Choosing a Caregiver – Agency vs. Private

When choosing a caregiver, you must decide between an agency caregiver and a private caregiver.  There several things you should consider.

Private caregiver

Employee of the client, they are not a 1099 contractor

Client is responsible for employer’s share of social security, unemployment insurance and worker’s compensation

Client is responsible for federal and state tax deposits based on the caregiver’s pay

Client is responsible to background check the caregiver(s)

If a caregiver calls off, the client must coordinate for another caregiver to cover

Agency caregiver

Employee of the agency

Agency pays taxes, unemployment insurance and worker’s compensation

Agency is responsible for background check of the caregiver

Agency has multiple caregivers and can cover when a caregiver calls off

Agency has liability insurance to cover the caregiver for theft or damage

Although a private caregiver may have a cheaper hourly rate than an agency caregiver, when the added cost of unemployment insurance and worker’s compensation are added to the cost, it may end up being more expensive to have a private caregiver.

Are You Prepared For An Emergency?

In the past, most Americans lived their lives without any emergency plans.  After 9/11, many people began to think about what they would do if there was a catastrophic event or terrorist attack in their town.  These contingency plans included having food and water, batteries and other emergency gear.  Families planned where they would meet and who would get the children.  These plans have become necessary due to the current world culture.  Although many of us have these plans in place for catastrophic events, most of us do not have contingency plans in place for the more common crisis in our lives.

What would those who depend on you do if you got hit by a bus, or had a stroke?  What would you do if your parents were unable to take care of themselves?  These situations happen every day and most of us do not have a plan in place.  Unfortunately, without a plan, these events often become a crisis and families end up making rash decisions to deal with the crisis.  Those who do have a plan in place are usually able to make better decisions because they have more time, information and resources.  

All of us have preferences for handling emergencies, our finances, medical decisions, legal matters and end of life choices.  The problem is that we often do not discuss them with anyone.  It can be difficult to discuss these issues with our families, so often we just avoid the topic.  Unfortunately, if we don’t discuss these topics, we won’t have the information necessary to make a well informed decision.  If you are having a difficult time getting your loved one to talk about these issues, consider having an independent third party talk to you and your loved one.  Sometimes a physician, attorney or an Aging Life Care Professional can be more effective in discussing these topics because they are considered to be a professional and there is no emotional history to overcome. No matter who leads this discussion, the focus should be on your loved one and how they would like these preferences carried out.  It is important to get specific information now so if the time comes, there will be no question what your loved one wants you to do.  Some of the topics you should address include:

1.          Medical

a.          Current medical providers – name and phone number

b.         Current medical conditions

c.           Current medication(s)

d.         Allergies

2.          Legal

a.          Power of Attorney

b.         Living Will – give a copy to your physician

c.           Will

d.         Trust

e.          Location of legal documents

f.            Verify the people appointed in legal documents have a copy

3.          End of Life

a.          Feelings about death

b.         Is it important to die at home?

c.           Burial or cremation preferences

d.         Funeral/Memorial preferences – be specific!

4.          Emergency Assistance

a.          Who will be called first/second in the event of an emergency?

b.         Is there someone local who can assist if family lives far away?

5.  Financial

a.          Location of bank/investment accounts

b.         Location of safe box and keys

c.          Location of financial documents

d.         Who is monitoring bank & credit card statements

Statistically financial fraud is becoming more prevalent.  Anyone who has a mailbox, writes a check, or has a credit card is a potential victim.  To protect yourself, review your bank and credit card statements when they come in and report any unrecognized activity.  Since elder adults are particularly vulnerable, it is a good idea to have the person who is nominated as Financial Power of Attorney or Successor Trustee to monitor these statements as well.  Financial fraud comes in many forms, so keep track of your finances and be careful who has access to your financial information. 

Once you have the information, share it with anyone who could be responsible for making these decisions.  If you are geographically distant from your loved one, look for a local resource to be available for emergencies.  A local Aging Life Care Professional can be an invaluable resource in putting together a contingency plan.  The Life Care Professional not only knows the local resources, but often can be available on an emergency basis to get things stabilized while family is in route.  The Life Care Professional can also take a proactive roll, making recommendations to help prevent potential crisis or monitoring unstable situations.

Whether you work with a Life Care Professional or do it yourself, take the time to put a contingency plan in place.  It will give you and your loved one a peace of mind knowing you have a plan in place for an emergency.  You may never need it, but it is good to know it is there if you do!

What Level of Care Does Your Loved One Need?

When looking at a facility option in Arizona, there are many types of facilities to choose from.  The type of facility required is based on the physical and functional needs of the resident.  Below is a breakdown of the facility types available and what they offer. Your Care Manager or Aging Life Care Professional will be familiar with the best care solutions in your area and provide the advice you need to make the best decisions for your loved one.

Independent Living in Arizona

These communities are geared for the independent senior.  They often have organized activities/outings for the residents.  Many have a clubhouse and a pool on the property as well as other amenities.  The residents either own their home and are responsible for the maintenance or they rent their living space like a traditional apartment.  These properties are not appropriate for a person who needs assistance with their activities of daily living.

Assisted Living in Arizona

The Assisted Living Federation of America (ALFA) defines an Assisted Living residence as a combination of housing, personalized supportive services and health care designed to meet the needs – both scheduled and unscheduled – of those who require assistance with activities of daily living.  In Arizona, the Department of Health Services (DHS) licenses Assisted Living homes and centers.  Assisted Living homes are licensed for ten (10) or fewer residents and residents usually have either a private or a semi-private bedroom.  Assisted Living centers are licensed for eleven (11) or more residents and usually are set up as apartments.  Assisted Living residences typically charge a monthly rent.  Additional charges may be added to cover the cost of services required by the resident.  There may also be a one-time, non-refundable facility fee due at time of move in.

In Arizona, there are three levels of care available in Assisted Living homes and centers and many facilities offer more than one level of care:

1. Supervisory Care Services – general supervision, including daily awareness of resident functioning and continuing needs, the ability to intervene in a crisis and assist in the self-administration of prescribed medications.
2. Personal Care Services – assist with activities of daily living that can be performed by persons without professional skills or professional training, and includes the coordination or provision of intermittent nursing services, and the administration of medications and treatments by a licensed nurse.  Must meet all the requirements also of the Supervisory Care Level.
3. Directed Care Services – programs and services, including personal care services, provided to persons who are incapable of recognizing danger, summoning assistance, expressing need, or making basic care decisions.  Must meet all requirements of Supervisory Care and Personal Care levels.

Most Assisted Living communities provide the following either as part of the monthly rate or for an additional charge:
• A minimum of one meal per day, many provide all three
• Housekeeping services
• Transportation
• Social and recreational activities
• Medication management
• Laundry services
• 24-hour security and staff availability
• Emergency call systems for each resident’s room
• Assistance with eating, bathing, dressing, toileting, and walking
• Access to health and medical services

Facilities licensed by the state should be checked out for deficiencies (enforcement actions).  This can be done by contacting the Arizona Department of Health Services or going to their website http://azdhs.gov/licensing/medical-facilities/index.php.

Memory Care in Arizona

Memory Care centers are a specialty form of Assisted Living designed for the person suffering from a memory disorder.  The physical environment and the programs provided in a Memory Care setting are specifically tailored to the individual, with the goal of nurturing independence while maximizing quality of life.  Memory Care settings are a secure environment to protect those who wander.  In addition the staff at these facilities have had additional training in the care of persons with dementia.  In Arizona, Memory Care centers are licensed as Directed Care.

Skilled Care in Arizona

In Arizona, Skilled Nursing Facilities are also licensed by DHS.  Licensed nursing care facilities provide the highest level of medical care for persons who are not able to perform their activities of daily living.  The care is provided by nursing professionals under the direction of a physician.  Skilled Nursing care is often used for acute, short stay care after hospitalization.  These stays may be covered by Medicare after discharge from a hospital.  Long-term care in a skilled setting is reserved for those who need nursing care on a regular basis but do not require hospitalization.  These stays are not covered by Medicare, although Medicaid (if eligible) and long-term care insurance will often cover part of these costs.  Often these facilities also provide services such as speech therapy, physical therapy and occupational therapy.

Continuing Care Retirement Communities in Arizona

Continuing Care Retirement Communities (CCRC) usually provide independent, assisted and skilled levels of care in one community.  Some CCRCs also offer Memory Care.  This type of community offers a contract that secures living accommodations and services over the long-term.  These communities are designed to provide services over the life of the resident.  There are three common types of contracts used in CCRCs:

• Extensive – covers shelter, residential services, amenities, and unlimited skilled nursing care with little or no increase in the usual monthly payments.  Due to the nature of this contract, the fees are usually higher



• Modified – covers shelter, residential services, amenities and a specified amount of Skilled Nursing Care.  Any additional Skilled Nursing Care required beyond the specified amount is the resident’s financial responsibility.

• Fee-For-Service – covers shelter, residential services and amenities.  Skilled Nursing Care is paid for by the resident as it is used.

Most CCRCs also require a one-time entrance fee in addition to the monthly payments.  Examine the refund policy on the deposit.  There should be a pro-rated refund available based on the length of residence.  Finally, inquire into the financial stability of the CCRC.  Some unlucky families put down a deposit only to find out that the company is on the verge of bankruptcy and the deposit is lost.  Due to the complexity of these arrangements, it is wise to have an attorney review the contract prior to signing.  You can also obtain information on CCRCs from The Continuing Care Accreditation Commission at www.ccaconline.org.

Choosing an appropriate facility can be a challenge.  There are many levels of care and dozens of facilities which offer one or more level of care.  When it is time to look for a facility option, engaging an Aging Life Care Professional (www.aginglifecare.org) can make the process easier.  The Life Care Professional can assess the proposed resident’s needs and then guide the selection process, making the process easier and less stressful.

Make sure to consult an Aging Life Care Professional in Arizona.

Should Mom Still Be Driving?

Whether or not an aging parent should be driving is a question we are frequently asked.  It is a very touchy subject and most children do not want to force the issue with their parents.  Getting a drivers license is a rite of passage that most teenagers look forward to.  Having to give up that license can be very difficult.  It affects a person’s sense of independence.  Once a person surrenders their driver’s license, they are suddenly dependent on others to get around.  Going to the grocery store, going to the doctor and even going out with friends can become difficult without transportation.

There are several warning signs to look if you are concerned about a loved one’s safety behind the wheel.  If you notice any of the following 17 warning signs, it is time to evaluate whether your loved one should continue driving.

1. signaling incorrectly
2. trouble making turns
3. changing lanes improperly
4. confusion at highway exits
5. difficulty parking
6. stopping inappropriately in traffic
7. confusing the brake and gas pedals
8. driving too fast or slow
9. hitting curbs
10. failing to notice stop signs or traffic lights
11. reacting slowly to traffic situations
12. failing to anticipate potential dangers
13. getting lost in familiar places
14. scrapes or dents on car, house, garage, etc.
15. traffic violations
16. near-misses
17. accidents

There are several options for driving evaluation.  One option is to have an evaluation through a driving evaluation center.  Although there are companies that offer these services, many of these programs are offered through larger rehabilitation centers as well.  Another option is to have a physician write a letter to the Department of Motor Vehicles (DMV) expressing their concern about their patient’s driving ability.  Once the DMV receives this letter, they will send out a letter to your loved one either revoking their license or requesting them to come in for a written test and/or an on the road driving test.  Successful completion of the testing is necessary for the license to remain valid.

It can be hard for family members to address the topic of driving safety with their loved one.  Involving the primary care physician in this process can be helpful because it takes the role away from the family.  Another option is to consult with a Certified Care Manager or Aging Life Care Professional.  These care management specialists are typically well versed in the resources to evaluate driving and can facilitate not only the testing, but also put a plan in place to address the need for transportation once the person stops driving.  Again, involving an independent third party takes the pressure off the family and takes some of the emotion out of the situation.

Addressing driving concerns with your loved one can be stressful and very difficult.  It is an emotional topic with significant consequences.  Having a plan to both evaluate your loved one’s driving and to accommodate their transportation needs if they stop driving will help make this difficult task somewhat easier.

Are Your Affairs In Order? It’s Time to Talk…

“My mother didn’t want to put a Power of Attorney document in place because she didn’t want anyone to make decisions for her.”  “My father doesn’t have a Living Will because he wasn’t comfortable talking about end of life issues.”  These comments are common.  Making decisions about who we want as our decision maker if we can’t make our own decisions is difficult.  No one wants to think that they won’t be able to make their own decisions.  Most people do not feel comfortable talking about end of life issues, death or dying.  As difficult and uncomfortable as they can be, these conversations are necessary.

Before you are unable to make decisions, you can empower a person of your choosing with the authority to act on your behalf under a Power of Attorney.  A Power of Attorney documents is a legal form in which you nominate someone else with the authority to make certain decisions and act on your behalf.  The person to whom you give these powers is called an “agent” and you are called the “principal”.

If you do not choose an agent under a Medical Power of Attorney and you need a medical decision maker, you may end up with a Guardian.  The Guardian is appointed by a judge and may or may not be the person you would have chosen to be in that role.  The Guardian may not know what decisions you would have made if you had the ability to make them.  The same is true for your finances.  If you do not choose an agent under a Durable Power of Attorney and your need someone to handle your financial affairs, you may end up with a Conservator.  The judge will select a person to serve as Conservator.  This person may or may not have been the person you would have chosen to be in that role, and they may not know how you would handle your finances if you had been able to do so.
Equally important is the Living Will.  This document directs the medical providers and your medical decision maker how you would like your end of life issues to be managed.  The document can be as detailed as you like and give instruction on anything you think is important regarding your care and end of life decisions.  Although an attorney can draft your Living Will, you can also use a form such as Five Wishes to make you desires known.  No matter how you do it, make sure that your family knows your wishes and make sure you write it down.

It’s important that your chosen loved ones have the authority to make decisions in your behalf when the time comes. You definitely don’t want the courts deciding who will choose your Care Professional. A trusted, Life Care Professional can help you or your family get the best care and quality of life possible.