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Elderly parents or loved ones often live independently for many years. A sudden illness, a surgery, a fall or an accident, or the onset of Alzheimer’s or dementia can change their lives abruptly. Suddenly family members are faced with the hard reality that Mom or Dad are unsafe without full time custodial care. Who will care for them? How much will it cost? How will the family pay for it?

Bonds of love or a sense of duty may cause a family member voluntarily to fill this need at first. It may start informally by a good natured soul doing the shopping, cleaning the house, cooking meals, or helping with bathing or bathroom needs. Before too long, it becomes apparent that giving Mom or Dad the care they need is a full time job. Few family members are willing or able to quit their own jobs to care for aging parents. What can be done?

Family members are often dismayed to learn that Mom’s or Dad’s insurance coverage or government benefits may pay for skilled nursing care, but not for custodial care. One potential solution is to hire a family member, rather than an outside agency, as the custodial caregiver.

The benefits of having a family member take on the paid job of caregiver for an aging parent are significant. Parents can remain at home rather than become institutionalized. They are usually happier, and feel more secure, in their own environment surrounded by people they know and love. The family caregiver, motivated by love and filial duty, often provides a level of attention above and beyond what is ordinarily expected from even the finest agency provided caregivers. Paying a family caregiver can help spend down countable financial resources, so that the aging parent may qualify for need based benefits like Medicaid. This also can help to reduce the parent’s estate, and provide a needed source of income to an unemployed or under-employed family member.

The challenges posed by having a family member serve as a paid caregiver can be significant as well. Family relationships can be strained when expectations and duties are imperfectly discussed, defined, and met. Without a management team imposing accountability, a family caregiver may be tempted to cut corners on hours and care. “Sham” arrangements can hurt the aging parent’s chances of receiving public benefits. Informal arrangements can also have the unintended consequence of depriving the aging parent from receiving timely skilled intervention or nursing care.

There is no substitute for careful planning and oversight. Here are some observations for successful family caregiver arrangements:

1. Consult with the aging parent’s doctor to determine whether the parent’s needs can be met at home, or whether nursing home care is indicated;

2. Prepare now for future incapacity. Now is the time to address the need for a Power of Attorney, guardianship, drafting a will, setting up trusts, executing advance medical directives, and establishing an estate plan. The mental capacity of the aging parent will dictate which strategies are useful and possible.

3. Create a formal, written caregiver agreement signed by both the parent and by the family caregiver. Some matters, which one should address in the agreement, include:

  • The nature and scope of services. For example, what hours and days of the week will the caregiver work; will the caregiver do the shopping; prepare the meals; do house cleaning; help the parent bathe, shave, and dress; help with the toilet; go for walks; help with exercise; organize and administer prescription medications; drive the parent to appointments and activities?

  • The caregiver’s compensation. It should reflect the fair value of the services agreed upon in order to satisfy spend down requirements. The family should survey the cost of local home care agencies and independent home caregivers. Third parties, like the family accountant or broker, should be hired to do tax reporting and withholding, and to obtain workers compensation insurance.

  • Respite and caregiver leave. The family caregiver will need time off for holidays, vacation, personal days, illness, and respite. What is your backup plan when the family caregiver is not there?

  • Start dates and termination. When would the caregiver start their job? How would the caregiver go about terminating their employment? How and when would the parent or family members terminate the caregiver’s employment, and under what circumstances?

4. Realize that the aging process will advance. The middle of a health crisis is not the time to begin thinking of a life plan and of an estate plan for your loved ones or for yourself. It is more difficult to think clearly and to make good judgments on the spur of the moment in highly stressful conditions.

Planning and acting now can help you and your family to remain focused and in control. Planning and acting now can also help you to qualify more quickly and readily for government benefits like Medicaid, and to avoid unnecessary ineligibility and penalty periods. Planning and acting now is simple, common sense.

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