Caregiver Tip of the Month

Situation. I have just started to look for someone to assist my parents. What should I expect for hourly fees and what services can be provided? Mine need some light housekeeping, shopping, errands, cooking, driving, etc. What can you tell me about fees, licenses, insurance and other information to look for?

Solution. A large number of businesses provide the homemaker/companion services you want for your parents. Most can be found in the yellow pages of your telephone directory under Home Health Services. Or, call the Eldercare Locator. Developed by the U.S. Administration on Aging, the Eldercare Locator is a free nationwide directory assistance service. It helps older people and their caregivers find local support services to help them live independently in their own community. This information is available only through their toll-free telephone number 1-800-677-1116, between 8am and 9pm weekdays, Eastern Time.

Two types of agencies are listed in your phone book's Home Health Services category: (1) agencies that are certified by Medicare, and (2) agencies that are not certified by Medicare. Generally speaking, there is no difference in quality between the two. Agencies that are certified by Medicare generally provide health/medical care services that are paid for by Medicare. Any homemaker/companion services they provide are usually only minimal and provided only on days when medical services are provided.

Most agencies that are not certified by Medicare provide homemaker/companion services as well as personal care services (assistance with activities of daily living such as bathing, dressing, medication reminders, etc.). There are two types of personal care services: (1) those requiring only suggestions and reminders, and (2) those requiring hands-on assistance. These services are not covered by Medicare, and must be paid out-of-pocket by the client.

Costs vary widely, generally from $15 to $20 per hour depending on which and where services are to be provided. Because most home health agencies have a 4-hour minimum per visit, it's most economical if the specific activities to be done by the agency are planned out ahead of their visit. This can even include preparing a few meals every week for storage in the refrigerator.

Licensing, insurance requirements, bonding requirements, etc. vary widely depending on where the home health agency is located. However, here's some advice based on personal experience:

• Interview each agency in person to narrow down your list of candidates.

• Ask each agency for a list of referrals. Then, actually check out several referrals. Don't forget to ask each one what they didn't like about the agency. (Or, to be more tactful, ask each referral what the agency could have done better.)

• Require that the agency and its employees be fully bonded, even if your state doesn't require it. (I would never make an exception to this rule.)

• Select agencies that are locally-owned. While they may charge the same, larger regional or national home health firms with many offices have a lot of managers who must also be paid; that leaves less money to hire quality caregivers. Locally-owned agencies can usually afford to hire better caregivers.

• Before making your final selections, interview the owner of the agency, or the person who hires the agency's caregivers if that isn't the owner. More often than not, caregivers tend to reflect the attitudes and ethical standards of the people who hire them. You want compassionate caregivers who will genuinely be concerned for your parents, not people for whom it's simply a "9-to-5" job.

• After you've narrowed down your choices to a few agencies that you feel are the best available, let your parents make the final choice. After all, the agency will be coming into their home to help them. If their personalities don't mesh, you haven't made any progress in helping them.

Finally, take a look at our article Elder Care - First Steps. It will be a helpful guide as you become increasingly involved with helping your parents.

Our visitors ask ...

Q. What happens to people who use up all their savings and they're in a nursing home? Do they throw them out on the curb?

A. In most cases, if your loved one is already in a nursing home when he or she runs out of money, the nursing home cannot throw them out.

In 1999, Congress passed Public Law 106-4, "Nursing Home Resident Protection Amendments of 1999." In summary, the federal law says:

1. If a private-pay or Medicare patient lives in a nursing home while the nursing home is a Medicaid provider (most are), he or she cannot be discharged for financial reasons, even if the nursing home later withdraws from the Medicaid program, but continues to provide nursing home care to other types of patients. HOWEVER, nothing prevents the nursing home from moving the patient, without his or her permission, into a lower-cost room, including a ward-type room for several patients, or a special Medicaid section of the facility. But, the nursing home cannot transfer the patient into another nursing home without his or her specific permission.

2. A Medicare or private-pay patient who enters a nursing home when the nursing home is not in the Medicaid program can be discharged [evicted] when he or she is no longer able to pay the charges of the facility, even if the patient then qualifies for Medicaid. But for this type of discharge to be allowed, the nursing home must have informed the patient of this discharge [eviction] policy in writing, and received the patient's written acknowledgment, when the patient began residence in the facility.

As you can see, there are several "ifs" involved, including whether or how soon your loved one should apply for Medicaid, the federal/state program that pays about half of all nursing home expenses. If you or your loved one is in this situation, or will be shortly, we highly recommend that you discuss all of this at your earliest opportunity with an attorney who specializes in elder law. Check the yellow pages in your local telephone directory, or go to the National Academy of Elder Law Attorneys' website. On their home page for the public, you'll find a link in the upper left corner (just below their logo) that will help you locate an elder law attorney.

Daily Living Solutions

— products for seniors —

As we grow older, it often becomes difficult to use many everyday products because of arthritis and other conditions. If you or a loved one needs a little help – or a lot – we've selected a group of practical and affordable solutions from our affiliated merchants to help overcome those limitations.

Whether you are looking for yourself, or to help an elderly senior continue living in their own home, you'll find a wide variety of supplies and accessories – raised toilet seats, safety rails, incontinence supplies, large-handle eating utensils, pain relief, diabetic supplies, pill splitters and crushers, big-button telephones, canes, walkers, rollators, wheelchairs – and much more.

Everything is sorted into convenient categories in our Solutions for Seniors section.

Caregiving – Finding the money for care at home

In addition to the resources discussed in previous issues (click on Archives to see them), you might qualify for a tax-deduction if your mother and/or father moves into your home, and you modify your home to accommodate them.

Under Section 213 of the Internal Revenue Code, at least a portion of the expenses you incur for modifying your home COULD be deductible in the year you pay them. (FYI: Section 213 defines tax-deductible medical and dental expenses.) Whether you actually can deduct those expenses depends upon many variables including:

1. Does your mother or father qualify as your dependent for tax purposes?

2. Is your tax accountant intimately familiar with Section 213 as it pertains to qualified long-term care expenses? Or, can he or she read the Internal Revenue Code just as well as anyone else? (You want the first type of accountant!)

For more insight as to what the IRS rules are (including the definition of a dependent for tax purposes), Section 213 is explained in IRS Publication 502 (to see it, simply click on the underlined link – it may take a few minutes to download if you use a dial-up connection).

If this situation might apply to you, we highly recommend that you discuss this matter with a qualified tax accountant.

Caregiver Tip #2

If your aging loved one lives in another state, it is usually not easy to manage their care long distance. Hiring a geriatric care manager may be your best solution.

A geriatric care manager is an elder care professional trained in geriatrics, social work, nursing or counseling. He or she will conduct a thorough patient assessment to identify needs and develop an appropriate plan of care for your loved one. They can also screen and supervise professional caregivers; coordinate medical care; pay bills; and act as a liaison with your family. And, they can screen and supervise other qualified people to help with housekeeping, laundry, shopping, maintenance and repairs; review applicable financial and legal issues and offer referrals to geriatric specialists; and assist with a change of living arrangements, if that is most appropriate.

To find a qualified geriatric care manager near you, look at the website of the National Association of Geriatric Care Managers. This is the major national association of health care professionals who oversee long-term care arrangements needed by older people. Their Web site includes a locator to help you find a nearby care manager.

Our visitors ask ...

Q. My mother has a hard time getting to the bathroom at night so she uses a bedside commode. The problem is the odor and emptying it. Do you have any suggestions?

A. Switching to a portable camping toilet would solve the odor problem, and it would not have to be emptied every day. My mother-in-law used one for years in her summer cottage where the bedrooms were on the second floor and the only bathroom was on the first floor. Because she had difficulty getting up from a toilet, my father-in-law built a 6-inch high platform for the toilet to sit on. She found it very easy to use, virtually odor-free (you add special deodorizers to a camping toilet's holding tank), and because she used it only at night, had someone empty it for her just once a week.

For more information about the portable toilet made by Coleman, the well-known manufacturer of quality camping supplies, click on Coleman Portable Toilet, then click on the picture for complete details.

Recommended Reading and Videos

Many excellent books and videos can help guide you through the caregiving process. For our recommendations, including a brief description of each one, click here.

The material on this site is for informational purposes only, and is intended as a supplement, not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. More