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Aging Care.com

Carol Bradley Bursack

Covered in this article:
Dementia contributes to elder's fear of outside caregivers
Trying a new caregiver might alleviate elder's fear and abuse

When my uncle had in-home health care, he liked a couple of the caregivers, he thought one was okay, and barely tolerated two others. I wasn’t always there to witness his behavior, but I’d say that the caregivers he didn’t particularly like were not thrilled with him, either. Yet they did their job.

My neighbor, Joe, had a similar situation. He locked one caregiver out of his home, let another one in but was rude to her, and thoroughly enjoyed one young man because they could discuss golf. Quality of care wasn’t the issue. Joe resented anyone but me helping him, and the only reason he liked the guy was for talking about a shared sport.

Paid caregivers, hired by family members or even elders themselves, go into the elder’s home as nurses, assistants (CNAs) and custodial help (non-medical help such as shopping and light house keeping). Often their best efforts are frustrated by anger and actual abuse dished out by the elder they are there to care for.

I believe some of this abuse comes from fear. The presence of an outsider suggests to the elder that their family can’t (or doesn’t want) to take care of their needs. It also magnifies the extent of the elders’ care needs and makes them feel vulnerable. This fear, plus the denial of their actual need for care, can make them angry. If they are prone to lashing out when angry, then this person who represents the care they wish to deny becomes the target.

Alzheimer's disease,other dementias, and personal care contracts

Millions of Americans are currently caring for a loved one or friend with Alzheimer's disease or a related dementia without receiving compensation. Depending on the circumstances, however, it may actually be beneficial for both parties to enter into a care contract wherein the caregiver accepts payment for the care they are providing their loved one. They also formally assume responsibility for that care of an elderly family member or friend with Alzheimer's disease or a related dementia.

If the loved one you are caring for reaches a point where nursing home placement is the only option, all of their money will be considered available to pay for their care at the nursing home and they will not be eligible for Medicaid assistance until all of their assets have been depleted. Certainly the care they were provided by you, while they remained in the community, is just as valuable to them and worthy of payment as that they will be provided in the nursing home. With a care contract in place, they can pay their caregiver, and every penny spent will count towards their "Medicaid spend down" should they apply for benefits.

It is important to note that without a proper contract in place, Medicaid will assume the money paid is a "gift" or a "transfer of assets" and will impose penalties resulting in ineligibility for Medicaid benefits.
While most of you may already be aware that Medicaid allows care contract payments for caring for loved ones living at home, you may not be aware that payments made via personal care contracts for providing care services for nursing home residents are also an allowable spend down.

Support group with some answers click here

Let's give an example: Imagine that daughter agrees to perform a number of services for her mother, including but not limited to preparing meals, cleaning, laundry, assistance with grooming, bathing, personal shopping; monitoring her mother's physical and mental conditional and nutritional needs in cooperation with health care providers; arranging for transporting; visiting weekly and encouraging social interaction; interacting with and/or assisting in interacting with health care professionals, etc. for her mother's lifetime, in exchange for a lump sum of $30,000 via a care contract.

Now, whether this will be allowed will be dependent upon the state determining that the Contract in place had fair and valuable consideration. While a personal care contract may not be appropriate in everyone's situation, if you are caring for your loved one at home or in a nursing home, it is something that you may want to discuss with a knowledgeable Elder Law Attorney who can advise on possible tax consequences and/or Medicaid and estate planning issues.

visit the Alzheimer's Legal Resource Center by clicking here

click here for more information about this policy

forms for legal contracts click here

click here for a practical guide for caregivers