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Getting Support For An Older Adult Living At Home

Even when they need some help with daily living needs, most older Americans, studies show, still prefer to stay in their homes. As a result, most support for the elderly is delivered in their homes, usually by family members.
Being the primary caretaker for someone who requires assistance with activities of daily living, such as walking, eating, and toileting, can be a consuming and sometimes exhausting task. To help with these responsibilities, families often turn to adult daycare or to home care services, and sometimes both. Following are details on these options, including the tax implications of hiring a caregiver and ways to keep a home safe for an older person. The last section provides information on the new profession of geriatric care manager, which has evolved to help families coordinate services for a senior in need of care.

ADULT DAYCARE
Adult daycare provides a safe social environment for those unable to remain at home alone during the day, and it also serves as a respite for caregivers. There are more than 2,000 such centers around the nation, usually affiliated with churches or nonprofit community agencies. Adult daycare can be a cost-effective alternative to placing a family member in a nursing home. It can also provide otherwise homebound seniors a chance for more social interaction with their peers. Adult daycare centers typically offer: social activities; medical and health services; a nurse on duty; some provide services like speech or occupational therapy; supervised recreation; assistance with daily activities, such as eating or dressing; and at least one meal – usually a hot lunch.
Some programs specialize in individuals with specific medical conditions (such as Alzheimer’s disease), while others are for any older person who needs help with ordinary tasks. (Not all programs accept people with Alzheimer’s.)

The settings can range from brand-new facilities to nursing homes or church basements. Transportation may be provided, and people generally attend three to five days per week.

The average cost is about $40 per day, although subsidized programs are available for only a few dollars per day. At the other extreme, some programs can run more than $100 per day. Insurance or Medicaid may cover some of the costs, and the adult child who incurs the expense may qualify for Dependent Care Tax Credit on his or her tax return.

To find an adult daycare, contact the local Agency on Aging. For a directory of Agencies on Aging, consult the Eldercare Locator, <www.eldercare.gov>. The website for the Extended Care Information Network, <www.extendedcare.com>, allows you to search by zip code or city/state to find adult daycare in your area.

HOME HEALTH CARE AGENCIES
If your or a family member needs home care services, you can hire a worker on your own or find one through an agency. Although it will usually cost more to work with an agency, many families find the extra costs worth it. An agency will typically: screen and select the home care worker for you; take care of all paperwork pertaining to hiring, pay, taxes, and insurance; get a worker to your door quickly – usually within a day or two; provide a backup on a day the worker is unavailable; supervise the worker; and provide bonding or insurance.
There are some drawbacks to working with an agency, however. You may not be able to choose whom your worker will be and you may not have the same worker every day. The agency may also limit what the worker can and cannot do for you.

Here are some questions to ask a home health care agency you are considering using:
• What licenses do you hold?
• How much experience do your workers have with the patient’s types of needs?
• Are services available on weekends, holidays, or at night?
• Do you accept Medicare or Medicaid?
• How do you screen your workers?
• Do you use your own employees or do you rely on contract staff?
• Will the same person provide the services every day?
• Are your workers licensed and/or insured?
• What kind of training do the workers receive?
• How will you coordinate services with our physician?
• How do you handle complaints?

You may be referred to an agency by a hospital discharge planner or other medical provider. If you meet the income requirements, you may be able to work through a state- or county-funded public home care agency, which provides services at discounted rates. Or you can contact an agency privately. ExtendedCare.com and another website, <www.carescout.com>, both offer listings of home care agencies.

TAX AND LEGAL RESPONSIBILITIES
If you hire an in-home caregiver, you have legal obligations as an employer. Be sure to check with legal, tax, or financial advisers to obtain more details on these responsibilities and any additional rules that may apply to your family’s particular situation.

You have tax obligations if you pay an in-home caregiver a certain amount of money and the government considers the worker to be an “employee” (rather than an independent contractor or an employee of an agency).
There are no hard-and-fast rules about when a caregiver is considered an employee, but among the factors the IRS considers are whether the caregiver comes into your home on a regular basis and whether you control what work is done and how it is done. A caregiver sent by an agency might be considered an employee of the agency if it sets the fee and exercises control over the work.

If you have exceeded the payment threshold and your caregiver is considered your employee, you must report and pay Social Security and Medicare taxes on that employee’s wages (unless the employee is under age 18). You and the caregiver each owe 7.65% of the caregiver’s wages, which you file annually using Schedule H. You are responsible for either withholding your employee’s share from his or her paycheck or paying the taxes yourself.

If you pay more than $1,000 in any calendar quarter to caregivers or helpers, you will also owe the state and federal government unemployment insurance tax.

MAKING A HOME SAFE FOR AN OLDER ADULT
Older adults are more likely to be injured in the home than any other age group. Falls are the major threat, accounting for half of all injury deaths among people age 65 and older. Other leading dangers are fire and scalding water. Some basic home safety measures can prevent many accidents and injuries.

A good place to start in reducing hazards in the home is to review the older person’s daily routine and make a list of needed safety improvements. Many of the improvements are steps you will be able to take on your own. Others may require the help of family members or professionals. 

GERIATRIC CARE MANAGERS
The families of those who require long-term care face a bewildering array of choices and questions. Is a nursing home necessary? If so, which one? What about care at home? Who will pay for it?
Answering these and other questions requires not just medical know-how but expertise in elder law, financial services, insurance, social services, and counseling as well. A new profession – that of “private geriatric care manager” – has evolved to help families think through these issues and coordinate services for the person in need of care.

Geriatric care managers usually have a background in social work, nursing, psychology, or law and are well enough versed in other areas to offer sound advice and to refer to a specialist when necessary. All have experience or training in gerontology. A geriatric care manager can: evaluate the patient to determine the necessary level of care; assist in finding a nursing home or investigate and recommend alternatives; make all arrangements for the delivery of health care services; review financial, legal, and medical issues; monitor care once it is being delivered; serve as a liaison to families at a distance, making sure things are going well and warning of problems; and serve as an advocate for the patient and the family.

Some hospitals and public agencies have social workers who serve as geriatric care (or case) managers. However, such services are usually limited to the time the patient is under the agency’s care and these workers’ time is often stretched too thin to provide the level of assistance that patients and their families need. Some non-profit agencies provide care management services on a sliding-fee scale, with payments based on one’s income.

Fees range from $50 to $100 an hour, and some care managers charge a flat fee for the initial assessment, which can range from $200 up to $750.

The field of private geriatric care managers is growing and chances are there is, or soon will be, one of these professionals in our area. To find one near you, visit <www.caremanager.org>.

This material is not intended to replace the advice of a qualified attorney, tax adviser, investment professional, or insurance agent. Before making any financial commitment regarding the issues discussed here, consult with the appropriate professional.

Reprinted with permission from MFS Investment Management®, © 2003.

For more information, contact Boz Marchi, CRPC, a personal finance representative with Allstate Financial at Walters Insurance Agency in Wake Forest. He may be reached by phone at 673-6449 or via e-mail at bozboz@allstate.com.