Three Benefits of Home Care

Independence

When seniors reach the point of needing outside care, their greatest fear is the loss of their independence.  We all value our freedom and relish our ability to take care of ourselves, but for seniors, it is no longer a voluntary relinquishment, it is something that is imposed on them by the limitations of frailty and sometimes, mental capacity.

Understanding the Independence Issue

When something is taken from you, even by nature, it makes us angry and we want to strike back in defiance.  We go into denial and refuse help, especially outside help that costs money.  You may have experienced this with someone close to you for whom you are considering care.

At least 86% of people over age 60 say they want to avoid ending their days in a nursing home.  But until something dramatic occurs forcing the issue, most seniors typically refuse even home based supportive care and it’s all about the fear of losing one’s independence; having someone else tell them what they can and cannot do.

So it’s important when attempting to arrange care for a loved one that they know that home based supportive care is just that, supportive.  The primary mission of any home health agency should be to ensure the customer’s independence at home for as long as possible.  It’s important that we help them understand that the presence of a caregiver is not a restriction but rather, a way of helping them keep what they cherish most, their independence.

There are several important things to understand in advance of the qualification process including:

1. You or your loved one can’t have too much income or assets in their name(s).
2. You will be required to prove financial need
3. The process will include a 5 year “Look Back” period.

The Five Year “Look Back”

The 5 year “Look Back” period means that any money spent in the five years prior to the Medicaid application must be accounted for as having been used for “verifiable goods and services.” The 5 year “Look Back” period is there to prevent people from transferring assets to a family member and then claiming they are destitute.  The idea is to prevent fraud and insure Medicaid funds are there for those that actually need them. If you can’t formally and legally establish that the money spent was for acceptable purposes, there is a penalty, often equal to the value of the amount spent but unsubstantiated.

Common Mistakes

The most common mistake is to spend down the assets by hiring a private companion/aide to help the loved one in need until the funds run out. The catch is that if the private aide is not properly set up as an employee with taxes withheld then the money spent on them will NOT count against the spend down when you go to apply for Medicaid. Now, the money is gone and you still may not qualify for Medicaid.

Often that mistake involves the hiring of people working under the table or whom are not legally entitled to work in the US.  In those circumstances they can’t give you proof of employment for obvious reasons.  So now you are stuck with no money and can’t get qualified for Medicaid because they penalize you for the amount you spent on home care but couldn’t properly substantiate.

At this point, if you can’t take care of your loved one yourself, you are forced to pay for the facility (or extended home care) out of your own pocket until the penalty has been satisfied.  That could amount to hundreds of thousands of dollars over time and most folks can’t handle that.

Planning for Medicaid

If you are considering home health care for your loved one it is important, for the reasons mentioned above, to hire a home health agency right from the start and allow the agency to handle the details of employment, ensure proper documentation and establish the legitimacy of expenditure so that the 5 year “Look Back” period can be legally satisfied.   A legitimate agency can and will provide you with qualifying verification on the amount spent, thus greatly smoothing out the qualification process.

If you’re in our service area and would like more details on planning for the qualification process through the proper use of home health care for your loved one, give us a call at 908-359-4663 or drop us an email.

Does The Driver’s Insurance Provide Coverage for Everyone?

First, insurance companies do not cover people who transport someone in their own vehicle while being paid. The caregiver’s agency may provide liability insurance but the caregiver’s car will not be covered for physical damage. The best way to negate this problem is to provide a vehicle for the caregiver to drive. The owner can give anyone permission to drive so as long as the vehicle is properly insured, it should be ok. If you or your loved one have a vehicle hang on to it for the caregiver to use (only when they transport the person they are taking care of).

When Is It A Bad Idea For A Caregiver To Provide Transportation Services?

For a caregiver to take a patient (especially someone with dementia) to doctor’s appointments without an accompanying family member is not in anyone’s best interest. They are not family and should not be used as a surrogate for a family member who is responsible for them.

What Else Should I Know?

As a general rule, people who drive do not usually make good long term live-in caregivers. Why? It’s because people who drive tend to be independent in nature. To be tied closely to a geriatric person for days, weeks and months on end requires a special person. Sooner or later, a person who drives will all too often start finding excuses to go out or take time off more frequently, requiring frequent relievers who may or may not be familiar with the case. If they start leaving the customer unattended, it can be a serious problem and you may not be aware of it until something goes wrong.

If you have a live-in caregiver and your loved one will need to be transported from time to time, consider alternative means of transport.  Options to consider include:

1. Having a family member drive them
2. Senior Care Transportation services which often use accessible vans and buses
3. Your local church, synagogue or other religious organization which may have volunteers that will assist with transportation needs
4. Public Transportation which will often have special rates available for seniors (remember, you caregiver can accompany them)
5. Taxi or Private Care for occasional or spur-of-the-moment travel needs

It’s best to have a few options on hand with contact numbers and rates readily available so that you can address any transportation needs that may arise.

Mistakes To Avoid

When it comes to caregivers handling money there are several common mistakes:

1. The biggest mistake you can make is to give a caregiver a credit card.  There is never a need to give a caregiver a credit card.
2. The second biggest mistake is asking or allowing the caregiver to assist the customer in writing checks and paying bills.  Seniors often have a heightened sense of paranoia and may have a difficult time trusting even their own children with handling their money so you should not place the caregiver in such a position.  There are plenty of services that will assist with bill paying for free or for a nominal fee.
3. Third, asking the caregiver to cash a check for you or your loved one sets up a paper trail that can lead to very serious misunderstandings.  Check cashing is as problematic as the fourth mistake… handling cash.
4. Forth, handling cash can lead to misunderstandings very quickly. For example,  the customer gives the caregiver a $10 bill.  The caregiver dutifully goes to the store, buys groceries, gets a receipt and brings them back along with the change.  The customer then swears they gave them a $20 bill.  What do you do?  From then on, no matter how honest the transaction was trust is diminished.  Ideally, a signed receipt would accompany every step of the transaction but realistically, this does not happen.  The only thing you can do is make sure that everyone agrees on the denomination(s) and amount of money exchanged up front.  But dementia patients in particular cannot be relied upon with this procedure so you are taking your chances that everything will be alright.

How To Have Caregivers Handle Money

The best method for a situation where a caregiver needs to handle money is to provide the caregiver with a dedicated debit card.

When using a debit cared keep the following rules in mind:

1. The card should be dedicated and not used for any other purpose so that it is easy to account for all of the spending on the card.
2. The card should have a limited transaction value
3. A strict procedure for accounting for receipts and reconciling transactions should be in place and understood by everyone involved.
4. Accounting for the card should be done regularly using a strict procedure.  If everyone knows the process then there is far less likelihood of there being a misunderstanding.

Caregivers are there to help in many ways and transactions requiring money may be necessary.  But anytime money is involved it’s best to control things as tightly as possible to mimimize misunderstandings.

What most people don’t realize is that not everyone is suited to caregiving, even when the patient is someone close to them.  So what makes a person a good caregiver, especially when the patient is someone they don’t even know?  Here are 7 key points to understand:

1. Personality – This is the single most important ingredient to consider.  Caregivers need an innate sense of selflessness and empathy, and sometimes what may seem like a natural personality fit can be deceiving.  Most people have a good degree of human compassion but only those with the right set of inner ingredients can voluntarily sustain themselves over time.  Don’t assume that one personality type is best until you have experience with it.  Look for “sweetness,” a willingness to serve, an absence of “attitude,” and the patience to weather a patient’s bad days.  Be leery of people who stipulate non-medical tasks they won’t do.  With the exception of injections, wound care and dispensing medication out of prescription containers, there should not be much they won’t do. It’s their attitude toward work that matters most.
2. Experience – Experience is valuable in that it helps the caregiver determine whether or not they can handle a particular assignment.  But it is NOT the primary ingredient one should look for when evaluating a caregiver.   An inexperienced caregiver can be more eager to please and willing to go the extra mile.  Caregivers are human and they can project inappropriate characteristics and responses from past experience onto a new case without realizing they are doing it.  If they have experience with a specific ailment, they may know whether or not they can handle it but your patient may exhibit entirely different behavior and past experience may or may not be relevant.  On the other hand, someone with no experience caring for particularly taxing ailments like say, a dementia patient, should be carefully considered before being hired.
3. Training – It is hard to argue that licensed caregivers are not more prepared for caregiving than those who have never undergone formal training.  However, if the caregiver has a bad attitude or a poor work ethic, all the training and licensing in the world won’t make them a good caregiver.  If your loved one needs personal care (assistance with bathing, dressing, toileting, etc.), you should look for a Certified Home Health Aide (CHHA) but always assess how well their personality fits.  However, an experienced person with a natural aptitude can be every bit as effective with a particular patient. Providing training is one of the many functions of a home healthcare agency.
4. Reliability – Caregivers work largely unsupervised.  Hourly caregivers can run into all manner of obstacles in getting to and from their assignment locations and excuses abound.  Prior references will provide clues as to whether or not they can be relied upon.  Take this seriously but not too seriously.  References can provide a measure of what will happen when you are not around but a lot of people are reluctant to disclose negative characteristics about former caregivers.  They are unwilling to expose themselves to possible recrimination and often don’t want to harm someone’s chance to make a living.
5. Accountability – How a person accepts criticism is usually a reliable indication of whether or not they feel responsible for their patient.  Anyone who cannot admit past mistakes should be viewed with suspicion.  Caregivers who place blame for things that go wrong everywhere but themselves are not to be trusted.  It may be natural to avoid blame but responsible people do accept responsibility.
6. Honesty – Honesty doesn’t just mean that they do not steal from helpless old people or their families.  It means they show up on time, handle their responsibilities accurately and can usually account for things such as drugs, supplies and monies entrusted to them.  Where live-in caregivers are concerned, it also means they arrange for time off and return according to the schedule they agree to, giving adequate notice and not playing games to make relievers look bad in order to assure their own job security.
7. Financial Need – We have a natural repulsion for caregivers who openly acknowledge they are doing this work because they need money.  We have a tendency to assume it means they do not care about the loved one.  However, judging a person who does this work for money is not necessarily a good gauge as to their aptitude.  After all, most of us hold jobs because we have to pay the bills.  This is not something to be upset about.  If you are paying an aide privately, then you have taken on the responsibility for managing that person and continually negotiating their compensation.  Unless they continually push, don’t be surprised or offended if they try to negotiate for more money.

So what makes a good caregiver?  It is a set of intrinsic qualities that certain human beings possess and others do not.  It is all about personality and how that personality fits with the patient and the members of their family.  It’s just as simple and just as complicated as that.

Mesothelioma patients may encounter difficulty in dealing with symptoms of the disease. These symptoms, which can be quite debilitating, may compromise quality of life and can make it difficult to carry out normal activities. Similarly, dealing with the side effects of treatments such as surgery, radiation and chemotherapy can be life-changing. Although mesothelioma treatment options are certainly designed to help the patient combat the disease, they can weaken the body and mind.

Treatment for mesothelioma will vary from patient to patient, and thus affects what a caregiver may cope with depending upon the patient’s response to treatment. Although no cure exists, patients can elect to undergo therapy that may improve their overall quality of life. Attaining an early diagnosis can expand treatment options and may result in more effective treatment results. In addition to surgery, chemotherapy and radiation therapy, some patients may qualify for experimental treatments through clinical trials.

Whether or not a patient elects to undergo treatment, those who may aid in caregiving should find ways to reduce stress. Many choose to meditate, pray, read, exercise or take a walk. Stress and anxiety are factors when dealing with a terminal illness and are important issues to address after a friend or family member has received a diagnosis.

The patient and family advocates at Asbestos.com can assist mesothelioma patients in a variety of ways. They can help patients find the best doctors and treatment facilities in their area, provide access to local support groups, offer free literature and informational books on asbestos-related illnesses, and help veterans receive their VA benefits for asbestos-related health issues. Being diagnosed with an asbestos related disease often leads to a mesothelioma lawsuit.

Written by the content team at asbestos.com

As concerns over the future of the economy mount, families facing the uncertainty of extended home care for a loved one look harder for cost saving solutions.  And who can blame them?  Everything was fine until granny took that fall or grandpa had a stroke.  Now, all of a sudden, when it’s time to come home, the family is forced to examine the options available to them and none of them are cheap.  Too often, there was no chance to prepare financially and all the kids are working to support their families.  When one person is out of work, that person is often expected to render the kind of care that only professionals are trained for and when they “burn out,” anger and frustration build until the entire clan is at odds.  Friends and neighbors are also depended upon until they can’t continue and eventually garner the courage to ask for relief.  The job of care giving is hard and relentless and sooner or later, it’s going to cost money to give a senior the support they need.

So why shouldn’t the family place an ad in the newspaper or ask a friend to refer a caregiver they know of who has served them or someone they know?  Why shouldn’t they yield to the temptation to avoid employer’s taxes and pay an illegal immigrant under the table for the care they need?  It is undeniably cheaper than going through an agency and sometimes everything works out just fine.  It may also be less stable and unless things are handled properly, it is certainly illegal.  It’s funny how people will rationalize things when their wallet is at stake.

Putting the legal issue aside for the moment, the answer to this question comes in several parts.

First, if a person is not properly insured and they fall or pull out their back or whatever, the employer can be held liable for three times as much in compensation as if they had Workers Compensation in place.  That compensation has the potential to last lifetime.  At the very least, make sure the homeowners insurance policy where the care is rendered has a “Contingent Workers Compensation” endorsement attached.  A responsible agency will have the proper insurance in place and not just Workers Compensation but General and Professional Liability as well as Hired and Non-Owned Auto coverage.

Second, the proper administration of domestic employees is not as difficult as what other employers face but it is still a task that an informed and responsible family member will have to consistently attend to over time.  They need to handle withholding, reporting and form preparation and filing.

Third, the successful matching of caregiver to customer is not as straight forward as many people think and it is a big part of what an agency should do.  The family may think that a certain nationality, age or personality type is best for their loved one but they often get it wrong for reasons that are not readily obvious.  Further, they don’t have the opportunity to know hundreds of caregivers over time and don’t always know how to evaluate the caregiver’s relative experience, personality or true capability.  Agencies deal with these people every day and should take the time and interest to make a good match.  They won’t always get it right on the first try but they should be able to provide a good match.

Fourth, what happens when the primary caregiver needs to take time off?  Many families are nervous to begin with about having someone take care of their loved one.  Now they have to deal with finding, evaluating and training a reliever who is usually someone different each time.  Relying on the recommendation of the primary caregiver is good but that person is usually more interested in finding a warm body to make sure they get their break than making sure they are qualified.

Fifth, if the family is attempting to recover some or all of the cost of a caregiver from a governmental agency or a private insurer, the caregiver is usually required to be employed by a licensed agency.  There are some government programs that are exceptions to this but not everyone qualifies for all government programs.

Sixth, an agency is there to provide a go-between to work out differences that arise between the customer or their family and the caregiver.  Sometimes, the agency is in a better position to suggest and affect a compromise than the parties directly involved.  When no correction or compromise can be found, the agency is usually in a position to rapidly replace the caregiver without seriously impacting the family.

If these issues do not impress you as sufficient to warrant getting the help of an agency, then try it on your own.  You may get lucky.  But if you don’t, you can always call an agency later.

By: Kelly M. Ellis

Owner

We Offer:

• Peace of Mind
• Better Quality of Life
• Independence

Assignment Duration:

No assignment is too short or too long. We do not impose a minimum or maximum duration contract. We serve as long as required by each customer. We do, however, require a per visit 3 hour minimum for hourly assignments.

Area Served:

Central New Jersey including Somerset and Middlesex counties. Now Serving Both Union County too!

Insured and Bonded:

Coverage provided by a national insurer including:

• General Liability Insurance
• Professional Liability Insurance
• Workers Compensation (for injury to our caregivers)