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Elderly orphans

Elder Orphans. What Happens If An Elderly Person Has No One To Take Care Of Them?

What Happens If An Elderly Person Has No One To Care Of Them?

When an elderly person has no one to take care of them, they may opt to take care of themselves and continue living in their own home. Programs for seniors without family are available, as are nursing homes and assisted living. Some states will enlist a guardian for seniors who can no longer keep up with daily tasks of living or make decisions for themselves.

We have a lot to unpack in this article as we explore a senior’s options when they’re old, their physical health is declining, or they have dementia or memory loss, but they have no family (and possibly no money as well). Make sure you keep reading for lots of helpful information!

What Happens To Elderly Living Alone?

According to a 2013 report from AARP called The Aging of the Baby Boom and the Growing Care Gap: A Look at Future Declines in the Availability of Family Caregivers, the AARP estimated that by 2030, a whopping 16 percent of women up to 84 years old will have never had children.

For others – well, it’s hard enough losing the people we love as we get older. But for some seniors, they may lose family members or become estranged from those who were closest to them in their younger years – their spouse, their kids, and their friends.

For other seniors, it could be that they are close to family, but their loved ones have moved to another part of the world.

Either way, these “elder orphans” only have themselves to rely on. It can be a really tough situation to be in, but there are ways to cope.

Here is what can happen to them.

They Continue Living Alone

No rule says an aging senior has to change their lifestyle just because they’re getting older.

They should consider their care options, but due to fear of the unknown or stubbornness, they might decide to continue caring for themselves like nothing is wrong.

This can be highly dangerous, as we’re sure we don’t have to tell you. If an elderly person living alone slips and falls and is not wearing a medical alert device and is out of reach of the phone, then they have no way to call for help.

NOTE: if you don’t want to wear a medical alert device, a voice-activated Amazon Echo Dot or a smart watch, such as an Apple watch, can be used instead. There is even medical alert jewelry that looks like a regular necklace.

Without anyone checking in on them, the senior would have to force themselves to get to a phone or risk being stranded.

This happened to my mom – she fell and broke her shoulder and could not get up to reach the phone that was on the counter just above her. Thankfully my dad came home and found her after a couple of hours, but I still shudder to think about what would have happened if she had lived by herself.

Sadly, many older people will go through this trauma alone (and, in some cases, their quality of life will be severely impacted or they will not survive).

 

They Move Into An Assisted Living Facility Or A Nursing Home

After a drastic change in their physical condition, such as one slip and fall without anyone to help them, a senior might change their tune and decide that they need assistance in their day-to-day lives.

They could move into an assisted living community or even a nursing home.

Usually, adult children or other family members would encourage this decision for the elderly, but not in this case.

They Enter A Conservatorship

Of course, we should note that both assisted living and nursing home care are anything but cheap.

According to Where You Live Matters, a resource for seniors, as of 2018, the yearly cost of assisted living was $48,000. We’re sure the costs have only continued to climb in the years since that data was released.

Senior Living.org states that, as of 2021, the monthly cost of nursing home care is $7,756 for a semi-private room and $8,821 for a private room. The costs would be between $93,072 and $105,852 a year.

Keep in mind too that Medicare doesn’t often pay for these services, which means a senior would have to rely on different insurance or other financial means.

That’s a lot of money to ask of anyone, let alone an elderly person who likely hasn’t worked in decades.

So what happens when a senior can’t afford to live in a facility and they have no family who can step in and help?

Well, in some states, such as California, a senior could receive assistance. The state could offer a conservatorship where someone is assigned the role of the senior’s guardian.

They likely wouldn’t know the guardian, but the guardian still makes financial, health, and medical decisions for the senior.

Usually, this only happens if a senior is unable to make decisions for themselves.

Not every state offers conservatorship services though, and even for the ones that do, it’s not easy to obtain these services. The conservators who step in on a senior’s behalf are doing so on a volunteer basis, after all.

How Do You Plan For Old Age With No Family?

Aging is inevitable. Even with a full support system of beloved family, aging can be scary. Once you remove that network, the prospect of facing old age alone is daunting.

We don’t recommend an elderly individual does it alone, for their own health, safety, and mental well being.

Instead, these should be the pillars of planning as a senior determines how they’ll proceed through the years without a spouse, partner, or adult children.

Put Your Affairs In Order

One of the best things you can do for yourself is to make sure your legal and financial affairs are in order before you have a health problem or cognitive decline. You’ll make better decisions when you aren’t under stress.

If you live alone, this is especially important, as there may be no one else who knows your wishes or how to access your accounts.

Good legal planning with the help of an elder care lawyer is an important part of ensuring that your wishes are carried out in the event that you are unable to make or communicate decisions on your own behalf.

Here are some key elements of legal planning to keep in mind:

  • First, take inventory of existing legal documents, such as your will, power of attorney, and health care directive. Review these documents and make any necessary updates.
  • Second, make legal plans for your finances and property. For example, you may want to consider establishing a trust or setting up a beneficiary designation.
  • Third, put plans in place for enacting your future health care and long-term care preferences. This may include making decisions about end-of-life care, guardianship, and long-term care insurance.
  • Finally, name another person to make decisions on your behalf when you no longer can. This person, known as your agent or proxy, will be responsible for carrying out your wishes according to the terms of your legal documents. In order to do this, start by designating someone you trust as your power of attorney. This person will be able to make financial decisions on your behalf if you become incapacitated.

Many people don’t think about appointing a power of attorney until it’s too late.

Whether you’re dealing with an illness, injury, or just the natural aging process, there may come a time when you can no longer make your own decisions. That’s why it’s so important to have a power of attorney document in place.

This document allows you to appoint someone you trust to handle your financial and other affairs if you’re ever unable to do so yourself. You can also name successor agents in case your original choice is unavailable or unwilling to serve.

And it’s important to remember that power of attorney does not give the person you appoint complete control over your life. You still have the right to make your own decisions, as long as you have the legal capacity to do so.

So don’t put off appoint a power of attorney – it could be one of the most important decisions you ever make.

You should also write a will or talk to an attorney who can help with estate planning to outline how you would like your assets to be distributed after your death.

While these may not be pleasant topics to think about, making these plans now will give you peace of mind knowing that your affairs are in order.

End Of Life Wishes

Many people choose to avoid thinking about end-of-life care or funeral arrangements, but it’s an important topic to consider. End-of-life care can encompass a wide range of issues, from medical treatment to funeral arrangements.

Ideally, it’s best to express your wishes now while you are able to make decisions for yourself.

Addressing your wishes with your care team or a legal professional will ensure that your expressed requests will be followed when appropriate.

By taking the time to plan ahead, you can ensure that your wishes will be respected and that others will not have to make difficult decisions on your behalf.

Build Social Bonds

If you thought it was hard to find friends after college, it can be even more difficult in one’s senior years, but it has to be done!

A senior can find new friends in all sorts of places, from the doctor’s office waiting room to the post office.

Talk to neighbors, too, especially younger neighbors or neighbors with families. Explain the situation to them.

The point of being sociable is to build a support network. A senior should have people around them who will notice if they don’t pick up their phone. They need someone or several people who know the senior’s routine and can thus determine if they’re not following it.

These people will check in on the senior so that if, goodness forbid, a situation transpires where a senior has fallen and can’t get help or is otherwise unresponsive, the support network can step in and get the senior the proper medical care they need.

Mail carriers are also helpful if you ask them to keep an eye out for trouble. There are plenty of stories about mail carriers who asked for a home welfare check after someone who regularly picked up their mail stopped doing so. You can actually register to get this service.

Move Into A Joint Household

Assisted living can be expensive, but an informal joint household is usually a lot more affordable.

What is a joint household? This housing arrangement includes friends or extended family members of the senior who live under one roof. Collectively, they provide care for the senior.

This is a win-win-win situation. A senior doesn’t have to deal with the isolation of living alone, they’re surrounded by people they love, and they’re receiving care.

Find Other Family

Families are often bigger than we give them credit for and sometimes just need to reconnect. A senior should look into their family lineage if they’re fearing the years ahead without any care.

They just may have extended family in the area that they never realized were so close! For example, when I moved to Colorado, I was able to reunite with an elderly uncle who had been estranged from the family for several years.

Programs For Seniors Without Family

Another option for an older person is to seek the assistance of social services and programs designed for seniors without families. Here are some programs to look into.

Senior Centers

According to the National Council On Aging, a senior center serves “as a gateway to the nation’s aging network—connecting older adults to vital community services that can help them stay healthy and independent.”

They can put you in touch with your local Area Agency On Aging for things like meal delivery, financial assistance and help with personal needs.

AmeriCorps Senior Companion Program

The AmeriCorps Senior Companion Program provides companionship to nearby seniors living on their own. The companion program is about building friendships between volunteers and the elderly.

The goal is to “keep seniors independent longer.”

No Wrong Door

No Wrong Door in association with the Centers for Medicare and Medicaid Services, the Veterans Health Administration, and the Administration for Community Living offers seniors and others in need community-based support.

Equality Conversion Mortgage

The Home Equality Conversion Mortgage or HECM  through the U.S. Department of Housing and Urban Development allows a senior to use some of their home equity, none of which accrues interest or has to be repaid as long as they live in their home.

To be eligible for the HECM program, a senior must be at least 62 years old and have significant equity.

What Happens To Dementia Patients With No Family

After a diagnosis of Alzheimer’s or other dementia, it’s natural to feel overwhelmed. Suddenly, there are a lot of decisions to be made and new challenges to face.

If you have dementia, or are caring for someone with the condition, you may be worried about what will happen if you have no family members who can help you if you can no longer care for yourself.

After all, you may be able to manage perfectly well in the mild / beginning stages of the disease, but dementia is a progressive condition and it can lead to a decline in physical and mental abilities over time.

This can make it difficult to do everyday tasks and may eventually make it impossible for you to continue to live independently.

If you don’t have any family or friends who are able to help you, there are still options available to you. There are also many support services available for people with dementia.

Housing Options

One option is to move into a dementia-specific care facility. These facilities provide 24-hour care and support, and the various programs in this type of community can help to delay the progression of the condition.

The goal is to receive in-home support. This can include help with cooking, cleaning, and personal care.

Financial Considerations

The sooner you start planning, the more control you will have over your finances and the less stress you will feel. There are a few key things to keep in mind when financial planning with dementia.

Begin by collecting all of your important financial documents in one place. This should include bank statements, investment accounts, insurance policies, and wills or trusts.

Once you have gathered everything together, sit down with a trusted friend or accountant to review your finances and make a plan for the future. It may seem daunting at first, but taking these steps will help to ease your anxiety during an uncertain time.

Financially, consider the cost of the type of care you may need for memory care issues (such as home health aides or nursing home care) which can be extremely high. Even informal care, such as help from friends, can come with a significant financial cost, as it often requires hiring outside help to cover regular tasks like cooking or cleaning.

To help ease the financial burden:

  • Investigate any long-term care insurance that may be in place.
  • Also, if you are a veteran, you may be eligible for benefits that can help.
  • If you are younger than age 65, SSI (Supplemental Social Security) or Social Security Disability Insurance (SSDI) may be able to help.
  • You may also qualify to get help from Medicaid (there are income and asset qualifications to meet).
  • If you own a home, a reverse mortgage may be of assistance.

Put A Care Team Into Place

A care team is the group of people who you’ll partner with and rely on to provide you help, care, support and connection throughout the course of the disease.

The team may include your friends, co-workers or trusted neighbors. It also may include your doctor, nurses, social workers, geriatric care managers, clergy or therapist.

The goal of the care team is to provide physical, emotional and spiritual support. The care team also can provide important practical assistance, such as transportation to doctor’s appointments or help with household chores.

Begin to assemble a care team by making a list of everyone you can think of who may be willing to help.

Then, tell them about your diagnosis and let them know what you might need in the future (transportation to the grocery store or medical appointments, help preparing food, etc).

If they agree to help, add their names and contact information to your care team list.

Legal Paperwork

Put legal paperwork into place so that your wishes are carried out for both medical care and end of life care.

It is crucial to do this before you begin to experience cognitive decline, so if you have a family history of dementia or Alzheimer’s disease, it’s a good idea to put plans into place “just in case” you are ever diagnosed.

Regardless of a dementia diagnosis, you’ll need to appoint a power of attorney for both your financial and medical needs.

A power of attorney is a document that allows you to appoint someone to make decisions on your behalf. This can be useful in a variety of situations, such as if you become incapacitated or are unable to make decisions for yourself.

The person you appoint is called an attorney-in-fact or agent. It’s important to choose someone you trust, as they will have a lot of responsibility.

You should also name a successor agent, in case the person you originally choose is unable or unwilling to serve.

Keep in mind that even though you are giving the person you designate as your power of attorney the authority to make decisions, you still have the final say. They are there to help you, not override your decisions.

Power of attorney is a valuable tool that can give you peace of mind knowing that your affairs are in good hands.

How Do You Help An Elderly Person Who Lives Alone?

It can be tough for elderly people to get by without any family nearby. They might not have anyone to help them with yard work, grocery shopping, or even just keeping the house clean. And if they live alone, it can be easy for them to become isolated and lonely.

But there are some things you can do to help.

Check On Them

Just a quick check-in every now and then can make a world of difference in their lives. Something as simple as a phone call, a cup of coffee, or even simply waving to them from the sidewalk can help them feel connected and valued.

Checking in also gives you an opportunity to make sure that they are safe and comfortable. If you notice any problems, you can alert the proper authorities or provide assistance yourself.

Help Them Out

You could also offer to help out with practical tasks like grocery shopping or yard work.

If they don’t have transportation, you could give them a ride to appointments, social events, grocery shopping or medical appointments.

Visit Often

Solo seniors who struggle with mobility or age-related conditions like dementia probably don’t have the biggest social circle. They may not see or speak to anyone for days especially if they’re living alone.

By visiting the senior several times per week and spending companionable hours with them, you could improve their mental health and well being just through your presence.

Listen

Considering that a senior who lives alone might not have many people to talk to, they likely will have a lot to say when you two talk.

Sometimes, the senior may use you as a sounding board whereas other times, they’ll want to have an everyday conversation.

Let the senior talk, as this could be their only opportunity. Listen to them and respond thoughtfully and helpfully if you can.

Do Activities Together

Making your time together meaningful will have a senior looking forward to seeing you again.

You can engage in senior-friendly arts and crafts, watch old films or listen to old music together (which can invoke memories for dementia patients), or even get outside and take a walk if the senior is able to leave the house while under your care.

Conclusion

More seniors today are facing the prospect of getting older with no one to care for them.

Whether they never married and are childless, or divorced and childless, or their family moved away, or a tragic loss occurred, these seniors have to go through their most difficult years without family.

This never means that a senior is alone though. Through programs, conservatorships, community volunteers, friends and neighbors, and even long-distance family, a senior can almost always find a way to have someone looking out for them!

Read  more related articles here:

‘Elder orphans,’ without kids or spouses, face old age alone.

Elder Orphans Hiding in Plain Sight: A Growing Vulnerable Population

The Rise of Elder Orphans: What You Should Know

Also, read one of our previous Blogs here:

When Do I Need an Elder Law Attorney?

Click here to check out our On Demand Video about Estate Planning.

Click here for a short informative video from our own Attorney Bill O’Leary.

 

 

nursing care

Getting Paid to Care for Mom or Dad. Are You Eligible?

Introduction

Many adult children wonder if they can be compensated for the countless hours that they spend caregiving for their aging parents. This is especially true with those family members who are caring for a loved one with Alzheimer’s or another form of dementia. The short answer to this question is yes, it is possible. Unfortunately, the short answer is insufficient, as the subject is complex. Many variables impact whether a loved one who requires care is eligible for such assistance, and what many people fail to ask, is if they, themselves as caregivers, are eligible.

The article that follows comprehensively explores the many different options and programs that can be used to pay family members as caregivers. However, this in-depth exploration makes for heavy reading and many of the programs won’t be relevant to the reader based on varying eligibility criteria, such as veteran’s status, income, or state of residence. An alternative approach is to use our Paid Caregiver Program Locator. This interactive tool asks a series of questions and provides the reader with a list of programs that are relevant to their family’s situation.

Medicaid Options

Of all the programs that pay family members as caregivers, Medicaid is the most common source of payment. Medicaid has eligibility requirements that apply to the program participant and it has rules that dictate who is allowed to provide them with care. While Medicaid is historically thought of as paying for nursing home care, modern Medicaid programs offer assistance options outside of nursing homes, in the beneficiary’s home or primary place of residence. We have identified four types of Medicaid programs / options that allow family members to be paid as caregivers. The bad news is that not all four are available in every state, but the good news is at least one of the four is available in every state.

HCBS Waivers and 1915(c) Waivers

The first and most common Medicaid option is Medicaid Waivers. These are often called HCBS Waivers, short for Home and Community Based Services, or 1915(c) Waivers or occasionally Section 1115 Waivers. Waivers allow states to pay for care and support services for individuals residing outside of nursing homes. Commonly, they pay for personal care (assistance with activities of daily living, such as eating, dressing, and mobility) and chore services provided for elderly or disabled persons who live in their homes or the homes of family members.

Most states’ Medicaid Waivers have an option called “Consumer Direction”. Consumer direction allows the beneficiary (the ”consumer” or the “care recipient”) to direct or choose from whom they receive care services. With this option, the care recipient can choose to receive care from a family member, such as an adult child, and Medicaid will compensate the adult child  for providing care for the elderly parent. In most cases, the adult child / caregiver is paid the Medicaid approved hourly rate for home care, which is specific to their state. In very approximate terms, caregivers can expect to be paid between $9.00 – $19.25 per hour.

It is important to note that the phrase “consumer direction” is not used in all states. However, the concept of consumer direction is available in all states. A variety of other terms or phrases are employed to describe this same concept. Depending on one’s state, alternative language may include Participant Directed Services, Self-Directed Care, Cash and Counseling, Choice Programs, and Self-Administered Services.

Waivers are offered as an alternative to nursing home care. Waiver names, eligibility requirements, and benefits are different in each state. While nursing home Medicaid is an entitlement, Waivers are not entitlements. They are enrollment capped, meaning there is a select number of people who can be enrolled in the program, and waiting lists are fairly common. A complete list of Waivers that allow family members to be paid as caregivers is available here.

Medicaid Personal Care Services

State Medicaid programs often cover personal care under their regular Medicaid program, sometimes referred to as their “Medicaid State Plan”. Unlike Waivers, regular Medicaid is an entitlement program; if an applicant meets the eligibility requirements, then they can receive benefits. Waiting lists do not exist. Please note that some states elect to offer personal care services in the home and community through their state plan via an option called Community First Choice (CFC).

Similar to how Waivers offer consumer direction of services, State Plan Personal Care often allows the beneficiary to choose their care provider. Family members, including adult children can be chosen to provide care for their mothers and fathers. Again, like Waivers, the adult children caregivers are paid the Medicaid approved hourly rate for their efforts. During the initial enrollment process, the elderly individual is assessed, and it is determined how many hours per week they require care services. A list of state Medicaid programs that offer the choice of provider in their personal care benefit is available here. Readers should be aware of the various names these programs use, which include Personal Assistance Services (PAS), Personal Care Assistance (PCA), Attendare Care, and Personal Attendants. Sometimes, states don’t make a point to distinguish this option as a separate program, they just call it the personal care benefit under their regular Medicaid program.

Medicaid Caregiver Exemption

The Caregiver Exemption is also referred to as the Child Caregiver Exception. This option does not directly pay the adult child for their caregiving efforts on an hourly basis, but instead compensates them indirectly. To better understand this option, some background information on Medicaid eligibility is required. Eligibility for elderly persons is based largely on their income and their assets. One’s home, provided it is lived in by the Medicaid participant, is considered an exempt asset. However, if one moves from their home (into a nursing home, for example), then their home is no longer considered an exempt asset (unless their spouse lives there or the Medicaid recipient expresses an intent to return home). When the elderly person passes away, their state may try to take the home or some of the home’s value as reimbursement for the elderly person’s care. This is known as Medicaid Estate Recovery.

The Caregiver Exemption allows the adult child who provides care for their elderly parent in their parent’s home to inherit the home, instead of the state taking the home under Estate Recovery rules. There are additional requirements. The adult child must live in the home with their parent and provide care for at least two years. The level of care they provide must prevent their parent from being placed in a nursing home and they must have the medical documentation to validate this fact.

How much the adult child receives in compensation depends on the value of the home and their parent’s equity in the home.

The Caregiver Exemption is complicated. Therefore, it is strongly advised that families plan in advance for this option to avoid both Medicaid and family conflicts. One can read more about the Caregiver Exemption here or connect with a Medicaid planning expert to discuss if, and how this option, would work for your family.

Adult Foster Care

In a limited number of states, Medicaid allows the adult children to become adult foster care providers for their aging parent(s). In this situation, the aging parent moves into their adult child’s home. The caregiver / child is responsible for providing personal care, assistance with the activities of daily living, meals, transportation to medical appointments, and other supports. Medicaid will continue to fund the elderly parent’s medical care, prescriptions, etc. In return, the adult children are compensated by Medicaid for their care services, but not for room and board. Medicaid, by law, cannot pay for room and board. However, many states offer supplemental financial assistance from state funds to Medicaid beneficiaries who live in an adult foster home situation. This additional financial assistance is intended for room and board expenses. To summarize, the adult children caregivers will be compensated from two sources, Medicaid and the state’s supplemental program. It is estimated that the caregiving child will be compensated between $1,550 – $2,550 per month, dependent on the level of care required by their aging parent and, of course, their state of residence. State Medicaid programs offering adult foster care.

Programs for Veterans

Veterans Directed Home and Community Based Services

This program is often abbreviated as VD-HCBS or referred to informally as Veterans Directed Care. The program is open to any veteran who is currently enrolled in the VA health care system whose care requirements are such that “nursing home level care” is required. Under Veterans Directed Care, veterans are able to select from whom they receive care services. Veterans with a certain level of care needs, require personal care or personal care attendants. This program gives veterans the option to hire whoever they choose, including family members, such as their adult children to provide them with personal care services.

Adult children caregivers are paid an hourly rate. This rate is determined annually by Veterans Health Administration and modified for regional differences in home care costs. It is difficult to accurately project what caregivers will receive, as each veteran is assessed for a different amount of home care assistance. That said, caregivers might expect to be compensated between $8.44 – $20.00 per hour for their efforts.

The program is run at the local level through participating VA Medical Centers. See a list of participating VAMCs here.

Veteran’s Aid & Attendance and Housebound Pensions

The veterans’ pensions, which are called the Aid & Attendance and Housebound benefits, are programs specifically designed for wartime veterans and their spouses. How they can be used to pay individuals to provide care for their aging parents is a little complicated. It is important to understand that the dollar amount of pension that a veteran or their spouse receives depends on their current, non-pension related income. The second important factor is when calculating income, the Department of Veterans Affairs allows the beneficiary to deduct all care related expenses from their income. This can include the cost of personal care assistance provided by an individual or home care agency. Therefore, an aging parent can hire their adult child as a private caregiver. The adult child invoices their parent for their caregiving services, the parent deducts those invoices from their income, and the VA increases their pension check by the amount of the invoices. While confusing and seemingly roundabout, this approach is well documented, legal, and encouraged by many VA benefits experts. Learn more about the Aid & Attendance and Housebound Pensions or connect with a VA Pension planning expert to determine if your family is eligible and to discuss if either of these approaches can work for you.

Other Options

State Based, Non-Medicaid Programs

The concept of Consumer Direction (discussed under Medicaid) is not limited to Medicaid programs. Most states offer what are loosely categorized as nursing home diversion programs. These are state funded programs that provide assistance to elderly individuals who live at home with the objective of preventing unnecessary placement of these persons in Medicaid-funded nursing homes. Some of these state programs allow for consumer direction of care services. Phrased another way, program participants are given the flexibility to choose their own caregivers. This allows participants to choose their adult children to provide them with care services and assistance, instead of working with a state-chosen caregiver or home care agency. Caregivers are paid a rate comparable with the average hourly rate for home care in their geographic area.

Unfortunately, these programs are not available in every state. Further limiting this option is the fact that some programs allow for consumer direction, but do not allow family members to be hired. Finally, many of these programs are means-tested (this means eligibility is based on the financial resources of the participant). See a list of state programs that allow consumer direction here.

Life Insurance

Persons with life insurance policies with a death benefit valued at over $50,000 can use those policies to pay family members to provide care. As with many of the programs described in this article, the process is complicated. The policyholder, while living, engages in what is called a life settlement. A life settlement is the sale of one’s life insurance policy to a 3rd party while the policyholder is alive. The buyer pays the policyholder a lump sum amount, they take over paying the monthly premiums, and when the policyholder passes, they collect the full amount of the death benefit. In taking this approach, the original policyholder receives a lump sum of cash from their policy while they are alive.

This money can be used directly to pay a family member, such as a son or daughter, to provide care. However, a better option exists called a Medicaid Life Settlement. This type of life settlement allows the policyholder to preserve the option to receive Medicaid in the future, should the proceeds from their life settlement run out. A more thorough investigation of this strategy and its pros & cons can be found here.

Long Term Care Insurance

Some elderly individuals that have long-term care insurance may use the benefits from that insurance to pay their children to provide them with care. Each policy is different and some policies may expressly prohibit family members from being compensated. However, such rules are relatively rare. More common is the long-term care insurance policy that requires care providers to be licensed. Fortunately, this should not prevent the family members of the policyholder from being paid to provide care. It does, however, create a minor logistical obstacle in that the son or daughter will have to obtain a business license as a care provider and register with their local authorities. While this process may sound daunting, it is in fact a fairly simple and quick process. The adult children who are now paid caregivers must declare their payment as income and pay taxes as they would with any other income.

Paid Family Leave Laws

Paid Family Leave (PFL) is a type of program that allows working individuals to take time off from their jobs (or take non-consecutive days off) to care for their family member. Paid Family Leave laws are not limited to caring for aging parents, one can also care for their children or spouses. However, caring for aging parents is most relevant to this article. The caregivers continue to receive a large percentage of their salary and they are legally protected from losing their jobs or their health insurance.

Most laws will pay the adult children for periods of between 4 – 12 weeks, so this is not a permanent solution for most families. However, the paid leave does not have to be taken in one consecutive period. Instead, the caregiving child could take one day off each week for many months. Additionally, multiple siblings could take consecutive paid family leave if they live in the same state, which when combined, can make a large impact in helping an elderly parent.

Unfortunately, not all states currently have paid family leave laws. While they are under discussion in many states, at present only California, New Jersey, New York, Rhode Island, Washington, and the District of Columbia have programs. More about each program can be found at the following links: CANJNYRI and DC. At the time of this writing, the paid family leave acts have not yet been implemented in Washington and the District of Columbia. Both are expected to be in effect in 2020.

State specific, paid family leave laws should not be confused with the national Family and Medical Leave Act (FMLA), which allows family members to take time off work to care for a loved one and protects their job and health insurance but does not offer compensation. More about the FMLA.

Tax Deductions and Credits

Tax deductions or tax credits do not pay the adult children directly as caregivers. However, they can considerably decrease the tax burden of those caring for their elderly parents. The net effect is the same, they have more money available to them as a result of their familial caregiving efforts. For persons whose parents are financially dependent on them, the medical and care expenses incurred by the aging parents can be deducted from their own income. Read about medical and care expense deductions here. Another option is the Dependent Care Credit. For persons who must pay for care for their elderly parent so that they are able to continue working, this credit is highly relevant. Expenses such as home care or adult day care, in most instances, are fully deductible under this credit. Read more.

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Covid, Nursing home

Visiting Grandma at the Nursing Home

In spots where visits have resumed, they’re much changed from those before the pandemic. Nursing homes must take steps to minimize the chance of further transmission of COVID-19. The virus has been found in about 11,600 long-term care facilities, causing more than 56,000 deaths, according to data from the Kaiser Family Foundation.

AARP’s recent article entitled “When Can Visitors Return to Nursing Homes?” explains that the federal Centers for Medicare and Medicaid Services (CMS) has provided benchmarks for state and local officials to use, in deciding when visitors can return and how to safeguard against new outbreaks of COVID-19 when they do. The CMS guidelines are broad and nonbinding, and there will be differences, from state to state and nursing home to nursing home, regarding when visits resume and how they are handled. Here are some details about the next steps toward reuniting with family members in long-term care.

When will visits resume? As of mid-July, 30 states permitted nursing homes to proceed with outdoor visits with strict rules for distancing, monitoring and hygiene. The CMS guidelines suggest that nursing homes continue prohibiting any visitation, until they have gone at least 28 days without a new COVID-19 case originating on-site (as opposed to a facility admitting a coronavirus patient from a hospital). CMS says that these facilities should also meet several additional benchmarks, which include:

  • a decline in cases in the surrounding community
  • the ability to provide all residents with a baseline COVID-19 test and weekly tests for staff
  • enough supplies of personal protective equipment (PPE) and cleaning and disinfecting products; and
  • no staff shortages.

Where visits are permitted, it should be only by appointment and in specified hours. In some states, only one or two people can visit a particular resident at a time. Even those states allowing indoor visits are suggesting that families meet loved ones outdoors. Research has shown that the virus spreads less in open air.

Health checks on visitors. The federal guidelines call for everyone entering a facility to undergo 100% screening. However, the CMS recommendations don’t address testing visitors for COVID-19.

Masks. The federal guidelines say visitors should be required to “wear a cloth face covering or face mask for the duration of their visit,” and states that allow visitation are doing so. The guidelines also ask nursing homes to make certain that visitors practice hand hygiene. However, it doesn’t say whether facilities should provide masks or sanitizer.

Social distancing. The CMS guidelines call on nursing homes that allow visitors to ensure social distancing, but they don’t provide details. States that have permitted visits, state that facilities enforce the 6-foot rule.

Virtual visits. Another option is to make some visits virtual. Videoconferencing and chat platforms have become lifelines for residents and families during the pandemic. Continued use after the lockdowns can minimize opportunities for illness to spread.

Reference: AARP (July 22, 2020) “When Can Visitors Return to Nursing Homes?”

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