My Dad lives alone at home in a neighboring state. I drive up at least once a month, but for the past year and a half, for the days when I can't be there, I have hired caregivers from a local home care agency to come in almost daily (about 3 hours at a time) to do light housekeeping, provide companionship, take him shopping, check up on him, take him to lunch/movies/entertainment, make sure he hasn’t forgotten to care for the cats, and so on.

This has worked mostly pretty well for the last year and a half, but Dad’s dementia (FTD) has been progressing and his need for more extensive supervision is increasing. He is starting to express irrational or (at least apparently) unfounded beliefs more frequently — usually some kind of story his brain seems to have cooked up to “explain” something he has seen or not seen in his neighborhood (for example, that a neighbor whom he cannot remember seeing drive by in a few days has killed herself ... or (in relation to the never-ending construction project across the street that he's been complaining about for the past six months), that the neighbor who stepped out her front door last Saturday morning, no suitcase in hand, and drove off in her car was abandoning her house and fleeing to another state to escape the financially, sexually, and physically abusive contractors who have been doing extensive roofing, driveway, and foundation work on her home.

Based on recent retesting, Dad's doctor confirms a “precipitous decline” over the past six months and tells me that I need to at least double the number of caregiver hours I’m currently covering.

When I first started to hire caregivers, Dad was in a more functional state of mind, and I was reluctant to do or say anything to “squeeze in on” his autonomy. He continued to go to the bank (sometimes with his caregivers) and withdraw cash as he always had (he had only ever paid cash for anything), store cash in a lockbox in his house, and write occasional checks to repair people. But by last September, I realized there was a problem. The math was not adding up. Thousands of dollars of cash were simply missing (i.e., my Dad’s spending behavior, bank withdrawals, and lockbox contents were not lining up).

I did not and still do not know whether the problem was (a) caregiver theft; (b) service provider theft (though I’m almost positive his gardener was for a time happily accepting multiple cash payments every month because Dad would forget he’d already paid); (c) Dad giving money away to people on the street; or (d) Dad simply misplacing/losing envelopes of cash from the bank.

But my solution was to say to the agency and the caregivers, “Dad's been diagnosed with dementia. He can no longer drive, and it's not safe for him to handle cash anymore. From now on, he needs to use this credit card, on which I'm an authorized user. Now, he’s never used a credit card before in his life, so I’ll need you to show him how to do this when you take him to the store and to restaurants, and to help him make sure he always gets his receipts and copies, and his card back, and that he signs properly. When you get him back home, please put all receipt and credit card slips in the box by the TV. In the weeks when I’m not here, I’ll monitor his credit card use remotely to make sure his number hasn’t been cloned/ID stolen, and when I come up, I’ll pick up all receipts and slips and take them home to reconcile against his bank records and previous receipts, which will help me and his doctors pick up on any changes in his behavior patterns.”

This has worked very well, generally. But sometimes, only cash will do. For example, Dad's barber and the repair people who come occasionally to the house (e.g., plumbers) typically only take cash or checks. in the past year Dad has gradually worked down through his remaining supply of “in-house” cash (some to the above, but also giving away a fair amount to people on the street ... and in one case, making a loan to one of his caregivers that I only know about because I found a note he left to himself in his lockbox about it -- ’m sure he doesn’t even remember making the loan or whether it was ever paid back ... and while I am, of course, not thrilled about this, I don’t want to fire her or have her fired because she is my father’s absolute favorite caregiver, and he would be beyond crushed if she disappeared).

The caregivers are not in a position to “forward” their own funds for such expenses and not be reimbursed until they get a regular paycheck up to two weeks later. But I am feeling that Dad is really not “safe” to handle anything but the credit card anymore.

Can anyone suggest a system or systems that would allow me to make cash available to these agency caregivers for those times when nothing but cash or a check will do – e.g., when Dad needs a haircut, or when a plumber has to be paid – but without just giving anyone free rein to help themselves or “borrow” from a cash stash?

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PaulaK, in light of your father's precipitous decline, I wonder how long he will be able to live in his home. Most people with dementia eventually reach a point where they cannot live alone -- not with 3 hours of care or 6 hours of care per day. They need 24/7 supervision and help. (This was certainly true of my husband throughout his entire 9.5 years of dementia.)

You have done an awesome job, in spite of living in another state, to give your father at least a year and half living on his own that he couldn't have done without you. You've come up with creative solutions to the challenges. I have no doubt that you'll resolve the cash issue, too.

I suggest that you look ahead a bit, as the dementia progresses more. Will Dad be able to afford 24/7 care? Would he be better off in a care center, near you, so you can visit him more often than once a month?

I think it would be good to talk to his doctor about these issues. Starting soon will give you plenty of time to research various options. And if you never need to use your research, so much the better! But it is always better to be prepared than to have to act hastily in an emergency situation.

Best wishes to you all.
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Would the agency be willing to provide the money for the caregiver? They could provide cash that you have prepaid to them, perhaps.
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I agree in part with the last poster - LadeeC. The only problem will be that the agency pays these caregivers, so withholding from their paycheck is not under your control. Find out if the agency will add this to the care plan for your father. I have this arrangement with one of my clients, and keep her petty cash in an envelope at my home. Of course, I've been her caregiver for two years and we have a good and fully trusting relationship. I do her shopping prior to arriving at her home, which is why I require access to the funds before coming to "work". I think you can work out a system which is agreeable to both you and the agency, and works for the caregivers. The difficulty will be replenishing the supply of cash, as you are not local. I suppose this would require hiring yet another person, although I certainly hate to see that happen.
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Another thing you can do is keep the equivalent of a petty cash fund on hand, in the house, in a place only the caregivers can access. Require signed acknowledgment from the caregivers of the amount, and specify that the funds are only to be used for receipted items. Missing balances will be taken from pay checks, until the receipt or funds tally. I've done this for years, from both sides of the fence and it works well. For instance, I'm responsible for all the household buying (groceries, sundries, etc) and have a $300 bank from which to draw. The funds are reimbursed as they're spent. If I lose a receipt (and I've done it), I just bought it, lol. I accepted that responsibility, so it's on my shoulders. Another example: the family purchased a hospital bed (yah, we could've gotten a medicare paid bed .. this one was WAY better). The DPOA brought the cash, I signed for it, sealed it in a signed envelope; then when the bed was delivered, I turned over the envelope, still sealed and had the delivery guys sign for it, as my receipt.
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Another option is to speak directly with the plumber or the place where your father gets his haircut to see if they would be amenable to billing you directly. The caregivers could inform you when the services were provided and you could match this against invoices received and then pay accordingly.
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Hire a geriatric care manager. These are professional people who will oversee your fathers finances, caregivers,etc. They are to be in touch with you letting you know what is going on. Geriatric care managers came about to help adult children who live out of state from their aging parents. Google it, research it and talk with a few. It won't hurt and it may give you much peace of mind. Good luck!!
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