Caring For Your Parents

Last April, PBS aired the program "Caring for Your Parents", which focused on the fact that many adult children are "grappling with an unprecedented social, cultural, economic, and personal revolution as they transition into the primary caregiver role for their aging parents."

This two-hour program covers "today's struggle to keep parents at home, tensions between siblings, and the complexity of shifting caregiver roles through an intimate look at five American families."

After the program, there is a half-hour discussion with medical correspondent Dr. Art Ulene entitled "A Conversation About Caring." During this session, the speakers offer concrete advice and guidance (read interviews with the doctors here)on how to start the conversation, which is quite often the most difficult step in caregiving - and one we cannot afford to avoid.

Watch the PBS program "Caring for Your Parents" online.

Access the Caregiver Handbok.

When Your Aging Parents Need You

Caregiving can bring guilt and anxiety—and it can be a gift as well.

By Sally Wadyka for MSN Health & Fitness

For most children, their parents are the people in charge of taking care of them from infancy and even into adulthood. Mom and Dad were there to bandage your boo-boos, sing you to sleep, and soothe you when you were sick. But as the population ages—and more are afflicted with age-related diseases such as Alzheimer's, stroke and cancer—the tables are often turned on parents and their now-adult children.

According to statistics from the National Institute on Aging, there were 37 million people age 65 or older in 2006; that's about 12 percent of the population. But by 2030, as the Baby Boomer generation ages, that number is predicted to rise dramatically. Projections forecast that approximately 71.5 million people—about 20 percent of the population—will be 65 or older. Alzheimer's disease currently affects 5 million Americans, and strokes, which also afflict about 5 million people, are the number-one cause of adult disability.

Finding answers to tricky questions

For most adult children who are thrust into a caregiving role for a parent, the change happens suddenly. "It usually starts with a phone call, and it's like getting hit over the head," says Andy Cohen, CEO of caring.com, a Web site that offers support and advice to caregivers.

Read the remainder of this excellent article by clicking here.

Home Instead Senior Care

Home Instead Senior Care is a company that serves around 200 Central Ohio senior citizens that live in their homes. They suggest that adult children will speak to their parents who are in their 70's about various issues to ensure the senior's needs are met.

Their "40-70" program is organized nationwide through the Home Instead Senior Care franchise,, and it offers various resources at 4070talk.com. These materials include a "conversation starter guide", an "online communications assessment", and a "communications guide". A booklet can be ordered online or by calling (614) 849-0200.

They emphasize talking early about aging issues so that there is less of a communication barrier when issues pop up later.

Eons.com - An Online Community for 50+ Americans

This website follows in the footsteps of popular websites such as MySpace.com and Facebook.com. These websites are an "online gathering place" which are very popular with teens and young adults.

Eons.com is similar, but specifically made for the 50+ crowd. It includes networking tools, information on "body", "money", "love" and "fun", as well as a search engine designed to find items related to the users stage in life.

Give Eons.com a try and leave a comment as to whether you find it useful!

What is The New Medicaid Lookback period?

What is the appropriate Medicaid Look-Back period under the DRA?

This is an important question for anyone making a Medicaid application in that the local office will request financial records for the time period of the Look-Back. I find it can be very difficult to gather 3 years of records for a senior who now requires Medicaid to pay for his or her long term care, and 5 years is an even greater burden.

So what is the Look-Back Period? I had been going with 60 months, as until recently all the States that had created the DRA enacting legislation had used that timeframe.

However, in Most States Fudging DRA Look-Back Change from Elderlawanswers.com, there is an excellent analysis that the states may have the changes to the Look-Back Period wrong.

In New York's enacting legislation, they have taken note of the fact that that DRA did NOT in fact changes the Look-Back Period from 36 months to 60 months. Instead, it said that IF there had been a transfer in the 60 months after enactment, THEN there was a 60 month Look-Back for the transfers.

New York then has taken a staggered approach to the Look-Back Period, since 60 months obviously have not expired since the DRA was enacted. For the first 36 months, the Look-Back Period remains 36 months (since any transfers would be before the DRA was enacted). The Look-Back Period then extends to 37 months in the 37th month after the DRA to capture any transfer in that month, until it finally reaches 60 months.

This approach appears to resolve the issue of the 60 month Look-Back for transfers after 2.8.06 with the 36 month Look-Back period in the Code not being changed by the DRA.

One would hope that in creating its enacting legislation to the DRA that New Jersey would take such a measured approach as well.

Most States Fudging DRA Look-Back Change - Elder Law Answers Articles:

"Since 1993, the look-back date on a Medicaid application for long-term care coverage has been 36 months, 42 U.S.C. S. 1396p(c)(1)(B), and this figure was not erased by Congress in the amendments to the statute it made through the DRA. Instead, the 36-month figure was preserved and a 60-month look-back date was added to the statute but made applicable only to transfers that occurred after the DRA effective date.

The last time Congress made any modification to the look-back date was in the Omnibus Budget Reconciliation Act of 1993, P.L 103-66 (OBRA-93), when it simply deleted '30' from the statute and replaced it with '36,' and thereby left little doubt that it intended to increase the look-back period on all prospective applications to 36 months. But Congress chose not to make the change in the same manner in its DRA amendments. In keeping the 36-month figure in the statute, Congress was clearly indicating that a 36-month look-back date is still applicable in some fashion. By attaching the 60-month look-back date to transfers made after the DRA enactment date, as opposed to applications filed after that date (a la OBRA-93), the design was obviously to at least phase in the extended look-back date over time. Based on the language Congress used in the DRA, the look-back period cannot be greater than 36 months until at least February 2009, because that will be the first point at which an
individual will have possibly made a transfer that occurred more than 36 months after the DRA enactment.

Agreeing with this reading of the DRA statute, New York keeps the look-back period at 36 months (60 months for trusts) until February 1, 2009. Beginning on that date, Medicaid offices will require resource documentation for the past 37 months (60 months for trusts). "

This is a confusing issue. Before you rely on "the grapevine", consult an elder law attorney who can help you sort through the convoluted laws of Medcaid.

Advancing Excellence in America's Nursing Homes

On September 29, 2006 the National Nursing Home Quality Summit was held in Washington, D.C.

The Advancing Excellence in America's Nursing Homes website describes their work as follows:

Advancing Excellence in America's Nursing Homes is a new coalition based, two-year campaign that launched in September 2006. The campaign is reinvigorating efforts to improve the quality of care and quality of life for those living or recuperating in America's nursing homes.

The campaign's unprecedented coalition includes long-term care providers, caregivers, medical and quality improvement experts, government agencies, consumers and others. Together, we are building on the success of other quality initiatives, including Quality First, the Nursing Home Quality Initiative (NHQI), the culture change movement, and other quality initiatives.

Learn more about the campaign and its goals.

To learn about how you can help by registering as a Nursing Home consumer, visit this link.

Squidoo Lens - Elder Law

Check out my Squidoo Lens on Elder Law. It has many links and is generally a portal I've created for you to access information related to issues you may be facing. Please sign the guestbook and leave a suggestion so that I may make it better!

Thank you!

The "Senior Sandwich"

The "Senior Sandwich" generation refers to persons over 60 years old and who face costs related to 1) college tuition for thier kids, 2) retirement for themselves, and 3) at-home or nursing home care for thier parents, all at once.

The fact that nearly 50% of people in thier 60's today have at least one parent still living is a far cry from the near 10% at the beginning of last century. This means that these families are facing concerns and problems that no generation before them have had to face. The bottom line can be a crushing financial burden.

Jean Chatzky of Money Magazine suggests in "Just When You Thought It Was Safe to Retire" that if you're already in your 60's you might plan to work a little longer, live a little leaner, and encourage your kids to study hard and qualify for merit aid. She goes on to sugges that if you are planning ahead in your 40's or 50's you're in a better spot, especially if you focus on the following:

1) Fit kids into your budget. When you make projections about your annual spending in your retirement years, be sure to plan for the possibility that one of your kids moves back home! This can increase food, utilities, and other costs.

2) Ask your parents hard questions. Understanding what sort of assets your parents have, and what type of lifestyle they wish to live is important. Ask them the following: How expensive a lifestyle do they want to live for the rest of thier life? Where do they want to live, and in what kind of home? What sort of health-care and lifesaving measures do they want to have taken, if needed? Who do they want to put legally in charge of carrying out all of these wishes?

3) Consider insurance. Long term care is very expensive. Buying long term care insurance may bring a great deal of financial secuirty, and personal comfort.

4) Look out for No.1. Too often those in the "sandwich generation" put thier own needs last. If you ruin yourself financially (by neglecting your own needs) at this point to take care of those around you, you'll only be setting up your children to face these difficulties later.

If you are a card-carrying member of the "sandwich generation" and you'd like to learn more about how to help implement a plan to make sure you and your family members are taken care of personally, legally, and financially, feel free to contact an elder law lawyer for assistance.

Look Closer, See Me

I am told that this poem was found with the belongings of an elderly woman who died in the geriatric ward of a hospital near Dundee, Scotland. It is a powerful piece that should remind us all that a failing mind or body does not change who we are. I hope it helps you in some way.

If you can share a story, or any way that this poem affects your life, please leave a comment or contact Golowin Legal.

Look Closer, See Me

What do you see nurses, what do you see?
Are you thinking when you are looking at me— A crabby old woman, not very wise,
Uncertain of habit, with far-away eyes.
Who dribbles her food and makes no reply,
When you say in a loud voice—"I do wish you'd try."
Who unresisting or not, lets you do as you will,
With bathing and feeding the long day to fill.
Is that what you are thinking—is that what you see?
Then open your eyes, nurse, you're not looking at me.
I'll tell you who I am as I sit here so still;
As I do at your bidding, as I eat at your will,
I'm a small child of ten with a father and mother,
Brothers and sister, who love one another.
A young girl of sixteen with wings on her feet,
Dreaming that soon now a lover she'll meet;
A bride soon at twenty—my heart gives a leap,
Remembering the vows that I promised to keep;
At twenty-five now I have young of my own,
Who need me to build a secure, happy home;
A woman of thirty, my young now grow fast,
Bound to each other with ties that should last;
At forty, my young sons have grown and are gone,
But my man's beside me to see I don't mourn.
At fifty, once more babies play round my knee.
Again we know children, my loved one and me.
Dark days are upon me, my husband is dead.
I look at the future, I shutter with dread,
For my young are all rearing young of their own,
And I think of the years and the love that I've known.
I'm an old woman now and nature is cruel—
'Tis’ her jest to make old age look like a fool.
The body it crumbles, grace and vigor depart,
There is now a stone where I once had a heart;
But inside this old carcass a young girl still dwells,
And now and again my battered heart swells.
I remember the joys, I remember the pain,
And I'm loving and living life over again.
I think of the years all too few—gone too fast,
And accept the stark fact that nothing can last.
So open your eyes, nurses, open and see
Not a crabby old woman, look closer see me!

Courtesy of the Peninsula Hospital Center, Far Rockaway,
New York, and Greater New Hospital Association.

Golowin Legal is your source for elder law, estate planning, probate and asset protection.

Caregiver Agreement Follow-Up - Details

If you read my prior post on caregiver agreements (also known as "personal care contracts" or "personal service contracts"), you know that they are a valuable tool. But knowing that they are out there is not enough! You need more!

This follow up to the Wall Street Journal article provides some additional infrormation and quotes several elder law attorneys on the topic. For more information on elder law, estate planning or medicaid planning, feel free to contact me today.

Setting Up a Contract For Who Will Mind Mom

By Rachel Emma Silverman

From the The Wall Street Journal Online

Trish Richert recently signed a binding employment contract. In exchange for taking care of a 77-year-old woman -- arranging and taking her to doctors' appointments, doing her bills, keeping her house tidy -- Ms. Richert, of Greensboro, N.C., receives a modest stipend that covers travel expenses and other costs.

Ms. Richert's employer: her mother. The two recently entered into a so-called caregiver contract -- a formal agreement, set up by a lawyer -- in which Ms. Richert, 45, receives a small payment for the long hours she spends caring for her mom.

A small but growing number of families are setting up caregiver contracts, in which adult children or other relatives are hired, for modest salaries, to take care of elderly or disabled family members. These arrangements, which are also called personal-service or personal-care agreements, can help reduce the size of a parent's estate and thereby improve their chances of becoming eligible for long-term-care coverage under Medicaid. They can also minimize battles between siblings and other family members. For many other families, the contracts simply help reward the significant amounts of time, effort and money that family members often spend watching over and taking care of an elderly relative.

There aren't any national statistics on how many family members are compensated for caregiving. But a huge swath of Americans already provide long hours of voluntary care for family members and friends -- and these numbers are likely to grow as the population ages and more people live longer. Some 44.4 million adult caregivers -- or 21% of the U.S. adult population -- provide unpaid care to seniors or adults with disabilities, according to a 2004 study by the National Alliance for Caregiving in Bethesda, Md., a research and advocacy coalition, and AARP, the Washington advocacy group for seniors. On average, those caregivers provide 21 hours of care a week; the average length of time spent providing care is 4.3 years.

Many caregivers have to balance their family duties with their real jobs. Nearly 60% of caregivers either work or have worked while providing care, the study found, with many having to make adjustments to their work life, including reporting late to work or even giving up their jobs entirely.

Kathy Nalven is in the process of drawing up a caregiver contract with her mother's 88-year-old fiancé, Edward Campbell. Ms. Nalven, a Fort Lauderdale, Fla., real-estate broker who is in her 50s, has agreed to take care of Mr. Campbell, but "the parameters have to be really clear," she says. "If it means that I can't work because I'm busy taking care of him, which I'm very willing to do, I need to be compensated. I'm not a saint." Ms. Nalven and Mr. Campbell both say that the terms of the arrangement are still being worked out.

Elder-lawyers and caregiver advocates say that more people are considering compensating family members for their efforts. In recent weeks, Jennifer Cona, a Melville, N.Y., elder-law attorney, has drafted five caregiver contracts. Before that, she had drawn up only three in the preceding couple of years. "We're seeing a real increase," she says.

"I know in my own practice they are definitely increasing," adds Lauchlin Waldoch, a Tallahassee, Fla., elder-lawyer. "People are more receptive to them now."

Qualifying for Medicaid

There's another key reason for the uptick: Legislation passed earlier this year makes it tougher to qualify for Medicaid long-term-care coverage by making outright gifts to family members. The measures were passed to prevent seniors who have the means to pay for their own care from obtaining Medicaid, which is intended for poor patients. Lawyers say that if set up properly, caregiver contracts shouldn't be considered gifts to children because the patient is receiving a real service in return.

Medicaid isn't likely to "disqualify you for making those payments to your children if you have an arm's length, commercially reasonable contract, in writing, ahead of time," says Charles Sabatino, director of the American Bar Association's Commission on Law and Aging in Washington. Scott Solkoff, a Boynton Beach and Miami, Fla., elder-lawyer, says he has drafted more than 250 caregiver contracts in recent years; about half of the arrangements, he says, have been "Medicaid-driven."

Still, there's a lot of stigma to overcome when recommending the idea to families, lawyers say. The main reason: "People are still uncomfortable with the idea that you are paying your kids," says Palo Alto, Calif., lawyer Michael Gilfix.

Indeed, when Ms. Richert first heard about the contracts from her mother's lawyer, A. Frank Johns of Greensboro, N.C., "it felt funny," she says. "It's hard to put a dollar figure when you are doing something for your mom."

Advisers and family members say the deals are also smart because a formal arrangement, done ahead of time, can minimize feuds among siblings and other relatives. Oftentimes, one child serves as a primary caregiver and a parent may reward him or her by making informal gifts or by doling out a bigger piece of the estate in the will. Unfortunately, those arrangements can lead to family fights or will contests.

A formal caregiver contract, drafted ahead of time, makes the arrangement "more iron-clad," says New York elder-law attorney Bernard Krooks. "You have a written document showing this is what mom wants you to do and what mom wants to do for you. It helps avoid family squabbles." But lawyers say it's important to discuss the contract with other siblings or relatives so they are aware of the arrangement ahead of time; that can help minimize family tensions later.

Terry Huffines, of Brown Summit, N.C., set up a caregiver contract with her aunt, who is 92 years old, to help avoid any estate problems down the road with her aunt's 15 additional nieces and nephews. The agreement, set up by Mr. Johns, the Greensboro, N.C., lawyer, outlines the services Ms. Huffines, 72, will provide for her aunt, including driving her to the doctors, the grocery store and other household chores.

In order for a caregiver contract to be respected -- and to pass muster with Medicaid authorities -- it has to follow certain formalities. For one, you can't pay the caregiver an inflated rate in order to shift lots of money out of your estate. Instead, you should specify what duties the caregiver is expected to perform and then contact local home-care agencies or geriatric-care managers to establish the market value of those services in your area. Such duties can vary from preparing meals, bathing and dressing to housecleaning and chauffeuring, as well as arranging doctor's appointments and friends' visits and overseeing medications.

Cost Varies Widely

The cost of care varies widely, depending on location and the services being performed, and can range from about $15 an hour to more than $100 an hour. Some families choose to pay a discounted rate to family caregivers, which is also acceptable, lawyers say. It's also much better to set up the caregiver contract when the incapacitated adult is of sound mind, as the arrangements can become far more complicated if a person acting as power of attorney signs the contract.

The contract should also specify whether the payment will be done in one upfront lump sum based on the senior's life expectancy -- a technique often used for Medicaid-planning -- or in regular weekly or monthly payments. It's also wise to create safeguards to prevent a caregiver from taking the money and running, such as depositing paychecks into an escrow account rather than to the caregiver directly.

There are also tax consequences to consider. The compensation is considered ordinary income, so the caregiver has to pay income taxes on the payment. Also, depending on how the contract is structured, Social Security and other payroll taxes may have to be withheld.

Many lawyers say they generally only set up the contracts as part of more-comprehensive estate plans, including power-of-attorney documents and wills, but that the arrangements can cost anywhere from about $500 to several thousand dollars to create.

It's smart to check whether there are other sources of funding you can use to pay family members. Some long-term-care insurance policies, such as those that pay lump-sum "indemnity" benefits, may be used to pay family members who provide care, says Jesse Slome, executive director of the American Association for Long Term Care Insurance in Westlake Village, Calif. If you already have a policy or are considering one, see if the coverage will allow you to pay family members for their caregiving services.

In addition, some state or federal government programs provide funding to compensate family members in what is known as "consumer-directed care." For instance, a growing number of states have a "Cash & Counseling" program for Medicaid enrollees that allows participants to pay family members for their services. Contact your local agency on aging or department of social services for more information on government funding.

Email your comments to cjeditor@dowjones.com.

-- September 13, 2006

Caregiver Agreements and Medicaid

This recent Wall Street Journal article discusses a valuable planning technique for seniors who need help with thier daily activities, do not wish to move out of thier home, and have a relative who is willing to provide daily care.

In short, caregiver agreements are written contracts in which a relative agrees to care for a loved one for a specified amount of money. Not only do they help ensure the senior recieves the care they need in the comfort of thier home, but their assets are being transferred with no penalty under the Medicaid laws.

Without the use of a caregiver agreement, many children care for thier parents out of the goodness of thier hearts for years without any compensation. Unfortunately, in instances where the parent eventually needs nursing care, the senior must spend down essentially all of thier assets. The end result is that they leave thier loving child or family member nothing as an inheritance. Many times seniors would rather pay thier relative to care for them, even if the relative would gladly do it for free.

For more information, contact an Ohio Medicaid Attorney.

Who Will Mind Mom?
Check Her Contract

Seniors Turn to Written Agreements to Compensate
Relatives as Caregivers; Reducing Estate Size

By RACHEL EMMA SILVERMAN
September 7, 2006; Page D1

Trish Richert recently signed a binding employment contract. In exchange for taking care of a 77-year-old woman -- arranging and taking her to doctors' appointments, doing her bills, keeping her house tidy -- Ms. Richert, of Greensboro, N.C., receives a modest stipend that covers travel expenses and other costs.

Ms. Richert's employer: her mother. The two recently entered into a so-called caregiver contract -- a formal agreement, set up by a lawyer -- in which Ms. Richert, 45, receives a small payment for the long hours she spends caring for her mom.

A small but growing number of families are setting up caregiver contracts, in which adult children or other relatives are hired, for modest salaries, to take care of elderly or disabled family members. These arrangements, which are also called personal-service or personal-care agreements, can help reduce the size of a parent's estate and thereby improve their chances of becoming eligible for long-term-care coverage under Medicaid. They can also minimize battles between siblings and other family members. For many other families, the contracts simply help reward the significant amounts of time, effort and money that family members often spend watching over and taking care of an elderly relative.

There aren't any national statistics on how many family members are compensated for caregiving. But a huge swath of Americans already provide long hours of voluntary care for family members and friends -- and these numbers are likely to grow as the population ages and more people live longer. Some 44.4 million adult caregivers -- or 21% of the U.S. adult population -- provide unpaid care to seniors or adults with disabilities, according to a 2004 study by the National Alliance for Caregiving in Bethesda, Md., a research and advocacy coalition, and AARP, the Washington advocacy group for seniors. On average, those caregivers provide 21 hours of care a week; the average length of time spent providing care is 4.3 years.

Many caregivers have to balance their family duties with their real jobs. Nearly 60% of caregivers either work or have worked while providing care, the study found, with many having to make adjustments to their work life, including reporting late to work or even giving up their jobs entirely.

Kathy Nalven is in the process of drawing up a caregiver contract with her mother's 88-year-old fiancé, Edward Campbell. Ms. Nalven, a Fort Lauderdale, Fla., real-estate broker who is in her 50s, has agreed to take care of Mr. Campbell, but "the parameters have to be really clear," she says. "If it means that I can't work because I'm busy taking care of him, which I'm very willing to do, I need to be compensated. I'm not a saint." Ms. Nalven and Mr. Campbell both say that the terms of the arrangement are still being worked out.

Elder-lawyers and caregiver advocates say that more people are considering compensating family members for their efforts. In recent weeks, Jennifer Cona, a Melville, N.Y., elder-law attorney, has drafted five caregiver contracts. Before that, she had drawn up only three in the preceding couple of years. "We're seeing a real increase," she says.

"I know in my own practice they are definitely increasing," adds Lauchlin Waldoch, a Tallahassee, Fla., elder-lawyer. "People are more receptive to them now."

Qualifying for Medicaid

There's another key reason for the uptick: Legislation passed earlier this year makes it tougher to qualify for Medicaid long-term-care coverage by making outright gifts to family members. The measures were passed to prevent seniors who have the means to pay for their own care from obtaining Medicaid, which is intended for poor patients. Lawyers say that if set up properly, caregiver contracts shouldn't be considered gifts to children because the patient is receiving a real service in return.

Medicaid isn't likely to "disqualify you for making those payments to your children if you have an arm's length, commercially reasonable contract, in writing, ahead of time," says Charles Sabatino, director of the American Bar Association's Commission on Law and Aging in Washington. Scott Solkoff, a Boynton Beach and Miami, Fla., elder-lawyer, says he has drafted more than 250 caregiver contracts in recent years; about half of the arrangements, he says, have been "Medicaid-driven."

Still, there's a lot of stigma to overcome when recommending the idea to families, lawyers say. The main reason: "People are still uncomfortable with the idea that you are paying your kids," says Palo Alto, Calif., lawyer Michael Gilfix.

Indeed, when Ms. Richert first heard about the contracts from her mother's lawyer, A. Frank Johns of Greensboro, N.C., "it felt funny," she says. "It's hard to put a dollar figure when you are doing something for your mom."

Advisers and family members say the deals are also smart because a formal arrangement, done ahead of time, can minimize feuds among siblings and other relatives. Oftentimes, one child serves as a primary caregiver and a parent may reward him or her by making informal gifts or by doling out a bigger piece of the estate in the will. Unfortunately, those arrangements can lead to family fights or will contests.

A formal caregiver contract, drafted ahead of time, makes the arrangement "more iron-clad," says New York elder-law attorney Bernard Krooks. "You have a written document showing this is what mom wants you to do and what mom wants to do for you. It helps avoid family squabbles." But lawyers say it's important to discuss the contract with other siblings or relatives so they are aware of the arrangement ahead of time; that can help minimize family tensions later.

Terry Huffines, of Brown Summit, N.C., set up a caregiver contract with her aunt, who is 92 years old, to help avoid any estate problems down the road with her aunt's 15 additional nieces and nephews. The agreement, set up by Mr. Johns, the Greensboro, N.C., lawyer, outlines the services Ms. Huffines, 72, will provide for her aunt, including driving her to the doctors, the grocery store and other household chores.

In order for a caregiver contract to be respected -- and to pass muster with Medicaid authorities -- it has to follow certain formalities. For one, you can't pay the caregiver an inflated rate in order to shift lots of money out of your estate. Instead, you should specify what duties the caregiver is expected to perform and then contact local home-care agencies or geriatric-care managers to establish the market value of those services in your area. Such duties can vary from preparing meals, bathing and dressing to housecleaning and chauffeuring, as well as arranging doctor's appointments and friends' visits and overseeing medications.

Cost Varies Widely

The cost of care varies widely, depending on location and the services being performed, and can range from about $15 an hour to more than $100 an hour. Some families choose to pay a discounted rate to family caregivers, which is also acceptable, lawyers say. It's also much better to set up the caregiver contract when the incapacitated adult is of sound mind, as the arrangements can become far more complicated if a person acting as power of attorney signs the contract.

The contract should also specify whether the payment will be done in one upfront lump sum based on the senior's life expectancy -- a technique often used for Medicaid-planning -- or in regular weekly or monthly payments. It's also wise to create safeguards to prevent a caregiver from taking the money and running, such as depositing paychecks into an escrow account rather than to the caregiver directly.

There are also tax consequences to consider. The compensation is considered ordinary income, so the caregiver has to pay income taxes on the payment. Also, depending on how the contract is structured, Social Security and other payroll taxes may have to be withheld.

Many lawyers say they generally only set up the contracts as part of more-comprehensive estate plans, including power-of-attorney documents and wills, but that the arrangements can cost anywhere from about $500 to several thousand dollars to create.

It's smart to check whether there are other sources of funding you can use to pay family members. Some long-term-care insurance policies, such as those that pay lump-sum "indemnity" benefits, may be used to pay family members who provide care, says Jesse Slome, executive director of the American Association for Long Term Care Insurance in Westlake Village, Calif. If you already have a policy or are considering one, see if the coverage will allow you to pay family members for their caregiving services.

In addition, some state or federal government programs provide funding to compensate family members in what is known as "consumer-directed care." For instance, a growing number of states have a "Cash & Counseling" program for Medicaid enrollees that allows participants to pay family members for their services. Contact your local agency on aging or department of social services for more information on government funding.

Write to Rachel Emma Silverman at rachel.silverman@wsj.com

Choice of Health Care 'Proxy' Often Surprising

In every meeting I have with a new client, I spend a considerable amount of time explaining what a "Health Care Power of Attorney" is, what a "Living Will" is, and the difference between the two.

Many people don't realize that failing to have these documents drafted to fulfill their personal, individual wishes can result in unfortunate circumstances where an unfavored person is making life or death medical decisions for them.

For example; if one-half of an unmarried couple becomes incapacitated, the "other half" has no legal right to make medical decisions for the other. In fact, under HIPAA, they likely have no right to any medical information at all, including whether they are even at a certain location. The parent(s) of the incapacitated person will likely make all medical decisions for them, regardless of whether they have a close relationship or not.

The article below illustrates that going to the "default" of spouse or parent decisionmakers is quite often not what people want. Make sure you are taken care of how you want, and by whom you want by seeing an estate planning attorney today.

Choice of Health Care 'Proxy' Often Surprising

By Alan Mozes
HealthDay Reporter

MONDAY, Aug. 21 (HealthDay News) -- When your health declines so badly that you can no longer speak for yourself and choose your care, who should speak for you?

Ideally, experts say, that's when a legally designated health-care "proxy" would take over. But, according to a new study, the choice of a proxy is often unexpected.

For example, a full third of married individuals said they would choose someone other than their spouse as their proxy, the study found. And female relatives -- such as a mother, a sister or a daughter -- are more likely to be chosen for the role than male relations.

Regardless of who is chosen, "every competent adult should name someone as their agent for health care," said study author Dr. K. Michael Lipkin, an assistant professor of clinical preventive medicine with the department of preventive medicine in the Feinberg School of Medicine at Northwestern University in Chicago.

Otherwise known as a "durable power of attorney for health care", a proxy is a patient-selected adult -- be it relative or friend -- who acts as the decision-maker for all health concerns if and when the patient becomes incapacitated.

"It's like insurance," Lipkin added. "You hope you never need it, and it's likely that only 5 percent of the population is going to get into the kind of crazy trouble that would require it, but that's exactly the point -- it's for the unexpected."

The study was published in the August 2006 issue of the Journal of General Internal Medicine.

In most states, in lieu of a designated proxy, power over health care decisions is automatically granted to spouses or parents if an individual becomes incapacitated.

For many Americans, these "default" choices for proxy may not be the best for them.

In the study, conducted for a six-week period in 1997, Lipkin interviewed 298 adult outpatients between the ages of 19 and 96, in various states of health, all of whom were patients at the General Eye Clinic at the University of Chicago.

These men and women were asked who they would want their doctor to notify in case of an emergency and who they would choose to represent them to execute decisions and deal with doctors if they were too sick to do so themselves.

Over half of the patients also completed a 12-question interview to ascertain attitudes toward choosing a health care proxy.

Among the findings:

* 100 percent of patients could identify a single individual to be their health proxy.
* 28 percent chose someone other than their emergency contact to serve as their proxy.
* Among the 45 percent of patients who were married, one-third did not choose their spouse as their proxy.
* Female relatives were preferred over males. For example, interviewees chose daughters over sons by a margin of 3 to 1, and sisters were twice as likely to be chosen as proxies compared to brothers.
* Nine out of 10 were supportive of doctors asking their patients to choose a proxy, and almost the same number said they would do so right away if their doctor asked them at that very moment.
* However, just over one-quarter said they had ever been asked to consider naming a proxy by their doctors.
* Only 18 percent of those interviewed had a proxy at the time, and just five percent knew for sure that they had given a copy of their proxy to their physician.

Lipkin said the findings should alert physicians that patients are more than willing to discuss the issue of health care proxies and related issues.

Everyone would benefit by talking things over while the patient is healthy, rather than dealing with these potentially difficult decisions when a crisis is at hand.

"What I think the public needs to know is that there's nothing better than having a human being to use their best judgment to speak for you when you can't," said Lipkin.

Living wills are available, but, "as an instructional document, a living will can not anticipate the ever-changing flow of issues when you're in coma, or unconscious or injured, or undergoing surgery," according to Lipkin. "So, a lot of times, the instructional documents alone -- which are static and unchanging -- are misinterpreted. Patients are much better off naming a trusted loved person as their medical proxy and giving them verbal power of attorney for health care," he said.

Another expert agreed. Lis Nielsen, the program director for the Psychological Development and Integrative Science department at the U.S. National Institute on Aging in Bethesda, Md., supported Lipkin's call for a greater focus on health care proxies.

However, she sees the establishment of a health proxy as just one piece of a good advanced-care plan.

Advanced-care planning is "not a one-shot decision," Nielsen stressed. "It's certainly an important part of planning, as people are living longer. But, as the author points out, keeping the channels of communication open is the key. You have to have continuing discussions with whomever you choose to make decisions for you if you become incapacitated, since your preferences can change over time. And you also have to open up an ongoing dialogue with care providers to facilitate having your wishes attended to later in your life."

"So, appointing a healthy proxy is one part of a project that could include a conversation about advanced directives -- namely, stating what I do or don't want to happen to me -- as well as long-term assisted care options," added Nielsen. "Naming a proxy is not a decision that you make and you're done."

More information

For more on health care proxies and other advanced-care issues, head to the AARP.

SOURCES: K. Michael Lipkin, M.D., assistant professor, clinical preventive medicine, department of preventive medicine, Feinberg School of Medicine, Northwestern University, Chicago; Lis Nielsen, Ph.D., program director, Psychological Development and Integrative Science, National Institute on Aging, Bethesda, Md.; August 2006 Journal of General Internal Medicine

Copyright © 2006 ScoutNews LLC. All rights reserved.

Consumer Reports - A Nursing Home Ratings Website

Consumer Reports has launched a new website called the Consumer Reports Nursing Home Quality Monitor which ranks nursing home facilities in each state.

This site included general advice on how to choose a nursing home that is a good fit for you or your loved one, and also has detailed information on which homes have been fined for violating state or federal regulations, and so forth.

Consumer Reports suggests that persons who are interested in learning more about area nursing homes contact their local Area Agency on Aging. In Ohio, call 1-866-243-5678 to find your local agency.

Note: The Ohio Long-Term Care Consumer Guide also provides information on Ohio nursing homes (data compiled by Ohio’s Office of the State Long-term Care Ombudsman. Visit thier website to compare.