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My mom was recently discharged from a skilled nursing facility and requires more care than what Medicare will pay and what our family can do. We need a home health aide to come in more than 3 times a week for an hour and a half.What are my options? I live in the Fairfield County area of CT.

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Your options are Assisted Living if she is able to get around with a walker or wheelchair. If she is not able to walk, she needs a Nursing Home.
Why was she discharged from the NH?
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I would go back to the social worker at the skilled nursing facility and find out what other resources there are for your mother. Also check with your local Area Agency on Aging. They should be able to point you to some other resources as well. When each of my folks were discharged from rehab facilities following surgery, it took about two weeks to get all the pieces in place for follow-up home health aides, including occupational therapy and physical therapy. The follow-up care lasted for 12 weeks for PT. Neither of my folks needed help with OT or assistance in bathing and dressing at that point. Hope this helps.
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If she's eligible for hospice care, Medicare will pay for that.
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Grandma Lynn gave the answer we would have. But in addition, there is a federally funded program that places elderly companions with elderly who need a little help called Senior Companions. You might want to check them out as an option, especially to see if they are available in your location -- http://www.nationalservice.gov/programs/senior-corps/senior-companions
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You don't mention your mom's income. If she is poor, there is a program called the Alzheimer's Initiative that will provide 8 hours of care per week for an amount of money that is a percentage of her income. You can't get anyone to come for 1.5 hours unless they get $20/hour, and 1.5 hours is not enough time to get much done. I have hired a retired nurse to help me take care of my mother at home. This way she does not have to give up her own bed, her luxury sheets, her money that she wants to spend on Hair Color Experts and new clothing, a porch that overlooks the water and often has lots of sun for her to enjoy while she reads a magazine. In my opinion, private care is ALWAYS a better option than any assisted living or nursing home because you get one on one care. Nursing homes have one nurse per 12 or 13 patients and the patients who poop in their underwear do not get changed and cleaned up right away. My father was in assisted living because he was too sick to stay home with me. They tortured him until his doctor finally gave him a prescription for hospice, which Medicare will cover. He paid full price for the assisted living facility while others paid nothing (were on Medicaid) and he still got less attention than those who pay nothing because he insulted all the nursing home staff so they ignored him as much as possible. Agencies are expensive....so what I would do, even though it is not legal, is pay someone under the table to do the job and then all the money goes to the nurse or CNA instead of to the agency. Good luck.
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If your mother or father were either one veterans, she is probably eligible for Aid and Assistance from the VA. My mother was considered "house bound" so she got a check to help with medical bills since her bills (including a caregiver) exceeded her income and she owned her home, but nothing else. Your mother won't be eligible if she has a large savings account or additional real property in addition to her home.
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You live in an expensive area in your state. The first question is whether you or your mother are willing to pay for a private home health aid. I am sure that there are many home health agencies in your area who provide private care. Then there is the option suggest by Beverlyhegdal where you pay the person directly. Both options have advantages and disadvantages.
People wanting private care often resent paying an agency because they perceive the owner is taking advantage of their clients by charging for overhead, including insurance, FICA, recruitment, payroll, scheduling and training. Thus they employ a private care aid, which they recruit by themselves and then pay them under the table to avoid the costs of being an employer. This option leaves both parties at risk, especially if there is a major accident.
The second option works if you are able to recruit, train and management what is essentially an employee.
Neither option will ensure that your loved one will receive the type and level of care you want for your loved one.
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Just remember, if you are "paying someone under the table" that Medicaid will consider those payments gifts if you apply for services later. Your parent will also not be able to include those payments in any medical deductions for income tax purposes.
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The NH should have had the Dr write orders for home care.. Medicare will pay for follow up.. She will need to have a follow up appointment with her regular Dr and he will also need to get info from home care agency so medicare will pay..

Her gp can also prescribe home care.. When home care comes for intial appt. they will go over her finances to see if she qualifies for financial need..Make sure someone is with her for the intial appt. They ask a lot of questions and will ask financial questions..
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As for the caregiver you might like to hire, skip the agencies. They are all sharks as far as I can tell. I had thieves, undependable workers who wouldn't show up etc. Check out care.com. I got a great women to come live in with us. If you are worried about the responsibilities of being an employer, go through a PEO. They will handle the taxes, workers comp, unemployment insurance etc. I used Einstein. I think they are a chain or a franchise. I'm in Atlanta, GA You pick your staff and then turn the paper work over to them. You are in charge.
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Sherry1anne
I resent and dispute your characterization of agencies. You should only make derogatory statements if you have used every agency in your area. As an agency owner, the people who resent agencies are generally those who think they can do it cheaper by themselves.
Unfortunately, many caregivers are in desperate financial situations and therefore willing to accept the conditions offered by those who want to pay the least possible amount for care by paying under the table.
The belief that you are in charge is often a fallacy held by those who want to pay as little as possible. In reality, a loved one's disease is often the control factor in hiring a caregiver.
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Please dont make this personal tgat helps no one. I have seen good and bad in both situations private and agencies. I have worked private duty for many years and manage to pay my taxes and never am in want for work. I think it comes down to two things 1. What can you afford and 2. What makes you feel the most comfortable. One family I worked for had myself as primary caregiver and used an agency as backup for weekends and when i needed a day off. It was a wonderful arrangement. However I must say that no one should use private duty to undervalue the services a caregiver preforms. People who want to pay 8.00 hr under the table should just be ashamed of themselves. Whoever you hire pay a living wage.
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I agree with sherry1anne that the agencies do not send dependable caring educated people. ADCaregivers is right to say that if you "employ a private care aid, which you recruit yourself and then pay that person under the table to avoid the costs of being an employer" you are taking a risk. This option leaves both parties at risk, especially if there is a major accident. The second option works if you are able to recruit, train and manage what is essentially an employee. Neither option will ensure that your loved one will receive the type and level of care you want for your loved one." I personally have the skills and desire to recruit the best retired nurses in my area and I do it by becoming friends with them and then asking them to give us a reduced rate in exchange for cash. Let me clear about the law here: You have a right to pay someone cash and tell nobody. It is legal as long as the amount does not exceed $600/year. The person who accepts the cash and decides not to report it to the IRS is the only one breaking the law and if she does not care because she wants extra cash to supplement her social security that is not enough, it is no big deal. The only way you will get yourself in big trouble is if you do not make sure the person you are hiring is in this country legally. If you accidentally hire an illegal alien or illegal immigrant, you face felony charges if such person is working for you or living in your home. The ONLY way to make sure your parent gets really good care is to do it yourself, which is what I decided to do, but since I am disabled and have difficulty walking and driving, I need a nurse to come and help me out once a week. You have to give her a list of things to do. You have no control over whether or not your parent will agree to do the things on the list (especially if she hates taking showers). If you go to an elder care attorney, they will explain to you how to set up a fancy trust so that your parent qualifies for Medicaid but this is not great advice. It is so much better to use your money to get quality one on one care.
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Sweaping statements like those beverly made are not true. And yes you can find good caring people in both private and agencies. Saying ONLY family can provide good care is very insulting to all the hard working caregivers out there. Don't lump everyone in a big batch, do your homework that is what any reasonable person would do. And the post above has conflicting statements throughout.
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My opinions reflect my personal experience with agencies. When my Dad got sick, he did not want to go to a nursing home. I tried all the agencies in the area. Seniors Helping Seniors sounded good for $15/hr but they never had anyone available. Most agencies require 20 hours and don't help people who only need 4. I never suggested not paying people a living wage. I just prefer to pay my friends a fair wage in cash, and they benefit from all the free tax and legal advice they need. If they don't have a power of attorney or living will, I prepare those documents and charge them nothing. The agency I hired to help with getting groceries up a flight of steps (the condo we owned had no elevator) sent a lady who hated climbing stairs. All the people sent by the agencies in the Pompano Beach area were not interested in doing any of the work I wanted help with -- cleaning, laundry, cooking, bathing Mom, and they had ZERO skills at dealing with dementia patients. When the agencies failed, we put Dad in the Five Star Premiere assisted living because they had gourmet food. After a year, they told us to move him out because he is too much work for them. We transferred him to a nearby assisted living facility but it was like a jail. They had a porch to sit on but because of the ramp, I could not get the wheelchair outside safely and the $9/hour staff members did not want to bother. They ignored all the difficult patients. I tried getting a volunteer to keep my mother company, but they sent an uneducated person who my mother could not relate to at all and I had to apologize for my mother's behavior (she kept telling her to leave -- that she does not want company). Then, I tried the agencies. Seniors Helping Seniors offered me help for $15/hour. I accepted. They could not find anyone to do the job because I only needed help once a week. The other agencies sent women who do not speak fluent English or they speak with a heavy Haitian or Jamaican accent and my mother wants a white Jewish CNA. Could not find that for her. So I decided to take things into my own hands. I hired a neighbor to help with driving to doctors, a disabled nurse to take her to get her hair done and do a tiny bit of grocery shopping (nothing too heavy), and a wonderful retired nurse who is 65 and spent her whole life working in nursing homes. She is an angel. She used to work for an agency and had all the necessary background checks....as well as the knowledge a nurse would have. I pay her a fair wage and if she asks for more hours so she can make more money, I will help her with that. She isn't just a nurse, she is a HHA, CNA, nurse, and friend rolled into one. I am not saying that all the people who work for agencies are bad employees. I'm just saying that your love one will get better care from a friend you trust than from a stranger who barely speaks English.
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ADCaregiver, as someone who has considered a private hire rather than an agency, not necessarily under the table, it has more logical basis. The nursing care that will be covered by some govt programs is actually more skilled than we require. They won't cover in home care unless the patient needs changing or feeding. We need someone to be there simply because he can change on a dime and we need someone there in the event of an emergency and to also keep him company, a companion. VA only wants to provide skilled nursing care and when they come there is nothing for them to do.
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Thereisnotry, if you have VA A&A you can hire anyone you want to do the care, even family. You just need to 1099 them at end of year incase your file gets audited and also incase you ever need medicaid. We tried in home care for my mom but could not do it so now her VA benefits pay for her Adult Family Care Home which is wonderful!
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If an elderly person loses all his assets to a con man (possibly even one who is a relative) or in a law suit how can a home deny them care paid for by Medicaid? Surely there must be some safety net for the elderly who, for whatever reason, do not qualify for Medicaid. Surely all disabled and elderly people are given food, medical care and shelter in this country. If they aren't, they should be.
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I'm in the same boat. My mom was discharged from skilled facility in Aug 2014and ever since then we are footing the bill to keep her at home. Medicare will only cover 2 hrs a week of an aide and 1 hr with a nurse. Siblings and I are paying for diapers gloves ointments care during the day while we work and my dad broke his hip in dec 2014 and also has needed care with diapers. We can not afford $10-$12 hr for 40 hrs week so we get them someone to come in 2 hrs in morning and two in afternoon and I rush home after work. Wish Medicare would provide some relief to those who are dirt poor (Medicaid eligible) but who are providing care to keep them from nursing homes. When they're in nursing home they get diapers gloves ointments covered but the moment they send u home you have to foot the bill even if it is medically necessary to wear diapers. I don't get it. Can't understand how they can cover diabetic supplies and catheters but not diapers -those require you to be on Medicaid and 2 hrs a week with CNA to help around house is so little for seniors that can no longer do for Themselves. People are actually financially encouraged to institutionalize their loved ones rather than keep them at home. Makes no sense
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Relief for those who AREN'T dirt poor but not even middle class. We're struggling to keep them afloat and out of any facility but it is hard to make ends meet. I'm running around buying diapers off of craigslist and rushing home so the weekly pay won't be too much for caregivers that help us out. Anyway. This system really needs to be revamped to offer relief for hardworking caregivers sandwiched with work responsibilities and providing nursing home care at home for aging parents
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Pat, have you looked into a medicaid waiver program? Many states have them and they will cover more care. How about VA is either one a vet? Also contact your Area Agency on Aging they may help with more resources in your area and supplies. It is very hard and I agree the system is broken.
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Have you applied for Medicaid?
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Pat, I heard you mention purchasing adult diapers off of Craigslist, but have you looked at thrift stores? We have several near us, actually attached and run by our local Senior Centers, and they always have a surplus of A Diapers on the shelfs, perhaps you could speak to the manager, who could hold them for y6. Just a thought! Take care!
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