What is a Care Agreement or Contract and Who Needs One?

Hundreds of people maybe even thousands today are caring for a senior in their home or even taking them into their own home to care for them. Most of the time this is a family member. When faced with caring for a loved one often times a person has to give up work or retire early in order to care for their needs. This may put a financial burden on the one providing the care. To help compensate them for the loss of income many family members chose to pay their caregiver either from their own income or savings or by using funds provided by government benefits. 

If this is the case for you or someone you know you should consider putting a care agreement or care contract into place. But what is a care contract?

How Many Days Does Medicare Pay for In Nursing Home or Rehab After Hospital Stay?

Hello All,

I was on the senior care forums these past few days and one of the threads was talking about how many days are covered by Medicare in a Nursing Home or Rehab after a hospital stay. The answers were all over the map and quite confusing I must confess, so I thought I would do a post about it to clear things up. I have always told my readers I am no expert, but when it comes to this subject I know it all to well. You see mom has been in and out of rehab 3 times in the past 2 years so we know the rules by heart.

According to Medicare rules a person must have a qualifying hospital stay of at least 3 days 
( 24 hours) and be in need of further skilled nursing or rehab care in order for them to pay for the stay. The doctor and the physical therapy department at the hospital must agree that the patient would benefit from continued care or therapy at a nursing home or rehab facility. 

It is important to note at this point that the patient needs to be an inpatient at the hospital for 3 days, and time spent in observation or the ER does not count. They have to be admitted to the hospital. This is very important!

Procedure for Setting Up VA Fiduciary Account for Mom's Benefits

"It Really Was Quite Easy and Painless. "

Hello All,

Today we finally had the meeting with the rep from the VA to set up the Fiduciary Account for mom's Aid and Attendance Benefits. As promised I will tell you all how it went and what I found out about the process. 

The meeting was very informal. We met at the Adult Family Home where mom is now living. The rep needed to meet with my sister who was to become the fiduciary and my mom, in order to assess her abilities to handle her own money. I went along to see how the process worked and just in case there where any questions about her application since I was the one who filed the initial forms.

The rep was very nice. She asked my mom the usual questions when checking for dementia; Do you know what year it is? Do you know who is president? Do you know where you are? Have you been in the hospital in the past year? Mom was able to answer some of the questions but with further conversation and my mom's own admittance, it was obvious that she needed help and could not manage her money on her own. 

The rep then gathered required information. She needed copies of my mother's financial  statements, bank accounts and any other sources of funds. She needed verification of my mother's current monthly income - social security and any other sources besides the VA benefits. A list of her current medical expenses was also needed - medicare supplement premiums, and lists of medications and cost of care at the Adult Family Home. Then she asked for two references from my sister who would testify to my sisters trustworthiness. She also asked for my sisters approximate yearly income.

After gathering all the information she went over the process for setting up the account. My sister will receive a letter of approval from the VA after they complete a background and credit check on her.  She then needs to take the letter along with a direct deposit form which the rep gave her to the bank and have them set up the account. The account will be in my mother's name with my sister's name listed as fiduciary. She said any bank can be used. Once the account is set up the back payment that is owed to my mother will be deposited into the account and her regular monthly payments will start going into that account.  

Here are a few rules about how the account is to be handled:

•  My sister will have to write checks from this account directly to the Adult Family Home, she cannot transfer the money into mom's other account and write one check, she will have to write two checks every month.
• There is never to be any commingling of funds with any of my sisters own money. The money is to be used only to pay for mom's  care ( already knew that ).
• My sister must keep records of all expenses in case they were to ever audit the account. Not hard since it's money in money out kind of situation.
• We are to notify the VA if mom moves or goes on medicaid anytime in the future. 

Other than that it was pretty straight forward. The meeting lasted about 30 minutes and she wanted to see my mother's room before she left. We were glad to get this piece of the puzzle in place so that from here on out things should be straight forward. 

By the way, if someone has ever filed for bankruptcy they cannot be a fiduciary for another under the VA rules. 

Hope this helps you if you are facing this procedure in the future. It really was quite easy and painless. We are very grateful to have these benefits for mom as they allow us to have her in a nice quiet place with some wonderful people looking after her. Without the VA we would have had to apply for medicaid and then the uncertainty of where she would end up would have been an issue. We will have to apply for medicaid in the future if she out lives what she has left but at least this buys us some time (about 4 years) to see what our options are without having to make a hasty decision we may regret. 

If you are in a situation like ours, I suggest that you take the time to research medicaid facilities, as I will be doing, over the course of the next several months. Find out what facilities take medicaid and if there is a waiting list. I find being proactive makes things easier and less stressful for all. 

Until Next Time
Take Care All,
Ruth Anne

New Study On Dementia Shows They are No Closer To Answers IMO

Hello All,

Hope this nasty blast of cold is not hitting you to hard. In Michigan it was another brutally cold day today, but the weather man says by the weekend 50's are forecast, hope Al is right.

"More education leads to less cases of dementia, yet we live in the most educated time of the past 200 years and then they say that the number of overall cases is going up."  -New England Journal of Medicine

A new study just published and referenced by NPR titled
"Can Dementia Be Prevented? Education May Bolster Brain Against Risk"
shows in my opinion that they are no closer to having answers about these brain disorders plauging the world. Here is some of what the article stated and then I will share some of my experience with you to prove my point. 

In part is what the article stated:


"The odds of getting Alzheimer's disease or other forms of dementia are declining for people who are more educated and avoiding heart disease, a study finds.- The results suggest that people may have some control over their risk of dementia as they age."

This isn't the first study to find that the incidence of dementia is waning, but it may be the best so far. Researchers looked at 30 years of records from more than 5,000 people in the famed Framingham Heart Study, which has closely tracked the health of volunteers in Framingham, Mass.

They found that the incidence of dementia declined about 20 percent per decade starting in the 1970s — but only in people who had at least a high school education. The decline in people diagnosed with Alzheimer's wasn't statistically significant, but there were fewer people with Alzheimer's, which could have affected that result.

Meeting with VA for Fudiciary Account Posponed a Week

Happy Saturday to all,

Our meeting with the VA rep to set up mom's fiduciary account was suppose to be yesterday. The rep called in sick so now the meeting is set for next Friday 2/19/2016. I was disappointed as I hoped to have information to share with you on how the process works, but this extra week with give you more time to send in your questions about VA Aid and Attendance Benefits. You can use the link at bottom of article or you can email me at ruthann@palcaregivers.com.

Hope to hear from some more of you as this is a great chance to get you questions answered by a expert, the rep, not me.....


Until Next Time
Take Care
Ruth Anne

Tomorrow is VA Meeting Remember to Send Me any Questions

Just a quick reminder, I am meeting with the VA rep in the morning to set up Fiduciary Account. If you have any question you want me to ask her about anything related to Aid and Attendance Benefits send them to me before 9am eastern time Friday the 12. 

I will try and get answers for you.

Staying on Task When You Work From Home, How Do You Do it?

Hi All,

Hope today was a great day for you. Today I feel like I am in a rut. You know doing the same thing over and over again. Well that is how today was. Not sure why the feeling comes on as it does, but every now and then I just can't shake it.

As caregivers we do have a routine and so we repeat the same tasks day in and day out.  It's a must for us when caring for a loved one or a client. Now that mom is in an Adult Family Care Home I do not have the same schedule I had a few months ago, but I still try to keep a routine up. I have my little lady I visit and care for several times a week and I go and see mom on a regular basis, but I do work from home and that is a challenge for me. I would like to know how others deal with the challenge of working from home. Either as a caregiver or in another business. How do you stay on task?

I am trying to set goals for each day, and checking them off when completed. I also try and not let house work or other personal things interrupt my work, but that is one thing that is really hard for me. It's so easy to throw a load of laundry in the wash, then clean up the kitchen, you know house stuff. 

So how do you stay on track? I would love to hear your ideas for this challenge.

Until Next Time
Take Care
Ruth Anne 

94 Year old Abused By Caregiver. How to Hire the Right Caregiver

Hi everyone,

Hope you are doing well today. Monday I posted about how the weather here in Michigan was so mild this winter, I spoke to soon.....Now it's snowed and by the weekend it's going to only be 9 yes I said 9 so winter is not done yet. 

My post today about how to hire the right caregiver for your loved one was prompted by something I saw on TV Tuesday . Just as I was leaving the Adult Foster Home where my client lives I caught a glimpse of the show Right This Minute. The show was airing a clip about  a caregiver who was caught on camera abusing her 94 year old dementia client.  It is quite disturbing. I will provide you a link however I must warn you watching it is hard and very unpleasant. 

Because this is not a random case unfortunately, it got me thinking about how do you go about finding the right caregiver. Although we try to care for our loved ones ourselves, that is often just not possible for us to do on our own, so we turn to outside help to accomplish the job. Wanting only the best for our loved ones we should use caution when hiring someone to come into our home. We all know we should do background checks and check references but here are a few things you may not think to do.

Meeting With VA For Fiduciary Account This Week

Hello Everyone, 

Well the Super Bowl is over tomorrow is Fat Tuesday and the weather is still not that bad here in Michigan. All this means we are marching ever forward toward spring...hooray !

This week we finally will be meeting with the person from the VA to set up the fiduciary account for my mother's Aid and Attendance Benefits. Now mind you she has been getting monthly benefits since June of last year so that tells you how far behind the VA is in getting stuff done. 

For those of you who are working with the VA setting up a fiduciary account may be in your future too. Just what is a fiduciary and why do we need to go through this process? I will try and explain to the best of my knowledge.

When we applied for mom's benefits she was, because of her dementia, deemed unable to manage her finances by the VA. We already knew this as she no longer could remember to even ask about her finances which was quite a change for her. All her life she was sharp as a tack when it came to money. She worked hard and saved her money wisely. She knew where her money was and when things came due etc... Because of her failing eyesight myself or my sister have been helping her with her bills for years but she always knew exactly what was what. Then about a year and a half ago she just stopped showing interest in it. By this time she was living at my sisters and my sister was a signer on her accounts so I guess mom knew in her mind everything was taken care of. 

Adult Family Care Homes What Does Your State Call Them?

Hello Everyone,

Well yesterday it was 50 here and today it's snowing, but that's Michigan for you! 

I know many of you have been following my posts and I thank you for that. If you have you know I have talked a lot about Adult Family Care Homes. This is the type of home my mom is in. Let me describe it for you. It's a beautiful home in beautiful wooded area. The family that runs the home lives there. They use the upstairs of the home as their residence and have a beautiful lower level walk out that is designed for the seniors they care for. The house is licensed  by the state of Michigan to take up to 6 residents. Similar home are set up for residents only and the owner does not live there, caregivers are hired for round the clock care. 

The nice thing about these homes, I have seen many of them, is that it's like a family. The residents who have dementia benefit greatly from these homes because they do not have to get use to different caregivers all the time and because the area is smaller they get use to the layout and routine easily. My mom is doing wonderfully at her new home.

What I was wondering is what other states call these type of homes. I know some call them Board and Care Homes, however with the inconsistency of terms when it comes to senior care across the US I was hoping some of my readers could help me put together a list of states and the term they use for these homes. 

If you are in a state other than Michigan and know what your state calls these homes I would love to hear from you. You can leave a comment at the bottom or email me at ruthanne@palcaregivers.com

I am off to help a fellow caregiver find a home for her mom. If you need any help let me know. I will do what I can to assist you. 

Until Next Time
Take Care
Ruth Anne

How To Chose The Right Assisted Living Facility For a Loved One

Hello Everyone and welcome to February 2016. 

The time just seems to be going by so fast. It's a beautiful day here in Michigan sunny and on the warm side for this time of year. My daughter just left to go home and we both commented it looks like spring outside. But don't be fooled there is plenty of winter left. Ground hog day is tomorrow and we should know what old man winter has left in him for this year, if you think old Mr. Ground Hog knows his stuff.

I was thinking today about the hard decision we often have to face with regards to a loved one. The decision to move them to assisted living. I know how hard it is to make this important decision because recently my sister and I wrestled with it ourselves. If you follow my blog you know that in the fall we moved my mother to an Adult Family Home. Previously she had lived with myself for 9 years and more recently with my sister. It took us a couple of months to finally decide it was the right thing for all involved and several visits to varying types of facilities before we settled on one.

With the wide variety of facilities available, how do you know which one is right for your loved one? There are some things to consider when making your decision. These are the things that came into play for us.