THE CAREGIVERS' LIVING ROOM A Blog by Donna Thomson: A Fight Between PSWs, Clients and Agency Service Providers Spells Trouble For All
an article by always erudite Howard Gleckman He wrote in Forbes:
Should the aides who provide home care for frail elders and younger people with disabilities receive a living wage and decent benefits? If they do, how can families, who often are unable to afford care today, be expected to pay those higher wages and benefits? Should the market be allowed to set these prices, or should government intervene through minimum wage and mandatory overtime laws? …. These questions have set off an enormous, but largely unnoticed, political firestorm. In some states, they have pit states against the federal government, people receiving care against their aides, and large home care agencies against independent direct care workers.
In Ontario, exactly the same questions are being asked. This time last year, the then Ontario Liberal Health Minister Deb Matthews and Finance Minister Charles Sousa announced an election promise of an increase in the minimum wage for 34,000 publicly paid Personal Support Workers to $16.50 an hour by April 1, 2016, up 32 per cent from the current rate of $12.50. Implementation of that promise hasn’t been easy. According to the Canadian Union of PublicEmployees (CUPE), some home and community care agencies have chosen not to implement the wage increase or they exclude sick leave, vacation and training hours in the new hourly wages. The sum total effect, says a CUPE spokesperson, is that most Ontario PSWs have yet to receive a wage increase.
The real lives of personal care workers are documented in a new film titled CARE, due for release later this year. The trailer is riveting and I recommend watching it HERE for a clear picture of the human side of our crisis in home and community care.
The care workers depicted in the film are all women. They are mothers and daughters who have left their own families behind in more impoverished countries in order to care for more affluent strangers in the United States.
Many care workers in Canada, the UK, Australia and New Zealand match this description. Eva Kittay drills down into the issues surrounding immigrant care workers and the role they play in a larger, profit driven dynamic.
The migration of care workers is caused both by a pull, the need for care workers, and a push, the need of these women to provide for their families.
Eva Feder Kittay‘From the Ethics of Care to Global Justice
The truth is that people need care and care workers must be able to earn a living wage.
New LinkedIn Group
Canadian Caregivers United is a new group on LinkedIn.
Palliative Care for Caregivers | Get Palliative Care
Palliative Care for Caregivers | Get Palliative Care
Today, family caregivers provide about 80 percent of elder care, delivering meals, taking loved ones to doctor’s visits and managing medications and family conflicts. This results in lost work hours or lost jobs, high stress and serious declines in physical and mental health. Palliative care is a solution.
 |
Mayo Clinic
Top 10 Things Palliative Care Clinicians Wished Everyone Knew About Palliative CareAugust, 2013 By Jacob J. Strand, MD, Mihir M. Kamdar, MD , Elise C. Carey, MD |
Today, family caregivers provide about 80 percent of elder care, delivering meals, taking loved ones to doctor’s visits and managing medications and family conflicts. This results in lost work hours or lost jobs, high stress and serious declines in physical and mental health. Palliative care is a solution.
Get Palliative Care
Get Palliative Care
What Is Palliative Care
Learn more about adult and pediatric palliative care, refer to the glossary and get answers to some frequently asked questions.
How to Get Palliative Care
Talk to your doctor, find a hospital and meet with your palliative care team. Just two simple steps to get palliative care.
Is Palliative Care Right for You
Take a quiz to determine if palliative care is right for you or a loved one.
What Is Palliative Care
Learn more about adult and pediatric palliative care, refer to the glossary and get answers to some frequently asked questions.
How to Get Palliative Care
Talk to your doctor, find a hospital and meet with your palliative care team. Just two simple steps to get palliative care.
Is Palliative Care Right for You
Take a quiz to determine if palliative care is right for you or a loved one.
Home Health Aide Certification and Certificate Programs
Home Health Aide Certification and Certificate Programs
Each state has its own requirements for home health aide certification. Some states only require that the employing agency be certified, while others require home health aides to pass a certification exam following completion of an educational program. Besides a skills assessment examination, certification may also require a state administered criminal background check. Some states maintain a registry database of certified home health aides that can be accessed by the public
===============
Each state has its own requirements for home health aide certification. Some states only require that the employing agency be certified, while others require home health aides to pass a certification exam following completion of an educational program. Besides a skills assessment examination, certification may also require a state administered criminal background check. Some states maintain a registry database of certified home health aides that can be accessed by the public
===============
Home Health Aide Training Requirements in MA
Massachusetts does not require a State issued certification, nor is there a State exam required to be eligible to work as a Home Health Aide. Instead the State recommends national certification through the National Association for Home Care and Hospice. The NAHC requires a 75 hour training course and a competency test before you are eligible to apply for their certification.
Caregiving Criticism and Unsolicited Advice From Family - AARP
AARP Home » Home & Family » Caregiving »How to Handle Criticis...
How to Handle Criticism While Caregiving
Well-meaning advisers try to help but some can cause hurt
by Barry J. Jacobs, PsyD., AARP, December 29, 2014
just react to the message being given but to consider the background and
intentions of the messenger. Advisers often have a sincere desire to
help, because they truly are caring and invested. They just don't have
enough information and understanding to know how to actually be helpful.
They are also unaware that their good ideas may come across as
critical. If you express appreciation for their caring, they will
usually feel satisfied that they are making a difference and stop
pressing specific recommendations.
Some people, though, use pieces of advice as thinly veiled barbs. Out
of competitiveness or their own misery, they consciously or
unconsciously mean to take caregivers down a peg. They should be kept at
arm's length. It is seldom worth debating them or giving them the
satisfaction of having caused hurt.
Caregiving Criticism and Unsolicited Advice From Family - AARP
How to Handle Criticism While Caregiving
Well-meaning advisers try to help but some can cause hurt
by Barry J. Jacobs, PsyD., AARP, December 29, 2014
Take it from whence it comes
Caregivers would be well-advised (there's that word again) to notjust react to the message being given but to consider the background and
intentions of the messenger. Advisers often have a sincere desire to
help, because they truly are caring and invested. They just don't have
enough information and understanding to know how to actually be helpful.
They are also unaware that their good ideas may come across as
critical. If you express appreciation for their caring, they will
usually feel satisfied that they are making a difference and stop
pressing specific recommendations.
Some people, though, use pieces of advice as thinly veiled barbs. Out
of competitiveness or their own misery, they consciously or
unconsciously mean to take caregivers down a peg. They should be kept at
arm's length. It is seldom worth debating them or giving them the
satisfaction of having caused hurt.
Caregiving Criticism and Unsolicited Advice From Family - AARP
staff scheduling and labor management
OnShift provides staff scheduling and labor management software
They are focused entirely on the long-term care and senior living industry, software and services are built upon an in-depth understanding of how providers work day-in and day-out, and how industry regulations and issues affect their every move.
{ staff scheduling and labor management is of interest to the world of Caregiving}
Jan 26, 2015 Mark Woodka posted the following to their Long Term Care & Senior Living Blog
For some strange reason we encourage ourselves to prognosticate about the future annually as one year recedes and another begins. These projections might not always be correct, but I think they nicely balance out our attempts at New Year’s resolutions and give us something to aim for. (I hope this list goes more smoothly than those resolutions usually do…)
I’d like to outline my predictions for long-term care and senior living in 2015 – the big things that may change how you run your communities and provide care for your residents. So without further ado, here we go:
Affordable Care Act Penalties: The Employer Mandate began January 1 after two years of delays, and we must now be very, very cautious in managing our workforces to ensure we do not get penalized. There was a bill proposed to exclude certain industries from having to participate due to large populations of lower-wage hourly workers and low margins. Guess what? One of the original intents of the ACA was to get these very workers healthcare benefits. Therefore, this bill is a non-starter, and we will not see our industry excluded. The Affordable Care Act will remain the law of the land until and unless we have a new party in the White House in 2016, so tracking employee hours will be key.
More Doc Fix Activity: The game of kick-the-can that has been the Doc Fix for the past decade will continue. However, in an effort to kick the can as far as possible, Adam Vinatieri will be the kicker, and he will kick it 21 months into the future. This will nicely coincide with the new administration taking office in January of 2017. (I don’t think Congress will want to deal with this again in 12 months.) Ideally, our friends at AHCA will be able to focus the pay-fors to other segments or maybe even help them find a permanent solution if in fact there is an appetite for one.
- See more at: http://www.onshift.com/blog/5-game-changing-predictions-senior-care-2015#sthash.36ZATwXG.dpuf
==
You may want to Visit >>
Next Generation Educators blog
They are focused entirely on the long-term care and senior living industry, software and services are built upon an in-depth understanding of how providers work day-in and day-out, and how industry regulations and issues affect their every move.
{ staff scheduling and labor management is of interest to the world of Caregiving}
Jan 26, 2015 Mark Woodka posted the following to their Long Term Care & Senior Living Blog
For some strange reason we encourage ourselves to prognosticate about the future annually as one year recedes and another begins. These projections might not always be correct, but I think they nicely balance out our attempts at New Year’s resolutions and give us something to aim for. (I hope this list goes more smoothly than those resolutions usually do…)
I’d like to outline my predictions for long-term care and senior living in 2015 – the big things that may change how you run your communities and provide care for your residents. So without further ado, here we go:
Affordable Care Act Penalties: The Employer Mandate began January 1 after two years of delays, and we must now be very, very cautious in managing our workforces to ensure we do not get penalized. There was a bill proposed to exclude certain industries from having to participate due to large populations of lower-wage hourly workers and low margins. Guess what? One of the original intents of the ACA was to get these very workers healthcare benefits. Therefore, this bill is a non-starter, and we will not see our industry excluded. The Affordable Care Act will remain the law of the land until and unless we have a new party in the White House in 2016, so tracking employee hours will be key.
More Doc Fix Activity: The game of kick-the-can that has been the Doc Fix for the past decade will continue. However, in an effort to kick the can as far as possible, Adam Vinatieri will be the kicker, and he will kick it 21 months into the future. This will nicely coincide with the new administration taking office in January of 2017. (I don’t think Congress will want to deal with this again in 12 months.) Ideally, our friends at AHCA will be able to focus the pay-fors to other segments or maybe even help them find a permanent solution if in fact there is an appetite for one.
- See more at: http://www.onshift.com/blog/5-game-changing-predictions-senior-care-2015#sthash.36ZATwXG.dpuf
==
You may want to Visit >>
Next Generation Educators blog
Dealing with a “Code Brown”
Dealing with a “Code Brown” | Scrubs – The Leading Lifestyle Nursing Magazine Featuring Inspirational and Informational Nursing Articles
by Ani Burr, RN • October 22, 2010
When you are doing your best to get your client cleaned up, there is still that smell issue that can get in the way of your ability to focus and get in and out of there quickly! While it’s not guaranteed, you can try these tricks to protector your olfactory senses:
by Ani Burr, RN • October 22, 2010
When you are doing your best to get your client cleaned up, there is still that smell issue that can get in the way of your ability to focus and get in and out of there quickly! While it’s not guaranteed, you can try these tricks to protector your olfactory senses:
Caregiving MetroWest a program of BayPath Elder Services, Inc
Caregiving MetroWest –is a program of BayPath Elder Services, Inc. for MetroWest caregivers.
The site offers Information on all aspects of caregiving; "Caregiving is a complex and demanding undertaking. There are many elements involved in the caregiving role, and we’ve assembled some helpful information on a variety of areas of importance to caregivers.
BayPath Elder Services, Inc
BayPath Elder Services, Inc. administers programs offering home care and related services enabling people to live independently and comfortably in their homes while promoting their well-being and dignity.
Many BayPath services are free, others are based on one's ability to pay, and some are offered on a fee-for-service basis.
“This non-profitcorporation is organized to plan, develop and implement the coordination and delivery of services and supportive programs for persons sixty years of age and over unless otherwise restricted by conditions of grants or contracts, in the City of Marlborough, and the townships of Ashland, Holliston, Hopkinton, Dover, Sherborn, Natick, Framingham, Wayland, Sudbury, Hudson, Northborough , Southboro ugh and Westboro ugh , Massachusetts. The corporation shall endeavor to assist older persons to obtain services including but not limited to information and referral, homemaker and chore assistance, housing services, health maintenance and rehabilitation, nutritional services, legal and advocacy assistance, transportation, emergency assistance, and whatever medical or supportive services may be needed to prolong the life and well - being of older persons in the community and to prevent premature institutionalization."
The site offers Information on all aspects of caregiving; "Caregiving is a complex and demanding undertaking. There are many elements involved in the caregiving role, and we’ve assembled some helpful information on a variety of areas of importance to caregivers.
BayPath Elder Services, Inc
BayPath Elder Services, Inc. administers programs offering home care and related services enabling people to live independently and comfortably in their homes while promoting their well-being and dignity.
Many BayPath services are free, others are based on one's ability to pay, and some are offered on a fee-for-service basis.
“This non-profitcorporation is organized to plan, develop and implement the coordination and delivery of services and supportive programs for persons sixty years of age and over unless otherwise restricted by conditions of grants or contracts, in the City of Marlborough, and the townships of Ashland, Holliston, Hopkinton, Dover, Sherborn, Natick, Framingham, Wayland, Sudbury, Hudson, Northborough , Southboro ugh and Westboro ugh , Massachusetts. The corporation shall endeavor to assist older persons to obtain services including but not limited to information and referral, homemaker and chore assistance, housing services, health maintenance and rehabilitation, nutritional services, legal and advocacy assistance, transportation, emergency assistance, and whatever medical or supportive services may be needed to prolong the life and well - being of older persons in the community and to prevent premature institutionalization."
Talking with a person with Alzheimer's guidelines: five basic ones
Marie Marley is the award-winning author of Come Back Early Today: A Memoir of Love, Alzheimer's and Joy. Her website contains a wealth of information for Alzheimer's caregivers.
www.ComeBackEarlyToday.com
When relating to a person with Alzheimer's there are many guidelines to follow.
five basic ones:
1) Don't tell them they are wrong about something,
2) Don't argue with them,
3) Don't ask if they remember something,
4) Don't remind them that their spouse, parent or other loved one is dead
5) Don't bring up topics that may upset them.
Marie Marley author of Come Back Early Today
Dementia and Cognitive Impairment Diagnosis and Treatment Guideline
Dementia and Cognitive Impairment Diagnosis and ...
www.ghc.org/all-sites/guidelines/dementia.pdf
Dementia and Cognitive Impairment Diagnosis and Treatment Guideline. 1 ..... Guidelines are systematically developed statements to assist patients and providers in .... new and challenging mental activities, such as a language or musical instrument. .... Many different tools are available for assessing cognitive function.
Group Health Cooperative
About Group Health
Group
Health Cooperative is a member-governed, nonprofit health care system
that coordinates care and coverage. Founded in 1947 and based in
Seattle, Wash., Group Health and its subsidiary health carriers, Group
Health Options, Inc. and KPS Health Plans, serve more than 600,000
residents of Washington and North Idaho.
"Care Transitions for the Home Care Industry." Ankota software
Chronic Care Management Services:
Here's the deal... Physicians are starting to be incentivized (and penalized) for their performance with respect to their chronic patients, but there's a reimbursement associated with it. The reimbursement is for patients with two or more chronic conditions in a practice with a certified EMR (Electronic Medical Record) system. The reimbursement has two levels. The first level, reimbursed at $42/month, requires a 20 minute check-in (e.g., on the phone) with the patient. The second, reimbursed at almost $100, requires telehealth.
Home care agencies can put a program in place where your best aides are paid $10 for a 20 minute check-in call. If you charge $32 for this service (leaving a $10 margin for the referring practice) and allocate some of the revenue to your staff nurses and for software, you can provide a great service and make a reasonable margin. Care Transitions Services: You can provide services to help transition patients from hospital to home. Most hospitals are now being penalized for excessive readmissions These hospitals can use your help and there are many benefits to your agency. We have a new white paper to teach you about the numerous benefits that your home care agency can achieve.
At Ankota, we love providing home care software, telephony, care plans, scheduling, billing, payroll and all the other basics, but we really love that we can enable your agency to play a broader role in the future oh health care. We can make a difference together. Please download our newest free white paper "Why Care Transitions is the Next Big Thing for the Home Care Industry."
About Ankota Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination.
Here's the deal... Physicians are starting to be incentivized (and penalized) for their performance with respect to their chronic patients, but there's a reimbursement associated with it. The reimbursement is for patients with two or more chronic conditions in a practice with a certified EMR (Electronic Medical Record) system. The reimbursement has two levels. The first level, reimbursed at $42/month, requires a 20 minute check-in (e.g., on the phone) with the patient. The second, reimbursed at almost $100, requires telehealth.
Home care agencies can put a program in place where your best aides are paid $10 for a 20 minute check-in call. If you charge $32 for this service (leaving a $10 margin for the referring practice) and allocate some of the revenue to your staff nurses and for software, you can provide a great service and make a reasonable margin. Care Transitions Services: You can provide services to help transition patients from hospital to home. Most hospitals are now being penalized for excessive readmissions These hospitals can use your help and there are many benefits to your agency. We have a new white paper to teach you about the numerous benefits that your home care agency can achieve.
At Ankota, we love providing home care software, telephony, care plans, scheduling, billing, payroll and all the other basics, but we really love that we can enable your agency to play a broader role in the future oh health care. We can make a difference together. Please download our newest free white paper "Why Care Transitions is the Next Big Thing for the Home Care Industry."
About Ankota Ankota provides software to improve the delivery of care outside the hospital, focusing on efficiency and care coordination.
Hiring Home Care Workers: Why Work through an Agency? By Rona S. Bartelstone,
Hiring Private Duty Home Care Workers: Why Work through an Agency
Quoted:
One of the greatest long-term needs of older adults and those with
chronic illnesses is for in-home, custodial care services. These
workers are often referred to as home health aides, certified nursing
assistants and custodial care workers. These in-home workers make it
possible for people with functional limitations to remain at home in a
comfortable, familiar environment. Home health aides (as we will refer
to this class of workers) provide a wide range of assistance with
activities of daily living (ADLs), such as bathing, dressing, grooming,
assisting with ambulation or transferring, toileting, feeding and
providing medication reminders. In addition, home health aides help
with what professionals call, instrumental activities of daily living
(IADLs), such as shopping, meal preparation, making medical
appointments, transportation, laundry and companionship.
While it is true that most people would prefer to remain in their
own homes, there are circumstances in which care in a residential or
nursing facility is more appropriate and more cost-effective. For
example, the individual who needs round the clock care because of
treatments or behavioral issues will find a nursing facility or
residential setting likely to be more affordable.
The biggest proportion of people who utilize home health aide services are those
who need several hours per day of assistance, as opposed to those who need full-time care.
Due to the cost and the increasing shortage of home health
aides, many families seeking to hire in-home staff turn to private
individuals rather than working through an agency. While at first
glance this seems reasonable, it can also cause numerous problems and create unexpected liabilities for the family, who becomes the employer.
Quoted:
One of the greatest long-term needs of older adults and those with
chronic illnesses is for in-home, custodial care services. These
workers are often referred to as home health aides, certified nursing
assistants and custodial care workers. These in-home workers make it
possible for people with functional limitations to remain at home in a
comfortable, familiar environment. Home health aides (as we will refer
to this class of workers) provide a wide range of assistance with
activities of daily living (ADLs), such as bathing, dressing, grooming,
assisting with ambulation or transferring, toileting, feeding and
providing medication reminders. In addition, home health aides help
with what professionals call, instrumental activities of daily living
(IADLs), such as shopping, meal preparation, making medical
appointments, transportation, laundry and companionship.
While it is true that most people would prefer to remain in their
own homes, there are circumstances in which care in a residential or
nursing facility is more appropriate and more cost-effective. For
example, the individual who needs round the clock care because of
treatments or behavioral issues will find a nursing facility or
residential setting likely to be more affordable.
The biggest proportion of people who utilize home health aide services are those
who need several hours per day of assistance, as opposed to those who need full-time care.
Due to the cost and the increasing shortage of home health
aides, many families seeking to hire in-home staff turn to private
individuals rather than working through an agency. While at first
glance this seems reasonable, it can also cause numerous problems and create unexpected liabilities for the family, who becomes the employer.
Great Big List of Caregiver Blogs | Caregiver's Corner July 14, 2010
Great Big List of Caregiver Blogs
One of the best ways for a caregiver to find answers, reassurance,
and understanding is to connect with other caregivers. To help with
that, here is a list of blogs run by caregivers. If you know of any
blogs that should be added to this list, let us know!
One of the best ways for a caregiver to find answers, reassurance,
and understanding is to connect with other caregivers. To help with
that, here is a list of blogs run by caregivers. If you know of any
blogs that should be added to this list, let us know!
Top 10 Codes You Aren’t Meant To Know - Listverse
Top 10 Codes You Aren’t Meant To Know - Listverse
Stores, hospitals, entertainment venues, and other places where the public are together in large numbers, use secret codes to pass information between store employees. These are meant to be a secret as they don’t want to alarm the non-staff members or alert someone (like a thief) to the fact that they have been noticed. Many stores have their own codes – for example WalMart, but there are a number that are nearly universal in application. This is a list of ten secret codes that may prove useful to you in future, or at least dispel any curiosity you may have if you hear them.
Stores, hospitals, entertainment venues, and other places where the public are together in large numbers, use secret codes to pass information between store employees. These are meant to be a secret as they don’t want to alarm the non-staff members or alert someone (like a thief) to the fact that they have been noticed. Many stores have their own codes – for example WalMart, but there are a number that are nearly universal in application. This is a list of ten secret codes that may prove useful to you in future, or at least dispel any curiosity you may have if you hear them.
Strategies to Protect Your Money from Medicaid - AgingCare.com
AgingCare.com is not simply a website, but a community of caregivers facing the challenge of caring for an elderly loved one.
They provide a comfortable meeting place for the free exchange of ideas with knowledgeable professionals, responsive experts, and people just like you. They provide an excellent knowledge network, use it.
The following is extracted from AgingCare.com
{quote}
Too few older adults know and understand their rights and options regarding health care, particularly long-term care, which, to quote the New York Court of Appeals, is "ruinously expensive."
A Caregiver Agreement is an excellent strategy in many cases where extra services are needed or desired that would not be covered by Medicaid, and are outside the scope of what a nursing facility or home care attendants would provide.
The caregiver can be a son, a daughter or other family member, a friend, a geriatric care manager or a home care agency. The services can be paid for in advance, and the payment will then reduce countable resources, helping the person in need of care gain Medicaid eligibility. A family member can render these services, providing income for that person (who may have given up a job or taken time off from work), and reducing conflict with other family members who are unable or unwilling to help out.
If the caregiver is to be paid in advance, the keys to creating an agreement that will be accepted by Medicaid are:
The contract must specifically define the services provided and hours to be worked by the caregiver.
The lump sum payment must be calculated using a reasonable life expectancy and legitimate market rates for the services.
A daily log of actual services rendered and hours worked must be maintained, along with written invoices.
Upon the death of the patient, any unearned amounts must be paid to Medicaid, up to the amount that Medicaid paid on behalf of the patient.
Spousal Transfers and Spousal Refusal
An important feature of the Medicaid laws is that transfers between spouses are permitted, are not subject to the "look back," and thus do not result in any penalty. In the case of a married couple, one of the basic strategies is to transfer any assets that are in the name of the spouse who needs care to the name of the well spouse (also called the "community spouse" where the spouse who needs care is in a nursing home).
New York and some other states permit something called "spousal refusal." In these scenarios, the well (or community) spouse will refuse to provide support for the spouse who needs care.As a result, the spouse who needs care will be immediately eligible for Medicaid, and will receive services.
Once Medicaid provides services, it has the right to seek contribution from the well spouse. In some cases, however, Medicaid does not pursue its rights, and in other cases it is willing to settle at a discount. At a minimum, the well spouse will receive a significant benefit because any reimbursement to Medicaid will be at Medicaid's discounted rates, rather than at the private pay rates that the providers would have charged.
Unfortunately, the majority of states are "spousal share" states that do not permit spousal refusal. In these states, the resources of both spouses are counted towards the Medicaid eligibility amount, and the above strategy is therefore ineffective.
Elder Law attorneys are able to work within the Medicaid laws to produce favorable outcomes for their clients. Bear in mind that every case has its unique facts, and these strategies might or might not be the top five for you, given your circumstances. In any case, it's hardly ever too late to develop an effective strategy to obtain benefits, and protect at least some of your assets or income at the same time.
David Cutner is a former family caregiver and co-founder of Lamson & Cutner, a boutique elder law firm in Manhattan, known for its successful strategic planning and insights into the issues of today's elder law maze.
{End of Quoting}
I have no connection with David Cutner the following contact information is my thanks to him.
They provide a comfortable meeting place for the free exchange of ideas with knowledgeable professionals, responsive experts, and people just like you. They provide an excellent knowledge network, use it.
The following is extracted from AgingCare.com
{quote}
Too few older adults know and understand their rights and options regarding health care, particularly long-term care, which, to quote the New York Court of Appeals, is "ruinously expensive."
A Caregiver Agreement is an excellent strategy in many cases where extra services are needed or desired that would not be covered by Medicaid, and are outside the scope of what a nursing facility or home care attendants would provide.
The caregiver can be a son, a daughter or other family member, a friend, a geriatric care manager or a home care agency. The services can be paid for in advance, and the payment will then reduce countable resources, helping the person in need of care gain Medicaid eligibility. A family member can render these services, providing income for that person (who may have given up a job or taken time off from work), and reducing conflict with other family members who are unable or unwilling to help out.
If the caregiver is to be paid in advance, the keys to creating an agreement that will be accepted by Medicaid are:
The contract must specifically define the services provided and hours to be worked by the caregiver.
The lump sum payment must be calculated using a reasonable life expectancy and legitimate market rates for the services.
A daily log of actual services rendered and hours worked must be maintained, along with written invoices.
Upon the death of the patient, any unearned amounts must be paid to Medicaid, up to the amount that Medicaid paid on behalf of the patient.
Spousal Transfers and Spousal Refusal
An important feature of the Medicaid laws is that transfers between spouses are permitted, are not subject to the "look back," and thus do not result in any penalty. In the case of a married couple, one of the basic strategies is to transfer any assets that are in the name of the spouse who needs care to the name of the well spouse (also called the "community spouse" where the spouse who needs care is in a nursing home).
New York and some other states permit something called "spousal refusal." In these scenarios, the well (or community) spouse will refuse to provide support for the spouse who needs care.As a result, the spouse who needs care will be immediately eligible for Medicaid, and will receive services.
Once Medicaid provides services, it has the right to seek contribution from the well spouse. In some cases, however, Medicaid does not pursue its rights, and in other cases it is willing to settle at a discount. At a minimum, the well spouse will receive a significant benefit because any reimbursement to Medicaid will be at Medicaid's discounted rates, rather than at the private pay rates that the providers would have charged.
Unfortunately, the majority of states are "spousal share" states that do not permit spousal refusal. In these states, the resources of both spouses are counted towards the Medicaid eligibility amount, and the above strategy is therefore ineffective.
Elder Law attorneys are able to work within the Medicaid laws to produce favorable outcomes for their clients. Bear in mind that every case has its unique facts, and these strategies might or might not be the top five for you, given your circumstances. In any case, it's hardly ever too late to develop an effective strategy to obtain benefits, and protect at least some of your assets or income at the same time.
David Cutner is a former family caregiver and co-founder of Lamson & Cutner, a boutique elder law firm in Manhattan, known for its successful strategic planning and insights into the issues of today's elder law maze.
{End of Quoting}
I have no connection with David Cutner the following contact information is my thanks to him.
| Lamson & Cutner, P.C. | ||||||||||||||||||||
| 9 East 40th Street | ||||||||||||||||||||
| New York, New York 10016 | ||||||||||||||||||||
| ||||||||||||||||||||
800AgeInfo - Information on Programs - Caregiver Support Page
800AgeInfo - Information on Programs - Caregiver Support Page
Caregiver Support
administered through a partnership with local Area Agencies on Aging
(AAAs) and Aging Service Access Points (ASAPs). MFCSP provides family
caregivers guidance, support, and attention that often is unavailable or
overlooked. Caregivers receive individual attention to:
even isolating; yet it can be meaningful and rewarding as well. It is
critical that caregivers are aware of available services. Through the
MFCSP compassionate and knowledgeable professionals work directly with
caregivers offering a range of services that may include:
Caregiver Support
(caring for an individual)
The Massachusetts Family Caregiver Support Program (MFCSP) isadministered through a partnership with local Area Agencies on Aging
(AAAs) and Aging Service Access Points (ASAPs). MFCSP provides family
caregivers guidance, support, and attention that often is unavailable or
overlooked. Caregivers receive individual attention to:
- discuss their caregiving situation
- increase knowledge of and access to resources
- make informed decisions and solve problems related to their caregiver role
- increase their own personal well-being including reduced stress
Family caregivers are individuals who:
- Care for a spouse, parent, other relative or friend who is age 60 or older, or who has Alzheimer’s disease.
- Are grandparents age 55 or older who are caring for grandchildren who are 18 years of age or younger, or who are disabled.
- Are over the age of 55 and caring for a disabled individual who is not their child.
even isolating; yet it can be meaningful and rewarding as well. It is
critical that caregivers are aware of available services. Through the
MFCSP compassionate and knowledgeable professionals work directly with
caregivers offering a range of services that may include:
- One-on-one Counseling
- Family Meeting
- In-home Assessment
- In-home Services
- Respite (a break for caregivers)
- Nutrition Services
- Transportation Services
- Caregiver Training
- Support Groups
- Supplemental Services (such as assistive devices, emergency response system)
- Financial Counseling
- Legal Referral
Comfort Care DNR protocol
When a patient is in a non-hospital setting, Emergency Medical
Technicians (EMTs) are required to provide emergency medical care and to
transport patients to appropriate health care facilities. Emergency
Medical Services (EMS) personnel are required by law to provide
treatment to the fullest extent possible, subject to their level of
training.
Comfort Care DNR Order Verification Protocol (Comfort and Care DNR)
- The Comfort Care DNR is designed to allow EMTs and first responders to honor a DNR order in an out-of-hospital setting.
- Before 1999, when Massachusetts implemented its Comfort Care DNR protocol, there was no mechanism to enable EMT’s and other first responders to recognize DNR orders in a non-hospital setting. So EMT personnel were always obligated to perform full resuscitation measures when they encountered a patient unable to convey directions regarding medical treatment.
- The Comfort Care DNR protocol provides for a statewide, uniform DNR verification protocol.
- The purpose of the Comfort Care DNR is to: (a) provide a verification of DNR orders to enable EMTs and first responders to honor DNR orders, (b) clarify the role and responsibilities of EMTs and first responders at the scene and/or during transport of patients who have a valid current DNR order, (c) avoid resuscitation of patients who have a current and valid DNR, (d) provide for palliative/comfort care measures for patients with a current Comfort Care DNR order verification form.
- Comfort Care DNR order verification forms must be completed and signed by the patient’s physician, authorized Physician’s Assistant or Nurse Practitioner.
- The patient must post the Comfort Care DNR where any EMT or first responder can easily find it. (Usually the patient’s refrigerator, or taped to the patients bedroom door. The Department of Public Health stopped issuing Comfort Care DNR bracelets in 2007, but the Department’s approved form contains bracelet inserts that can be used in generic wrist bracelets.
- The Comfort Care DNR Order Verification form can be accessed by anyone, in downloadable format from the Massachusetts Department of Public Health/Office of Emergency Medical Services website, at: http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/oems/comfort-care/public-health-oems-comfort-care-verification.html. But the form must be fully completed and signed by the attending physician, authorized nurse practitioner or authorized physician assistant as proscribed by the regulations.
Comfort Care Order (CCO-DNR) program Plus MOLST
EMS Comfort Care Order Do Not Resuscitate Program | doh
The
Emergency Medical Services (EMS) Comfort Care Order-Do Not Resuscitate
(CCO-DNR) program allows patients diagnosed with a specific medical or
terminal condition to express their wishes regarding end of life
resuscitation in the pre or post-hospital setting.
The program requires that a patient’s attending physician certify and sign a Comfort Care Order
(CCO) that states the patient (adult or child) has a specific medical
or terminal condition. The patient, or his or her authorized decision
maker or surrogate, must also consent and sign the CCO (verbal orders
are not valid). The physician then places a Comfort Care bracelet on the
patien
Emergency Medical Services (EMS) Comfort Care Order-Do Not Resuscitate
(CCO-DNR) program allows patients diagnosed with a specific medical or
terminal condition to express their wishes regarding end of life
resuscitation in the pre or post-hospital setting.
The program requires that a patient’s attending physician certify and sign a Comfort Care Order
(CCO) that states the patient (adult or child) has a specific medical
or terminal condition. The patient, or his or her authorized decision
maker or surrogate, must also consent and sign the CCO (verbal orders
are not valid). The physician then places a Comfort Care bracelet on the
patien
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