Personal Care Arrangements

We like to think of our parents as being around forever but the inevitability of time and the aging process robs us of this desire. But before their time is up, there may be a period where your parent is no longer able to be self-sufficient or to perform many or all activities of daily living (ADL). To care for your loved one, personal care arrangements may need to be considered.

The signs that your parent or loved one needs assistance are evident. Their driving ability is no longer safe, memory lapses become more pronounced, falls are becoming frequent, there are unpaid bills and episodes of confusion. In some cases, your parent may be found wandering around the mall with no idea of how they got there or how to get home. If these and other scenarios are playing out, then you should have a family meeting to discuss the future care of your parent as well as personal care arrangements.

One way of caring for your parent is by hiring either a family member or a trained home caregiver to be with your parent as much as needed. Whether it is a family member or other person, that individual needs to be compensated. If a family member, this can mean giving up other employment and moving in with the parent or vice versa. In any case, you must create a formal contractual arrangement. These are called elder care contracts, personal support services agreement or caregiver contracts.

Personal Care Contracts

Compensation

If a family member agrees to become a caregiver, compensation can come from long-term insurance or Medicaid.  In Massachusetts, in-home Medicaid eligibility depends on the person’s functional abilities, their location and the personal assets of the applicant to qualify for the Home and Community Based Services (HCBS) Waiver. There are different ways to qualify for this assistance and getting sound advice from an elder law lawyer is essential.

The compensation can also come from other family members and should be based on the market rates for homecare givers, which is easily obtainable. You need to take certain deductions from their check as required by law. Health and workers’ compensation insurance may be needed as well.

Care Assessment

Before entering into the arrangement, have your parent assessed by a physician. A current physical examination is needed as well. The results can form the basis of the duties the caregiver can be expected to provide that should be detailed in the personal care contract.

Contents of the Contract

 A written contract is needed for many reasons. If your parent has to eventually enter a nursing or assisted living facility to be paid for by Medicaid, you must show that the compensation paid was a legitimate expense and not intended to hide assets or was a “spend down” so that the senior could qualify for benefits.

The written contract also should clearly set forth the duties of the caregiver, hours and other essentials. It also must be for future services and cannot include compensation for past care. Terms for your personal care arrangements should include:

  1. 1. Duration of the agreement. You can keep it open-ended with the proviso that it may end by mutual agreement or by either party-include the starting date.
  2. 2. Location of where the services will be provided.
  3. 3. Compensation and how it is to be paid—weekly, bi-weekly or monthly.
  4. 4. Does the compensation paid affect the family estate? For instance, will the caregiver’s and other family members’ share be affected and if so, explain how.
  5. 5. Duties of the caregiver–bathing, dressing, grooming, toiletry, feeding, grocery shopping, other shopping for clothes and other essentials, driving to medical and other appointments and recreational activities, doing laundry, cleaning, cooking, administering medication, taking care of financial matters such as banking, paying debts and other expenses, record-keeping, bringing health problems to the attention of a physician and any others.
  6. 6. Who has power-of-attorney or is the conservator? Name the individual.
  7. 7. Temporary caregiver if the member takes a vacation or becomes ill.
  8. 8. Will the caregiver be given a cost-of-living increase each year or vacation pay? If so, give details.
  9. 9. How changes may be made-mutual agreement, in writing and signed by the parties.
  10. 10. A plan regarding evaluation of the parent if nursing home or assisted living becomes necessary.

The document should be signed by the caregiver and all immediate family members. If the parent lacks the capacity to sign, then the person with durable-power-of-attorney should sign. Along with the agreement, include some essential documents:

  • – Medical records, including those outlining the parent’s physical and cognitive limitations
  • – Care assessment records
  • – Health care directive
  • – Durable-Power-of-attorney
  • – Last Will and Testament
  • Trust agreements
  • – Insurance policies

Having all of these documents in one place makes it much easier should the time come for your parent to enter a nursing home facility, to qualify for Medicaid and for probate purposes.

Personal care arrangements can help you, your parent and your family deal with the difficulties and trauma that are associated with aging and provide a better quality of life for your parent. It can also minimize misunderstandings among family members when your parent needs to enter a nursing home or passes away and the estate needs to be settled.

Consider having elder law attorney Patricia Bloom-McDonald advise you on your caregiver contract so you can avoid future problems with Medicaid or with your immediate family. Attorney Bloom-McDonald has been representing the interests of the elderly for over twenty-five years. Allow her to draft your elder care contract or fashion an estate plan for you that meets your goals and allows you and your family to retain as much of your assets as possible.

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