member, it may be a home health aide. Whomever can give truthful reporting as to the elder’s abilities and needs should be at this screening. As most of us decline, whether physically or mentally or both, we become very good at downplaying our shortfalls. No one wants to admit that they need help, especially not with the basics of life, like climbing stairs and getting dressed. Elders tend to be embarrassed that they can no longer do these basic things alone and will tell the nurse that they are more able than they in fact are. The caregiver needs to make sure that the screening nurse gets a full picture of the elder’s needs.

Remember that your job is to make sure the nurse has as accurate a picture as you can give her of the elder’s abilities and needs. Only then can she design a plan that will bring in as many services as possible to fit your loved one’s needs.

Circuit Breaker Tax Credit = Free Money!!

March 23, 2011

Filed under: Living at Home — admin @ 1:18 PM

It’s that time of year again, time to do your taxes.  Even if you don’t file taxes, be sure to check the math on this one: The Circuit Breaker Tax Credit helps Massachusetts senior homeowners whose real estate taxes, sewer, and water bills combined consumed more than 10% of their total income.  The state helps renters whose water, sewer, and 25% of the rent combined totaled more than 10% of their income.

If you typically file taxes, be sure to remind your preparer to check your eligibility for the Circuit Breaker Tax Credit.  And if you weren’t planning to file taxes?  The state will actually mail you a check in the amount of the Circuit Breaker – you simply need to file a one-page form with the Massachusetts Department of Revenue (that’s the state equivalent of the IRS).

If you need help filing for the Circuit Breaker Tax Credit, here’s more good news – each year, AARP trains volunteers who help seniors with their tax preparation.  Call your local senior center to make an appointment with an AARP volunteer.  Spots fill up fast – call soon.

 

More Reasons to Write up a Caregiver Contract

November 13, 2009

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.

Veterans Benefits: Aid & Attendance Benefits

October 26, 2009

Filed under: Living at Home,Veterans Benefits — Tags: , — Alexis @ 11:31 AM

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.

Howard Gleckman’s Caring for Our Parents

October 23, 2009

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.

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