Prepare for the ASAP Nurse Screening Visit

March 23, 2012

Filed under: Living at Home — Alexis @ 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 — Alexis @ 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.

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.

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.

Home Modification Loans Available at 0% to 3% Interest

May 5, 2009

Filed under: Living at Home — Tags: , — Alexis @ 4:43 PM

Many elders and disabled folks are doing well living at home, but their house needs some modification to make life a little easier.  Maybe it’s building a wheelchair ramp to the front door, widening doorways, modifying the kitchen and bathroom, or installing a lift.  Whatever it might be, the state is providing very low- or no-cost loans to homeowners and to landlords of small buildings (under 10 units).

Loans are for up to $30,000 and are based on very generous income guidelines.  For example, a two-person household with an annual income of up to $72,200 qualify for the 0% loans, and couples with incomes up to $144,400 qualify for the 3% loans.  The 0% loans are repaid when the house is later sold, and the 3% loans are paid back on a monthly basis within 5 – 10 years of the time the loan is made.

This is a great opportunity to make those one or two modifications to your home that would make it much easier to remain there longer.

For full details, see the Home Loan Modification Program’s website, or for South Shore residents, call Mary Ann Walsh at the South Middlesex Opportunity Council, 508.202.5919.

Being Paid to Care for Your Parents

January 28, 2009

As their parents have needed increased hands-on care and errand-running, many “Boomers” have been squeezed trying to juggle caring for their parents and performing well at work.  Our current economy has produced a mixed blessing for some – lost jobs means time to address their parents’ needs, but without economic security.

One solution is a “caregiver contract.”  This is a written agreement between the parents and the 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 her own family.  Only an elder law attorney familiar with the ever-changing rules of Medicaid should draft a caregiver contract, so that it will protect the elder in the event she needs nursing home care in the future.  If not done correctly, a caregiving arrangement can result in a later denial of MassHealth nursing home benefits.

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