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Tips on Finding the Right In-Home Aide

About 90% of older adults would prefer to age in place, rather than move into an assisted living facility or nursing home, according to an AARP survey.

WRAL’s recent article entitled “How to choose an in-home health aide” says that, fortunately, you can have good health care and independent living with an in-home health aide. An aide can provide you with care for a short amount of time during the day or can stay with you around the clock. Depending on your needs, an aide can help with many tasks. These include things such as:

  • Chores, such as laundry, cooking and shopping
  • Daily activities, such as bathing, dressing, eating, grooming, moving from one place to another and toileting
  • Monitoring vital signs, like blood pressure, respiration, and pulse
  • Keep an eye on your physical and mental health, including your level of exercise and how much you are eating, drinking, and going to the bathroom; and
  • Assist in emergencies, like an accident, heart attack, or stroke.

There are a number of actions to take when you hire an in-home health aide. Here’s the rundown:

  1. Determine what kind of care, and how much, you need.
  2. Decide if you want to hire through an agency or on your own. The advantages of using an agency are that you will get a prescreened aide and will have backup care when that person is unavailable. You also won’t have to be concerned about offering benefits as an employer because the agency takes care of those.
  3. Consider what you can afford. If you qualify for Medicare or have long-term care insurance, some or all your care may be paid for. If you use an agency, the Mayo Clinic suggests you ask for written, detailed explanations of all services and fees associated with home care. Once you have this from several agencies, you’ll be able to choose the best one for your budget. If you hire a home health aide yourself, remember to think about sick days, holidays, vacation, payroll taxes and Social Security. That is because your aide will be considered a household employee.
  4. After you’ve found your health aide, create a care plan, which may include the following:
  • The days and hours you need assistance
  • The daily tasks that need to be completed
  • A schedule of appointments and medication times
  • A list of contacts, such as your doctor’s information
  • An emergency plan; as well as
  • Any of your personal preferences.

Re-evaluate your care plan every few months. Ask your family to discuss this with you because having loved ones on board will be helpful in the future, when you may need more support as you continue to age in place.

Reference: WRAL (April 17, 2022) “How to choose an in-home health aide”

Is Your Incapacity Plan in Place?

Wise incapacity planning usually includes the execution of a power of attorney.

This is a document that appoints an agent who can legally sign checks, pay bills and make other financial decisions on your behalf, as the principal, in the event you become incapacitated by illness or an accident.

A power of attorney is also used when the principal is unable to be present to sign necessary documents.

The designated agent can be given broad legal authority or limited authority to make decisions about the principal’s property, finances, or medical care.

FedWeek’s recent article entitled “Putting an Incapacity Plan in Place” suggests that, rather than a “regular” power of attorney, you may prefer one of the following:

A durable power of attorney can name a trusted friend, relative, or advisor to sign papers, if you are unable to make knowledgeable decisions.

These documents remain in effect if you become incapacitated.

Springing power is a durable power of attorney that will go into effect only if one or more doctors declare that you are incompetent or that you cannot perform some “activities of daily living,” such as being able to get dressed and go to the bathroom.

A springing power will not go into effect as long as you are competent.

Some financial institutions also may not accept your power of attorney because they require the use of their own forms.

Send a copy of your power to each of your banks, brokers and other accounts to see if there is an issue. Some companies will also not recognize old powers.

Add an expiration date on the document and update it every year or two, so it expresses your current wishes.

A power of attorney can also end for a number of reasons, such as when the principal revokes the agreement or dies, when a court invalidates it, or when the agent can no longer carry out the responsibilities outlined.

In the case of a married couple, the authorization may be invalidated if the principal and the agent divorce.

Reference: FedWeek (Feb. 1, 2022) “Putting an Incapacity Plan in Place”

Can I Avoid the Economic Dangers of Caregiving?

AARP’s recent article entitled “5 Steps to Avoid Economic Pitfalls of Caregiving” reports that 20% of family caregivers have to take unpaid time off from work due to their caregiving responsibilities.

The average lifetime cost to caregivers in lost wages and reduced pension and Social Security benefits is $304,000 — that is $388,000 in today’s dollars. This does not count the more than $7,200 that most caregivers spend out of pocket each year, on average, on housing, health care and other needs for loved ones in their care, according to the AARP report.

Step 1: Calculate the gap. The average cost of a full-time home health aide is nearly $62,000 a year, and a semiprivate room in a nursing home runs about $95,000. Ask your parents about the size of their nest egg, how fast they are spending it, whether they have long-term care insurance and how much equity they have in their home. Compare your parents’ assets against their projected expenses to determine your gap.

Step 2: Fill the gap without going broke. Try to find free resources: Use the National Council on Aging’s BenefitsCheckUp tool to find federal, state and private benefit programs that apply to your situation. Then create a budget to determine what you can contribute, physically and in dollars, to closing the gap. In addition, ask your siblings if they can pitch in.

Step 3: If a gap remains, consider Medicaid. This program can cover long-term care. However, your parent or parents may need to spend down assets to qualify. Note that if just only one parent is in a nursing home, the other can generally keep half of the assets, up to a total of $137,400 (not including their house). However, the rules differ by state. As a result, this can get complicated. Speak with an elder-law attorney for help.

Step 4: No matter what the gap, try to get paid. If your parents have enough resources, you may discuss having them pay you for caregiving. However, you should speak with an attorney first about drawing up a contract. This should include issues like the number of hours a day you will spend on providing care and whether doing so will require you to quit your job. The caregiving agreement is written carefully, so that it does not violate Medicaid regulations about spending down assets.

Step 5: Protect your own earning ability. If you are mid-career, it is very difficult to leave a job for ​family responsibilities like caregiving and then go back into the workforce at the same salary. The Society for Human Resource Management says that it costs six to nine months’ salary to replace an employee, so many employers now see it is less expensive to make an accommodation.

Reference: AARP (Feb. 24, 2022) “5 Steps to Avoid Economic Pitfalls of Caregiving”

Assisted Living Providers Face More Pandemic-Related Scrutiny from OSHA

The U.S. Department of Labor announced this week that the Occupational Safety and Health Administration (OSHA) is beginning a time-limited enforcement effort for focused inspections in assisted living communities, nursing facilities, and hospitals treating people with COVID-19.

McKnight’s Senior Living’s recent article entitled “Assisted living providers to face additional pandemic-related scrutiny from OSHA” reports that the inspections are limited to organizations with previous COVID-19-related citations or complaints. They will look at the correction of the citations and compliance with existing OSHA standards to stress monitoring for current and future readiness.

OSHA explained that its goal is to expand its presence to ensure continued mitigation efforts to control the spread of COVID-19 and future variants, and to protect the health and safety of healthcare workers “at heightened risk for contracting the virus.”

OSHA will devote 15% of all of its inspections to healthcare organizations in the following classifications: assisted living facilities for the elderly, nursing care / skilled nursing facilities, psychiatric and substance abuse hospitals and general medical and surgical hospitals.

“We are using available tools while we finalize a healthcare standard,” Assistant Secretary of Labor for Occupational Safety and Health Dough Parker said. “We want to be ahead of any future events in healthcare.”

This strong effort in pandemic-related scrutiny may be a temporary action until OSHA finalizes an anticipated permanent infectious disease standard for the healthcare industry. OSHA withdrew the non-recordkeeping part of its healthcare emergency temporary standard in December. However, they said it would “work expeditiously to issue a final standard.” The agency said it would accept continued compliance with the healthcare ETS as satisfying employers’ obligations under OSHA’s general duty clause.

OSHA adopted its COVID-19 healthcare ETS in June. This required assisted living communities and other healthcare settings to conduct hazard assessments and have written plans in place to mitigate the spread of the coronavirus. These rules also required healthcare employers to provide some employees with N95 respirators and other personal protective equipment. The standard also included social distancing, employee screening and cleaning and disinfecting protocols.

While OSHA highlights skilled nursing facilities and hospitals in its memorandum for regional administrators, assisted living facilities also are mentioned.

At least 20 states have their own OSHA-approved state plans and may proceed differently than those subject to federal OSHA standards. However, the agency recommended that all healthcare employers in high-risk settings be ready for inspection. Healthcare employers should also have COVID-19 procedures and protocols in place and review their procedures for managing OSHA inspections.

Reference: McKnight’s Senior Living (March 10, 2022) “Assisted living providers to face additional pandemic-related scrutiny from OSHA”

What Is Virginia Doing to Protect the Residents of Assisted Living Communities?

The eviction bill is sponsored by Virginia state senators Lionell Spruill (D) and Ghazala Hashmi (D). The legislation would amend the Virginia code to give assisted living residents the same protections as nursing home residents facing eviction, reports McKnight’s Senior Living’s recent article entitled “Assisted living providers may face new requirements before evicting residents.”

Susan Rowland, Spruill’s chief of staff, told the McKnight’s Business Daily that the legislation is meant to close a loophole in Virginia law that lets assisted living communities evict residents with no legal recourse.

If SB40 becomes law, assisted residents would be provided with certain safeguards from being involuntarily discharged. These include requiring operators to provide a description of the reasons for eviction, such as that the facility no longer can meet the resident’s care needs, behavioral issues or non-payment. Facilities would also need to make reasonable efforts to resolve any issues leading up to the eviction. Residents would need to be given 30 days’ notice before evictions and also be notified of their right to appeal the involuntary discharge.

In addition, according to the legislation, “Prior to involuntarily discharging a resident, the assisted living facility shall provide relocation assistance to the resident and the resident’s representative, including information regarding alternative placement options.”

Amy Hewett, vice president of strategy and communications for the Virginia Health Care Association / Virginia Center for Assisted Living, remarked that the association “appreciated the opportunity to work with the bill patron Sen. Lionell Spruill and advocates to take steps toward ensuring that both residents and providers have an understanding of the involuntary discharge process.”

Dana Parsons, vice president and legislative counsel for LeadingAge Virginia, said the organization “believe[s] this legislation is a positive step forward and will provide housing protections as well as stability and positive support to aging Virginians.”

Assisted living communities in the commonwealth are deemed non-medical in nature. As a result, they are not subject to the same regulations as skilled nursing facilities. Assisted living residents also are not covered by the commonwealth’s Landlord and Tenant Act. Geriatric homes are specifically excluded from eviction protections afforded other renters, “as these tenancies and occupancies are not residential tenancies under this chapter.”

Residents evicted from the state’s assisted living communities could only go to the Office of the State Long-Term Care Ombudsman, which could attempt to mediate disputes. However, there was no requirement for assisted living communities to cooperate.

Reference: McKnight’s Senior Living (March 10, 2022) “Assisted living providers may face new requirements before evicting residents”

Suggested Key Terms: Elder Law Attorney, Assisted Living

Must I Sell Parent’s Home if They Move to a Nursing Facility?

If a parent is transferring to a nursing home, you may ask if her home must be sold.

It is common in a parent’s later years to have the parent and an adult child on the deed, with a line of credit on the house. As a result, there’s very little equity.

Seniors Matter’s recent article entitled “If my mom moves to a nursing home, does her home need to be sold?” says that if your mother has assets in her name, but not enough resources to pay for an extended nursing home stay, this can add another level of complexity.

If your mother has long-term care insurance or a life insurance policy with a nursing home rider, these can help cover the costs.

However, if your mom will rely on state aid, through Medicaid, she will need to qualify for coverage based on her income and assets.

Medicaid income and asset limits are low—and vary by state. Homes are usually excluded from the asset limits for qualification purposes. That is because most states’ Medicaid programs will not count a nursing home resident’s home as an asset when calculating an applicant’s eligibility for Medicaid, provided the resident intends to return home

However, a home may come into play later on because states eventually attempt to recover their costs of providing care. If a parent stays a year-and-a-half in a nursing home—the typical stay for women— when her home is sold, the state will make a claim for a share of the home’s sales proceeds.

Many seniors use an irrevocable trust to avoid this “asset recovery.”

Trusts can be expensive to create and require the help of an experienced elder law attorney. As a result, in some cases, this may not be an option. If there’s not enough equity left after the sale, some states also pursue other assets, such as bank accounts, to satisfy their nursing home expense claims.

An adult child selling the home right before the parent goes into a nursing home would also not avoid the state trying to recover its costs. This because Medicaid has a look-back period for asset transfers occurring within five years.

There are some exceptions. For example, if an adult child lived with their parent in the house as her caregiver prior to her being placed in a nursing home. However, there are other requirements.

Talk to elder law attorney on the best way to go, based on state law and other specific factors.

Reference: Seniors Matter (Feb. 25, 2022) “If my mom moves to a nursing home, does her home need to be sold?”

What If an Estate Owes Back Taxes?

If grandma did not finish up all of her duties as the executor of her husband’s estate before she passed away, it would be wise to speak with an experienced estate planning attorney.

An estate planning attorney can help with the issues with estate administration, says nj.com’s recent article entitled “My grandmother’s estate owes back taxes. What next?”

The fiduciary appointed to administer an estate—called an executor or personal representative—is responsible to make certain that all creditors are paid before making distribution of estate assets.

An executor of an estate is the person designated to administer the last will and testament of the decedent. His or her primary duty is to carry out the instructions to manage the affairs and wishes of the decedent.

An executor is appointed either by the testator of the will (the one who makes the will) or by a court, in situations where there is no will (also known as intestacy).

If there is a probate proceeding, the executor is required to officially notify creditors of it pursuant to the state probate statutes.

If there are not enough assets to pay all creditors, state statutes give a priority regarding how creditors are paid.

Funeral expenses and taxes are typically paid first.

Note that if the creditors are not paid, and money is distributed to beneficiaries, the creditors may seek the return of those distributions from the beneficiaries.

However, the executor’s individual assets would not be responsible for payment of estate debts. It is just the assets that are received from the decedent.

As far as taxes, the IRS is still legally entitled to the money owed by the decedent. The federal government will usually go to great lengths to collect it, even if the will instructs the remaining assets to be distributed elsewhere.

Reference: nj.com (Feb. 3, 2022) “My grandmother’s estate owes back taxes. What next?”

Can a Teddy Bear Help Elderly with Dementia to Communicate?

This cuddly bear engages with individuals with memory disorders.

WGAL’s article entitled “Talking teddy bear gives patients with dementia a new way to connect” reports that Cue Teddy is the brainchild of Dr. Roger Nelson.

Dr. Nelson is a retired physical therapist whose family dealt with dementia. He saw a need that was not being met.

“They lacked this ability of being able to talk and to think and then to connect with other people,” he said.

Dr. Nelson, therefore, teamed up with Rod Tosten, the vice president of IT at Gettysburg College, to bring the bear to life.

“Cue Teddy cues the individual to move and to stay active,” Tosten said.

The bear goes through a series of questions and commands, tapping into three areas of the brain: thought, motion and touch.

“One of the things we’re testing is what colors work well and what kind of fabric works well,” Tosten said.

But why a teddy bear?

“Everybody kind of remembers their first teddy bear they ever got and the name of the teddy bear,” Nelson said.

In addition, making people remember is part of the goal.

“I hope that a lot of people adopt it and use it because it’s a valuable tool,” Nelson said.

“To be able to help other people is just amazing. I just love working on this,” Tosten said.

Cue Teddy is currently in the early stages of development. When it is ready, the two creators will be looking for a partner to mass produce it.

Reference: WGAL (Feb. 14, 2022) “Talking teddy bear gives patients with dementia a new way to connect

Am I Getting All the Social Security Benefits I Can?

Money Talks News’ recent article entitled “7 Social Security Benefits You May Be Overlooking” says that the Social Security Administration provides payments to spouses, children and those with disabilities, among others. Let’s look at this in detail.

  1. Spousal benefits via a husband or wife. Spouses can get up to half of their husband’s or wife’s monthly benefit. Even stay-at-home spouses without their own work history can claim benefits with this method. You can start claiming spousal benefits as early as age 62. However, benefits are reduced if payments begin before your full retirement age. If you are entitled to your own benefits, as well as spousal benefits, you will get an amount equal to whichever benefit level is greater.
  2. Spousal benefits via an ex-spouse. Even if you are divorced, you may be entitled to get spousal benefits. However, all of the following must apply to your situation:
  • Your ex-spouse is entitled to receive Social Security benefits;
  • You were married at least 10 years to your ex-spouse;
  • You are currently unmarried; and
  • You are at least 62 years old.

The benefit that you are entitled to get based on your own work is less than the benefit you would receive based on your ex-spouse’s work. Claiming spousal benefits as a divorced person does not impact your ex’s benefit amount. It also does not affect any benefits their current spouse can receive, if they have remarried.

  1. Survivor’s benefits for widows and widowers. If your spouse dies, you may still be able to receive up to 100% of their Social Security retirement benefits. Divorced spouses may also be able to get survivor’s benefits, if they were married for at least 10 years and are now unmarried. Most widows and widowers can begin claiming survivor’s benefits as early as age 60. Those who have a disability and became disabled prior to or within seven years of their spouse’s death can start benefits as early as age 50. In addition, widows and widowers of any age can get survivor’s benefits, if they are caring for a deceased worker’s child who’s younger than age 16 or disabled.
  2. Survivor’s benefits for children. Children can get payments from a deceased parent’s record as well. Survivor’s benefits are available to children up to age 18 (or 19 for if attending elementary or secondary school full-time) These benefits may extend beyond that, if a child becomes disabled and remains disabled before age 22. Depending on the circumstances, grandchildren and stepchildren may also be eligible for these benefits.
  3. Parent’s benefits. Parents who depended on their children for financial support may be eligible to get benefits from Social Security if that child dies. To be eligible , you have to meet a number of criteria, including the following:
  • The deceased worker must have sufficient work credits to qualify for Social Security benefits;
  • You must be at least age 62 and, in most cases, cannot be married after the worker’s death;
  • You must have received at least half of your support from the deceased worker at certain points in time;
  • You were the natural parent or became the legal adoptive parent or stepparent prior to the worker turning 16 years old; and
  • You are not eligible for a retirement benefit from Social Security that exceeds the parent’s benefit.
  1. Disability benefits. To get monthly benefits through the Social Security Disability Insurance program you must have a work history that makes you eligible for Social Security and be unable to work now because of a medical condition that is expected to last at least a year or end in death.
  2. Supplemental Security Income. These benefits do not come from Social Security taxes, but rather the program uses general tax dollars to provide benefits to adults and children with disabilities, blindness, or limited income and resources. The SSI program is designed to provide cash assistance for basic needs, such as food, clothing and housing. Because it is funded by general tax revenue, there is no work history requirement to receive these benefits.

Reference: Money Talks News (Feb. 8, 2022) “7 Social Security Benefits You May Be Overlooking”

What are States Doing to Help Pay Long-Term Care Costs in Future?

Starting this year, workers in Washington state must pay 58 cents of every $100 they earn into the Washington Cares Fund. That money will help pay their long-term care costs in the future. Those with qualifying long-term care insurance can be eligible for an exemption.

Next Avenue’s recent article entitled “How Medicaid and Medicare Fit Into Planning for Long-Term Care” says that starting in 2025, those Washington residents who’ve paid in for at least three out of the prior six years, or for 10 years in total, will be able to withdraw up to $36,500 to pay for their costs of care. It is an effort by the state to fill in a major gap in our long-term care system. California has also enacted a law to bring down the eligibility threshold for Medicaid to totally eliminate it by the end of 2023. New York state is considering similar legislation.

Any senior may need assistance as they age, whether due to dementia, illness, loss of eyesight, or simple frailty. The level of assistance and how long it will last can vary greatly. However, few retirees have enough saved to pay for their care for very long out-of-pocket. According to research from Boston College, more than half of today’s 65-year-olds will need a medium to high level of assistance for more than a year. Almost two thirds of that care will be provided by family members – mostly children and spouses – for no cost, but more than a third will be provided by paid caregivers.

According to the Congressional Research Service, 43% of long-term care services are paid for by the Medicaid program, 20% by Medicare, 15% out-of-pocket and 9% by private insurance. The rest comes from a combination of private and public sources that includes charitable payments and VA benefits.

Medicare Coverage. This is the federal health insurance program for people beginning at age 65. Note that Medicare only covers so-called “skilled” needs following a hospitalization. It pays for up to 100 days of care in a skilled nursing facility following a hospitalization and longer term for home health services.However, the home health coverage is not comprehensive.

Medicaid Coverage. The financial rules for Medicaid coverage are complicated and state-specific. However, generally people must spend down to about $2,000 in savings and investments. Planning to use Medicaid to pay for long-term care is also complicated by the fact that while its coverage of nursing home care is comprehensive, its payment for home care and assisted living facility fees is only partial and differs both from state to state. Even if you may be able to leverage Medicaid to help pay home and assisted living care, you must also rely on your own savings.

Out-of-Pocket Costs. The low percentage of long-term care costs paid for out-of-pocket is surprising, in light of the vast growth of both assisted living and private home care agencies over the last several decades. However, this demonstrates the fact that most older adults have limited resources to pay for anything beyond their basic living expenses. When the need for care arises, they must rely on family members or Medicaid.

Insurance. A large component of insurance coverage of long-term care consists of Medicare supplemental insurance payments for skilled nursing facility copayments. While Medicare will pay for up to 100 days of skilled care following a hospitalization, it actually pays entirely for only the first 20 days. For days 21 through 100, there is a copayment which for most is paid by their MediGap insurance. As such, long-term care insurance pays for a very small share of long-term care costs. For those who have coverage, it can be terrific. However, due to its high cost, those who have it often also have the resources to pay for their care out-of-pocket, at least for some period of time.

Veterans Benefits. More vets are taking advantage of a Veterans Administration benefit known as Aid & Assistance that will provide veterans who qualify financially with up to $2,431 a month (in 2022) to help pay for their care.

Reference: Next Avenue (Feb. 2, 2022) `“How Medicaid and Medicare Fit Into Planning for Long-Term Care”

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