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My dad is moving through the early stages of diagnosed dementia faster than we expected. We are looking for in-home caregivers who can assist with medication management, cooking, cleaning and occasional doctor visits. My siblings and myself live out of state and are not able to move in with him. During his lucid moments, he is absolutely, hostile towards the idea of moving into an assisted living and/or memory care facility.



Over the past 2 years, I have tried various caregivers, (both personal referrals as well as agency sponsored) and they have not really worked out. The biggest issue is the cost...it is cost prohibitive to employ the # amount of time he really needs...we have exhausted family members (many of whom are otherwise committed or do not have a vehicle).



Has anyone in this thread ever used an in-home caregiver option, where room and board were included in the rate? Medicare options and other state provided aid are not an option for him as he owns his home and receives social security, so they feel he has too much income.

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Pamarks, I would look up the rules in your state. This varies widely, so what may be true for me in AZ, won't be for you.

I recommend having a solid, attorney drafted/approved contract in place that addresses compensation and how it is paid, you will need to pay an hourly or salaried wage, the hours expected to work daily, weekly, monthly and vacation time. You want to address the caregivers responsibilities; daily, weekly, monthly and what happens with a termination of employment, whatever the cause is, be it dismissal, death, firing, etc. Get it notarized so everyone signing knows it's a legally binding document.

Best of luck, this is a tough situation for many seniors.
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Yes to getting a written contract. Also, the family live-in caregiver should be the DPoA for this person, and hopefully is. If not, it may not be too late for your Dad to create one. An experienced elder law attorney will assess his capacity in person, soo don't make any assumptions that would prevent him from doing to an attorney.

Regarding Medicaid (not Medicare)... rules vary by state but in most states it only pays for LTC, which needs to be medically assessed by a doctor. Your father then has to also qualify financially. I strongly recommend you consult with a Medicaid planner for your state. You sound like you are assuming he won't qualify but if the only assets he has is a house and SS, he very well might. In most states there is a 5-yr lookback period on the financial application. This means that whoever is managing his finances had better do it correctly lest they inadvertently disqualify him for Medicaid. Again, educate yourself: all info is online on his county's website, usually found in the Department of Health and Human Services, or Social Services.
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This seems to be such a common problem. Seniors may own property but require income to fund their care needs. Where I live the way property has been used for generaltions to grow wealth (many tax deals) has added to this. People reluctant & even penalised in a way to downsize. People left to heat & light just a room or two, without the income for maintenance for the whole house, let alone for cleaner, aides etc.

So yes, in theory, renting out rooms or arranging care for board may work.

My own opinion is once a person is can no longer independantly arrange this themselves, you need a very attentive family member or a very capable (paid) Manager to run things. Sick leave, days off, all must be covered.

Once a person cannot be left home alone or there are behavoural issues affecting care, the balance can tip from 'aging in place' to 'not coping at home'. Then the big issue of a care home comes up. This is when *needs* outweigh *wants*, especially when sense & insight is lacking.

No-one wants to sell their home. They worked so hard to buy it. They feel comfortable there. I get that. The fact remains, they need a NEW home. One that suits their level of health, mobility & cognition issues. Call it *The Downsize*.

I would suggest getting an up to date needs assessment for Dad. What ADLs (activities of daily living) does he need? What about evening/night? Then armed with that, really think about whether care at home will work. Trial it as Plan A - but also start working on Plan B.
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You can't expect one person to take care of him 24/7, though. How will you handle the caregiver's days off and the other 16 hours a day?

If Dad's hostile to the idea of moving and also has dementia, the decision really isn't his to make any longer.
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This is a situation you would have a really hard time setting up. First: who is going to be 'happy' to live with a needy, elderly man 24/7 and probably be paid peanuts for the hours when they're 'off the clock' and have probably very little personal time? Second: What are you willing to pay, in terms of hourly compensation? You need to go through an agency, so the person will have been 'vetted'--if not, they will not be bonded or insured in case of accidents, whatever. Third: The quality of the care is going to be pretty iffy. No training? No certifications? I'd be concerned about that. Fourth: What if this person just walks away? You state your dad can get very hostile. This makes trying to help him a lot harder. Fifth: How closely will you be monitoring the situation? Why can't dad move to an AL that's within his budget? Is he trying to save money for some reason? SS is often all the person has and plenty of Srs make it just fine in group settings. You'd still need to 'cover' the times the CG is off. You can't expect them to be at dad's 24/7 with NO time off. That's actually illegal!While it is expensive for decent care, I'm sure you can find something in dad's price range that will work. Hiring a 24/7 aide, even acct for board and room? You're still going to be out $10-15 an hour. Sadly, I know you don't want to do this, but I think that a search for placement for dad would be a better option.

My DH 'looked' for just an overnight aide to do the 8pm-8am shift to relieve him and his siblings. The cost was $35 an hour. $12K a month. For while she's ASLEEP. The NH they were looking at was $6500 a month.

Elder care is NOT a place you want to 'cheap out' on.
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