Some Items for Long-term Caregivers

Lately, I have been dealing with a lot of cases involving those saintly people who have a dependent parent or loved one to whom they are providing care. As these cases become more frequent, I thought I would share some of the issues that have arisen, and how these families are dealing with them.

One case involves an elderly person whose ‘caregiver’ is an out-of-town daughter. She talks to her mother daily and visits nearly every weekend. This kind of long-distance care is very stressful on both sides. The daughter has a career and a family, which would be enough to handle by itself. The care needed for the mother is not a full-time job by any means, since the mother can handle a lot of her own things. But the bigger things, like changing over the summer and winter clothes, arranging for medical tests and examinations and even planning the weekly menu, have begun to tax her abilities.

For the daughter, the two-hour drive on Saturday mornings has become more and more difficult, too. Her personal life now involves cramming seven days of activity into six, and her own family is starting to pull on her. In this case, we have advised the family to consider engaging the services of a professional care manager. These are paid professionals whose business it is to identify the needs of the elderly person and engage someone to fulfill those needs.

When the mother and daughter met with the care manager, they worked together to identify the problems that the mother was having, and put together a care plan, which included hiring certain people to carry out the plan. For example, they hired a handyman to come in and take out all of the storm windows and insert the screens, and he even washed the windows and cleaned out the gutters while he was up on the ladder. This meant that the daughter’s next visit was spent having a nice lunch with her mother rather than hauling things up and down the steps and the ladder. The cost was $175, which both parties felt was reasonable.

Another thing that their care plan included was to get a physical therapist to come to the house so that the mother’s strength and balance could be improved. Instead of the mother having to impose upon a neighbor to drive her to and from a PT session, the therapist now comes in twice a week and the sessions are far more beneficial. There was no extra cost because the mother’s insurance carrier covered the sessions.

The care manager was able to get two or three of the mother’s medical appointments rescheduled for one day a month and set up transportation to all of them, so the daughter and the mother did not have to think about any of that. Now the daily telephone calls are much lighter in tone, less stressful and much friendlier. And the weekend visits are easier, too.

The cost of the care manager’s services for the initial assessment and care plan was around $450. The ongoing cost per month has been under $150, which is about two hours of professional time for the care manager. This has been a good match for everyone.

In the other case, we were working to get a caregiver service agreement put together between the parent and the child. Here, the child lives down the block from the father’s house and comes over daily to attend to the father’s needs. There are many reasons why this is working out well. One reason is that the father’s care can continue with someone that he knows, trusts and is comfortable with. Second, the father’s money is being spent down in order to qualify him for Medicaid sooner. And third, the money is staying in the family.

The child who has put his or her career on hold to help out a parent is not financially punished for doing so. He gets paid for his time. And the other children who cannot or will not assist their father cannot complain that they are being shortchanged, because the amount of money being paid to the child who is helping is directly related to the amount of time and effort that he is putting forth.

These are not simple agreements. An elder law attorney should help with the negotiations for the services and the inclusion or exclusion of language in the Care Manager Agreement and the Care Giver Service Agreement. In the first case, you are hiring outside service providers, and questions can arise as to whether you have hired an employee or an independent contractor. Beware of income taxes, withholding and reporting and other issues. Likewise for the Care Giver Service Agreement. Make sure you solicit the advice and guidance of an elder law attorney, and don’t overlook the need for an accountant’s input, too.

Christopher M. Abernethy has been practicing law in Hampton Township since 1976. He focuses on elder law, which includes wills, trusts, powers of attorney, living wills and probate matters. He also is proficient in all aspects of real estate law and business law. He is a member of the National Association of Elder Law Attorneys and the AARP Legal Services Network. He can be reached at (412) 486-6624 or by email at cabernethy@aaylaw.com.