Posted on March 3, 2016 by Jim Koewler
This morning's post was borrowed from a post of the Koewler Law Firm found to have substance regarding V.A. applications in terms of an aging adult who wants to stay in his or her home. Today's discussion involved hiring someone to help with activities of daily living (a professional caregiver).
When an older adult is no longer able to perform the routine daily tasks that he or she could easily perform when younger, it is time to consider how to help the older adult. The routine daily tasks that people who work with seniors usually considers are:
Someone who is trying to stay in his or her home but is having difficulties with one or more activities of daily living can hire help. Professional caregivers are available who will help someone with these activities. Such caregivers can be found through a commercial home care agency, and there are many such agencies. Such caregivers can also be hired directly by the aging senior or by his or her family. Commercial home care companies can be expected to provide oversight of the caregivers as well as to manage the business relationship with the caregiver. The caregiver should be an employee of the company, so the company handles long term care insurance, bonding, payroll, taxes, and accident liability. The downside is that the actual person who acts as caregiver may change from time to time. This may happen when the senior has come to rely on a particular individual. Commercial home care companies are bound to a Department of Labor proposal that would force higher pay for the caregivers because of the rules on length of the work day and overtime pay. If a family member or individual chooses to hire a caregiver that is not from an agency, they may have to adhere to the same regulations. When the older adult or family hires the caregiver directly, much of the pay for directly hired caregivers is sometimes done “under the table,” without proper tax and payroll compliance. (I cannot recommend such an evasion of tax and labor laws.) For some older adults, the Medicaid program and/or the Veterans Administration’s Pension (more commonly called Aid and Attendance) program can help pay for such home care services.
"Having worked as a case manager with the Medicaid program, I can say that the amount of care giving hours often provided under the program are greatly reduced and may not meet the needs of someone with greater needs."
Sometimes home caregivers may be nurses. In Palm Beach County there are some very good Nurse Caregivers who charge $40/hour minimum if working privately. Nurses provide medical care (in the way that “medical” is used by hospitals, doctors, and health insurance companies.) Home health aides provide more personal care or “custodial” care. While nurses in the home are more highly paid than aides, their costs are usually covered by some long term health insurance. Home health aides through an agency are usually covered by long term care insurance as well. I try to call nursing services “skilled care” and call home health aides “non-skilled care.” I do not want to imply that home health aides are not skilled. They are great! Often, people who work with seniors call them “medical home care” and “non-medical home care.” I try to avoid the “non-medical” label because of the rules for the VA Pension.
The VA Aid and Attendance program covers “medical” costs for certain veterans and surviving spouses of certain veterans. The rules for VA Pension defines “medical” costs in a way that includes the services of home health aides. Some Elder Law Attorneys providing help with VA Pension applications have encountered difficulties with the review of applications if the home care provider describes itself as a “non-medical” provider. (This description has most often been in the letterhead of the care provider.) The care provider or VA Pension applicant must provide a letter explaining the services provided. A reference to “non-skilled” care does not seem to trigger the same difficulties in the application process.
The bottom line is this....If the older adult has funds available to pay for home care services and is willing to accept a “stranger” coming to the house, home care support can allow the older adult to stay in his or her home.
If a family caregiver is interested in having a referral to experienced agencies with good staff, please feel free to contact me directly at: firstname.lastname@example.org As a geriatric care manager I have worked with some of the best agencies within the Palm Beach area.
Posted: 5th of March, 2016 by Olga Brunner
Labels: aged, disabled, elder law attorneys, long term care
I Have worn many hats in my day: Nursing Home Assistant Admin and Activities Director, Assisted Living Admin, Case Management for the State-wide Medicaid Program, and Trainer for Dept of Elder Affairs.