My cousin is currently in rehab and looking at hiring a live-in home health aide. Her other alternative is to seek admission to a nursing home. She is in a wheelchair and needs assistance with bathing, food prep, and just daily life. I am wary of hiring live-in help. I live 100 miles from her and cannot be her live-in caregiver myself, and there is no other family. Does anyone have experience with hiring live-in 24/7 caregivers? What pitfalls should she be aware of? Her finances are limited.
financial assistance for home health care
If you have any asset like a house, Medicaid usually doesn't pay for your homecare unless you legally agree that whatever is paid out gets paid back after your death when your home is sold.
This is what I learned:
* A live-in caregiver IS an employee.
* Person hiring is employer and must adhere to all state and federal rules.
- They must pay all taxes, keep accurate records, make payroll checks
* If it doesn't work out, it can be difficult to get 'caregiver' to leave premises.
- A sheriff may need to be called. If someone in a wheelchair, they are very vulnerable.
* If you decide to hire a live-in, see an attorney first.
* Have everything written up in a contract and have it reviewed by an attorney.
* Be sure that landlord approves of the live-in.
Do your research before hiring a live-in. Know what you legal obligations are.
Personally, if no one else is in the area to supervisor and assist your cousin, I would be very careful / cautious.
* Screening a potential caregiver requires:
- Check references
- Performing a background check, including criminal record check
- Ensuring they have experience as needed
- If foreign born, must have legal documentation in order
- Make copies of all documents, including their DL
- Know what questions to ask.
Hire an attorney to discuss it.
Gena / Touch Matters
I can understand she would prefer living at home (resuming her normal life) with the help of a live-in aide. Hopefully she can find someone that works out well.
There is nothing wrong with being in a nursing home. Check out several for comparison. She might find one that feels comfortable, and takes care of all her needs. There are people who live in a nursing home for years.
If she can afford it, assisted living might just be the ticket. her care needs can be tailored to her, and otherwise she lives independently in an apartment.
Don't disrupt your life to become her full time caregiver.
You don't mention why your cousin is currently in rehab and in wheelchair.
She should stay in rehab long enough for occupational therapists to help her learn how to adapt to her daily living functions. As independently as possible.
My sister and I also were there to help, and this was for caregiving one parent at a time - dad sick, then mom sick. They were determined to die at home. (I will never support that madness again.) All had to be coordinated and scheduled by guess who? Yup. Fortunately we had a great team, and that's what it took - a team. You can find a team ready-made at your local care facilities. My advice is to start looking.
All that work, and for the last days of his life, when he was dying at home, Dad thought he was in a hospital anyway.
There are many pitfalls regarding at home 24/7 care. If you pay under the table you risk a lot of liability plus you will need to set contracts that will require tax regulations. It is so much more than it worth unless their income is so great that it can be affordable.
Your last sentence "Her finances are limited" implies at home private pay 24/7 care will not be attainable. Sorry for the grim outlook. Wishing your cousin well during a very challenging time.
Thank You for your input
Big hugs out to you.
Home care is expensive. We are paying $22.75 an hour from the cheapest agency I found in my area.
Nursing homes actually cost more. Granted, Medicaid or LTC insurance covers most of it where they don't pay for live-in care.
I have read your responses to us below and thank you for them. Often we get a question and no one bothers to reply to the advice.
I am just going to say that by allowing "a friend" to draw you into this VERY BAD DECISION about home going, is a massive mistake in my opinion. And if you think you can afford to help pay for the costs of this care then you must be absolutely rolling in money, and I am speaking millions, because it takes a lifetime to save for our OWN care.
I feel you are enabling a dreadful decision by participating in these very bad plans to go home. You say her "friend" in involved in all this, even choosing caregivers. And that you are to pay for it. Nope. Nope. Pull out. Leave the friend to it. Call discharge planning and tell them you don't wish to be involved in any way in these plans of homegoing with inadequate care and management of your cousin's dangerous discharge. Then tell your cousin and this "friend" the same thing.
That would be my last word on this, and you surely are free to kick my advice to the curb and continue on with this, but it's going to be, imho, a massive and costly mess.
You hire two people. One weekdays, one weekends. Or split the week. Or hav them work one week on, one week off. The time arrangement can be whatever works for the client.
Be totally honest about what the job is going to be. Understand the difference between say a person needing help in and out of the shower, and the caregiver literally having to get the person in, wash them, dry them, and dress them. Needing some help with meals to me is taking something in and out of the oven for someone. Not the aide plans the meal, cooks it, feeds it to the client, then cleans up after it. No. Be honest about the level of care the person needs.
I can tell you for a fact that if you hire privately from a site like care.com you can negotiate the wage. Live-in caregivers DO NOT get paid hourly. They get paid salary. Also, the free room and board they get is considered part of their wages. So it really isn't as expensive as many people believe. Look at a few caregiver profiles on some websites. Have your cousin put one up for themselves stating what they're looking for. Good luck.
For a Live in caregiver you still need to pay a living wage, you need to have a back up because 1 person can not work 24/7/365.
Add to that you must pay legally taxes, have workmen's comp, make sure your home is insured properly in case of injury.
"Room and Board" is not payment for caregiving.
If necessary begin the application process for Medicaid ASAP.
Your cousin should talk to the Social Worker at the rehab facility.
Where are you getting these "facts" about a live-in being far more expensive than a facility?
The reason why everyone doesn't do it is because Medicaid and most other insurances won't pay for 24-hour homecare. They will only pay out to a residential care facility. My only guess for why is because the LTC industry greased a lot of palms and did a lot of favors for our legislators. The other reason is a person is too far gone to be cared for in the home and they need a facility staff to meet their care needs.
If you're hiring privately (not going through a homecare agency) you can negotiate what you're paying. I did caregiving for a long time and most of those years were with private cases.
I can't believe I'm even going to say this because I operate a homecare. When it comes to live-in or round-the-clock care when you hire directly (privately) yourself and leav the middleman (the homecare agency) out of it, you'll save money. It's way less than a nursing home.
The aid needs to earn some actual cash in order to live properly. There are also numerous posts from live-in aids who also regret the arrangement.
If she has limited resources she can maybe consider going into a good facility that accepts Medicaid on private pay initially and then going through the application process (she needs to qualify both medically as needing LTC and financially).
Please find those posts and have her read them -- they are eye opening.
Also, hoping your cousin has assigned a PoA and has all her other legal ducks in a row. Never be tempted to pay for her care, even if she asks. The monthly cost can be in the thousands, and sometimes in the tens of thousands.
This is very important because if you pay even once, you may be pressured when they try and get you to pay again. Especially never sign anything because they may pressure you even more. Facilities know all the avenues to "try" and collect any way they can... but they also should know how to help her go the Medicaid route... and maybe even expedite it. They also know that by doing so, a resident will be paying less once it is approved.
If not, she really should find a nursing home and apply for Medicaid.
I am sorry for your family, my sister died of breast cancer and it truly took a village of friends and family to have her at home on hospice. One person would have never been able to handle it.
As far as you paying, solid no, she has public resources available.
If she needs help in managing this it's a good sign that she's not capable of being home at this time.
I would tell her you can't/won't handle this for her.
Rehab is the perfect place to go into care from with the help of their discharge planning. It will be much more difficult if she returns home in need of this level of care and is alone and helpless.
This gets a big "NO!" from me, or a more gentle "I am so sorry; I couldn't possible help with that; I don't feel anything like competent to do that".
Speak to discharge planning TODAY by phone to tell them you can't assist. And caution them against an unsafe and unwise discharge home from their facility.