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?

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

Should Parents Pay Their Children For Care?

Do you have loved ones you are caring for? How about grand children? If you are here reading this blog, chances are you are a caregiver.

It's been a few days since I have posted and I am sorry for the delay. I have been caught up in my caregiving duties as well as enjoying time with my precious 16 month old grand daughter, she is such a delight and a welcome refreshment to help make it through the tough times!

Do you visit and post in the online forums such as caring.com or agingcare.com? I have also been doing a lot of reading and posting on these forums lately and find there are so many wonderful people out there doing what we do, caring for a loved one with all that entails and just trying to put one foot in front of the other on the journey we travel.

One subject that has been coming up quite a bit in the forums lately is the debate on whether or not it is proper to ask your parents to pay you to act as their caregiver, provide housing and the like. And the opinions run the gamut. So I thought I would share some of my thoughts as well as how the government feels about the subject.

Consider: What type of care are you providing? What have you had to give up to provide this care? And how do your parents feel about the services you provide?

Many of you have given up so much to care for your parents and do so willingly, out of love. When your parents need intense care or supervision as my mom now needs, you may have moved them into your home in order to provide that care. Many of you have also had to give up outside employment to stay home 24/7. 

Some feel that no matter what you have to give up, you should never charge your parents for care, after all they raised you and provided for you for many years. If that is your opinion and you have the financial resources to do so that is fine and I applaud you for your devotion and love. Some however do not have the financial resources to not work. So when their parents need care they have a few options. They can hire a caregiver, put their parent in an assisted living or nursing home or they can work for their parents and provide the needed care. If given the options most parents would likely prefer to have their own family caring for them for as long as that is possible.

Consider what it would cost to put a parent in an assisted living facility. If they need anything other than basic assistance such as meals and general supervision the costs can be $5 to $6 thousand dollars a month. If they need to go to a nursing home the costs can skyrocket to $8 thousand and above. If you were to hire an in home caregiver the cost would be anywhere from $20 to $30 dollars an hour depending on how much care is need and what area of the country you live in. These costs can eat up even a healthy retirement account in no time. 

If you are the one providing the care, you may as many people feel, it is only reasonable that you get paid. How much is something you and your parent can work out, which in my experience is very reasonable and so much less than what they would have to pay for outside care. No one should take advantage of their parents and charge them outrageous amounts of money just because they feel they can, this is a form of elder abuse. However no one should question a reasonable amount. 

Caring for a parent who is aging is a very tough sometimes full time job. If you have siblings who do not participate in the care they may question you getting paid. In that case you need to make them understand just how much you have given up and how much you do for mom or dad or both. If they are worried about their inheritance, remind them of how fast that will disappear if mom goes to a nursing home.

And the government too feels it reasonable for a family member to be paid for services. Many do not know that Veterans Benefits can be used to pay family members. In most states a medicaid waiver can be uses to pay family caregivers. The government is beginning to realize something that has been obvious for years, and that is, that keeping the elderly at home with family is much more cost effective. They are finally starting to get it. 

So if you are caring for mom or dad, grandma or grandpa and you need to be paid, in this person's opinion that is fine. You are working hard, maybe harder than you ever have before. You are also making a better life for your family member, because they are being cared for by someone they know and love. You are doing a good thing. Don't feel guilty!

One important note for paid family caregivers - please have a caregiver contract in place. This is especially important if you are using government benefits to pay your wages. Also this will protect you if in the future your loved one has to go on medicaid and the money to pay you was used during the 5 year look back period.  (The Deficit Reduction Act of 2005 expanded the look back period from 3 years to 5 years.  Almost every state has adopted this or is in the process of adopting this rule).  If you do not have a contract the government may look at those payments as gifts and require them to be paid back. The contract will save you in that case. Another good reason to have a care contract in place is if there are any disputes between family members regarding inheritance, we all know how nasty greedy relatives can be. For information on how to structure a care agreement you may want to check out this link click here . 

Dear Ruth Anne, Here's what I think...

I hope this information helps those of you who are wrestling with this subject. And I would love your feedback. How do you feel about it? What side do you come down on? Please share your thoughts. 

Until Next Time
Take Care
Ruth Anne






 

Do You Know About the Treatment for Edema In Legs ?

Today I want to share with all of you a treatment we just started using for my mother's edema*.

Until about 6 months ago my mom's legs were fine, no hint of edema at all. Then after her last hospitalization she started having problems. The pitting edema** would go up and down until it finally would not respond to the actions my sister and I were employing at all, such as elevating the legs. We even got her a hospital bed to help. We also used compression stockings, which my mother hates as do many people who have to wear them.  Then one day at a routine foot doctor appointment the nurse asked if we had a 'bio compression system' for her. I had never heard of it. The doctor who explained a little about how it worked, said 'Medicare pays for it and would we like to try it?'. So I thought why not, anything to get the edema in her legs down.

About 3 days later the rep from the Bio Compression Systems company came by and set us up. The system is very easy to use. It consists of a small compressor, and two ( what I call Moon Boots) sleeves that fit over each of the legs and zip up on the front of each boot. They each have a hose attached that you plug into the compressor. Once they are on you turn the compressor on and the boots begin to inflate in sections, starting at the bottom moving up to the top. The idea is that as they inflate in this gradual progression they push the water up the leg, and increase circulation at the same time. 

I must say we have seen an improvement. Mom is suppose to wear them for one (1) hour twice a day. Again the name of the company is Bio Compression Systems out of New Jersey. Their phone is 800-888-0908. They may be able to recommend a doctor in your area who can write a script for this. It has to be used under doctor supervision and not everyone is able to use this, but it may help some as it has my mother.

Until Next Time

Take Care

Ruth A

"Love me my Moon Boots!"

* Edema: A condition characterized by an excess of watery fluid collecting in the cavities or tissues of the body.

** Pitting edema: Observable swelling of body tissues due to fluid accumulation that may be demonstrated by applying pressure to the swollen area (such as by depressing the skin with a finger).

Wikipedia link describing "Pitting edema" with photos - Will

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VA Benefits In Less Than 3 Months !

On July 7th my mom received her first deposit for VA benefits for aid and attendance. 

This was less than 3 months after we applied! Now that is quite good considering they told us it could take 9 months to a year before we saw anything. So I thought I would share the way I went about applying for the benefits in hope that it would help anyone beginning the process.

I will try to make this as simple to understand as possible.

Aid and Attendance Benefits can be used to help pay for care in a facility like assisted living, in home caregivers and the like. These benefits can also be used to pay family caregivers. 

Unlike the government website I will make this as simple to understand as possible. I hope it helps.  

It's suggested to hand deliver the claim to your local VA office. Ask to speak to a representative and have them look everything over. They will let you know if anything is missing and they will begin your claim for you.

Open the form search page on the government website. CLICK HERE to open in a new window, or copy and paste this link in your browser - http://www.va.gov/vaforms/

Print out the following forms:

1. Form 21-534ez
2. Form 21-2680 
3. Form 21-22
4. Aid And Attendance Affidavit (see below where to get this form)

Form 21-534ez:  Application For DIC, Death Pension and or Accrued Benefits
This form is the one you will use when applying for Aid and Attendance Benefits. You can apply for the veteran or the surviving spouse of a veteran.

The first few sections are self explanatory. When completing section II you will find the information you need on the veteran's discharge papers. 

Section VII :  Your net worth at this point must be below 60,000 for a surviving spouse and this does not include a home, vehicle, furniture or clothing.

Section VIII : This is the section on your monthly income so have all your income sources handy such as social security, retirement benefits, pensions, public assistance etc... when it asks for social security  they what the full amount before the medicare deduction, this is listed on your social security statement as the gross monthly amount. 

Section IX :  Expected Income. Here is where you list your expected income such as interest and dividends or any income not listed in section VIII

Section X : Here you will need to show that your medical expenses including what you pay for care like paying a caregiver, paying assisted living costs and the like along with your insurance premiums if you have supplemental insurance along with your medicare and the premium you pay for medicare part D prescription drug coverage and the deduction for medicare that comes out of you social security.  Here you want to make sure to show that the amount of money spent each month on medical costs along with care exceeds their monthly income. If it exceeds the monthly income by $1149.00 or more you will be approved for the full amount of benefits which is $1149.00 a month. But don't make things up -  you will need to keep records and prove that you are actually paying out for these services. 


The one for whom the claim is being submitted will have to sign a couple of forms and there is a section for witnesses if the claim is being signed by someone else due to the inability of the claimant.

Form 21-2680:  This form needs to be filled out by a doctor. At the time we applied for my mom she was in rehab and they were very helpful in getting this filled out in just one day for us. The doctor should fill out the full diagnosis including the need for aid and attendance. If your patient is blind or mostly blind like my mother, this diagnosis will almost automatically get approval for benefits - as will dementia and other illnesses that require regular daily aid.

 

Form 21-22:  Appointment of Veterans Service Organization As Claimant's Representative

I recommend this form because I think one of the things that made our claim move so quickly is that I took all the forms to the local VA office and requested help in filing the claim. With this form the VA rep will be able to have access to the claim and can follow up on your behalf. This form also needs to be signed by the claimant, so make sure you put that in the stack of forms for them to sign. 

Aid And Attendance Affidavit form:

CLICK HERE to open a link to a copy of this form, or copy and paste this link in your browser -  http://www.stclaircounty.org/offices/veterans/forms/Attendant%20Affidavit.pdf

It is very important that you have a copy of this form filled out by each of the caregivers that will be paid for care giving. And as you will note the claimant will need to sign these forms also affirming that they are paying these people for care. If you have more than one caregiver being paid you will need a form for each one. ( note: you will be required to issue a 1099 if these are in home caregivers so make sure they know this and they will be required to pay the proper taxes on these wages unless you are taking taxes out of their pay for them. In that case you will issue a W-2 as usual for employees. 

 Now that you have these forms filled out you will also need the following when filing a claim:

• Discharge papers for the Veteran WWII Vets form 53-55 Vets -  after WWII Form DD214
• Marriage certificate if filing for surviving spouse
• Death Certificate if filing for surviving spouse

Well that is it for forms. Now I suggest as stated above to hand deliver the claim to your local VA office. Ask to speak to a rep. and have them look everything over. They will let you know if anything is missing and they will begin your claim for you. If you are missing anything get your reps email address as most missing information can be emailed to them by you, saving you extra trips. 

MAKE COPIES OF EVERYTHING - EVERY FORM - EVERY DOCUMENT - AND STORE THEM IN A FOLDER FOR EASY ACCESS.

Now you wait. If you have not heard from the VA in 60 days call your rep and ask them to check on your claim. 

If you have any questions feel free to ask me and I will answer to the best of my knowledge. I do not claim to be an expert, I just wanted to share what I did with the hope that it may  help others.

Until Next Time 
Take Care
Ruth Anne
 

Facing The Tough Decision To Place Mom In An Assisted Living

As my readers know I am not only a professional caregiver, I am also, along with my sister caring for my 91 yr old mother. Now we are at a crossroads in her care.

The task of caring for her at home is becoming just to much for my sister and I. And so we are searching for the next place to plant our foot on this journey of family cargiving. This is the toughest step we have had to take so far, but for the sake of all of us it is a step I feel we must take. Even if the road is a bit rocky and our footing is a bit unsure we must trudge ever forward.

Today we looked at a facility that is classified as an adult foster home in Michigan. It is the largest of its type, as classified in the state, being a 20 bed facility. In Michigan there are 3 types of adult foster homes licensed by the state, which are also called homes for the aged. They are 6 resident, 7-10resident and 11-20 resident.

The facility was nice with private rooms with private bath, staff seemed nice and she can bring some of her own furniture. And best of all it is close to all of her family and friends and so visiting will be easier. The only draw back is she only has enough money to stay there for 2 yrs which means if she runs out of funds and has to go on Medicaid we will have to move her again in 2 years. 

Monday I will reach out to the Area Agency on Aging ( most every county in the U.S. has one) to see what advise they can offer as we make some very tough and sometimes scary decisions.

My mom is a wonderful person and a great parent, grandparent and great grandparent and we want see to it that she is as happy as possible during her final years. And that is why these decisions are so hard to make.  I will share with all of you the progress we make as we take these next very tenuous steps. The time has come, the time no child looks forward to, when we have to make decisions for our parents that they may not at first like, hopefully mom will understand and know it is for the best. At least I pray she does.

Until next time

Take care my friends and share the story of your journey on this road with us. The old saying goes there is strength in numbers, and we all need strength on this journey.

Ruth Anne

This always reminds me of a verse in scripture which says:

"Very truly I tell you, when you were younger you dressed yourself and went where you wanted; but when you are old you will stretch out your hands, and someone else will dress you and lead you where you do not want to go." -John 21:18, New International Version 

It is a big responsibility.

Will