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The Job of Family Caregiving

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Instead of paying someone else or transferring a senior loved one to a facility, wouldn’t it be much better if a family member gave them care at home? The family member can pay the bills, balance the checkbook, keep the house clean, shop and make meals, and take their aging parent on outings and to the doctor. The senior stays in familiar surroundings getting the care and attention they need, and the family member can even be paid, so they don’t give away their time and labor for free.

What Should Be Simple May Require Legal Guidance

The daughter, Jessica, quit her job to care for Ellen, her mother. But when Ellen fell and needed nursing-home care, the caregiving arrangement cost them nearly $70,000.00 in lost Medicaid benefits. This led to litigation.

The court was sympathetic but was still unable to help. The judge understood that Ellen might as well pay Jessica rather than a third party to provide companion services, especially because she is a member of the family and had Ellen’s best interests in mind. Nevertheless, the court ruled that Jessica failed to document her hours and services with a contract as the law requires. Without that proof, the court found that Jessica should have returned to work instead, where she would have earned more and could afford to hire an agency. Without the required proof, it appeared that mother and daughter had entered into the caregiving arrangement only to give money to Jessica.

Medicaid has Strict Rules Regarding Paid Caregiving Arrangements

The Medicaid rules penalize people for gift-giving, even in a case like Ellen’s. Money or property must not be given away during a five-year lookback period prior to the need for long-term care services. By breaking this rule, Ellen no longer had Medicaid benefits to pay for the extremely high cost of nursing home care.

Other Complications in Family Caregiver Situations

Even if Jessica had treated caregiving like any other job, and if she had documented her work as the law requires with a signed caregiver contract specifying working hours and services provided, and logged her hours as the law also requires – payment under a caregiver agreement must also be reported to the IRS for income tax purposes, or risk stiff penalties.

There is also a risk that a caregiver could be injured on the job. Worker’s compensation insurance would be a good idea.

Consulting and Elder Law Attorney

How a family caregiver is paid is important. It may not be possible for them to receive a lump sum of money; instead, an hourly payment arrangement is required. The hourly rate must match the type of care being provided and the experience level of the caregiver.

A family caregiving arrangement can work under the following circumstances:

  • The caregiver must be capable of the hard work involved
  • They must be properly contracted with hours logged and documented
  • Taxes on the compensation must be properly paid

If your family member treats caregiving like any other employer-employee relationship, the arrangement can be rewarding. But the record-keeping and documentation can be tricky, and mistakes can be very expensive.

To benefit from family caregiving without financial penalties, please contact our elder law attorneys for help. Our law firm is dedicated to keeping you informed of issues that affect seniors who may be experiencing declining health. We help you and your loved ones prepare for potential long-term medical expenses and the need to transition to in-home care, assisted living care, or nursing home care.

This article offers a summary of aspects of elder law. It is not legal advice and does not create an attorney-client relationship. For legal advice, contact our Ruston, LA office by calling us at (318) 255-1760.

Which Child Gets the Farm?

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Imagine a pair of aging parents that have been farmers and own their farm. Now, though, they’re getting on in years and they’re considering moving into a smaller place. One of the daughters and her husband help run the farm, but the rest of the siblings have moved away and they aren’t interested in returning. It’s now time to think about how the farm legacy should be worked out.

The first order of business is to plan the finances so the parents can enjoy a comfortable standard of living in their later years. They may need long-term care in the future, so they should consult an elder-law attorney about how to plan most effectively. If they don’t plan, they could lose the farm later to a lien, to reimburse the government if they end up needing Medicaid assistance.

Elder law attorneys can also advise about how to avoid problems if a parent re-marries after the first one passes. There’s no telling what can happen to the family property when one spouse is left lonely and finds someone else. Sometimes the results are terrible for family harmony.

Next, it’s necessary to allocate the value of the farm among all the children, so that each child is accounted for once the parents pass. This is by no means an easy process. For a transition plan to be successful, a great deal of planning, preparation, and communication is needed.

Here, it’s best to do some research. There are a host of useful publications that can guide the exploration. Kansas State University provides a twelve-step analysis of questions to be answered.

Farm Bureau Financial Services offers several detailed guides covering various aspects of the planning process.

The Beginning Farmers website is loaded with links to farm-succession courses, blogs, toolkits, farm management advice, and cooperative extension assistance in various states.

For real-life success stories, consult the Successful Farming website, here

https://www.agriculture.com/farm-management/estate-planning/passing-down-the-farm-strategies-ideas-and-real-life-solutions

and here

https://www.agriculture.com/farm-management/estate-planning/tips-on-designing-a-farm-succession-plan

When you’re ready to start planning for your farm and other valuable property, we’ll be ready to help. Please contact our Ruston, LA office by calling us at (318) 255-1760 or schedule an appointment to discuss how we can help with your long-term care needs.

Tips for Caregiving During a Pandemic

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The Covid-19 pandemic has posed a challenge for caregivers given the demand for these caregivers to be especially prepared for a deadly virus. Caregivers must balance the need for their care partner’s health and balance it with that person’s safety. As the US heads into seasonally extreme weather months, it is prudent to create or revisit existing plans for evacuating a patient or loved one displaced or challenged by tornadoes, blackouts, hurricanes, floods, wildfires, cyber ransomware attacks, even a resurgence of COVID-19.

Suppose your loved one resides in an in-patient facility. In that case, it is important to know what plans and procedures are in place to address whatever crisis, including current COVID-19 protocols and restrictions the hospice, nursing home, retirement community, assisted living operators, and residence may face. You can share that information with your care partner in a general way to assure them there are protocols in place to protect them and what they can anticipate. An open conversation allows you to allay any fears they may have, and there could be many due to the isolating effects of the coronavirus pandemic.

If you do not have a caregiver disaster plan, it is a good time to create one. The plan can address specific seasons as summer plans can differ drastically from winter ones. Write a list of your loved one’s current needs, impairments, and routines, including important identifying information such as a current photo, date of birth, and Social Security number. Include all known allergies, medications, and diagnoses. A short biography that can inform providers of their interests, personality, and background can go a long way, especially if you as the caregiver typically provide their “voice.”

Emergency relocation requires addressing the need to move all assistive medical devices and durable medical equipment. Don’t forget batteries and rechargers! Remember that a proactive early departure during a crisis when cooler heads prevail can reduce stress levels and help you avoid potential difficulties like gas shortages and traffic jams. Does your chosen relocation site have adequate availability of food, water, toiletries, and medication? You can check with the pharmacy before leaving as many will provide early refills in times of emergency, and a host of major retailers offer prescription delivery. If you are remote to your care partner, check with charitable organizations or neighbors to supply donations or meals and provide daily checks.

Suppose you must leave your loved one in the care of an assisted living or nursing home where you will experience limited contact. Below are some recommendations:

  • Make sure the facility has your primary and alternative contact information.
  • Specifically request updates regarding any changes in your loved one’s emotional or physical state.
  • Ask for medical records that document all care they are administering.
  • Communicate with your loved one in any way possible and often, whether by phone, video chat, or any other means to ensure they are as safe as possible.
  • Take detailed notes because it is easy to overlook or forget important details during times of crisis.

Planning for unexpected crises is not easy because how do you create responses for what has not yet happened? However, there are basic strategies to implement that can be amended to fit specific situations as they arise. If the plan includes relocation, be sure to check with local authorities regarding current COVID-19 restrictions. The planning steps you take may seem very small in light of the larger impact of a crisis event, but these steps can provide organization, protection, and comfort in times of great uncertainty. Please contact our Ruston, LA office by calling us at (318) 255-1760 or schedule an appointment to discuss how we can help with your long-term care needs.

An Increase in Elder Abuse During COVID-19

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In both long-term care facilities and at home, the elderly population in America are facing increasing incidents of mistreatment and abuse as social isolation during the pandemic which creates more vulnerabilities. Stay-at-home guidelines isolate seniors from the systems that can protect them like medical providers, congregations, extended family, and senior centers. The high rate of coronavirus deaths for those Americans 70 and older increases fear and their dependency on those who might seek to take advantage of them. Sadly, most of these abusers are family members, such as an adult child or spouse, followed by caregivers or staff in a long-term care facility.

Four Common Types of Elder Abuse

The Center for Disease Control and Prevention (CDC) lists four common types of elder abuse: physical, sexual, emotional, psychological, and neglect and financial abuse. Many incidents of elder abuse, neglect, and exploitation are underreported, especially during social isolation. According to a PBS report, Paul Caccamise, the vice president for program at Lifespan, Rochester, NY, says that the stream of calls reporting abuse is lower than usual. Yet, elder abuse has not gone away during the pandemic. Many referrals of abuse to Lifespan come from home care agencies, physicians, or hospitals, reporting suspected signs of abuse. Now that many older Americans are avoiding interactions with doctors and hospitals, the monitoring function is no longer available. Similarly, for those elderly in long-term care facilities, family members are no longer allowed direct access to check on the welfare of their loved ones.

Elder Abuse Issues During Coronavirus

This situation is not exclusive to New York. Across the country, the number of reports of elder abuse is decreasing during the coronavirus pandemic. The Minnesota Elder Justice Center’s executive director Amanda Vickstrom understands that although the quantity of cases is down, the amount of help our elder Americans need is up. About the disparity in case reports versus senior needs, Vickstrom states, “It doesn’t tell me that suddenly we’ve reduced elder abuse. It tells me that people are unable to reach out for help.”

Other support groups for the elderly like the National Clearinghouse on Abuse in Later Life (NCALL) are seeing similar trends. NCALL founder Bonnie Brandl says, “Abusers are using the threat of the virus and the isolation to provide misinformation to people.” Isolated seniors can fall prey to threats of being visited by a caregiver who may have been exposed to the coronavirus or sent to a nursing home where COVID-19 death rates are disproportionately high.

Caregiver promises to keep a senior safe if they hand over checks or other assets during this pandemic is not uncommon as many Americans have lost their jobs or have reduced hours of income and are facing financially tough times. If the senior lives with an abuser, the situation can become desperate as abusers can threaten to hurt or manipulate the senior who, in isolation, has little confidence to seek outside help. The coronavirus pandemic, which already disproportionately impacts older people’s health, makes them more vulnerable to abandonment, neglect, financial, emotional, sexual, and physical abuse.

The increase of seniors’ dependency on their caretakers at home and staff in long-term care facilities can incentivize abusers to target these older adults. Many seniors are targeted as they have resources saved, consistent monthly incomes from investment sources, or Social Security benefits. Desperate for their health and safety, many seniors will turn over their money, hoping that it will be key to their survival. There are also thousands of reports of scam artists offering bogus or nonexistent free home test kits or fake cures, posing as counterfeit charities, or preying on other virus-related fears to gain personal information or money.

How to Help Elderly in Isolation

If you have a senior family member who is socially isolated due to COVID-19, it is crucial to stay engaged with them to prevent their mistreatment. There are programs available that help those who face isolation to stay connected. AARP has a program that provides weekly phone checks provided by vetted volunteers who can spot trouble signs. There are other nonprofits that check to see that seniors have proper resources during the pandemic such as food and medication. Volunteers will also address the emotional needs seniors have during isolation. For many seniors, it will be the only conversation they will have that day. Check with your community and see how you can best protect your senior during the social isolation and vulnerable times of the COVID-19 pandemic.

If you have questions or would like to discuss your particular situation with us, please don’t hesitate to reach out. Please contact our Ruston, LA office by calling us at (318) 255-1760 or schedule an appointment to discuss how we can help.

Five Facts About Dementia Caregiving in Louisiana

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Dementia, in particular, the prevalence of Alzheimer’s Disease in the American population, is creating difficult caregiving experiences for the family members who are primarily responsible for providing care. Even though you understand your loved one’s dementia behaviors are a symptom of the disease and not intentional or personally targeted to you, coping with them is often emotionally, financially, and physically challenging. Psychology Today reports caregivers routinely say, “Nobody really understands how hard caring for a loved one with dementia is!”

First Fact: Most Care is Provided to Someone with Dementia

Psychology Today is also reporting five facts that you should know about dementia caregiving, particularly since its incidence is increasing in the United States. The first fact is nearly half of all people who provide care do so for someone with dementia. The statistic is 48 percent of caregivers are providing for those who have Alzheimer’s Disease, Vascular Dementia, Lewy body dementia, and more. Additionally, dementia is typically not the only ailment a loved one suffers from, and dementia can have long phases from preclinical to its last stage, making caregiving a long-term commitment. The complexity, hours, and level of care needed throughout the stages of dementia are staggering.

Second Fact: Most People with Dementia are Not Living in Nursing Homes

A second fact about dementia caregiving is that most people with dementia are not living in a nursing home or assisted living but rather with a family member. Most Americans aged 65 or more live in the community, with only about 4.5 percent (roughly 1.5 million) of older Americans living in nursing homes and 2 percent (1 million) in assisted living facilities, according to the National Institutes of Health (NIH). These home care providers are more than two-thirds of women (67 percent), and more than one-third of these are daughters.

Third Fact: Care Requirements are Needed 24/7

Dementia, in particular Alzheimer’s, is the most expensive disease in America, costing more than heart disease and cancer. This third fact is unsurprising as care requirements are often needed 24/7 for years. The Alzheimer’s Association (alz.org) Fact Sheet reports that in 2020 caring for those with Alzheimer’s and other dementias cost American society an estimated 305 billion dollars. While much of this cost is born through Medicare and Medicaid spending, for caregivers, there is still an out-of-pocket expense that is nearly twice that of caregivers providing care for other conditions. Caregiver payouts can include medical care, personal care, respite care, household expenses, and more.

Additionally, the rate of progression of dementia disease varies widely. On average, a person with Alzheimer’s will live between three to eleven years post-diagnosis. Yet there are some cases where patients survive twenty or more years. Typically, a caregiver for a loved one with dementia will provide care one to four years longer on average than caregivers of other conditions.

Fourth Fact: Dementia Caregivers Work Multiple Hours a Week

The majority of these dementia caregivers are still working in formal employment. The fourth fact is 60 percent of dementia caregivers are working about 35 hours a week. Dementia caregivers are pushed beyond normal limits to provide a loved one’s care nearly 24/7 while still maintaining roughly full-time work. Since an average dementia caregiver spends over eleven thousand dollars a year out-of-pocket providing care, there is little wonder about the necessity of almost full-time employment.

Fifth Fact: Dementia Caregivers Tend to Experience Stress and Anxiety

Finally, the fifth fact is that dementia caregivers suffer higher rates of stress, anxiety, and depression than caregivers tending to other medical problems because of their enormous workload and responsibility. Dementia caregivers also experience more health problems than those caring for other medical diagnoses. It is easy to understand this is the case due to the high-level of caregiving, nearly full-time work, and expenditures that are expected of them.

These five facts about dementia caregiving outline the need for caregiver resources and encouragement. Dementia care providers must tend to themselves during their journey of caregiving to persevere. If you know a dementia caregiver or have one in your family, consider what they go through as it is profound. Listen to their stories. Ensure they receive education about the best ways to approach their intense workload and help them identify national and local resources. Community support and understanding are essential for success in a dementia caregiver’s journey.

If you or a loved one has been diagnosed with dementia, we can help navigate how to find appropriate care, how to pay for it, and how to protect your home and savings. We welcome the opportunity to talk with you further, please contact our office by calling us at (318) 255-1760 and schedule an appointment to discuss how we can help you with your planning needs.