Hourly rate for family care - any input?

From your profile: "I am caring for my father Rob, who is 78 years old, living in my home with alzheimer's / dementia, anxiety, mobility problems, sleep disorder, and stroke."

What exactly are the caregiving duties that you do for him? I see nothing wrong with $25/hour!

And why aren't YOU being paid for taking care of your father????? (Or are you?) If your father has assets, you should be compensated.

I got $20/hour, and did no hands-on care for my mother. I did not live with her. I was paid by a POA brother. No taxes taken out, and it was all a gift to me, as she would never have qualified for Medicaid.

It seems like you ARE doing hands-on care. Why should your brothers get paid and not you? They get paid to take care of THEIR mother, but you do it for free? (Again, I hope this is NOT the case!)

I'll also be compensated - we're doing a care agreement for me, as well; the attorney felt my compensation request is appropriate, but not for other family members coming in for an hourly rate. My brothers have been amazing the past couple of months, offering help often, so I'm hopeful that help continues.

Since having Covid, Dad's dementia has progressed considerably; I'm sad to report that some days he doesn't even remember me. I work from home, so it's a juggling performance to say the least, but I have great management and others on my team also caring for their aging parents... so they get it. I've also had some vacation time to burn on days when dad isn't doing so well.

Dad had a hip replacement earlier this year, so he requires help standing and walking at times. He feeds himself and needs minimal shower help; toilet assistance comes and goes depending on the day and how he's feeling. He cannot dress himself anymore. All meals have to be prepared and he obviously no longer drives.

I'm with you - I think $20-$25/hr is a fair amount to pay for that kind of care, but the attorney felt more comfortable erring towards the side of caution.

Not outrageous but it will have to be declared for income tax purposes to satisfy Medicaid lookback by each of you if it’s a caregiver contract.

The mileage question may very well be due to mileage cannot be deducted for transport to place of employment for anyone, anywhere. If it were mileage for errands while with dad that would be different, I would think.

My understanding is that the payment for caregiving services can be the same as an agency. How the agency overhead fits into that equation is an interesting question.... It sounds like the attorney is wanting to keep you out of trouble with the IRS. Is there someone in the firm that specializes in tax law?

I have a concern about this arrangement. How are income taxes and other withholding amounts going to be handled? There are payroll companies that do this exclusively. Or would the amounts that his kids are paid be reported as gifts, and taxable by the IRS? Check into that. Other than this, it sounds like you have everything set up nicely. Will dad also be paying rent or is everything covered by the agreement? Have you checked with your homeowners insurance to see if any additional insurance is recommended?

I am paying $16.50 directly to a licensed CNA in South Florida . The agency rate was $22 to $25.

If you expect to eventually apply for assistance for your father, everyone who is being paid must declare the income on their tax returns and you will have to file and pay employment taxes.

I'm in MA, and am thrilled to pay $25 for caregivers I know - not professional but extremely capable and caring. The agency was $39 per hour!

I think $20 on low end .. 25$ good
minimum… agencies more like 35/40
actually if family members giving you some respite and rest I wouldn’t be nickel and diming them … be thankful they’re helping .

We are paying direct pay in Maryland. We are in a poor part of Maryland. We start at $20 per hour. We pay legal with taxes taken out, workers comp and social security. Most of our caregivers are getting between $22 and $27 per hour.

Before you discount the VA for help PLEASE contact your local Veterans Assistance Commission. Get as much information that you have for your dad (DD214 if you have it) Depending on where and when your dad served some of his "conditions" might qualify as a "service connected disability") There may even be an Adult Day program that he would qualify for.
There are programs that can help even if he does not qualify for Aid and Attendance. (I am sure that is what the Elder Care Attorney looked into)
The VA will also pay family members to care for the Veteran. (for others in this situation they will now even pay spouses to care for the Veteran)

I think "easing" into outside caregivers might be the way to go with your dad. If you need to hire someone from outside the family take it slow. On the first day tell dad you are "Inviting a friend over". Spend some time get your dad involved so make it afternoon so you can have lunch. The caregiver can set and clear the table. Make it relaxing. Second day that they are there follow the same routine so dad gets used to this person and they are no longer a stranger. A good caregiver will be able to ease the transition.

As to the "going rate" call a few agencies in your area. As you ask questions about the caregivers and what they do, just as if you were going to hire them ask what the fee is. It will depend on what they have to do. If it is more companion it will be less, the more skilled the person is the higher the fee.
the caregiver from an agency gets a portion of what you are charges so scale down from there.(the 2 best caregivers I ever hired were from a local Community College, they had just finished their CNA certification and were awaiting for the nursing school to start. This was about 5 1/2 years ago and I paid them $20.00 an hour.)

My MIL’s aid gets $25.00 an hour

Ever seen the old tv show Green Acres where Zsa Zsa Gabor negotiated by increasing the amount instead of negotiating down?

Your family attorney wants to treat care like a business. Go for it. Tell her you’ve reconsidered. You were remiss in treating this as a family matter instead of a business matter. Thanks to her enlightening you, you realize that your status is an employee in this caregiver business and therefore you expect to be paid.

If you were in Connecticut, I’d say ask for a salary of $60,000/year plus costs for room and board for 24/7 care, 1 day a week off (the lawyer hires part time help), 20 day vacation and social security contributions as required by law. You will pay taxes. This is a real number for what a caregiver I knew was paid 6 yrs ago BEFORE todays inflation. Granted it was upscale Connecticut.

So, using that as a basis, set a comprehensive value and price for your services in your community and expect it. You are the single most qualified person for this job. Caregiving is tough and everything I’ve read on posts is that dementia takes an added toll on caregivers. The lawyer will patronize and try to play you, but seriously, she opened the door. Don’t let her bully you. You can tell her moving dad to a facility is an option. Obviously second rate option, but then what does that say about her respect and the family’s respect for you if you get paid less than a bad option?

Then you can afford to subcontract as needed and at a rate you feel necessary.

My mom passed away from Alzheimer's about 9 years ago, and most agencies charged $20-$25 an hour then. A friend pays an aide $25 an hr. now, directly to her, no agency involved. Hubby and I took care of my mom for 5 years, and like your dad, my mom was wary of strangers, unless we were here, so we never hired anyone, but I was wondering, if it becomes necessary, if a family member isn't available, if you could have an aide come over while you are there. Maybe you could do this for a week or so, for a few hours at a time, so your dad could get used to her, and then see if he'd be comfortable with her as you did other chores in the house, so you weren't as visible. Then you could see if he'd be comfortable with her for a few hours, with no one else home. (A nanny-cam might help. I think you should tell the person that you have one, so everything is on the up and up.) I wrote a book about our travails called, "My Mother Has Alzheimer's and My Dog has Tapeworms: A Caregiver's Tale." In it, I mention that I had no idea of the financial and emotional toll that Alzheimer's takes on everyone: patient and caregivers alike. Best of luck.

Pay mileage separately. I don't know who sets the "going rate" in the US (might be the IRS?) but here it's about 60 cents a mile for the first 10,000 miles annually, and 33 cents a mile thereafter. If they don't travel by car it's even easier: they can certainly claim back travel expenses incurred on your father's behalf.

The attorney is correct to argue in your father's best interests, and no doubt also has in mind how this might all potentially play with Medicaid; but I'd like to know where else she thinks you can source care at her reduced "family" rate.

They are right. Agencies charge $25 an hr and pay mostly just a little more than minimum wage.

You can hire Caregivers for $12 an hr in Texas.

You settled for $20 and that's high, you can get a Nurse for that amount.

I’m curious how much do you pay yourself for proving around the clock care?

The minimum wage here is 16.75. Indy aides start at about $20-$21. Agency rates are about $8, $10 more per hour.

$14 seems really low. Almost insulting. If anything family deserves to be paid more, not less. It's not like you're going to be getting rich off this senior simply by doing work for market rrate.

Agency rates are higher than you need to pay friend or family respite. There you are paying as well for administrative costs. Twenty dollars an hour is fairly generous as it is. Most families do not pay each other for help at all. Pay separately for gas and essential expenses.

I live in NY and paid my fabulous caretaker $20.00 hourly rate. - we used my parents account to pay for her care, and Medicaid to pay for additional agency care. The rates your lawyer gave you are correct. My siblings and I did not charge for any time we spent, (I actually slept there 4-5 nights a week, plus errands, extras, etc.)
Your Dad may not qualify for Medicaid now but your lawyer can legally protect his assets so that he can qualify 5 years from now. Believe me, it's worth the process.

Clearly every state and county will be different as the cost of living is different everywhere so to ask such an question won't provide you with the exact dollar amount "acceptable" in your area. You mentioned an Atty and that's great as they are privy to this information, also we will all answer your question depending on where in the U.S. we are located. I am in Massachusetts and here the low end for PCA'S is $22-$27 and CNA'S $27-$35 providing private in home care. Consumers here pay agencies upwards of $45+ an hour and in return pay a CNA $19-$23 hourly. Again please look at your area for competitive wages. I have always found no matter what state you live in the local Council Of Aging is an amazing resource and wealth of information from food programs to how to hire the perfect caregiver- the knowledge these folks have is priceless! I wish the best for you and your family- your family member is blessed to have such a caring family!

$25 is the going rate in Boston .

Wow, my immediate thought is that this attorney has never been a caregiver.

Poverty wages are appropriate for caregiving, really? Lawyer jokes are coming to mind. And what does she make for just sitting on her @55…?!?

Sorry, lost my temper there for a moment! 😉

JustVee: The rate of $25 per hour seems about right, accounting for inflation, which this year skyrocketed.

It isn't what you pay per hour, it is what is included in the hourly rate.
Whatever you decide to pay if ind contractor, you can start on a trial basis for a lower hourly and increase after 2 weeks or so. Or tell them you provide bonuses for 'good work' (I used to do this when hiring care givers who were really good and worked very hard, and were committed to my friend/elder).

INDEPENDENT CONTRACTORs
* You need to do all your own screening, i.e.
- Live Scan (finger printing / criminal check)
- Vaccine card; ongoing Covid testing
- get copy of Driver's license and insurance
- insure they are in country legally
- References (and from families, not only the person cared for)
- You need back up care givers if / for : 1) one doesn't work out; 2) they need to take off due to other clients / emergencies / child or self ill; or just do not show up or call and say they can't make it.
- You may be liable for worker's compensation if the person gets hurt on your premises (not sure).
- Lastly, hourly fees depend on where you live and what duties are required.
- Are you taking out taxes ? Draw up an agreement.

HIRE THROUGH AGENCY
* They do all the testing and background checks (ask to see copies if possible. Do ask person / caregiver for copy of vaccine records/covid testing anyway.
* They cover worker's compensation.
* Agencies are insured. They have protections you will not have.

DO:
1) Interview and have a list of questions prepared
2) Ask everyone the same questions to get a sense of comparison
3) Ask how they work with somone resistant to change / new people
4) Have them meet your dad even if briefly. You do not need to tell him what they are there for; you could say they are helping you with house chores or something.
5) Consider getting cameras to observe what is going on.

With all this said, I am a care manager/provider and an independent contractor for the last 8-9 years. My background includes counseling trainings, (I was going to become a psychotherapist and didn't); certified massage therapist, event/ coordinating up to 10,000 people, writing abilities (I write assessments for the families to track changes); studied on-line webinars for two years with Teepa Snow, one of the country's leading experts on Dementia. I am more like a social worker who manages all kinds of needs, including supervising caregivers/ contractors, workers, working with attorneys, medical personnel, real estate agents.

It works out well for me on this side. I was vetted/screened at the main elder care facility where I work 'to be able to work with their residents' although once vetted, I work / contract directly with the residents. The facility required work and personal references, copy of car insurance, Live Scan.

Gena / Touch Matters

You may not be able to pay them mileage but, there are always ways to make it work.

2021 is .56 per mile, if they keep track of their mileage, they will be able to deduct it from their taxes.

If dad can afford 20.00 an hour for help then he should pay it. Depending on matching SS/Medicare, workman's comp rate and unemployment insurance it is going to be closer to 25-28 hourly, so keep the labor burder in mind. Whomever is doing the payroll is going to be an added expense, even if it is you, you should be paid for doing it.

Because this is family, it is really important to do everything correctly. Medicaid will say gifting if taxes are not withheld and paid.

I know that all the insurances don't seem necessary because it is family but, there are labor laws that you must abide by to make this legitimate.

Your attorney or CPA can guide you on what your state requires.

This will seem overwhelming when you start getting it set up but, you only have to set it up once and then it is payroll, quarterly filings and year end forms and reports, not bad at all.

I, truly hope, that you are being compensated as a caregiver as well.

Here is the real pay that home health aides and caregivers receive. The agency charges more but the aide usually gets close to minimum wage up to about $15/hour. That is why the lawyer suggested those rates.

I agree that having family members help out is awesome. However, you will need somebody who is able to come in if you or your husband has an emergency. Check with friends, members of your faith group and paid help to fill in this gap.

Since dad is having problems with anxiety, please talk with his doctor about symptom management. Usually a consistent routine in a familiar environment is the first thing to try. However, anxiety like you are talking about may need to be treated with a low dose of anti-anxiety medication. It may make him a bit sleepier until he gets used to it. I see this as helping people not be afraid for the last season of life.

I am responding to your comment about Dad not qualifying for VA benefits. Did your dad serve during a time of war? If yes he may be eligible for a little know benefit called Aid and Attendance. My dad entered the army at the end of WW2 and was discharged after 18 months, 6 months short of qualifying for a VA pension. Korean and Vietnam vets are eligible, really anyone who served in the military since the Spanish war!

After his death I found out about the A&A pension and after a lot of paperwork got Mom a monthly pension of $1250. It was a big help in paying her AL fees. You have to provide proof of need, assets, cost of living expenses, service record, etc. I also had to be appointed as Mom's fiduciary (government speak for POA) as the federal government doesn’t recognize state level POAs.

I don’t know why the VA didn’t offer this when I applied for a pension for Dad. A lovely consultant at A Place for Mom ( not a plug) suggested it when I was looking for an AL for my mother. There are a lot of websites offering help in applying but be careful, you shouldn’t have to pay to apply. Go to a Veteran’s group in your state, city, or county and ask for more info.

Don't count on the pay rate being a motivator for brothers to help when needed. You had best have other options lined up.

Im confused why you have to pay your brothers to help? Are you getting paid as a live in nurse/aid??? 24/7? You should be getting paid. If your going to pay your brothers as incentive. I'd get that squared away right quick with them. If they wont drive over to give you a helping hand, let them pay for home health, or pay for your respite care worker. Bc IF and a big IF they aren't lifting a finger to help, they should come up with a solution if your doing all the caring. That is no easy task. I wouldn't pay them that is their DAD. They should be willing to help. If not then pay for the carer in their place.

I worked HH it was $12 pre -inflation. A agency charges double bc of insurance, and screening applicants, background checks, drug tests etc.
If your dad is afraid of new people, maybe you can get a HH aid to come in 1-2x a week for an hour so he gets used to them. That way you can build up hours and he gets accustomed to them. Talk to his doc, maybe get him anti anxiety meds so he's calm when they are there. Maybe not have them do much with him right away. Like not changing his depends, or sheets right away, but do some laundry, put away, or serve lunch, or lite cleaning, even a companion to watch tv and give you a break, and he gets used to them.
I wouldn't pay the brothers as incentive for their help, unless you are getting paid to take care of him. They should be thanking their lucky stars you took that on. And want to help, bc your not asking all that much. Don't let them talk you into its an inconvenience, I can't.
Your doing the work of 3 people/3 shifts. Good luck.

I think $20 is fair but I'd also reimburse for mileage too.

What one sibling gets paid all get paid. So whatever you decide on for them your father pays your for caring for him going forward. Family carers can be paid at a reasonable rate and with records kept. (You are also providing a roof over your father's head). Sure $20 sounds fine for brothers if they are going to provided their own food and cover costs whilst in your house if you are going to provide for the period of their stay then it sounds generous - acceptable but generous. I think the more important thing is that the brothers should get used to standing in for you and taking on some of the responsibility. If they don't want to then they should pay for the necessary 24/7 care whilst you are away for reasonable breaks - say 4 weeks a year - but whilst you want to pay them it should not be one rule for them and one for you, pay them the $20 and make sure you pay yourself the same.