Advice On Making Right Choice For Help With Elderly Care

The cost of hiring someone to help care for an elderly relative has remained fairly steady in recent years, according to a recent item in The New York Times.
It’s still about $19 an hour for a hired homemaker, someone takes care of things like cooking and cleaning. A home health aide, who can assist with personal care such as dressing or bathing, costs only $1 more an hour, according to the article by Ann Carrns.
Those figures represent an increase of only about 1 percent over five years ago, according to the story.
Something else that hasn’t changed, the writer points out, is that it takes some digging to make certain the homemaker or health aide is the right person to be given the job.
Carrns offers these suggestions, with a little help from experts:

  • How do I know what kind of caregiver my family member needs?
    You can assess needs, like his or her ability to handle activities of daily living such as dressing, eating and bathing, using a checklist, like one provided by the National Caregivers Library. Or, you can have a professional conduct the evaluation, which is advisable, said Amy Goyer, a specialist in home and aging with AARP. To find someone qualified to do the assessment, you can contact your local office of the National Association of Area Agencies on Aging for a referral. You can find the one nearest you on the federal government’s Eldercare Locator site.
  • How do I go about finding a home caregiver?
    One option is to use a home care agency, which will screen and train caregivers to make sure they can provide the level of care needed. Since the agency employs the caregiver, it also handles payroll tasks. An agency can also schedule alternative caregivers if your primary caregiver is ill or unable to work. Because the agency offers these services, its hourly rates may be higher.
  • What if I prefer to hire someone myself?
    You may be able to obtain a lower rate by hiring someone directly. But if you hire a caregiver yourself, you’ll have to handle payroll and possibly taxes, said Leah Eskenazi, director of operations for the Family Caregiver Alliance, a nonprofit that helps people caring for relatives. Ms. Eskenazi advises that word of mouth is often a good way to start your search; friends or family members who can vouch for a caregiver’s skill and reliability can be good first references. The AARP website offers a tool to search for an agency by ZIP code.

In addition, Carrns advise that websites like also help find independent candidates in a given geographic area.

Having A ‘Care Conversation’ May Be Easier Than Many Assume

Many adult children avoid have “The Conversation” with their elderly parents regarding their long-term care because they don’t want to hurt their feelings.

Parents (Photo credit: mohammadali)
Parents (Photo credit: mohammadali)
It’s just too sensitive a subject, or so the reasoning goes.
“These perceptions may not be reality,” according to a recent posting on the website “Loved ones may want to talk. The process may be easier than we think. We simply won’t know until we try, so it’s important to push past initial reservations and commit to taking action.
“Once you’ve made the decision to act, how do you go about initiating a delicate conversation? Even with the best intentions and strong determination, you may find yourself speechless.”
The website offered five tips for improving chances of a successful outcome for “The Conversation.” They are:

  • Address the Who, Where, and When – The right mix of people, place, and timing will help set the right tone for a pleasant, productive care conversation.
  • Be flexible – Unforeseen circumstances can alter even the best-laid plans. However eager we may be to “get it over with”, a care conversation should not be forced or rushed. Allow discussions to evolve naturally. Plan for a few hiccups.
  • Take the “right” approach – Everyone’s situation is different, so there is no one-size-fits-all “right” approach. Consider your loved one’s unique preferences and tailor your tactics accordingly.
  • Ask specific questions – Be specific in your questions to fully understand the situation and level of need. For example, if your loved one seems to struggle with a fear of dying, you might simply ask, “Are you afraid?” Honest questions can make difficult situations easier, and offer greater peace of mind.
  • Remember, it’s not about you – The goal at this point is to simply gather information, listen and observe. While we can certainly help our loved ones make choices, we should be careful not to take over the decision-making process.

Three-Step Process Can Help In Quick Long-Term Care Cases

An old saying goes, “Act in haste, repent at leisure.”

Dad at Diamond Ridge Healthcare Center (Novemb...
(Photo credit: cseeman)
Haste, though, can be obligatory when it comes to making decisions about long-term care for an elderly relative.
“Sometimes unexpected circumstances, distance or a lack of resources can escalate a situation to one of immediate need or crisis proportions,” according to a recent article on the website “A hospital may catch you off guard with plans of a discharge. Regardless of cause, you’ve got to find a care solution fast. Personal obligations or out-of-town coordination further complicate the situation.
“Fortunately, there are always care options available, even when time isn’t.”
The article offers a three-step process for arriving at a solution, one that should permit haste without regret.
These steps include:
“Ask family and friends to recommend caregivers or centers. Find and compare skilled nursing care centers online with Medicare’s ‘Nursing Care Compare,’ a rating site for Medicare- and Medicaid-certified nursing homes, professionally called skilled nursing care centers. Medicare has developed a five-star quality rating system based on health inspection results, care center staff data, quality measures, and fire safety inspection results. Though there is plentiful information you can find, relying on ratings alone is not sufficient enough to make a decision.”
“Based on your research, choose about three centers to visit. Call each to schedule a tour. Communicate the immediacy of your situation and ask to speak with an admissions director. The admissions director will tell you more about the center and availability. Only visit centers that you know have available accommodations.”
“After visiting nursing homes, professionally known as skilled nursing care centers, select the center that best meets your care needs.”

Elderly Self-Neglect Up To Others To Notice

The question is not if but when.
It is inevitable that as people get older, at some point they will no longer be able to take care of themselves. By then, however, the individual is in no position to be the judge of needing help, and the difficult decision of stepping in must fall to loved ones.

(Photo credit: Barbro_Uppsala)
“For inexperienced family caregivers, knowing when to get involved and where to go for help is not always clear, but its importance is unyielding,” according to a recent article on the website for Family Private Care Inc.  “The Public Policy Institute of AARP reports that self-neglect represents nearly 40 to 50 percent of all cases reported to states’ Adult Protective Services. Self-neglect often occurs when aging adults become unwilling or unable to manage necessary self-care, including personal grooming, general maintenance in the home, financial management, social affairs, and other standards of living.”
The website offers these possible signs for which friends and family members should look:

  • Malnourishment due to poor eating habits and inadequate nutrition at home
  • Poor personal hygiene, including dirty clothing, hair, skin, nails, etc.
  • Not receiving proper medical attention
  • Isolation from friends, family and regular activities
  • Noticeable changes in the home, such as repairs that need to be made, hoarding, expired food/drink in the kitchen, unusual smells
  • Self destructive behaviors, like excessive alcohol or drug use

“Struggling to perform these self-care tasks make individuals vulnerable to other serious health hazards,” the site warns. “To help protect elderly loved ones, be aware of the signs of self-neglect and observe his or her behaviors. Stay in close contact with loved ones and voice your concerns to those around you.
“Those who need help the most will likely be the first to refuse it. This puts caregivers in a tough situation. Be patient and encourage your loved one to accept help, and offer your support when necessary. If you feel that your loved one is in immediate danger, however, seek professional help.”

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Less Costly Options Exist To Afford In-Home Care

While in-home care for elderly parents or other relatives may be a kinder approach than placing them in a nursing facility, it can also be a very pricy proposition.

English: My parents.
(Photo credit: Wikipedia)
A recent article offers some creative approaches to affording this option.
“In general, pay rates in urban areas are higher than in rural communities, and still higher on the east and west coasts than in the central United States,” according to the article. “Costs also depend on whether you’re looking for homemaker services, defined as ‘hands-off’ care, such as cooking, cleaning, running errands, and general companionship, or home health aide services, which include personal care, such as bathing and dressing. A comprehensive 50-state survey of care costs by MetLife found that as of 2011, average hourly rates for home health aides ranged from $16 to $29 across the country, while rates for homemaker aides without medical training ranged from $13 to $24. These rates do not seem to be changing much over time. According to Genworth’s 2012 data analysis, the median rate for in-home care of $18 to $19 an hour nationwide is rising by only 1.15 percent every five years.”
Among the advice on making this sort of care more affordable are reversible mortgages, pensions for veterans that may have previously gone untapped and making alterations to life insurance policies no longer needed to care for others.
“The way this works is that your loved one sells the policy back to the issuing agency for 50 to 75 percent of its face value, an amount determined based on the amount of the policy, the monthly premiums, and the policy holder’s age and health,” the article stated. “There may be restrictions; some policies can only be cashed in if the policyholder is terminally ill. But many are quite flexible. And if yours isn’t, there are settlement companies that will buy the policy, also at 50 to 75 percent of face value, then pay the premiums until the policyholder’s death, when the company will collect the benefits.
“If the company that issued the policy won’t cash it in, don’t worry. Your loved one may be able to sell the policy for a ‘life settlement’ or ‘senior settlement.’ In this case the settlement company pays the premiums until the policyholder dies, then receives the benefits that would originally have gone to the policy’s original beneficiaries.”

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Website Offers Warning Signs For Caregiver Thieves

It should be the last thing people have to worry about when hiring someone to care for an elderly loved one.
But it’s not.

A German nurse in scrubs.
(Photo credit: Wikipedia)
“Talk to anyone who’s hired someone to help care for an older loved one, and theft is almost always a major worry,” according to a recent article on “Bringing a paid caregiver into the home, whether through an agency or privately, can come as welcome relief to all, but it can also feel like a risky decision. Stories abound about vulnerable people who’ve been taken advantage of.”
The site goes on to offer some helpful tips in being vigilant on behalf of the person being cared for.
These include receipts that don’t add up.
“If grocery shopping and other errands are among a caregiver’s responsibilities, it’s pretty easy for ‘mix-ups’ to occur,” points out. “You might notice items listed on a receipt that seem out of character for your loved one, or certain supplies that seem to run out, and be replaced, with surprising frequency.”
“You may see $6.50 for a lipstick, knowing Grandma doesn’t wear lipstick, but if you let it slide you’re sending a signal that no one’s minding the store,” Carolyn Rosenblatt, author of The Boomer’s Guide to Aging Parents,” was quoted as saying.
Other warning signs, states, include the caregiver making frequent cell phone calls while on the job, cultivating a personal rather than a professional relationship with the client, making bids for sympathy and frequently missing work on Mondays.
“This is a classic sign of alcoholism or substance abuse; people go on a bender over the weekend and then can’t make it into work on Mondays,” Rosenblatt told the website. “Unfortunately, alcoholism and chemical dependency often go hand in hand, and they frequently lead people to steal to meet their need for drugs.”

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Two Benefits That Provide Care for Veterans

There are various government programs and tax benefits available to those who provide significant care for veterans and their family members. If you are caring for a veteran at home, a recent article discusses the benefits you may be eligible to receive.
If the veteran you are caring for would otherwise be eligible to receive care in a nursing home, you may be eligible to receive the Veteran-Directed Home and Community Based Services program. Through this program, veterans are able to manage their own care. Importantly, veterans are able to select, hire, and compensate their own caregivers.
A wartime veteran or his spouse may also be eligible for the Aid and Attendance benefit. This benefit assists in paying for any necessary in-home caregivers, or care in an assisted living facility or nursing home. Even family members of the veteran or spouse may collect under this benefit. The Aid and Attendance benefit pays a maximum of $2,054 per month of tax free income for a married veteran, $1,732 for a single veteran and $1,113 for a widowed spouse.
In order to qualify for the Aid and Attendance benefit, the veteran must have served at least 90 days of active duty service, with one day during a period of wartime (the veteran does not have to have been in combat). Further, the veteran or spouse that you are caring for must require assistance with daily activities such as dressing and bathing. The VA also has income and asset requirements. However, proper planning with an elder law attorney can help in becoming eligible for those benefits.

Reducing the Pain When Longtime Partners Must be Separated

Many people assume that for elderly couples the death of a spouse is an inevitable and heart-wrenching experience, and they would be correct.

Elderly couple, Paris
(Photo credit: i.tokaris)
However, separation from one another because one of the partners requires a greater level care than the other is almost as keenly painful.
“Sadly, this scenario is more common than one might think,” Dave Singleton wrote in a recent piece on the website “After decades of living together, one parent needs more care than the other can provide. It’s not only hard on the parents; it’s a devastating situation for children and loved ones, too. You want to help, but you feel helpless in the face of what amounts to a forced separation.”
Based on conversations with two experts in the field of eldercare, Singleton offered some tips on ways to reduce the trauma of such a separation.
They include:

  • Determine in advance how the relationship will continue.

“Before anyone makes a move, encourage your parents to map out how the marital bond will carry on,” Mary Koffend, president of Accountable Aging Care Management, was quoted as saying.

  • Ensure that the facility supports the couple.

“The key is to promote the couple’s identity as a couple as much as possible, or desirable, for both partners,” Cheryl Woodson, author of ‘To Survive Caregiving: A Daughter’s Experience, A Doctor’s Advice,’ told Singleton. “Make sure the facility is convenient for the healthy partner in terms of transportation, access, and schedule.”

  • Help your parent with feelings of guilt and inadequacy.

“A parent might feel like he’s no longer honoring his wedding vows, or that he isn’t doing enough,” Koffend said.

  • Get your parents outside help if needed.

“No matter how cooperative the facility is, no one can understand how bereft these couples may feel,” Woodson was quoted as saying. “Families should encourage the healthy partner to talk to clergy, behavioral health professionals, and/or to participate in support groups with other spouses in similar circumstances.”

  • Help foster private time, if desired.

“For example, if a spouse can’t leave the facility for whatever reason, kids can step in and have a very straightforward conversation with the facility’s administrators about arranging alone-time for the couple,” Koffend told the writer.

  • Expect the unexpected.

“Don’t assume that this transition ends once the initial decision and move are over,” Koffend advised. “Be prepared for whatever your parents’ needs are afterward, when there’s sadness or frustration on either side. Help your parent realize they have a practical role in the care and upkeep of their spouse who’s now living in a new place.
“It gives purpose to the visits, even if it’s as simple as bringing a few products and a hairbrush to help maintain physical appearance.”

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Help Available Finding the Right Nursing Home

Few decisions are more gut-wrenching than having to find a facility in which to place a beloved elderly relative.

Nursing Home
Nursing Home (Photo credit: LOLren)
Unfortunately, many nursing homes and other eldercare operations sometimes offer misleading information and exaggerated claims, about such things as staff training and the kinds of services available.
Fortunately, there are resources for separating fact from fiction.
In a recent article on, contributor Caroline Mayer offered some tools for navigating the system, courtesy of eldercare consultant Carolyn Rosenblatt in her Forbes blog, “Free Resource for Your Aging Parents and You.”
These included the following sites:

Perhaps the most important information contained in Mayer’s article was that this is not something that can be done in a hurry and not by relying on single sources.
“Lots of consumers want a quick solution for finding the right place for their parents,” says David Spiegel, an FTC attorney who was the lead attorney in the CarePatrol and ABCSP cases. “Unfortunately, you have to use more than one tool if you want to be in a real comfort zone when you place your loved one in any eldercare facility.”

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What to Consider When Choosing a Long-Term Care Living Situation for your Loved One

Choosing a long-term care living arrangement is one of the most difficult challenges faced by aging adults and their loved ones. Most families try to avoid the nursing home option to the very end, believing that assisted living or small residential care homes provide a better quality of life. But this may not necessarily be the case.

New research suggests that the type of living situation itself makes little difference in a resident’s emotional well-being. Instead, the happiness and contentment of the resident depends more on the characteristics of the specific environment they’re in, and of course in no small part on their own personal characteristics — how healthy they feel they are, their age, and even their marital status.

Logically enough, a resident of a long-term care facility of any kind is more likely to report satisfaction and comfort if they had a hand in choosing their living situation, if they were part of the decision making process. In fact, studies show that the process of finding and choosing a living situation—researching options, visiting facilities, considering current and future social and physical needs and how they will be met—plays a very important role in the beginning of acclimatization.

Whatever your choice, you’ll need to talk to your family and plan how to finance whichever choice is made for long-term care living. has published a helpful chart summarizing and comparing the various options for long-term care financing. Or please feel free to contact our office for more information.