As the number of family members providing care for aging parents increases, the solutions to find help with loss of income because of time off from employment for caregiving has become a major concern for many.
The demands on both the time and energy needed to provide the needed care can make it impossible to maintain both a full time job with full time caregiving.
Seeing a need to give support to family caregivers the federal government Administration on Aging created the National Family Caregiver Support Program.
State Area on Aging division manages this program on the state and community level to offer support services that include:
- Information to caregivers about available services;
- Assistance to caregivers in gaining access to supportive services;
- Individual counseling, organization of support groups, and caregiver training to assist caregivers in making decisions and solving problems relating to their roles;
- Respite care to enable caregivers to be temporarily relieved from their care giving responsibilities; and
- Supplemental services, on a limited basis, to complement the care provided by caregivers.
Medicaid Cash & Counseling Program
A Medicaid approved assistance program called Cash & Counseling may be used to provide funds to hire personal care aides as well as purchase items or services, including home modifications that help them live independently.
The PayingForSeniorCare.com website gives the following information about the program:
"For Medicaid eligible seniors, the process begins with an assessment in the home to determine the senior's home care needs; this includes interviews with caregivers and possibly the senior's physicians. A determination of how many monthly care hours are required is made. The benefit amount is calculated using that determination and cost of care for that geographic area. This amount can be increased or decreased as the senior's needs change. A family care giver may need to qualify as a home health aid by the state to receive these funds."
This program is executed by each individual state Area on Aging Services division. It is a relatively new program and is not yet available in all States. Check with your state Area on Aging Services department for availability.
Using the Veterans Aid and Attendance Pension Benefit
A totally overlooked source of money to pay family caregivers to provide care at home is the Aid and Attendance Pension Benefit. This money is available to veterans who served during a period of war. Pension money is also available to the widows of these veterans. This benefit, under the right circumstances, can provide up to $1,949 a month in additional income to pay family members to provide care at home.
Getting the aid and attendance benefit to pay for family caregivers is not an easy task. This is because there must be a caregiver contract in place, a physician medical evaluation done, income and asset qualifications met and proof of medical expenses provided. Submitting the correct forms and documentation can easily be completed with the help of a VA Accredited Consultant who understands the process.
Long Term Care Insurance Benefit
If the senior being cared for has a long term care insurance policy that covers home care, payment to the care giver from this source could be arranged. Some policies require the care provider to be through a licensed home care agency, but others will pay for individual aides certified as such. This would require some training by the family member to become certified. There are policies that pay a daily benefit amount to the insured to use as they want to pay for their care. Check with a long term care insurance professional about types of policies.
Caregiver Contract
In some cases the senior parent has the funds to pay for care. If a family member is giving care it is very important that a caregiver contract be in place. A signed and dated agreement will outline the services provided as well as the amount of pay for these services. The contract will eliminate questions about what is expected from both parent and caregiver as well as providing a legitimate contract and payment record of services to qualify for Medicaid.
Attorney John L Roberts, in his article titled "Caregiver Contracts that Protect Elders and Their Family Members" states:
"A written Caregiver Contract is a good idea for every family that wants to protect family harmony, and make sure everyone in the family understands how care is being provided to an elder.
The family member who provides care can save an elder from needing nursing home services, and may also protect assets if nursing home care is needed in the future. Elders who want to cover all of these bases must have a written Caregiver Contract. Whenever adult children and other family members are providing valuable care, only a written agreement will protect assets from nursing home care costs and qualify the elder for Medicaid."
In having the parent pay a family member for caregiving, it will be an employer/employee situation and payroll records must be kept with payroll taxes paid.
This can also be set up by an elder law attorney at the time the contract is done.
Final Note
Taking the time to create the caregiver contract, research the government and state services that are available to caregivers and using community resources will make the family caregiving experience less stressful.
"The 4 Steps of Long Term Care Planning" from the National Care Planning Council
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For you, the consumer – A summary of important information you need to know about home health care: Remember to ask questions!
Home Health Care is a Medicare/Medicaid benefit (for 65 yrs. or older or the disabled). Your eligibility comes from (but not limited to), a discharge from a hospital or rehab center.
• The amount of care you will receive is determined by your diagnosis and evaluation/assessment conducted by the Home Health Care Agency.
• The benefit can run a maximum of 90 days (your certification period). But the Home Health Agency (HHA) can release you from care (discharge you) at their discretion.
• If you keep services for the entire 90 days, another evaluation will be conducted to determine (re-certification) for extended 90 days.
• There is no minimum service time guarantee and it all depends on the assessment/evaluation from the Home Health Care Agency and your primary care physician (PCP).
You have a CHOICE on your provider:
• Many health care organizations have internal home health care services and may gently persuade you to choose their service because it is within their best interest to keep you within their continuum of care.
• Remember – you have a CHOICE – Ask your Social Worker (or whomever is in charge of your discharge plans) or your health care provider for at least three (3) other choices – they will give you information on other home health care organizations that are reputable in the community.
• Interview the Home Health Care Agency prior to starting service with them. Ask to meet their representative.
• You need to have total TRUST in your Home Health Care provider!
Research All Your In-Home Benefit Options:
• If you need home health care, and feel you may not be getting what you are eligible for – contact your Primary Care Physician (PCP). Talk to them about what you think you might need and have him give you a referral.
• Find out if you are eligible for Medicaid or (State) funded services. You should contact your Aging Service Access Point (ASAP) nearest you (Elder Services) to check your eligibility.
If you have other insurance – ask about in-home care benefits
• Contact the Executive Office of Elder Affairs (EOEA) and inquire about other State benefits that you may be eligible for. If you are a Veteran – contact the Veterans Administration.
Still need more help?
• After you have researched your eligibility for Medicare and State funded home care services – and you still need more help – you may want to check into private pay in-home care.
• This may be to supplement what you are already receiving from Medicare or Elder Services – or after you are no longer eligible for those benefits, but you still want/need services.
• There are hundreds of private pay in-home care agencies. You need to choose wisely!
• Remember to ask for references, and meet the companies’ representative before signing on for services.
• Again – TRUST in your home care provider is very important!
The above information is only a summary – there is much more to know and learn about Home Health Care.
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How are their costs determined?
Why am I paying $25 an hour (or more) for my home health aide when I could pay them $12 an hour.
This is a very common, justified question. After reading the information provided below, you may find that the cost of a reputable private pay agency is well worth the extra money.
The average charge for a Home Health Aide in Massachusetts from a professional homecare agency is approximately $20 to $27 an hour.
How is that charge determined?
Hourly Wage: A Certified Home Health Aide’s average starting wage in Massachusetts is $10 – $12/hour. As high as $15/hour for specialty skilled, experienced.
Matching Taxes: On top of the hourly pay, the agency is required to pay payroll taxes. Payroll taxes are the state and federal taxes that you, as an employer, are required to withhold and/or to pay on behalf of your employees. You are required to withhold state and federal income taxes as well as social security and Medicare taxes from your employees’ wages. You are also required to pay a matching amount of social security and Medicare taxes for your employees and to pay State and Federal unemployment tax.
Currently the social security tax rate is 6.2%. You are required to withhold 6.2% of an employee’s wages for social security taxes and to pay a matching amount in social security taxes until the employee reaches the wage base for the year.
The Medicare tax rate is 2.9% for the employee and the employer. You will withhold 1.45% of an employee’s wages and pay a matching amount for Medicare tax. There is no wage base for the Medicare portion of the FICA tax. Both the employer and the employee continue to pay Medicare tax, no matter how much is earned.
The employer also must pay State and Federal Unemployment Taxes (SUTA and FUTA). The FUTA rate is 6.2 %
Liability, Workers’ Comp Insurance: Can cost an employer up to $4.50/hour. Healthcare liability and workers comp is among the most expensive. The cost is determined by payroll audits each year at the agency.
Health Insurance Benefits: Averages $0.75/hour
Other benefits: The agency may have an overhead of 24/7 hourly support services including RN’s on-call as well as their day-time support staff in the office. There is also a charge for Criminal Background Checks (CORI’s), and additional cost for Bonding the employees. All of which contributes to the safety of the client.
Summary of Costs:
- Employee Wages
- Employee Benefits
- Agency Matching Taxes
- Agency Liability and Workers’ Comp Insurance Coverage
- Bonding Insurance
- Background Checks
- Agency Support Staff – 24/7
It is worth the extra money to pay to a professional, credible private pay agency. The benefits far outweigh the cost.
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A unique program designed to meet the needs of a unique population.
For those seniors who have the ability to remain independent in their own homes, PACE (Program of All Inclusive Care for the Elderly) may be the solution!
ESPNS (Elder Service Plan of the North Shore) is a non-profit organization. PACE is an innovative model of care that enables eligible seniors to remain in their own communities rather than being placed in long-term care facilities.
Based on a system of care that was begun in the early 1970's in San Francisco's Chinatow, the PACE model provides one stop comprehensive health and social services for its participants.
PACE's goal is to maximize the health and functioning levels of program enrollees to enable them to continue living in the community. To accomplish this, the program:
- Provides a comprehensive range of
preventive, primary, acute and
long-term care services.
- Uses and integrated interdisciplinary
team to manage care.
- Develops appropriate
community-based alternatives to
providing care in
institutional settings, whenever
possible.
- Consolidates capitated funding from
Medicare and Medicaid to finance
service as needed.
Established in 1995, the Elder Service Plan of the North Shore's PACE Program began operating with 20 participants and seven employees. Over the past several years we have provided services to over 1400 participants and currently have over 210 employees. Our current client base of over 760 participants are served from one of our six Adult Day Health Centers in the North Shore.
LEARN MORE ABOUT THE BENEFITS OF THE P.A.C.E. PROGRAM!
http://pacenorthshore.org/
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Massachusetts does NOT regulate private pay home care agencies – what this means, is that anyone can open and operate a private duty home care agency without oversight from the State or other home care regulatory authority. Therefore, it is up to the consumer to be knowledgeable about what to look for when choosing a private duty home care agency.
Home Care Options: Questions to Ask
- Does the home care agency EMPLOY it’s workers? Take out taxes, provide benefits, liability insurance and workers’ comp? (Know the difference between Employment Agencies, Registries/Brokers and Independent Contractors: Registries and Independent contractors mean that YOU will be responsible for paying the caregiver, and may possibly be responsible for payroll taxes. And if the caregiver is an independent contractor, they may not have individual liability insurance. ASK.)
- How long has the Agency been in business? Can they provide references?
- Does the home care agency verify employment background?
- Do they conduct Criminal background checks?
- Do they perform immigration checks?
- Does the home care agency require competency testing, and skills testing for their caregivers?
- Does the home care agency require their “Care Givers” to be State Certified?
- Are the caregivers supervised by Registered Nurses?
- Does the home care agency provide a Nursing Assessment and a professional Plan of Care, individualized to the client’s needs PRIOR to start of services?
- Does the agency provide 24/7 on-call services, with a Nurse available to clients and employees?
- What happens if the caregiver is sick? Does the agency have a replacement policy?
- Can you meet your caregiver before they start?
Remember, YOU have a CHOICE
Many of the Hospitals and Rehab’s have their own Home Health Care Agencies that they will recommend to you when going home. Remember, it is YOUR CHOICE to which HHA you want to take care of you when you go home, therefore, ask for a list of 3 choices, and talk to representatives from each to determine which organization would be right for you.
Don’t be afraid to ASK QUESTIONS!
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CONSUMERS! You need to ask more questions and get more involved in your health care!
Questions to Ask Your Health Care Provider:
- What is the test for?
- How many times have you done this?
- When will I get the results?
- Why do I need this surgery?
- Are there any alternatives to surgery?
- What are the possible complications?
- Which hospital is best for my needs?
- How do you spell the name of that drug?
- Are there any side effects?
- Will this medicine interact with medicines that I’m already taking?
SOURCE: http://www.ahrq.gov/news/press/pr2009/quareapr.htm
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Not happy with the home care services you are receiving?
Choosing and receiving home care services can be stressful for some. It is a process that can be invasive because you are opening your home and personal life to strangers. After the initial process of setting up home care services, you should feel content, and relief that you are receiving help in the areas that you need them the most. You should feel comfortable with your home health aide, and the other health care professionals that come visit you.
But what if you don’t? For whatever reason, you have the right to change.
The worst thing that you can do is NOT express your concerns to the health care organization. A fear of rejection or getting someone in trouble, often keeps clients from sharing their true feelings.
Who do you talk to?
Upon start of care from a home care agency – you should receive information on who to contact with questions and concerns. You should receive the name of the Nurse Case Manager assigned to you (sometimes called Clinical Manager). The Nurse Case Manager is in charge of all of the other health care workers that are assigned to you. . If you are receiving only therapy services (physical, occupational or speech), then you will want to speak to the director of therapy. They are in charge of the therapists that are assigned to you.
Either via telephone or face-to-face, discuss your concerns with him/her. It is their responsibility to adhere to your requests, to the best of their ability, and to make you feel comfortable and happy.
If you do not feel satisfied with the home care agency after discussing your concerns, contact your Doctor’s office to request a referral to another home care agency. To avoid a lapse in services, the transition from one home care agency to another should occur within a few days.
If the home care agency is a private pay agency, you will want to know what their cancellation policy is. Make sure that you adhere to their cancellation policy so not to incur any additional charges. Contact another agency prior to the end of service from your current agency, so not to have a lapse in coverage. Contact your local senior center, and ask your Doctor’s office for suggestions on other private pay agencies.
Remember you have rights. Whether you are receiving Medicare, Medicaid, private pay or private insurance – YOU are the consumer.
Never be fearful of speaking out. The Agency you are working with should make every reasonable effort to comply with your requests and make the necessary changes and adjustments for your satisfaction. If they cannot, they should tell you within a timely manner and assist you with transferring to another agency.
So speak up. You are the consumer! Chances are, the agency will be happy that you expressed your feelings and that they have the opportunity to rectify any problems and provide you with the quality service that you deserve.
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Do you need to hire private pay home health care? Important information for you to know before doing so……
Massachusetts does not regulate private pay home care agencies; therefore, anyone can open a private pay agency, and hire anyone they want to be “caregivers”. It is important that you ask the following questions when choosing a private pay home care agency:
Who owns/manages the agency? It is important that you know who the principle owner and/or manager is of a private pay agency. Do they have a background in healthcare? And if so, what is it, and how long have they been in the healthcare field? Ask what their experience is and make sure you feel comfortable with their experience before doing business with them. You wouldn’t buy legal advice from someone who is not a lawyer or legal representative? Would you?
How long have they been in business? You want to deal with someone who has been in business or at least in the field of home health care, healthcare or nursing for a substantial amount of time. If they have only been in business for less than 5 years, but has 20 years of healthcare background, or other customer service background – you may feel that is OK.
Does the agency have professional liability insurance? Also known as Errors and Omissions insurance, Professional Liability insurance protects the employer from potentially catastrophic litigation caused by charges of professional negligence or failure to perform professional duties. This might include errors and omissions resulting in claims of non-performance, negligent oversell or physical harm or potential harm to you or your loved ones. You need to protect yourself and your loved ones from any liability incidents that may occur while you are contracting their services. This is a must. You also have the right to request a copy of their Certificate of Liability.
Does the agency provide Workers Compensation to their employees? You want the agency you are dealing with to provide workers compensation insurance to their employees to protect your assets if an employee is hurt while under providing the contracted services requested.
Are the employees Bonded? Companies that Bond their employees, insures you’ll get reimbursed in a timely manner if one of their employees steal from you, and are convicted of it. Companies that do not bond their employees, still may repay you in the event of a proven theft from their employee, but it is not guaranteed and could be timely, or not happen at all.
Does the agency employ Registered Nurses for Supervision and Case Management? There are several reasons you want a Registered Nurse working for the agency you contract for services:
Comprehensive Client Evaluation: They should offer to send a nurse out to you to evaluate your needs, so they can match your needs to the appropriate caregiver.
Case Management: The nurse should be assigned to you for case management including liaison between you (client) and physician(s), as requested and as necessary. Depending on the amount of services you require, you should be assigned a nurse case manager.
Supervision of Staff: Having a Nurse on-staff that is supervising the home health aides is very important. When you have a Nurse supervising, the nurse is responsible for all non-professionals that are working under their license. The supervision of staff should include quarterly in-home evaluations and yearly skills evaluation.
Are their Home Health Aides CERTIFIED? Again, Massachusetts does not regulate private pay home care agencies – therefore, some agencies will hire individuals that may have experience, but have NOT gone through a State approved Home Health Aide course. You want home health aides that HAVE gone through a State approved course. No exceptions. If you do NOT require personal care, a Homemaker/Companion may be offered. Homemakers and Companions are not required to go through a course.
Does the agency perform background checks? Ask them and let them explain the background checks that they perform. They should include:
Employment History: Verify where they have worked according to their application for employment
Professional Work References: Verbal or written reference checks should be done on at least two (2) of their prior work history. Those references should prove to be at least satisfactory.
Criminal Background Check: Any reputable agency can apply and be approved to have access to the Criminal History Systems Board (CHSB), and be able to access the Criminal Offender Record Information (CORI) from the State of Massachusetts. (A plus is if they also have access to the National Criminal History Systems Board).
Skills Check: Does the agency check the skills of their new hires, and again on an annual basis? They should. This should be performed by a nurse on staff.
When choosing a Private Pay Home Care Agency, make sure you ask these questions. Expect the best service for your money. It is not only important for your safety, but for your personal well-being.
CLICK HERE FOR IMPORTANT INFORMATION!
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Family Members Paid as Caregivers
Caring for a family member is one of the most rewarding and difficult jobs with financial impact as well as emotional stress. An alternative to placing relatives in nursing home care in Massachusetts is a program called Enhanced Adult Foster/Family Care.
This program is funded through state and federal funds and pays a family caregiver a daily stipend to take care of an aging relative or disabled individual at home, or pays non-family caregivers to provide this care.
Eligibility Guidelines:
A Client for the Adult Foster/Family Care program must be at least 16 years or older and need 24 hour supervision and daily assistance with physical care and must be on Mass Health standard, or eligible for a Frail Elder Waiver under the Mass health regulations.
Caregiver reimbursement is not taxed and is non-reportable to the IRS. Federal Medicaid law prohibits payment to a spouse or legal guardian.
The process begins with a home visit and the client and family meeting. A complete assessment of needs is then done by a Registered Nurse. Once in the program the client and family caregiver receive ongoing support from a team of professionals, including a Registered Nurse and a Care Manager.
The Registered Nurse and Care Manager provide specific caregiver training, establishes a formal Plan of Care, and conducts regular home visits. This team also coordinates with other services such as Adult Day Health Programs, Hospice Care or Visiting Nurses, to help ensure that clients receive the range of service they need to stay comfortably at home and in their communities.
FOR MORE INFORMATION, CONTACT:
Teresa Gove Arnold, M.S. of Caregiver Homes at (978) 241-2062 or toll-free: 1-866-797-2333 or visit  www.caregiverhomes.com.
Caregiver Homes, is a Massachusetts approved Enhanced Adult Foster Care provider.
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