Many families reach a point when they recognize that an ill or older relative needs more than occasional assistance—they need full-time care. But who will provide that care? The answer is usually close to home: an adult child. A child might be the default choice, or is selected because he or she lives closer or has fewer family responsibilities.

The person providing care for a loved one may make a significant sacrifice: giving up a job and employment benefits. A formal agreement among family members can provide a way to compensate a person providing care if he or she is no longer able to hold other employment. While most family members may wish to help care for a loved one, it is a job with heavy time commitments and responsibilities. One way of protecting the caregiver as well as the person receiving care is by putting the care relationship in writing. This binding agreement is most often referred to as a “personal care agreement.”

What Is a Personal Care Agreement?

The agreement is a contract, typically between a family member who agrees to provide caregiver services for a disabled or aging relative and the person receiving care. The personal care agreement is most commonly between an adult child and his/her parent, but other relatives may be involved, such as an adult grandchild caring for a grandparent.

Drawing up an agreement clarifies for a family what tasks are expected in return for a stated compensation. It can help avoid family conflicts about who will provide care and how much money will change hands. For this reason, the agreement should be discussed with other family members to resolve any concerns before an agreement is drafted.

When contracting with a family member, it is wise to treat the agreement as a legal document. If your relative is receiving state supported in-home care, the agreement will show the state where the money is going and for what kind of services. In addition, a caregiver agreement can offset potential confusion among family members concerned about bequests to heirs, and avoid misunderstandings later over the reduction of the amount of money that may be inherited.

Components of a Personal Care

Agreement

A personal care agreement has three basic requirements for a person to pay a family member for care:

1. The agreement must be in writing.
2. The payment must be for care provided  in the future (not for services already performed).
3. Compensation for care must be reasonable. This means tasks performed should match “reasonable”or “customary”fees typically paid to a third party for the same care in your geographic area.

A properly drafted personal care agreement will contain the following information: Date the care begins; detailed description of services to be provided, for example, “transportation and errands” (driving to medical, dental, adult day care, and other appointments) or “food preparation”; how often services will be provided (allow for flexibility in care needs by using language such as, “no less than 20 hours a week” or “up to 80 hours a month”); how much and when the caregiver will be compensated (weekly or biweekly); how long the agreement is to be in effect (the agreement should set time, such as a year or two years, or even over a person’s lifetime); a statement that the terms of the agreement can be modified only by mutual agreement of the parties in writing,; and, the location where services are to be provided (home of elder/adult with disabilities, caregiver’s own home, other location)–allow for the location of the care to change in response to increasing care receiver needs); signatures by the parties; and date of the agreement
.

Do I Need a Lawyer?

You don’t necessarily need to hire an attorney, but it may be advisable when entering into a contractual relationship. It depends on how complex an agreement your family requires.

A legal agreement template is available through nolo.com: https://store.nolo.com/ products/elder-care/elder-care-agreements

This article was reworked from a more extensive discussion of the topic at the Caregiver’s Alliance:

https://www. caregiver.org/personal-care-agreements

When a loved one has been diagnosed with a terminal illness or “failure to thrive,” consider seeking help from a hospice agency to assist with improving your loved one’s quality of life. Typically, hospice is available to people who are expected to live 6 months or less due to an incurable disease. Failure to thrive is defined as a patient who’s health has declined because of weight loss due to lack of appetite, depression and refusal of medical treatment. The patient may be giving up and feels there’s no reason to go on, or they may have recently had a stroke or other illness that has left them with complications. The purpose of hospice is to provide comfort care through pain management and symptom control. Hospice also provides medical equipment, medication and supplies, all which are covered through Medicare. Hospice does not treat the disease; rather, they focus on the patient’s quality of life, helping them to live fully, with dignity, surrounded by their loved ones.   Some families are concerned that by accepting hospice care they are giving up hope that their loved one will get better; however, if the patient’s condition improves, he or she will be taken off the program until such time is needed in the future. Hospice patients receive such excellent care that many times the response is dramatic and the TLC they receive provides an extra boost to their health which extends their life. Hospice also provides bereavement support for one year to the family after experiencing a loss.

By Amber Triebull

It’s inevitable; the longer we live, the more loss we will experience.  It could be the loss of loved ones, the loss of health, independence, or the loss of a feeling of purpose in life.  Grieving over these losses is completely healthy and normal.  The symptoms of grief can be described in five stages, the first being denial, disbelief or numbness.  The second, anger and blaming others.  The third, bargaining.  For example, “If I am cured of this cancer, I will never smoke again.”  The fourth is a depressed mood, sadness and crying.  The final stage is acceptance and coming to terms with the loss.  Not everyone experiences all these emotions when coping with loss, and it’s possible for the stages of grief to last a year or more.  But when a person has lost all hope and joy in life, they may be suffering from clinical depression.

It can be difficult to recognize the signs of depression amongst the elderly because symptoms of grief, side effects of medications, and symptoms of chronic illnesses can all resemble the symptoms of depression, causing depression to go unnoticed and untreated.  Assuming depressive symptoms are caused by another underlying problem can be detrimental to your loved one’s health.  Depression can increase a person’s risk of cardiac disease and their risk of death following a heart attack.  Depression also reduces a person’s ability to rehabilitate and can impact their sleep, energy and appetite.

Overcoming depression can involve finding new things to enjoy, staying physically and socially active and feeling connected to loved ones.  Medication and/or counseling may also be helpful.  As a caregiver, family member or friend of a depressed senior, consider scheduling regular social activities for them, take them out to do things they enjoy, prepare them healthy meals, be emotionally supportive by listening to them with compassion and without judgment, and encourage the person to follow through with treatment.

Although depression amongst the elderly is common, it is not normal.  If you believe you or your loved one is suffering with depression, don’t hesitate to talk to your doctor.  Several web-sites offer on-line depression screening tests, one being www.depression-screening.org provided by the National Mental Health Association.  Take this test with you to your doctor to begin the conversation about your concerns.

By Amber Triebull

Before starting my business caring for seniors, I knew very little about long-term care insurance.  I believed that as long as you were “saving for a rainy day” all would be well.  I soon found reality is very different!  None of us know what the future holds. Nothing is more disturbing than to see a senior who needs help but is unable to afford it.  Many I’ve talked to believe Medicare will take care of the cost. Medicare offers coverage for a very limited time and offers no coverage for non-medical, in-home care.  Long-term care insurance is an insurance policy which pays a set amount for the cost of care when an individual needs help with activities of daily living due to declining health or cognitive impairment.  The daily amount usually ranges from $100 to $200 per day for a designated time frame, often times 3 years, depending on the policy.  This differs from medical insurance because, while medical insurance will help cover the cost of immediate medical expenses such as doctors bills, it will not cover the cost of care required for the daily help a person will need if they are living with chronic illness or disabilities.   With the right policy, long-term care insurance will cover the costs of home care, assisted living, nursing homes, adult day care and respite care. The relief our clients and their families feel in knowing they’re able to receive the care they need without financial worries is priceless. For many, the amount of the policy is secondary to the peace of mind it offers for those fearful of becoming a burden to their family or depleting their retirement funds.

Policy costs vary depending on the age of the person when they purchase a long-term care policy and the length and amount of coverage.  According to the American Association for Long-Term Care Insurance, a 60-year-old healthy couple can expect to pay an average of $3,335 a year for a plan that pays out $150 per day for three years.  Once a policy is purchased, it is usually guaranteed renewable for life and cannot be cancelled by the insurance company for health reasons. Once a policy is activated, there are no monthly payments that have to be made.

By Angela DiNicola

Participating in activities can promote a sense of accomplishment, independence and overall happiness for a person with dementia.  It is important to remember that people with dementia are “people first,” and need to feel part of the world around them.  It may be challenging for a family member or other caregiver to think of activities to engage a person with dementia, so I have compiled a list I hope you will find helpful.  Pick activities the person can succeed in, keep directions simple and be flexible and encouraging!

1. Play a game; change the rules to make them simpler if necessary.
2. Garden together.
3. Prepare meals together. Give the person a specific task such as washing the lettuce or mixing ingredients.
4. Listen to music they used to enjoy. Sing together.
5. Read short stories aloud.
6. Look through old picture albums; encourage the person to reminisce.
7. Share stories about the “good old days.”
8. Complete art projects such as painting, scrapbooking, wood building, knitting or quilting.
9. Exercise! Take a daily walk together or encourage participation in a senior’s exercise class.
10. Plan outings to museums, parks, church, coffee or ice cream shops, places the person used to enjoy visiting.
11. Sorting projects; paper, work related items, coins.
12. Encourage participation in housekeeping such as dusting, wiping counters or folding laundry.
13. Do hair and nails together.
14. Care for a pet by grooming, feeding or walking.
15. Puzzles and crossword puzzles.
16. Watch classic movies together.

Find activities you both enjoy doing together while keeping the mind and body of your loved one living with dementia active!

By Amber Triebull