South Shore Senior Population Set to Boom
January 18, 2010
Yesterday’s South Section of the Boston Globe had a two-page story on the coming boom in the senior population. It’s reassuring to read that senior centers are reexamining their goals and programming in light of the change in clientele. The biggest issues I see facing my clients are (1) bringing in the support system required to remain at home for as long as possible and (2) transportation.
So far the societal responses to these needs have been minimal. Take transportation – the Ride is, well, a long ride. The senior centers have vans, but you need to set up your appointment in advance, and their funding allows them to transport seniors only for certain types of activities. Poor transportation options as an elder or disabled person have been the flip-side to the choice of living the quiet life in the suburbs.
As for remaining at home for as long as possible, there is more help available here, and I help my clients access the resources available to them as best as possible. There is veteran’s funding, MassHealth money, and then good old fashioned creativity – like setting up a contract with a child that allows her to leave her job in order to care for her parents, yet be paid so that she can still meet her own obligations at home. Or, another example would be two or three elderly neighbors sharing the services of a personal shopper or a personal chef so that the grocery shopping and cooking is taken care of.
As a society, we expect to be taken care of in our old age, yet we encourage our children to cross the county in search of their dreams, so we don’t have a built-in support system. And we don’t like to pay taxes. So who will care for the Boomers? I think the coming decades will see a blossoming of the American “creative spirit” – neighbors banding together to develop shared living arrangements, new businesses developing to serve seniors at home at prices they can afford. And in the mean time, each aging Boomer should be saving up funds for what they hope will be a long retirement. Meeting with a trusted financial advisor would be a very good first step.
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
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.
What Goes into a Caregiver Contract?
September 21, 2009
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.
Paying Your Children to Care for You? Put it in Writing.
August 30, 2009
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.
How Do You Purchase the Right Long-Term Care Insurance Policy?
December 10, 2008
If you can afford the premiums, long-term care insurance (LTCI) is usually good investment in your future. The right policy will pay for at-home care, medical equipment, nursing home care, and maybe even some of the monthly fees at an assisted living. Actuarial tables demonstrate that in many cases, families that paid LTCI premiums over many years and then needed some increased care came out ahead as opposed to paying out of pocket for home care, nursing home care, etc.
But how do you pick the right policy? A December Wall Street Journal article described that Conseco, Inc. has shed its LTCI unit to a trust run by the state of Pennsylvania. Observers suspect that this will not be the only company to give up its LTC customers.
The best way to pick the right policy for you – and that may be very different from the right policy for your neighbor, sister, or best friend – is to work with a trustworthy financial advisor. A good advisor should be able to generate quotes for you from several different companies and should walk you through the differences to help you make an informed decision. While no one can predict the future, a good advisor should have a handle on which companies have strong holdings backing up their policies. Your elder law attorney should have a relationship with one or more qualified advisors.
And remember – financial advisors are paid by commission depending on which policy you ultimately buy. Ask the advisor if he is willing to show you the commission statement associated with each of the quotes to make sure he is not steering you towards the one that benefits him the most, unless, of course, that happens to also be the policy that is best for you.