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My 93-year old father is in hospice at home in Oklahoma. He fell recently and the hospice doctor and nurse confined him to bed. He now requires 24/7 care. We´ve hired a retired CNA who was looking for some work as a private caregiver. She´s not with an agency. At this rate, his money runs out in 3 months if he stays in his rented apartment. If he were to move to a nursing facility, his money would last 3 times longer. It´s inevitable, should he linger longer than 4-8 weeks more, that we should think of putting him in a nursing facility so his money lasts 3 times longer. My question..for him to qualify for Medicaid after his money is gone, will the fact that we are currently paying a retired CNA instead of someone from an agency work against us? He will at some point need to go on Medicaid. And I´m concerned that Medicaid may not consider paying her as acceptable caregiving as we ¨spend-down¨ his assets so that Medicaid can kick in. In other words, would we be better off in the long-run to hire in-home care from an agency instead of paying a retired CNA privately? Are canceled checks considered enough proof?

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Your question is timely about private pay to caregivers Get the current December 2017 issue of Consumer Reports. If it is not at the newsstand then locate it at the library.
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Usually when someone is in hospice care they're within 6 months(I'm pretty sure it's a rule) they're of dying determined by a doctor. A nursing home may not be able to or want to take care of him. You may not be able to take care of him either----that's why he's in hospice care.! I would check with the nursing home first and medicaid to see what type of help they will pay for.
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Caregiver probably cannot get 1099 MISC as they can’t meet the IRS 20 point criteria for contract labor. They work in your home as a domestic / household employee so get W2. If more than $1900 per year, you have to take SS & MediCARE (FICAs) out as well, if more than 1k in a qtr have to add in unemployment tax as well.

IRS has a form SS-8, that you can submit to make the determination.

Also pls check your homeowners policy to see what coverage for caregivers if they should get hurt while on your property. Ditto for car insurance if she’s driving him to medical appointments.

Yeah it’s paperwork. Or you could do it and ask forgiveness later. If so, on any checks make them out as Jane Jones CNA & put hourly wage in check description area; & have her submit an invoice to dad every week so it’s very consistent & business like. No casual accounting & no cash paid out ever. Keep all as you as dads dpoa may have to answer to both IRS and Medicaid later on in 2018 and in detail.

For all these reasons families find its simpler to go with an agency.
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NorDoc, If the cna is an independent contractor, you will have to issue her a 1099. You must do this correctly with all required documentation. See an elder law attorney. Without a paper trail Medicaid may very well consider the payments to the cna as a gift and subject to penalty. Going through an agency would have been much simpler.
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However this is worked out legally, I would notify the retired caregiver that reporting is required by you, because she would have to report her extra income to Social Security and the IRS, perhaps agreeing to provide her with a 1099 form as an independent contractor for earnings over $600 for the year.
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Just a suggestion but, if hiring a person as you have mentioned you are responsible for paying or deducting all taxes to Social Security and the IRS, perhaps also local employee taxes.
As for the rest of your question, I would contact an accountant or contact Medicaid and verify their answer.
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