Studies suggest that Americans age 65 and older are less likely to be chronically disabled or living in a nursing home today than seniors of the same age were two decades ago. Still, there may come a time when you can no longer manage on your own. You may simply need help with daily grooming, bathing, preparing meals--or just getting around. You may need round-the-clock care in a nursing home. There are options available.
First, assess your mother's particular needs. (See Hiring Help in the Home below.) She may qualify for In-Home Supportive Services (IHSS) if she has limited resources. IHSS is a Medi-Cal program that pays for in-home assistance when it is necessary to ensure the elder person's safety. (WIC § 12301.05) To locate IHSS, call your local Area Agency on Aging.
If she does not qualify for IHSS and just needs help with daily tasks, you could hire a caregiver through a home care agency or home care referral company. You could hire someone on your own, but if you are the caregiver's direct employer, you are responsible for paying employment taxes and workers' compensation.
But whether you hire someone through an agency or on your own, be extremely cautious, seek referrals and ask a lot of questions. Such caregivers are not regulated. In fact, many agencies do not check criminal backgrounds nor require prior training or experience.
Caregivers who provide medical care, however, must be licensed or certified. You can hire such caregivers through a licensed home health care agency. Home health care agencies, certified home health aides, certified nurse assistants, registered nurses, nurse practitioners and licensed vocational nurses all must be licensed or certified by the state. The Department of Public Health can verify a caregiver's license or certificate or refer you to the appropriate agency. (See Resources.)
It depends. If a doctor prescribes medically necessary home health care for a homebound senior, Medicare will cover some of the costs. (You must use a Medicare-approved home health agency.) Medicare will not, however, pay for a caregiver who provides non-medical assistance. This is one reason why some seniors and their loved ones invest in long-term care insurance. (See Obtaining Health Care and Benefits.)
You can get hot meals delivered to your home through Meals on Wheels. To give caregivers a break, respite care is available. Check into Adult Day Care Centers and Adult Day Care Health Centers (ADHC). In addition, community care facilities may fill unused beds on a short-term basis to provide respite care for seniors who need 24-hour supervision. (HSC § 1505.5)
Contact your local long-term care Ombudsman. Go online to www.medicare.gov/nursinghomecompare, which rates some 15,000 Medicare and/or Medicaid-certified nursing homes based on health inspection results, quality measures and staffing levels. A Medicare guide on choosing a nursing home is also available online.
To verify the license of a nursing home or other licensed long-term care facility or to find out if any serious violations have occurred at a particular facility, call the Department of Public Health's licensing and certification unit at 800-236-9747.
Possibly, but not for longer than 100 days and only if your mother requires skilled care. In addition, Medicare would only cover part of the costs. After the first 20 days, your mother would have to make a co-payment of $148 a day. If she qualifies for Medi-Cal, however, more assistance may be available. Generally, Medi-Cal covers longer stays in a nursing home. For more information, you could contact Medicare or your local HICAP advisor. (See Resources.)
Your mother should obtain legal advice before giving away any assets. In determining eligibility, Medi-Cal reviews each individual's past finances to see what, if any, assets have been given away or transferred for less than fair market value. In 2013 reviewers will look back over a 30-month period, and may begin looking back over 60 months. The regulations will then penalize all asset transfers (unless it would cause a substantial hardship). Until the state adopts the new regulations, however, transfers made within the past 30 months may or may not cause periods of ineligibility. If your mother has very few assets, she may already qualify for at least partial coverage. Check with your county welfare department or an elder law attorney to learn more about meeting Medi-Cal's eligibility requirements.
Yes, possibly. California's Paid Family Leave Program--a State Disability Insurance (SDI) Program--insurance may provide you with up to six weeks of pay if you take time off work to care for a seriously ill child, spouse, parent or domestic partner, or to bond with a new child. (UIC § 3301(a)) For more information, call the California Employment Development Department's Paid Family Leave Program at 877-BE-THERE (238-4373) or go to the Paid Family Leave Collaborative's website at paidfamilyleave.org.
The law also allows workers, if they meet certain criteria, to take a leave of absence for up to 12 weeks during a 12-month period if a parent, spouse or child is undergoing treatment in a hospital, hospice or other health care facility. (Family and Medical Leave Act, California Family Rights Act, GC § 12945.2; UIC § 3300(d))
Maybe. If you have been taking care of him--or have promised to take care of him--you are legally required to continue giving your best effort. You cannot just leave him helpless in his home. (FC §§ 4400, 4401; PC § 270c) If you do fall short, your father or the county (on his behalf) can seek such support from you. (FC § 4404) If, however, your father abandoned you for at least two years when you were a child, you may not be required to care for him now. Nor would you be liable for supporting him if he is receiving certain governmental aid. (WIC § 12350)
Hospice care is a program--usually a mix of physical, emotional, spiritual and practical care--for the terminally ill. It may take place in a patient's home or in a specially designed facility. A doctor's sign-off is required for participation. Payment is often on a sliding scale based on income. Medicare covers hospice care as does Medi-Cal and other insurance programs.
Assess your needs. Do you simply need help with such daily activities as bathing and preparing meals, or do you need medical or skilled nursing care as well? How much can you afford to pay?
Ask a lot of questions. Does the agency screen and train caregivers? Do caregivers undergo a criminal background check? (A certified home health aide, for example, must pass such scrutiny and cannot have certain convictions.) Does the agency handle taxes and insurance? Are the agency and worker bonded? Will Medicare, Medi-Cal or your private insurance cover any costs?
Find out your responsibilities. What taxes will you have to pay if you hire the worker on your own? See the Employment Development Department publication Household Employer's Guide. To obtain a copy, call 888-745-3886 or go to www.edd.ca.gov (click on Forms & Publications -- DE 8829).
Seek referrals from a trustworthy source. Avoid using a "help wanted" ad to hire a caregiver. You do not know the background--or motives--of those who respond. Be wary of individual caregiver ads seeking employment. For lists of home care agencies and home health care agencies, contact your local Area Agency on Aging.
Consider taking some additional precautions if you do hire someone. It might be wise, for example, to move your valuables to another location for safekeeping--or at least lock them up. Seniors have lost many precious belongings to dishonest caregivers.
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