How do I get my aunt to pay for her own home care services?

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My aunt is 92, mentally very sharp, physically very fragile. She's on a wide range of meds that include pain management, a mood enhancer, Coumadin, among others. I've looked after her now for some 16 months in a nursing home and have been her POA for some 16 months. She can now walk quite well with a walker on her own for a good distance. She can get up out of bed on her own, go to the bathroom, and do other things all on her own. Now she wants to go back home but doesn't want to hire any home care and wants me, her nephew, to do home care for her. I don't want any of it except one day per week. She's offered to pay me for doing it full time, but I declined and said she'd have to initially hire enough home care for six days per week and I would take Sundays only. If not the six days per week, she could easily afford 3 hours a day, Mon., Wed. & Fri., or any other combination up to 10 hours per week or so. This is for $20/hour. She won't have any of this, and I feel she's trying to trap me into years of caregiving. She gave me POA years before all of this ever happened, and some 7 years after I retired, she had a deep vein blood clot and I found myself taking care of her financial affairs and looking after her house, lawn, etc. I was using the POA, which she had prepared some years before all of this happened, to pay her bills and take care of her house. etc. She's looking now to get out of the nursing home and going back to her home. I don't want the job of caregiving her, and if she doesn't get enough help, I won't agree to take her out of the nursing home, though I won't be able to stop her from going home I suppose. My opinion/belief is that since she can afford taking on some home care, she's obliged to do so, but I think she wants to save her money to bequeath it all to her nieces, nephews, and others, which is commendable, but she shouldn't do this on my back. She should get enough home care, however much that will be, even if she has to run out of money and then go on Medicaid. I'm just concerned that she'll force me to go to her house because she'll not hire any help for herself. Any words of wisdom on my situation would be appreciated even if those words will show me to be in the wrong. I know that in another 10 hears I'll be in the same situation, but it's just something that happens to the most of us.

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Top Answer
How is this physically fragile little ol lady going to force you do anything?

Ah, the guilt trip, right? She can buy the ticket but you can decline to ride!

Of course she needs to pay for the care she needs at home just as she's paying for the nursing home (I assume). Keep repeating this theme!

You are right that you can't stop her from going home, but you can make it very clear to the discharge planners that she would be going home with no family help.

Can you continue with the POA duties of handling her financial affairs? That is a sufficient contribution!
Marcel, I agree 100% that your Aunt would be using you to save money so she can hand out inheritance to other family members. Therefore, I wouldn't even recommend that you do caregiver one day a week, because that could easily become two days a week, then three days a week... and before you know it, you are doing 168 hours a week. And you would be doing the household maintenance and yard work. Whew. That makes me tired just thinking about it.

I say bravo for your Aunt at 92 feeling good enough to want to live at home, but at her age and being on blood thinners, all it would take is one fall to create a whole different scenario. Then what? Two shifts of caregivers?

Is the Aunt's house elder proof? Does she have a walk-in tub or shower? Are there grab bars in the bathroom? Are the hallways wide enough for her to use her walker? Can she easily get into the bathroom with her walker? Can she use the regular toilet or would a higher one be needed along with side grab bars so she can stand up? So much to think about.

If money is an issue, Independent Living with Assisted Living options might be the way for your Aunt to still feel like she is independent but be in a building that has Staff working around the clock. Could she afford $3000-$5000 a month for Independent Living? It's cheaper than hiring full-time caregivers. If there is enough equity in her house, she can sell it and use that money.... or is the house the "inheritance"?

If your Aunt runs out of money, and needs to go on Medicaid... well, Medicaid would put a lien on the house and once she passes, most of the equity would go to Medicaid to pay for her care.

Oh, if your Aunt hire caregivers who are independent contractors [not through an Agency], then she would need to put a "workman's comp" rider on her homeowner's insurance.
I think you're wise to see the drawbacks to the proposed arrangement, as well as to recognize that she's likely trying to reserve her funds for bequest to the other relatives.

As a countermeasure, could you think of a suggestion that would absolutely squelch the idea of her coming home and relying on you as a caregiver? Perhaps something such as that all the other nieces and nephews must agree to participate (and commit in writing), with each assigned to a specific time, day and responsibility? Assuming they won't agree, that might stop the whole issue, but I think there's another one, which is that your aunt is now reliant on you and doesn't want to consider alternatives, one way or the other.

I'm curious though, why was she in a nursing home for 16 months and now has apparently decided she wants to come home? Was she actually in an AL or iL facility? How has it worked out? Was/is she satisfied there?

I have a feeling that if you legitimately insist on home care and won't relent, she may become annoyed with you in some way or another, such as rescinding your proxy authority under the POA. If she's as determined as I think, she'll continue to push to get her way, and if/when she recognizes that won't work, will retaliate against you.

Just in case, I'd make sure all your activities as proxy are well documented in case she chooses someone else.
Marcel, don't let her force you to do anything. You have done enough. Just. Walk. Away. Time for the others to step up! Unfortunately, that probably won't happen unless you totally disengage yourself from her and her problems. You can resign your POA.
Keep us updated.
I know it is hard to refuse your aunt but please do for your own health and sanity. It is your aunts responsibility to pay for caregivers and if she refuses then she needs to stay in the nursing home. At her age she will likely need caregivers 24 hours a day very soon. If you bring her home, even if she agrees to pay for a caregiver a few hours per day, you will end up picking up the slack as her needs increase.
Marcel, if your Aunt continues to want you to be her caregiver, ask her if she knows of anyone who is currently taking care of her, at the nursing home, who is your age? Since you are retired, I assume you are a senior citizen yourself.

I bet your Aunt would be hard press to point out anyone working on the floor who is even close to your age. And there is a good reason for that, it's a very physically demanding job. Plus these nurses/aides are trained in their field... you aren't.

I remember couple years ago asking my parents if they called a caregiving agency needing help and the Agency said they have one person they could send over... but this person isn't physically able to you up if you fell... this person doesn't know CPR, or how to take blood pressure... she never had any training in caregiving and this would be her first job... oh, this person doesn't like to cook... this person is limited on driving... and this person is approaching 70 years old... shall we send her over to you? Of course my parent said they would say "no".... HELLO, that person would be me. That was an eye opener for my parents.

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