Good morning, everyone. I have a few questions about caregiver contracts.

Both of my parents live with me. My father needs more care than my mother due to Parkinson’s, and other health issues.

1.) Does each parent need a separate Care Giver Contract?

2.) When it comes to sharing costs of living expenses, my father has more income due to VA disability than my mother with her SSI. He also requires more care. He does get an increase in his disability income due to them being married.

3.) In the contract I found here it has a mileage reimbursement. How do you decide on fair market mileage for taking them to the doctor and other travel that they need to do?

I take care of both of my parents and provide all the care they need. I gave up my career in nursing when my father moved in with us 15 years ago to take care of him. My father has handled his own finances, along with my mother. My mom was living with my older brother and helping take care of him, due to his health issues. My father would send money for her to contribute to her living expenses with my brother. That is no longer an option as my brother is being placed into a home. Due to her age and her own medical issues, she is not able to live with him or on her own.

I am trying to cover all bases. I know when my mom was discharged from the hospital a few months ago and need some home health when she was with my brother. We reached out to an agency and the going rate hourly for a Home Health Aid was $30 per hour.

I do plan on calling around and seeing what the rate is for Assisted Living for someone who is independent, but does needs assistance with bathing, meals, laundry, and transportation to Dr. appointments. I know my dad would have to go to a skilled nursing facility for 24-hour total care. So, that would be a more expensive rate. If something should happen to my father, my mom's income would drastically decrease. Widowers VA benefits are much smaller. I do know the VA has a caregiver program which we have not utilized yet. I am both of their DPOA’s for health, financial, etc.

I do realize that I would never get paid fair market rate for providing 24-hour care. But I do know we need something in place should either of them need Medicaid to help pay for nursing home or care in the future. So, I would like a contract in place.

I plan on having in the contract their contribution to living expenses. Shelter, utilities, food. Keeping receipts of their medical co-pays, prescriptions, personal expenses, incontinence supplies, but also putting into place a 40 hour per week hourly rate for care. Along with Mileage for travel. My father has chipped into these expenses all along and was the one to approach this idea years ago. But we did not have anything in a contract. His reasoning was that I had to give up my career to take care of him. He did not want to go to a Nursing Home. I do get coverage for my parents when I have my own appointments, someone to come and be with them while I’m out.

Agree with others - get elder attorney to get you set up with appropriate contract, reporting earnings to IRS appropriately, correct way to pay toward housing or rent expense, etc. HE would also be able to explain how Medicaid works if they run out of money and need NH care and how the money will follow each of them.
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Reply to my2cents

VetCareGiver: Perhaps you will want to retain an elder law attorney because if either or both of your parents need to file for Medicaid, you will want to make sure that you cover all the requirements.
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Reply to Llamalover47

You might want to consult an attorney specializing in senior law. Connect with a local social worker, who may also be able to advise and who may be able to recommend pro bono attorneys, if needed.
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Reply to NancyIS

You replied below

Thank You so much for your reply. How does the aid and attendance work. Can an outside Dr, Physical Therapist fill out the VA for it. Or should it be the VA 

go to your county office for the VA , if it pertains,….. they will make the application for you….a
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Reply to babsjvd

Our experience in trying to secure and keep a consistent staff of 'in home' caregivers was not a good one and is what drove us to find an assisted living facility.
If someone called in sick; they sent over someone else we had never met. If there was a scheduling conflict; they would move the days/times for the visit. Every person that came had a different way of handling groceries etc. If they grocery shop or run errands; it's always done 'on shift' so they leave to handle that; and yes; they charge extra for gas. They only work/charge in 3 hour increments so whether you needed them or not; they were required to stay and you paid for it even if you sent them home.
It was awful.
Please call and visit 'assisted living' facilities in your area. We found an excellent one that gives my in-laws a discount because my FIL is a veteran. They are reasonably priced even without the discount. They have their own apartment; provide 3 meals/day; provide transportation to doctors; social and grocery outings etc. They have med techs/nurse on site 24 hours/day; provide a pendant for emergencies; coordinate with the hospitals for transport to/from ER etc. When my MIL/FIL needed more care (medication management; meals to their room; dressing/showering assist) it's immediately available at a reasonable increase to care. When my FIL had to be moved to memory care; they have a unit on premises so my MIL can see him whenever she wants. It's perfect and so much less stressful I can highly recommend assisted living.
To compare cost - if you were to pay $30/hour for just 12 hours of care ($10,800/month); at the low end; we paid $5,600/month for a 2 bed apartment in assisted living; we now pay; $7,725 for my FIL in memory care (24 hour care) and my MIL still living in her 2 bedroom apartment; but now receiving med management (they dispense all her medication on schedule/day & night); dressing/undressing assist; wellness checks every 3 hours when she needs it (got sick and stayed in bed a few days) and they will bring her meals to her room for as long as she doesn't have the energy to go down the hall to the dining room.
PS - this facility is very nice (not super fancy); has an excellent maintenance staff; and is in a safe neighborhood.

Please call around and get familiar with facilities in your area.
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Reply to robandjane
babsjvd Aug 12, 2022
Agree, also Google care advisors for her area.. realtor of sorts…they will meet you for tours, know the cost,m availability, needs.. paid by facility by placement.. invaluable service
You are doing the work for 2 people and should get paid for care for each of them. Write contracts for each person according to his and her needs. If they need to go to the doctor at the same time, split the mileage. If only one needs to go to the doctor, that one gets charged for mileage. Figure that you need to be paid for the time that they are awake and need your assistance.
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Reply to Taarna

I can relate-was in a similar situation. Look into your state having a NHTD program. Nursing Home Transition Diversion Medicaid program. It helped us keep my mom at home and helped with cost. Good luck.
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Reply to Jabnyc

Definitely check into any additional VA benefits your father might be qualified... as well as for you as his caregiver. Caregiving for a Veteran is finally getting more attention, at least at our VA Hospital, I have my own social worker to help me navigate the possible benefits to help me be a better caregiver. Do not rely on what others say they get or do not get. My friend and I both care for our husbands with PD. I get 14 hours of respite care each week and she only gets 11 hours. Every Veteran is an individual and benefits are awarded totally on their unique qualifications. If you have not already been receiving these things, check to see if you qualify. Depends, Ensure, Wheel Chair, Items to make the bathroom more accessible and the list goes on. I have found many things have to be requested specifically because the providers are not always aware of their availability or do not always ask if you need them. My friend and I have constantly learned about different items from each other and when we ask we have been able to get them. If you would like, please contact me privately and I'd be glad to share more information.

If they don't already qualify, check into aid and attendance... your mom may even qualify separately. Any of their income that can be documented as care expenses will help them qualify.

As far as transportation, the IRS has a mileage allowance so that is the place to start. When doing our taxes, I simply go to my calendar or EOBs and count the trips to various locations and add up the miles.

As far as comparing to an agency rate, remember their rate is based on paying workman's comp, background checks, payroll, etc., etc. You may want to check with your insurance company to see if you need additional liability insurance so if something happens a claim is not denied because with contracts it may now appear to be a business. Possibly divide all the household expenses by four people to get their share?

I applaud you for being so thoughtful and proactive about this. I have often suggested this to our sons for the things they do to help us but of course they don't want to take our money. I have even suggested they take it and put it in a designated savings account which would be available for them to use toward paying for outside help as our needs increase... if the money is never needed then they have secured part of an inheritance based on their individual contributions. I would love to hear the additional steps you take to use as encouragement for our sons to have a contract as well. We are blessed that our oldest son is a CPA so I know he can handle any tax issues that result.

I know many here feel adult children should never charge their parents for the care they provide, but documenting as you are trying will definitely help qualify for more assistance at such a time that the job becomes more than the children can handle. I know with VA Aid and Attendance, unless you have very low income you have to prove what you are spending in care giving to bring your income level to qualify. You are blessed as a adult child you can do this... as a spouse I can't even though when I became a 24/7 caregiver I gave up income but also important contributions that would have enhanced my retirement funding. As a spouse I could deduct the whole AL bill (which is mostly room and board, etc.) but I can't even deduct for my 24/7 care! It is one of my big frustrations! If you become a contracted employee, perhaps you can also contribute to your 401! Best wishes in figuring this out to make things easier down the road.

Also check with your local council on aging as they offer respite grants to pay caregivers.
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Reply to KPWCSC
VetCareGiver Aug 12, 2022
Thank You so much for your reply. How does the aid and attendance work. Can an outside Dr, Physical Therapist fill out the VA for it. Or should it be the VA Dr. Lately when my dad goes to the VA. They take him back alone and he doesn’t always say what’s going on. Once a Marine always a Marine he never complains or says what his ailments are as he thinks it makes him look weak.
I would tend to agree with BarbBrooklyn. However, if you don't want separate contracts, you could ask the attorney to prepare a more standardized, general contract which covers basic issues for both parents.

Then you can more specifically address each parent's needs and service through exhibits (A ...???)

Make sure the attorney you retain has experience in drafting care contracts. Not all elder attorneys do as they focus on activities that are more mainstream and repeated (i.e., Wills, POAs, Trusts).

I do think you're very wise and thoughtful in your approach to the situation.

I would tend to go with the latter, especially since it offers boiler plate opportunities and tasks which apply to both parents.
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Reply to GardenArtist

Here's how I normally contracted my own private homecare assignments. Prices went up with time. Here are the most recent figures.
My pay rate ranges from $25 and hour to $35 an hour depending on the condition of the client or if they are a married couple. One hourly fee includes personal hygiene care, meals, laundry, housekeeping, grocery shopping, and medication organization and monitoring. Also driving and companionship to appointments or social outings. I would work for two people for the maximum pay of $35 an hour as long as neither were invalid, immobile, or bedbound.
I would take on a client who was invalid, immobile, or bedbound but I would not provide service for a spouse or take them to any appointments or errands. Of course there is always room to negotiate.
Pretty much all of my clients needed me to take them to doctor's appointments and out for social outings. So part of my contracted agreement with a family was that I would take the client out two days a week for an appointment, social outing, whatever and that would be $30 a week extra. This was to cover gas and the use of my vehicle. If they needed to go out over the twice a week, it was a $20 additional charge which did not happen often.
If I were you, I'd look on caregiver websites and hire two private duty aides to do 20 hours a week apiece. Offer them $25 an hour to care for both your parents and I'd say with the price of gas and all an extra $40 - $50 a week for doing two trips out.
Get it all contracted and in writing. This will not affect their Medicaid application if one needs to be done at some point. All the money being paid out is for their homecare.
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Reply to BurntCaregiver

When it comes to the law, the government, healthcare, Medicaid, etc. each person is viewed individually, married or not.

With a contract you can probably get paid a fair market rate...the question is whether your parents can afford it for long. You should definitely find out what the labor laws are for caregivers in their state -- you working for them means you are literally their employee, and the IRS will expect wages to be reported and taxes to be withheld, etc. For this your parents should consider a contract bookkeeper. Also, this gives contributes to your SS, which you will definitely require for your own needs as you age. Don't depend on any inheritance, since facility care is very expensive and will drain them pretty quickly. Then they will need Medicaid and the bookkeeping will be scrutinized. FYI as your father's disease progresses you may need more in-home help (to turn him, among other things) and to give you breaks. This is also expensive.

When parents ask their children to promise to never transition them into a care facility, it is because they have out-dated concepts and memories of horrible places which are not accurate for the vast majority of today's facilities. They don't know (or care about) the sacrifice they are asking (usually from their daughters) and the children agree because they can't possibly anticipate the toll it will eventually take on them physically, emotionally, socially and financially. I know my own mother would want me to be her permanent caregive but I've already visited places with her so she feels like she has agency in the decision. She saw what happened to me while trying to solve my in-laws care problems (and they were broke). So my mom got a dose of reality first-hand. She knows when the caregiving at home is unsafe or untenable for her, or overwhelming for me, then it is time for a change. Ideally, she will move before a crisis.

Make sure you have DPoA for both your parents. This is a deal-breaker in you providing them care. Or, if the are still mostly cognitive, consult a CELA (certified elder law attorney) about them creating a trust. And defnitely have a lawyer or Medicaid Planner review the individual contracts for your parents.

I wish you all the best as you try to do your best for them!
Helpful Answer (3)
Reply to Geaton777
VetCareGiver Aug 6, 2022
I have DPOA medical and financial of both of them. I just want to make sure I’m covering my bases.
I think separate contracts would be prudent, as Medicaid will treat your parents' finances sepif one of them needs custodial care while one remains at home.

Is there a reason that you are not seeking a consultation with a certified eldercare attorney to set this up? It would be a smart move.
Helpful Answer (4)
Reply to BarbBrooklyn
VetCareGiver Aug 6, 2022
Hi that is actually on my list to do consult an attorney. Just seeing what others advice is so I can get my questions, or things I may have not thought about.
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