24 care home care for family member

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frankmorris
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24 care home care for family member

Post by frankmorris » Mon Sep 11, 2017 8:28 am

This is the first time our family has had to deal with this issue and it's a bit consuming. One of our family members is about at the point when she may require in home personal care - not medical, but bathing, kitchen, etc. She is elderly and wants to be independent, but less able. Probably your typical situation.

We're wondering how to best go about shopping for home care, and tips and tricks, and what to expect. We don't want to sacrifice quality of care, but don't want to be ripped off at the same time. She's in the Bay Area (CA) so we're assuming cost of care is likely slightly higher, but:

- What might be a ballpark range of expected daily rate for an in-home care provider (same person ideally, if not multiple).

- Are there strategies beyond going with the bigger care companies? We're hesitant with the Craig's List strategy, but are coming up short with doctor and friend recommendations.

- Are there ideas or strategies for arranging care that are more financially prudent?

Apologies if this has been discussed before.

SGM
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Re: 24 care home care for family member

Post by SGM » Mon Sep 11, 2017 8:58 am

I had a professional relationship with a social work group that had a 20+ year history of recommending home care. I referred all of my elderly patients considering home care to this group and they recommended larger companies unless they knew individual care givers quite well.

An in-law used a small company based on the experience of her nephew. The nephew's experience was for daycare only. It was a poor decision. The in-law had her silverware stolen by an aide. Also several aides brought in their children who destroyed a chair and some collectibles. One of the aides was fired as she was abusive. The aides spend most of their time watching TV or on their smart phones.

The cost of 24 hour care is higher than the cost of nursing home care in our area. Assisted living may be an alternative for some elderly patients who are no longer capable of living alone. A local assisted living facility costs about 50% of the cost of nursing home care. Assisted living facilities generally cannot care for patients who have feeding tubes or IVs or who are at risk for fleeing the facility.

Edit to correct typo
Last edited by SGM on Mon Sep 11, 2017 10:22 am, edited 1 time in total.

NotWhoYouThink
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Re: 24 care home care for family member

Post by NotWhoYouThink » Mon Sep 11, 2017 9:49 am

Unfortunately, there is likely no solution here that will satisfy everyone. If you have 24 hour care, expect to pay $20/25 per hour, 24 hours a day, 365 days a year.

If you arrange the care yourself, someone needs to be the "project manager" that screens and hires aids, makes sure 24 hours of every day is covered, handles payroll and taxes, deals with sick days, no shows, car-breakdown-related late arrivals, and firing aids that don't work out.

If you hire an agency, someone at the agency will handle all of the above, maybe, but you still need a vigilant family member.

Either way, the vigilant family member needs to keep a list of duties (cooking, cleaning, bathing, feeding, medicine dispensing, shopping, laundry, etc.) and protect the elder from theft and financial fraud, and monitor regularly to ensure the above is all under control.

Most people either
- have a family member move in with the elder
- have the elder move in with a family member
- move the elder, sometimes under protest and anger, to an assisted living facility, or possibly a board and care home.

Many people think they want to stay in their homes until they die, but can't because it isn't safe and there is either not enough money or not enough family commitment to put the infrastructure in place to keep them there.

Old age is hard. But the more money you have when you get there the more options you have to structure your aging the way you want it.

Jack FFR1846
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Re: 24 care home care for family member

Post by Jack FFR1846 » Mon Sep 11, 2017 10:06 am

If nothing else, do the math. If the goal is to avoid assisted living care, do your homework. As noted above, for 24 hour care, you need to pay for 24 hours a day. If the all-in cost is $25 an hour, the very simple math says $219k a year or $18,250 a month. Clearly this is misguided if cost savings is the goal. Reduced rate means less qualified people or hiring them without an agency, so add your work and time to manage them. Can sleeping hours do without a care giver? Maybe yes, maybe no. If staying in a home, there's home maintenance and day to day needs. How are the bills paid, orders for heating oil? Snow removal?
Bogle: Smart Beta is stupid

123
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Re: 24 care home care for family member

Post by 123 » Mon Sep 11, 2017 10:14 am

NotWhoYouThink wrote:
Mon Sep 11, 2017 9:49 am
...
Most people either
- have a family member move in with the elder
- have the elder move in with a family member
- move the elder, sometimes under protest and anger, to an assisted living facility, or possibly a board and care home.
...
+1 It is very difficult for an elderly person who needs assistance to continue to reside in their own long-term home. If you need to hire care providers that will soon become a full-time task for the family member who has to "manage" the situation. Care providers need time off, have doctor appointments, get sick, and sometimes just don't show up. The person who does the managing ends up stepping in. It's really much better to find a suitable assisted living facility. They have dealt with this issue before and they have the means to deal with issues that will arise that you haven't even thought of yet. I hate to be negative on 24 hour home care but in the majority of cases it's just not economically viable as a long-term solution.
The closest helping hand is at the end of your own arm.

frankmorris
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Re: 24 care home care for family member

Post by frankmorris » Mon Sep 11, 2017 11:03 am

Thanks everyone. This is all very helpful. Yes, it's very pricey and we're having consider the options. It's helpful to know that there aren't really any shortcuts. Another option we're considering is one of us moving in, but hiring hourly care to fill in when we can't be there.

delamer
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Re: 24 care home care for family member

Post by delamer » Mon Sep 11, 2017 11:08 am

Several general points:

It isn't realistic to think you'll find one person to care for your elder who need someone with them 24/7. People have lives to lead.

For agencies, hourly rates decline if you need more than a limited number of hours per day.

Most elders are going to be safer in an assisted living or care home than they will be their personal home with aides, particularly if they need round-the-clock attendance. There is more supervision of their care, and the facilities are set up to meet their physical needs. Plus they have more interaction with people their own age. And it is easier on family members, who have more time to simply enjoy their elders' company rather than spending all their time arranging care and dealing with house issues.

EDIT: i know there is no good way to tell an elder this, but it is a contradiction to insist that you want to be independent when you need to have someone living with you 24 hours per day in order to keep that "independence."

Billionaire
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Re: 24 care home care for family member

Post by Billionaire » Mon Sep 11, 2017 11:12 am

We went down this road with my mother last year. Regardless of the company or approach you take, I would make sure there is no cash in the house and whatever family heirlooms or other things of value are present get distributed to others. I'm saying that from personal experience with my mother and father-in-law. $20 to $25 per hour was/is the going rate in Northern NJ.

We finally forced an aide on my mother. There were painful, daily discussions with the company and/or the aide on my mothers behavior.
My mother went through a few aides. The first day with a new one resulted in my mother falling and fracturing her hip. She's been confined to a wheelchair in a nursing home ever since.

Wish I could be more positive on the topic.

Good luck.

sandramjet
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Re: 24 care home care for family member

Post by sandramjet » Mon Sep 11, 2017 11:41 am

Based on our family's experience ... Not cheap, but very doable if you are willing to put time & money into it. Our experience has been very positive, and we have not had any issues with theft, etc.
  • It does take someone in family willing to manage all the care givers (you will need to have more than one)
  • Caregivers need to be carefully vetted, even if from agency. In our experience, best ones have been non-agency
  • Consider various schedules to minimize cost & turnover. e.g. do you have 3 caregivers do 8 hrs/day each, or have them each do 2 days on 2days off, etc... (this depends on specific circumstances)
  • Need to have clear responsibilities for caregivers (e.g. we have separate housecleaner, so they don't do that. They do daily cleanup, etc. but primary responsibility is meal prep, nutrition, medication, and companionship
  • May want/need to remodel house to make it more accessible
Our mother spent about 3-6 months in assisted living facility while everything was put in place and house was remodeled (added bathroom/bedroom on first floor to avoid stairs, etc). She could not wait to get back home. And in the 6-7 years since then, she is much happier, healthier than before. And yes, it is expensive. Mom is lucky that she can afford the low 6-figure yearly cost

Pigeon
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Re: 24 care home care for family member

Post by Pigeon » Mon Sep 11, 2017 11:52 am

Having dealt with aging in-laws who very much wanted to stay in their home and now having a close friend doing the same with her mother, it's hard. You may see high turn-over even with larger, more established agencies. This is not generally a pleasant job, and the pay the individual worker gets is considerably less than what you are paying the agency. While some of the aides are problematic, frankly, some of the elderly people are pretty awful to the aides, too.

My MIL fought the idea of moving out of her house tooth and nail. She was in the early stages of dementia and it had become unsafe for her to stay. We were very, very lucky to have found an amazing memory care facility that was more expensive than some, but less expensive than 24/7 aides in the home. She blossomed there with the increased socialization and an endless stream of daily activities.

TN_Boy
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Re: 24 care home care for family member

Post by TN_Boy » Mon Sep 11, 2017 12:27 pm

frankmorris wrote:
Mon Sep 11, 2017 11:03 am
Thanks everyone. This is all very helpful. Yes, it's very pricey and we're having consider the options. It's helpful to know that there aren't really any shortcuts. Another option we're considering is one of us moving in, but hiring hourly care to fill in when we can't be there.

Many good points made. Is she having cognitive issues, or is it primarily physical issues?

curmudgeon
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Re: 24 care home care for family member

Post by curmudgeon » Mon Sep 11, 2017 12:32 pm

I've watched four people in our neighborhood go through this mode, though I was not involved closely with them. These were people who had a high sense of ties to the neighborhood (which is not ideal for aging in place in terms of walkability); they had typically built the house with their spouse 50 years earlier. They tended to start with someone coming in for a couple of hours each day, to prep a couple of meals and do other work. Over the course of a few years, they ended up with 24x7 caretakers. One, with a quite large house, had a couple who moved in and combined care with working in their business. I felt like most of these folks lived fairly isolated lives (other than the one with family across the street).

An alternative is moving to an "independent living" community, preferably one which has a range of living situation options. The baseline is typically an apartment with one or two meals a day available in a dining room, some transportation options, and emergency call capability. You could add hire some additional assistance for laundry or bathing. If more care were needed, then there would be an "assisted living" area which would have every meal and more regular assistance/checking, but still short of a nursing home. These types of places will offer a lot more community and interaction than remaining at home.

DetroitRick
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Re: 24 care home care for family member

Post by DetroitRick » Mon Sep 11, 2017 2:03 pm

I'll try to highlight our experience with this in the hope that it may be of some help to you. We've been using a home healthcare agency for my wife's mom since 2010 or 2011. We started out with very limited hours and now average around 22 hours per day, 7 days per week. Bottom line, the more you can learn about the agency and the specific caregivers the better. Which of course is not easy - you'll best be served by people with direct experience (both people who have used your agency and professionals who have referred to your agency). Of course, the situation and time constraints often prevent you from doing infinite up-front research. My wife relied first on a relative's referral (that relative worked in a local hospital that referred patients to this agency). Then she interviewed a number of agencies. Then we observed performance during limited hours (a few days per week, maybe 5-6 hours per day). By the time we needed full time assistance we had enough direct experience to be sure of our choice. We also just got lucky, frankly.

We are currently paying $21.50/hour rates in suburban Chicago (wife and I are in Michigan). 50% shift premium on holidays. Typically 3 workers, each for about 7 to 8 hours (so not live-in, which would be much different). Agency screens, pays and insures workers. I think the workers themselves get maybe $12/hour of that fee.

We've gotten mostly quality people, and a few mediocre. Two caregivers are very good, very compassionate, and at this point we have come to know them personally. They are angels. Problems are very possible, but we have had nothing beyond minor annoyances. Part of that is an agency with low turnover and the ability to hire good folks (not easy in this low-paying field). The agency we use has about 50 clients, so not huge. Care given has increased over time, but is generally what you describe - bathing, hygiene, light cleaning, cooking, shopping, errands. As my MIL is now bedridden, they also handle those tasks. Plus she has an elderly dog which they also help with. Because we are not located in the same state, we also rely on the workers for communicating needs and issues, both with us and with doctors and visiting nurses. This is a very important function - knowing who to call and when. We do check ourselves with quarterly visits and frequent phone calls. But I think there is a real advantage to being able to check in physically frequently to make sure the agency and workers are doing what they should.

We've used a long-term care facility as well, mainly for two stints (one last year and one a few years prior) and that is not my MIL's preference. Which we respect. In her specific case, this home care thing works out better, but is more expensive. IRS Publication 502 (medical expenses) will lay out the very narrow set of circumstances where personal care can be deducted as a medical expense. We happen to qualify (starting last year) and have gotten the necessary documentation to do so, but there are specific criteria that must be met first. It's worth a look if a chronic condition is involved and this care is basically being done under a physicians plan of treatment. That has helped us immensely with the cost.

This whole area is evolving and extremely local. Even where we live in Michigan, we are stunned by the quantity of adult living facilities (an alternative) that are being built or are operating. Those can be a mixed bag too. And pretty expensive. In Chicago, when our MIL was in such a facility for a while, we ended up still using our home care agency to visit the facility a few times per week to tend to things that weren't being tended to. I don't recall the cost of that facility, but it was cheaper than home care for our specific situation. Best of luck, I know this is not easy.

frankmorris
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Re: 24 care home care for family member

Post by frankmorris » Wed Sep 13, 2017 11:54 am

Very, very much appreciate everyone's stories and comments on this. As with many issues, it helps to know that we're a part of a larger group of people dealing with roughly similar issues.

To the question about cognitive vs physical issues, it's becoming both - moreso just becoming much slower and generally less able - nothing acute or particular. Most likely general care would work - medical not specifically required, although at some point that may come into play.

rxtra8
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Re: 24 care home care for family member

Post by rxtra8 » Wed Sep 13, 2017 1:05 pm

I have had a similar experience. My Mother had been living with my wife and myself for almost 4 years; she has been diagnosed with advanced dementia. We started running into problems with hygiene and physical ability and her personal physician recommend a home care giving agency. The cost is approximately $20+ per hour ( I live in Long Beach CA; HCOL area). The cost will quickly become more than the average assisted living facility. We were using 25 hours per week with me being the caregiver the rest of the time ( I had to take my Mother to the restroom, remove her cloths and change her diapers. She also fell a lot and I had to pick her up and move her in general which knocked out my back). Plus, even though the agency was well recommended and the caregivers bonded, I found much later that valuables had been taken by one of the caregivers. The situation soon became untenable; my Mother would not use a wheel chair or walker (did not want to look old), she had incontinence issues (did not want to use adult diapers initially) and eventually could not get up by herself. Plus she was a general pain and quite rude to my wife. Plus your relationship with your significant other can be greatly strained.

I evaluated assisted living but found them very expensive for a middle of the road facility. They may quote a low price to get you interested but, in my case, sent over a nurse to evaluate my Mother (I thought this was to see if she would quality; wrong as it was to see what extra care was needed = ka-ching, ka-ching and the estimate doubled; felt like I was buying a new car and dealing with the sales guy). I then looked at board and care places; evaluated 4 of them. One was horrible. The other three were acceptable with prices ranging from $3300-3800 per month; basically all inclusive. I choose one based on the fact that the owner and primary caregiver was there 24/7, would only use female caregivers, seemed to take great care and the home itself was very clean with no untoward smells.

The result, now after 6 months, was that my Mother is much happier, gained 1 pound (she is very petite) and in good health; her primary care physician was quite pleased on his evaluation of her. She eats better ( maybe not as healthy as at my house ) receiving fruit and vegetables with every meal and the caregiver will cook what pleases my Mother. She socializes with the caregivers, and all the people who come to the house either to see residents or the owner herself; at my house socializing was extremely limited and she generally made it unpleasant. When I visit, she is always in the living room, with her makeup on, earrings on, hair fixed and nails painted (her great pleasure).

My mother going to the board and care was better for my Mother and my wife and I.

Good luck. Hopefully your situation will be more pleasant.
“The eye sees only what the mind is prepared to comprehend.” | — Robertson Davies

Glomar
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Re: 24 care home care for family member

Post by Glomar » Thu Sep 14, 2017 7:21 am

We worked with live-in aide hired through an agency plus an additional person (privately, not through an agency) for several hours a week who bought groceries and supplies.

The live-in aide was there 24-7 and the cost was approx. $300/day (medium/ HCOL area). Less expensive than 2x 12-hour shifts staffed by two people, although of course the live-in aide is not expected to work 24 hours. Usually one wake-up or so at night is permitted. If it starts getting beyond that that is when a facility might start to make more sense. As others noted above, true 24-hour in home care (where someone is awake and working all the time) is most likely more expensive than a facility.

The live-in aide took care of meals, light housekeeping, bathing, medication reminders.

The private hire was paid about $20 per hour, for perhaps 10 hours total per week (maybe 2-3 days per week). This person also took care of the "heavy" housekeeping (all of the agencies we worked with over the years had the same "light housekeeping only" rule). These extras were initially done by a family member but as my relative's condition declined, there were just too many things to take care of so we outsourced.

Depending on the situation (if the client can be safely left alone for a few hours), the live-in aide may also be able to take care of grocery shopping. Live-in aides are usually very happy to get out of the house for a few hours. Housekeeping services and grocery delivery can also fill these gaps.

However, we found the additional private hire very valuable - another visitor for a homebound person is always welcome and drop ins are a good way to make sure the situation with the live-in aide is working out.

We found the private hire through word of mouth, but you could also scope out churches, senior centers or local assisted living places. We worked with several different folks over the years and found that hiring privately for the part-time extras worked out much better than hiring through an agency. There are some really caring, capable and responsible folks willing to do a few hours a week of this type of work, and often when you can find one they have friends. On the other hand we had no luck hiring a full-time/ live-in aide privately and so went through an agency on that.

The other gap can be medication management. All of the agencies we worked with did not allow aides, even CNAs, to handle medication. They can remind but they can't fill pill boxes etc. Some agencies can send a nurse once a month or so. This can be costly so if you can have a family member fill a weekly pill box that may be a good idea. Some pharmacies will even do this. Also recommend using a pharmacy that delivers.

Our aide was trustworthy but consider having your family member go "cashless" and get financial documents, checks, etc. out of the home. You could buy gift cards for purchases, or family can do the shopping/ order online.

Home care is not always better and definitely requires a lot of management by family, but at the same time no facility is going to have one-on-one care.

Best of luck to you and your family.

TN_Boy
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Re: 24 care home care for family member

Post by TN_Boy » Fri Sep 15, 2017 9:54 am

frankmorris wrote:
Wed Sep 13, 2017 11:54 am
Very, very much appreciate everyone's stories and comments on this. As with many issues, it helps to know that we're a part of a larger group of people dealing with roughly similar issues.

To the question about cognitive vs physical issues, it's becoming both - moreso just becoming much slower and generally less able - nothing acute or particular. Most likely general care would work - medical not specifically required, although at some point that may come into play.
The reason I asked about physical versus cognitive issues is that if the issues are (mostly) physical I think you have more options with assisted living, or (hopefully) "independent living" with extra help. In the latter case you have more housing options (nicer, larger places). As a couple of people have pointed out, one drawback of staying in the house is it may lead to increased social isolation. If your family member is still in pretty decent shape mentally, she can visit places with you -- if willing to consider moving -- and might like them.

Best of luck.

ResearchMed
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Re: 24 care home care for family member

Post by ResearchMed » Fri Sep 15, 2017 10:11 am

TN_Boy wrote:
Fri Sep 15, 2017 9:54 am
frankmorris wrote:
Wed Sep 13, 2017 11:54 am
Very, very much appreciate everyone's stories and comments on this. As with many issues, it helps to know that we're a part of a larger group of people dealing with roughly similar issues.

To the question about cognitive vs physical issues, it's becoming both - moreso just becoming much slower and generally less able - nothing acute or particular. Most likely general care would work - medical not specifically required, although at some point that may come into play.
The reason I asked about physical versus cognitive issues is that if the issues are (mostly) physical I think you have more options with assisted living, or (hopefully) "independent living" with extra help. In the latter case you have more housing options (nicer, larger places). As a couple of people have pointed out, one drawback of staying in the house is it may lead to increased social isolation. If your family member is still in pretty decent shape mentally, she can visit places with you -- if willing to consider moving -- and might like them.

Best of luck.
Many facilities will allow "trial stays" (aka "respite care").
When we were trying to get MIL to move closer to us, we kept telling her, "Try it; you don't need to stay". She kept refusing.
But we were prepared to fly her here to give it a try, and even more than once if necessary.
When a dear friend died after "falling and not getting up", MIL finally said, "I'm selling EVERYTHING and coming!" We tried to get her to do a trial stay.
People can be awfully stubborn!
But she's safe now.

And surprise! She has new friends, and is playing more bridge than she used to :happy

RM
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Chicken lady
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Re: 24 care home care for family member

Post by Chicken lady » Fri Sep 15, 2017 11:21 pm

Been there - a few thoughts. Home health entities may conduct a background check of the individuals who work for them but that is far from a guarantee that the individuals who they hire are honest and/or not abusive in your absence. Ask specifically what is their practice in checking their employee's criminal records and if there are behaviors that show up on a criminal check that they consider insignificant. Also, check if there is a statewide (or locality) database of persons who have been banned from working with dependent individuals due to abusive and/or neglectful staff behavior. Nursing homes, developmental centers, home health entities usually have a legal requirement to report when people are let go for these behaviors. BUT, not all people end up in these databases for a host of reasons. The health department is a good part to find out about this source of information.


You might consider hiring a geriatric care coordinator to help you sort through what you need and reliable sources of help. These folks are usually either Social Workers or RN's. This person has likely worked with many paid caregivers and could advise you of who is reputable and who is less so.

Ask around if there are local (non agency affiliated) people that friends and business acquaintances can recommend. Many people are facing or have faced the same challenges you are facing and are more than happy to share referrals to excellent caregivers. We found my mother's #1 caregiver from our vet's receptionist. You can have a background check run if you like and may save a few dollars though you or someone else will have to take over coordination duties. It was important to my mother that she see the same people day after day - this isn't always the case with agency staff - hiring local caregivers allowed us to do this.

Finally, each state has a respite program that supports caregiver support for people like yourself. You might want to check this site out: http://archrespite.org/respitelocator/r ... mation-map

So sorry you find yourself in this situation. Keeping your eyes open and carefully listening to your relative is especially important when the person needing care has dementia.

Best wishes,
Linda

dbr
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Re: 24 care home care for family member

Post by dbr » Sat Sep 16, 2017 9:02 am

My experience having hired home health care and having used a nursing home is that hiring the home health care did not end up being superior to the home though it was considerably more expensive and a huge job for me. The people we used were personal friends who were licensed for home health care. Trust and abuse were absolutely not issues. A huge factor is the difference for the individual being isolated in their home rather than in the company of other people. A second huge issue is that there is a dis-economy of scale. Hiring home care for 168 hours a week means full time employment for four people at 40 hours a week or three people with overtime. That is a huge disconnect in employment cost vs benefit. By the way, if you think you don't have to pay overtime for hourly employees, you have another think coming, unless the worker is a live-in worker.

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Jazztonight
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Re: 24 care home care for family member

Post by Jazztonight » Sat Sep 16, 2017 9:15 am

For the last few years of his life, my father had an in-home aide 24-7. He passed at 96, with Alzheimer's and blind from glaucoma.

My only advice, regardless of how much you wind up paying, is to work through a legitimate agency--don't hire the aides directly.

This eliminates you having to deal with withholding tax issues, SS payments, and health insurance. One of my dad's aides tripped and fell in his apartment and broke her arm. She did not have health insurance, and her agency took care of their employee without involving our family.

When he died, two of his long-time aides came to his funeral and cried--they really cared for him. We were fortunate. Good luck. It's a sad experience for all involved.
"What does not destroy me, makes me stronger." Nietzsche

frankmorris
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Re: 24 care home care for family member

Post by frankmorris » Sat Sep 16, 2017 9:42 am

Thanks everyone - thought I had posted a response before, but apparently it failed to go through.

So helpful to hear everyone's advice, and I think the most difficult part is involving the person needing care as the person gradually loses the ability to make informed decisions that will lead to safety, happiness, etc. Even if she ends up not being as happy or safe, if she's an adult and still has the capacity to make decisions, we struggle with letting her do so, made even more complicated by the fact that each month she seems a little less accurate in her decision-making. Where is that line between her be able to make decisions for herself vs not? Not sure there's a definite answer but certainly one that causes a bit of stress.

dbr
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Re: 24 care home care for family member

Post by dbr » Sat Sep 16, 2017 9:48 am

frankmorris wrote:
Sat Sep 16, 2017 9:42 am
Thanks everyone - thought I had posted a response before, but apparently it failed to go through.

So helpful to hear everyone's advice, and I think the most difficult part is involving the person needing care as the person gradually loses the ability to make informed decisions that will lead to safety, happiness, etc. Even if she ends up not being as happy or safe, if she's an adult and still has the capacity to make decisions, we struggle with letting her do so, made even more complicated by the fact that each month she seems a little less accurate in her decision-making. Where is that line between her be able to make decisions for herself vs not? Not sure there's a definite answer but certainly one that causes a bit of stress.
Part of the dilemma here is that home health care does not make decisions for people. You are going to have to do that. Presumably you are equipped with the necessary POA for health care and Durable POA for affairs. In some cases the necessary step is to become the person's custodian which gives you more power and a lot more responsibility for the person.

I should add that a relative of ours solved the home care issue by hiring a full time live-in aide. It wasn't cheap but the man was a blessing for reliability and personality. The family had to make up for days off. The person cared for refused to grant a POA so a relative had to go to court to get herself appointed custodian.

frankmorris
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Re: 24 care home care for family member

Post by frankmorris » Sun Sep 17, 2017 2:30 pm

dbr wrote:
Sat Sep 16, 2017 9:48 am
frankmorris wrote:
Sat Sep 16, 2017 9:42 am
Thanks everyone - thought I had posted a response before, but apparently it failed to go through.

So helpful to hear everyone's advice, and I think the most difficult part is involving the person needing care as the person gradually loses the ability to make informed decisions that will lead to safety, happiness, etc. Even if she ends up not being as happy or safe, if she's an adult and still has the capacity to make decisions, we struggle with letting her do so, made even more complicated by the fact that each month she seems a little less accurate in her decision-making. Where is that line between her be able to make decisions for herself vs not? Not sure there's a definite answer but certainly one that causes a bit of stress.
Part of the dilemma here is that home health care does not make decisions for people. You are going to have to do that. Presumably you are equipped with the necessary POA for health care and Durable POA for affairs. In some cases the necessary step is to become the person's custodian which gives you more power and a lot more responsibility for the person.

I should add that a relative of ours solved the home care issue by hiring a full time live-in aide. It wasn't cheap but the man was a blessing for reliability and personality. The family had to make up for days off. The person cared for refused to grant a POA so a relative had to go to court to get herself appointed custodian.
Yes - we've got things in place. The main issue is less with the legal dimension, and more with the element of preserving her decision-making as long as we can. Sadly, we're also all pretty far away, so wouldn't be able to do routine check-ins or cover days off.

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