10 Tips For Choosing A Caregiver
Over 41 million Americans have a chronic health condition that limits their daily activities in some way, according to the Institute for Health & Aging at the University of California, and 12 million are unable to live independently. Of the one out of five elders who have attained age 85, more than half are impaired and need long-term care — that is, the personal assistance that enables them to perform daily routines such as eating, bathing, and dressing.
Most people want to continue to live in their own homes for as long as possible. For those who are elderly and have disabilities, that may be possible only with outside help.
Most people who need help with their daily activities rely on unpaid care provided them by family members and friends. More and more, however, seniors and their families are recognizing the benefits of hiring caregivers, to help stay in their homes longer, in comfort and safety, and to give families peace of mind. Likewise, many states and the federal government are now setting aside some funds to allow people who otherwise could not afford it to pay for outside help.
1. Assess Your Home-Care Needs
Evaluate the help that is needed in the areas of health care, personal care, and household care.
Do you need home health care, such as physical therapy or medication management?
Do you need non-medical personal care, such as help with bathing, dressing, toileting, and meal preparation, or are you looking mainly for a companion or sitter?
Do you need help with housecleaning, shopping, home maintenance, and running errands, or with bill-paying and managing your money?
2. Write a Job Description
Write out a job description based on the help that is needed. Be sure to include:
• Health care training needed (level and what type: Certified Nursing Assistant, Licensed Practical Nurse, Registered Nurse) • Driving (car needed or only valid driver’s license) • Ability to lift care recipient and/or operate special equipment
3. Develop a Job Contract
The job contract is based on the job description and should include:
• Wages; when and how payment will be made
• Hours of work
• Employee’s Social Security number (because you must report wages paid to the caregiver to the Internal Revenue Service)
• Job description
• Unacceptable behavior (such as smoking, abusive language, tardiness, etc.)
• Termination (how much notice, reasons for termination without notice, etc.)
• Dated signatures of employee and employer.
4. Know Where to Look for a Caregiver
Identify the pool from which you can find a caregiver. You may have neighbors or friends who would be good prospective caregivers. If you belong to a church, ask your pastor or minister for prospects. Family members are OK, but first and foremost, hiring, managing, and firing a caregiver are all business decisions, and for that reason, many family members don’t make good paid help.
Hire a professional caregiver if you can afford it.
5. Prepare for the Interview
Prepare a list of questions to ask. Have a list for any applicant, caregiver agency, referral source, or reference you may call during your search. If you don’t know what questions to ask a private caregiver, call a caregiver agency. The agency should be helpful, because you are a prospective customer.
6. Interview Applicants
After you have screened applicants on the telephone, you should interview in person those who sound acceptable. Invite a friend or family member to sit in on the interview to provide a second opinion. Always observe interactions between the worker and the person who will be receiving care.
If you are interviewing a caregiver agency, ask to interview the in-home caregivers yourself. Many agency employees look good on paper, but will not be a good fit for you, for cultural, religious, social, or any number of reasons. You may just not like the person the agency has assigned to you.
7. Check References
It is important to check references carefully, talking to everyone who is given as a reference. You are looking for someone who is dependable and reliable as well as someone who is qualified to do the work.
8. Get a Criminal Background Check
People who are paid by state funds usually must always pass a criminal background check. But even if someone does not have a conviction for a disqualifying crime (which would be identified through the background check), he or she may have convictions for offenses that would concern you or present a safety risk (using drugs; driving under the influence of alcohol or drugs; driving without a driver’s license or insurance).
If you are hiring an agency or from an agency, make sure that the agency does criminal background checks. Many states’ laws require a background check, but that doesn’t mean it has been done.
9. Hire Thoughtfully
You want to hire a caregiver who has experience in the specific areas in which you need help. People who have Alzheimer’s disease often need help with toileting and bathing, for example, so look for someone who has experience in working with elders with this illness.
Try to hire a licensed and bonded caregiver. If the agency is not licensed or bonded, you may want to look somewhere else. Likewise, that probably disqualifies your next-door neighbor or churchgoing companion, who you may want to hire nonetheless because the person meets all of your other requirements.
10. Monitor
Set up a schedule to monitor the quality of the services the caregiver provides. This is especially important for family members. Do this by making personal contact with the caregiver and regular home visits with the elder, and getting periodic reports from the caregiver and the agency.
Consider hiring an independent geriatric care manager to monitor if you are unable to do it yourself.
Have a backup plan in case the caregiver or the agency fails to follow through or problems arise.
Watch for signs of abuse, neglect, and exploitation and report suspicious activity to the agency and state authorities.
Reproduced with permission of Tim Takacs.
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A Power of Attorney can be used to give another person the right to sell a car, home, or other property in the place of the maker of the Power of Attorney. A Power of Attorney might be used to allow another person to sign a contract for the maker of the Power of Attorney (the person who makes a power of attorney is called the “principal”). It can be used to give another person the authority to make health care decisions, do financial transactions, or sign legal documents that the principal cannot do for one reason or another. With few exceptions, Powers of Attorney can give others the right to do any legal acts that the makers of the Powers of Attorney could do them themselves. A General Power of Attorney gives the “power of attorney Agent” or simply “Agent” (the legal name of the person who is authorized to act for the principal) very broad powers to do almost every legal act that the principal can do. When Elder Law Attorneys draft general Powers of Attorney, they still list the types of things the Agent can do but these powers are very broad. People often do general Powers of Attorney to plan ahead for the day when they may not be able to take care of things themselves. By doing the General Power of Attorney, they designate someone who can do these things for them.
Normal Powers of Attorney terminate if and when the principal becomes incompetent. Yet many people do Powers of Attorney for the sole purpose of designating someone else to act for them if they cannot act for themselves. It is precisely when persons can no longer do for themselves that a Power of Attorney is most valuable. To remedy this inconsistency, the law created a Durable Power of Attorney that remains effective even if a person becomes incompetent. The only thing that distinguishes a Durable Power of Attorney from a regular Power of Attorney is special wording that states that the power survives the principal’s incapacity. Even a Durable Power of Attorney, however, may be terminated under certain circumstances if court proceedings are filed. Most Powers of Attorney done today are durable.
Yes. At the time the Power of Attorney is signed, the principal must be capable of understanding the document. Although a Power of Attorney is still valid if and when a person becomes incompetent, the principal must understand what he or she is signing at the moment of execution. That means a person can be suffering from dementia or Alzheimer’s Disease or be otherwise incompetent sometimes but as long as they have a lucid moment and are competent at the moment they sign the Power of Attorney, it is valid even if they do not remember signing it at a later date. At the time it is signed, the principal must know what the Power of Attorney does, whom they are giving the Power of Attorney to, and what property may be affected by the Power of Attorney.
Any competent person eighteen years of age and older can serve as an agent. Certain financial institutions can also serve. There is no course of education that agent must complete or any test that Agent must pass. Because a Power of Attorney is such a potentially powerful document, agents should be chosen for reliability and trustworthiness. In the wrong hands, a Power of Attorney can be a license to steal. It can be a big responsibility to serve as an agent.
For Medicaid
Medicare is health insurance and covers medical services such as physician appointments, therapy, blood tests, x rays, medical procedures and hospitalization. Medicare will sometime pay for rehabilitation in a long-term care facility for a period of 20 to 100 days, but not longer. In long-term care, Medicaid covers the cost of ongoing support services for daily functioning, such as room and board in a nursing home.
Medicaid is a federal program that is overseen by the Center for Medicare and Medicaid Services (CMS). In Pennsylvania, Medicaid is called Medical Assistance and is administered by the Department of Human Services (DHS).
In Pennsylvania, Medicaid funds are not available to pay for assisted living or personal care.
For Medicaid to pay for care in a nursing home, an individual recipient must be determined to need a nursing home level of care by a physician and the local Office of Aging. An individual whose income is not greater than three times the poverty level may keep up to $8,000 of total resources, but may otherwise keep only $2,400. The cash value of life insurance counts as a resource, but one car and a residential home does not count as a resource.
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At Keystone Elder Law, we believe that the physical, social, legal, and financial considerations of our clients all intertwine. We utilize an interdisciplinary approach to evaluate each area, which allows for the creation of a plan that addresses the concerns of the individual as a whole as well as the family. To this end, our model of practice includes a Care Coordinator (usually a nurse or social worker), whose expertise complements our team of attorneys.
When the road of life is smooth, decisions about legal and financial matters are easy to push aside for “a rainy day.” Planning ahead, however, will allow for more options as you view the map of where you’ve been and where you want to go. Don’t let a crisis limit your choices or derail your plans.
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