Several options are available for finding home care help in California. There are home health agencies that can help with the hiring of a helper, for a given fee, of course. In many cases, a more affordable solution is for the primary caregiver to hire in-home help privately. This requires more research and planning, but it is possible.

California caregivers should first contact their local Caregiver Resource Center in order to find out what kind of help is most required and what types of resources are already available in the community. After this is established, the remaining duties that cannot be fulfilled by a local caregiver resource center can be detailed in a written job description. In essence, the caregiver should write a job description for a prospective home helper that includes what kind of help is needed and what duties need to be carried out. This job description should be designed as a work contract and be signed by the caregiver and the in-home helper.

A typical home care provider job description should include the following information:

Expected duties

Unacceptable behavior (swearing, smoking, etc.)

Termination procedure and conditions

Wages/benefits

When/how payment is made

Work hours

The next step involves finding an appropriate individual to fill the job description. Referrals can be solicited from friends and relatives; however, church groups, synagogues, nursing homes, and assisted living facilities may also provide a good personal recommendation. The job can also be posted on a bulletin board at a nursing college or school focusing on geriatric care. Nonprofit community centers may also be a good source of information on home care applicants, and most community centers do screen their applicants.

Once applicant inquiries about the job begin, one or (probably) several interviews will need to be conducted. It is not necessary to conduct personal interviews for every applicant; an initial phone screen is far more convenient and appropriate for providing general information and asking questions. Some of the information to be provided includes the job description, hours, and pay. The applicant should be asked about his/her work history and references.

If the applicant passes the initial phone screen, a one-on-one interview should then be conducted. At the interview, be sure to provide a sample work contract and job description for the applicant to read. Be sure to ask the following questions too:

Where have you worked previously?

What job duties have you performed?

What training/education do you have regarding elderly/disabled person care?

How would you handle a situation where the elderly/disabled person was stubborn, angry, or sad?

Are you not comfortable performing any of the stated job duties?

Do you have a car? Would you be able to drive to a store, medical appointment, or other location with the elderly/disabled person?

What time commitment are you willing to make for this job?

Are you comfortable dealing with a mentally challenged individual who has memory issues?

Can you provide some work references and a personal reference?

Once the interview is finished, first impressions of each job applicant should be written down immediately. At least two of the references should be checked. Once the applicant is hired, a written statement should be sent to him/her detailing the start date, the number of hours he/she is expected to be on the job, and the pay scale.

Legally, a household employee should be covered by the employer’s homeowner’s insurance in case of an accident. Household employees who are paid over $1,000 per year must have a Social Security tax of 7.65% withdrawn from their pay and then filed with the Internal Revenue Service on an annual basis. The employee is also obligated to pay 7.65%.

Employers should report the household employee’s wages and taxes on their 1040 tax forms. The employers must also fill out a W-2 form and provide a copy to the employee. A W-3 form is required is there is more than one employee.

Should the employers pay $750 or more to a home care employee in one calendar quarter (e.g., April to June), they must register with California’s Employment Development Department (EDD), withhold state disability insurance, and provide quarterly employee earnings reports.

Employees are required to fill out an Employment Eligibility Verification form (I-9) and provide a copy of this form to the employers before beginning work.

Resources:

California Caregiver Resource Centers http://www.cacrc.org/californiacrc/jsp/home.jsp

Employment Development Department http://www.edd.ca.gov/

In her blog, “My Mother’s Brain: love in the times of dementia,” Beatriz writes about her day-to-day experiences as a caretaker for her mother.  She writes about flying the 600+ miles to her mother’s home in El Paso, Texas, only to find her mother unable to recognize her. She writes about her frustration with her mother’s insistence on collecting aluminum cans from a public garbage can, or with taking off her swimsuit in public. Most poignant of all is Beatriz’s description of how she still craves her mother’s advice and reassurance, and how dearly she misses it.

Beatriz and her sister currently provide home care for their mother, but they also take advantage of adult day care and Medicaid worker services in the state of Texas. They are agonizing over the possibility of placing their mother into a nursing home when their her condition worsens. Both Beatriz and Angelica were raised with a strong sense of family obligation and duty, and the idea of having strangers looking after their mother inspires both their guilt and fear.

Even the current cost of care for Beatriz’s mother is not cheap. Both her supplemental Social Security and pension checks total no more than $11,000 per year, which would never cover the cost of care in a skilled nursing or even an assisted living facility. While Medicaid does pick up the cost of adult day care and in-home services and equipment, there is a significant amount of reimbursement paperwork to be filled out. And then there are the procedures that need to be performed immediately, such as a tooth extraction; through several blog posts, Beatriz describes how she and her sister lament over how they will be able to pay for the immediate dental care that their mother requires.

The situation with Beatriz’s mother is much different than that of her mother-in-law, who also suffers from Alzheimer’s Disease. In the case of Beatriz’s mother-in-law, Nina, because the woman had better financial means, as well as long term care insurance, she is currently being cared for by the skilled nursing staff of a top-rated Texas memory care facility. This is fortunate, because Nina’s condition has progressed to the point where she can no longer walk, talk, or even feed herself.

Beatriz is often charged with conducting research on ways to enlist the help of Social Service and health agencies for her mother’s care. As a result, she knows about and provides a list of such service organizations in the state of Texas. Some of these organizations are geared towards Latinos, who make up a significant percentage of the Texas population.

The Texas Association of Community Health Centers (TACHC)

La Voz del Anciano (a referral agency for lower-income and elderly Latinos)

Sandra Bond Chapman’s Center for BrainHealth.

Beatriz also writes extensively about the Alzheimer’s Association, and how the organization can provide needed advice, referrals, and support group information in the state of Texas. Dallas has its own local Alzheimer’s Association chapter, which can be visited online at  www.AlzDallas.org.

JACC provides a wide range of home care services to the participant, including homemaker, respite, adult day care, home-delivered meal, transportation, and caregiver training services. The cost of certain medical equipment, as well as accessibility adaptations (e.g., mobility scooters), may also be covered. All required services and items are drawn up in a Plan of Care which is developed in collaboration with the participant and his or her Care Manager.

The JACC program is not a Medicaid sponsored program. Instead, the JACC program is a New Jersey supported program which serves those individuals who are deemed ineligible for Medicaid. The cap on JACC program services is $7,200 a year or $600 a month. Services providers for the participant must meet qualification requirements and be competent in their field. However, in collaboration with his or her own Care Manager, the program participant can employ his or her own service providers.

Qualifications for a participant in the JACC program include residency in the state of New Jersey, an age of 60 years or older, the owning or renting of a home (or residency in the private home of a relative or friend), and U.S. citizenship or legal alien status. The participant must also have no alternative means for securing the skilled nursing and other services that he or she needs.

Financially, the JACC program participant must be deemed ineligible for Medicaid, have a monthly income that is no greater than 365% of the federal poverty level (i.e., no greater than $3,296 per month), and have personal financial resources no greater than $40,000 (or $60,000 per couple).

There may be a co-pay involved in receiving JACC program services, and this co-pay is applied on a sliding scale basis, dependent on personal financial resources and income.

To apply for JACC, New Jersey residents may call 1-877-222-3737, or they may write to or contact the following agency: 

New Jersey Department of Health and Senior Services
Division of Aging and Community Services
PO Box 807
Trenton, NJ 08625-0807
Phone: 1-800-792-8820

Home care can be a wonderful alternative to a nursing home, allowing the participant to maintain his or her dignity and independence. The JACC program is available in every county throughout New Jersey, provides professional yet personalized services, and is a more cost-effective option to skilled nursing and nursing home care.

For elderly individuals who participate in the LIFE-St. Agnes Continuing Care Center program, a full spectrum of home care services are provided, including adult day care at a day center (transportation included), medical (including vision and hearing) and skilled nursing care, meal plans, home-delivered meals, physical therapy, psychiatric counseling, pastoral care, caregiver respite, transportation, housekeeping, personal emergency response systems, prostheses, and personal care (e.g., bathing). These services are available 24 hours a day, and 7 days a week. LIFE is based on the national All-Inclusive Care for the Elderly program, which aims to maintain the independence of elderly individuals living in their homes for as long as possible.

In order to qualify for either of the two LIFE programs operating in the city of Philadelphia, the applicant must first be assessed and deemed as requiring nursing home care. The applicant must also be 55 years of age or older and live in the service area. At that point, a team of LIFE nurses, physicians, and other health professionals will create a personalized home care plan for the person. A LIFE physician will become the applicant’s primary care provider, and payments for the program will be paid out monthly from Medicare and Medicaid.

Private applicants can also apply for and take advantage of the LIFE program’s services; their payments will be (on average) a total of $4,257 per month (in essence, the amount that Medicare would pay). While this sum is generally more than what is typically expected for a non-residential skilled nursing care program, it is still less than what a typical nursing home would charge. Of course, if the LIFE program participant spends almost all of his/her assets paying for the program, he/she then becomes eligible for Medicaid coverage.

In the city of Pittsburgh, there are two comprehensive LIFE programs, called LIFE Pittsburgh and Community LIFE. These programs have about 500 participants. The Pittsburgh programs are especially geared towards lower-income individuals who have serious health problems and require home care as well as some adult day care. These programs are also intended for individuals who are 60 years of age and older.

More information about Pennsylvania’s LIFE program may be obtained by calling 215-573-7200. The phone number for St. Agnes is 215-339-4747.

When the demands of caregiving become too great, many Virginia caregivers make the difficult yet wise decision to place their loved ones into assisted living facilities that specialize in Alzheimer’s care. There are many qualified assisted living facilities in Virginia that offer the specialized type of care that is required for Alzheimer’s patients. Staff at these facilities are on-call 24 hours and 7 days a week, supervising activities such as meal preparation and medication dispensation. In fact, one such assisted living facility in Virginia, the Morningside Assisted Living Facility, even offers a revolutionary memory recall program called the “Bridge to Rediscovery”.  

The staff at Virginia’s Morningside Assisted Living Facility engage their residents in a series of activities intended for memory recall. Some examples include having the residents bake bread, set the tables, and clean up after a meal is finished, activities in which they may have frequently engaged back when they ran a household. Residents also receive salon treatments while watching television shows such as “I Love Lucy,” since these leisure activities may also have been a part of their past regimen. The aims here are to utilize the residents’ senses of sight, hearing, touch, taste, and smell in order to stimulate their memories, as well as to keep them physically and mentally active. These activities also fall in line with the Alzheimer’s Association’s recommendation that keeping one’s mind active helps retard the progression and alleviate the symptoms of Alzheimer’s Disease.   

Such memory recall activities can certainly be performed by caregivers of Alzheimer’s patients who still live in the home with their family or friends. Unfortunately, the demands of work and family, paired with the responsibilities of caregiving, often prevent family and friends from providing such unique care. For this reason, it is often more realistic, as well as beneficial, to place a person suffering from Alzheimer’s Disease into an assisted living facility in Virginia.

Reference:

Morningside in the West End Assisted Living http://www.morningsideinthewestend.com/

Federal programs such as Medicaid and Medicare do pick up some of the costs of long term care; however, both programs require that certain conditions first be met. Regarding Medicaid, this is a state and federal assistance program that covers long term care costs for low income individuals. In order to qualify, most people will need to first pay for long term care out-of-pocket until their assets have dwindled to no more than several thousand dollars. At that point, Medicaid eligibility usually begins.

Medicare is a health insurance program typically used by individuals who are 65 years of age and older, or individuals who are under 65 and have a qualifying disability such as Alzheimer’s Disease. Medicare can pay for a variety of long term care programs, including skilled care in a nursing home, assisted living care, or skilled nursing care in the individuals’ home.

Should an individual not qualify for either Medicaid or Medicare, the cost of long term care will need to be covered either out-of-pocket, through a long term care insurance policy, or possibly via an alternative insurance policy.

Many individuals assume that their current insurance covers long term and/or skilled nursing care. However, unless this is expressly stated in the policy, most insurance carriers do not provide such coverage. This lack has left many individuals either bereft of much needed long term(and especially skilled nursing) care in their advanced years, or resigned to spending almost all of their hard-earned money in order to qualify for Medicaid coverage.

To address this issue, the state of Texas initiated the Long Term Care Partnership Program. This program, which is a partnership between private insurers and the state, provides Texans with incentives for purchasing long term care insurance policies. One of these incentives include an asset disregard benefit, which means that every dollar that the long term care policy pays out to the assisted living facility or nursing home is then disregarded by Medicaid when determining coverage eligibility. In other words, an individual will not need to “spend down” his or her personal assets in order to qualify for Medicaid.   

Another incentive is inflation protection, which permits the long term care policy to pay for long term care even as its costs increase. Inflation protection is based on the age of the policy holder. For someone who is under 61 years of age, he or she is required to purchase 5% compound annual inflation protection. From age 61 to 76, some form of inflation protection must be purchased, although it no longer needs to be annual. After age 76, most insurers will offer free inflation protection, so the individual no longer needs to purchase or retain such coverage.

The third incentive is tax deduction, meaning that an individual who is paying for a long term care policy premium may be able to deduct part of the cost of the policy from his or her income taxes as a medical expense. In addition, any policy benefits that are paid out are not taxed as income.

The bottom line, when considering long term care in the state of Texas, is to look into the state’s Long Term Care Partnership Program. This program provides several useful benefits to those who purchase long term care insurance policies. Most importantly, such insurance covers the majority of costs associated with long term care, especially skilled nursing care.

The Long Term Care Partnership Program was developed nearly 30 years ago in order to provide individuals with a method for financing their long term care and skilled nursing needs. In 2005, Florida directed the Agency for Health Care Administration (AHCA) and the Office of Insurance Regulation (OIR) to create a program that would provide incentives for individuals who purchased such policies. By 2006, a senior protection bill was also passed, making long term care insurance available and affordable.

What are the benefits of the Long Term Care Partnership Program? The first is that individuals are encouraged to purchase long term care insurance that will protect their assets should they ever require long term or skilled nursing care. The second benefit is that individuals who have a long term care policy and who then apply for Medicaid coverage are assured of asset protection. The asset amount that is protected is equal to the amount first paid out by the policy for long term and/or skilled nursing care.  

In order to better understand how the long term care partnership program works, consider the following example: a woman who is in her early 50′s purchases a qualified long term care insurance policy which offers $300,000 in asset protection. When that woman turns 75 years of age and requires nursing home care, her policy pays out $300,000 for the cost of her care in the nursing facility, after which Medicaid pays the bills. The woman keeps $300,000 of her own money.

Additional information about Florida’s Long Term Care Partnership Program is available via Florida’s SHINE (Serving Health Insurance Needs of Elders) program. This program helps individuals assess what their long term care needs might be and to plan for those needs. Various long term care options and costs are listed on SHINE’s Long-Term Care Insurance Self-Assessment Guide.

Reference:

SHINE (Serving Health Insurance Needs of Elders)

http://www.floridashine.org/longtermcare.html

Elder Helpline: 1-800-96ELDER (1-800-963-5337)

The article reports that the majority of California’s 440,000 registered home care providers, whether paid or unpaid, face considerable emotional, physical, and financial issues due to their increasing elderly caregiving responsibilities combined with their lack of training. These problems are exacerbated if the aging individual being cared for has a chronic and debilitating condition such as Alzheimer’s Disease.

By 2011, the first wave of baby boomers (i.e., those born from 1946 – 1964) will be age 65 or older and account for 11% of the current California population. By 2030, California’s over-65 population is expected to double or even triple. Nationally and in California, 80% of seniors age 65 and older have one chronic illness, while 50% have at least two. As a whole, home care providers are more likely to care for someone who has a chronic issue such as an emotional/behavioral problem, dementia/memory loss, stroke, or paralysis.

Combined with the influx of elderly individuals, some of which have these chronic conditions, is their hope of living an active post-retirement lifestyle. For home care providers, many of whom are the adult children of these baby boomers, providing appropriate eldercare is often difficult under these circumstances.

These findings are based on an analysis of caregiving data derived from California’s In-Home Supportive Services (IHSS), which is an agency that provides caregiving services for elderly and disabled individuals. These data derived from the IHSS indicate increased caregiver workloads and costs from 2005 to 2009. More recently, the threat of budget cuts to the IHSS means that caregivers will receive even less basic training and support. Lack of adequate preparation “increases the probability that they themselves will suffer from breakdown, neglect and abuse,” according to Gloria Barrett and Mary Blackburn, the authors of the report.  

Concluding advice from this article includes the recommendation that both paid and unpaid caregivers obtain training and support in areas including bowel and bladder care, dementia/memory loss, food safety, cancer, hypertension, diabetes care, infection control, skin care, fall prevention, heart attacks, and self-neglect. This recommendation was provided with the intention that a better educated home care and eldercare workforce stands a better chance of being less overwhelmed and stressed by the challenge of caring for someone.

Reference:

California Agriculture, October-December 2010 Volume 64, Number 4

The Golden State goes gray: What aging will mean for California

http://ucanr.org/repository/CAO/issue.cfm?issue=current

The federal government defines an SNF as one that is certified to accept Medicare coverage for its services. In order to be licensed in the state of Virginia, an SNF must provide 24-hour licensed nursing care and have a Registered (degreed) Nurse (RN) on duty for a least one eight-hour work shift every single day. The skilled nursing may be provided at several licensed nursing levels, including Licensed Practical Nurse (LPN), Registered Nurse (RN), Clinical Nurse Specialist (CNS), and Registered Nurse Practitioner (RNP).  The variety of training levels in the nursing staff enable patient needs to be matched with appropriate nursing training levels.

Some facilities may also enlist the help of Certified Nurse Aides (CNAs), which are not licensed or registered. In the state of Virginia, CNAs must complete a certified 120-hour training program, pass a competency test within four months of being hired to work in an SNF, and be registered with the Virginia Nurse Aide Registry. CNAs perform basic health and other services for patients, also known as Activities of Daily Living (ADLs). Specific ADLs can include bathing, dressing, eating, toileting, assistance with instrumental ADLs, changing of linens and other housekeeping duties, and meal preparation.

Skilled nursing is typically recommended for a patient whose day-to-day health condition is not in jeopardy but who still requires 24-hour nursing care services. Should the patient’s health condition become acute, he or she can be moved to a hospital upon a physician’s orders. Most (70%) SNF admissions occur as the result of a hospitalization due to illness and/or injury. Skilled nursing care may also be recommended for patients who are in the recovery and/or rehabilitation process, terminally ill, or who have chronic medical needs.

Although an SNF is staffed by nurses and nurse aides, Virginia’s nursing facility licensing requires that each resident be seen by a physician every 30 days for the first 90 days of care, followed by every 60 days. For SNFs that are Medicare-certified, physicians must see residents within 14 days of their admission to the SNF, followed by every 30 days.

In the state of Virginia, SNFs provide much needed services for incoming patients and long-term facility residents. In the event that there are patient or family concerns about a specific SNF, a long-term care ombudsman can help address them. SNFs must comply with state and federal licensing and certification requirements, which are routinely reviewed (and enforced) by Virginia authorities.

Recently, the New York State Office for the Aging (NYSOA) conducted a Caregiver Support Program Participants Survey in order to better gauge informal caregivers and find out about their caregiving concerns. By performing this survey, the NYSOA intended to become better informed about which of its services were being utilized and working well, and which services required improvement. Over 1,100 caregivers were randomly sampled from 30 of New York’s 59 local Area Agencies on Aging (AAA) and sent surveys by mail. Over 600 of these sampled caregivers responded to the survey.

What the survey reported out was the following: 79% of caregivers in New York are female and at an average age of 64. The majority of these caregivers are non-Hispanic (93%), white/Caucasian (87%), and married (66%).  

On the care recipient side, the majority of care recipients are likely to be female (64%), be 75 years of age or older (85%), have Alzheimer’s Disease or dementia as their most prevalent health condition (75%), and have at least one functional impairment, such as difficulty with walking, eating, or dressing (85%).

The person who is most likely to provide care is the daughter (48%), followed by the wife (23%). In 54% of the cases, the care recipient lived with the caregiver. Caregivers often reported that their loved one would probably need to be placed into a nursing home or other long term care facility if not for their care.

The most common benefits of caregiving that caregivers reported were the following: helping the care recipient/family, satisfaction, accomplishment, being appreciated, and having companionship. The most common burdens of caregiving were the following: emotional strain, not having enough time for oneself and for one’s family, physical stress, social life conflicts, health effects, work interference, and financial costs. These burdens were especially felt when the caregiver provided long term care (defined as greater than four years).

Caregivers reported that they often took advantage of various state (NYSOA) and local AAA services such as information and assistance, respite care, and caregiver counseling, training, or education. Caregivers also expressed a desire that the amount of services they receive be increased, that the services be provided in a less complicated manner (e.g., less bureaucracy and paperwork), that services be provided sooner and with a shorter waiting period, that services be provided consistently (i.e., one worker each time), and that there be an easier way of accessing services.

Thus, while it was evident that NYSOA/AAA services are being utilized by caregivers, more formal services, such as caregiver support programs and community-based services, are also required. These programs will help prevent caregivers from feeling overburdened and overstressed and allow them to continue providing long term care. The end result will be the prevention or at least the delay in having a loved one enter a nursing home or assisted living facility.   

Reference:

Sustaining Informal Caregivers, New York State Caregiver Support Programs Participants Survey, Report of Findings on the Aging Services Network, 2009.

http://www.aging.ny.gov/Caregiving/Reports/InformalCaregivers/SustainingInformalCaregiversPOMPSurveyReport.pdf