I need help in determining a rate of pay for my nephew and his wife to take care of my elderly mother. My mother is 93 years old and in sound mind. She uses a walker to get around. She is on oxygen and has recently developed other major medical problems. She may need to be put on palliative care soon. She needs assistance with:
-Toiletry and bathing.
-Shopping and meal preparation
-Laundry and maintaining a clean house.
-Medication administered and health needs monitored.
-Communicating with doctors and tracking her medical needs.
-Communicating electronically for online doctor appointments
-Transportation to medical appointments.
-Carried downstairs out of the house in a wheelchair for appointments.
-At night she may need to wake up someone to help her with bathroom needs or need for additional pain or sleeping medication. This may occur 0-5 times a night depending upon her difficulties (Average is about once a night).
-Always have someone in the house in case of emergencies or care needs.
My mother wants my nephew and his wife to care for her at her house and they want to provide that care. The proposal would be that they would be living with my mother at her house rent free with a stipend paid to my nephew and his wife for personal health care and a budget to cover her food.
My mother is currently paying my nephew and his wife ( Medical Asst Training) $100 a day each. She is also paying my niece (Physical Therapist Assistant student) $50 a day. My nephew’s wife feels that they are being paid far less than the value that they are bringing to the quality of life and care for my mother. My niece-in-law went out to local “for-profit” home care providers to find out the rate they charge for home care. The rate she came up with was $20,000. A month. This is what she is asking to be compensated to care. She is requesting to be compensated at $5000 a month now and $15,000 a month from my mother’s estate when she passes. They are also asking $1000 a month to cover food costs.
Currently my mother is paying $250 a day and has 3 people caring for her ($200 day for nephew and wife). On average this works out to $7500 month, ($6000 month for nephew and wife). My mother is not a rich woman. But thanks to my late father’s investments has enough money to live comfortably. Her monthly income including social security, retirement funds, and dividends from investments totals to $5570 a month. We have had to supplement this amount by an additional $4000 a month from the stocks to cover her currently monthly expenses including the amount she pays for personal health care.
Being the Financial POA for my mother they presented this proposal to me. My mother does not want to upset anyone and is feeling caught in the middle. My brother and I both feel that the current rate of compensation is a generous amount. My sister (mother of nephew) feels for all that they are doing that they should be paid more than $100 a day each but does not know what the new rate should be. Everyone but my nephew’s wife agrees that $20,000 a month is an extraordinary amount to be compensated.
We cannot agree or move forward without a Personal Care Agreement that would include a fair rate of pay for personal health care, food compensation, and location where the care should take place.
What I need help with is:
-What a fair and reasonable rate of compensation for my nephew and his wife to take care of my mother full time.
-A reasonable rate to be recompensed for food cost.
-If she should pay for any additional outside services such as house cleaning, lawn maintenance, snow removal etc. Or should it be covered for what is paid for health care?
-If my mother is paying for personal health care, should she have the right to say where that care should take place.
Thanks for your help.
Just for comparison:
We live in Spain, which is a reasonably wealthy country with a reasonably good level of care.
My widowed 87 years old mother, with mild dementia and mobility impairment after Covid is looked after at home 24/24 by 3 professional carers working in shifts.
What we pay to the carers, plus Social Security tax to them all, plus the employment agency fee, plus 10 hours a week of cooking and cleaning by another lady (included her Social Security tax), plus 2 hrs per week of physiotherapy at home is less than 4000 dollars. And they all work at the legal fee per hour.
I myself look after my mum between 3 to 4 days a week without pay (company, cooking, cleaning, night shifts, doctor and pharmacist appointments). I'm also renting an appartment from the family at about 1200 dollars. Lately I asked for a cut in my rent of about 200 $ a month to compensate for my work (and pay for therapy, both psychological and physical, to heal from the stress), and my siblings refused.
Well, a very different story....
20k a month seems totally far fetched to me!
Most will give a free initial consult.
I recently called a local agency and obtained rates for 24/7 care attendant for my 90 yo dad. The payment goes to agency who pays the employee their ‘rate of pay’. Annual cost for 1 person 24/7 was $88K. I’m in western KY. Your local agency rates may be different.
I have to ask... will these ‘caregiver family members’ be receiving a $ inheritance from mom? Is it already arranged? Non the less a family care giver who changes and gives their time and attendance may feel it just to be compensated something fair to market -all living costs considered and monetarily balanced including housing, food, utilities, transportation costs, etc.
Difficult care conditions including Loss of or interrupted sleep is part of the daily rate of the job for agency workers. If you find an agency fees are different for shifts during nights and weekends then consider adding the difference just to those hours.
Tough spot... I pray they will have utmost respect and concern for mom and appreciate not just the money being offered but the opportunity to give her what only loving family member(s) brings to quality of her late life stage.
Maybe if they want to be a part of your mom's life, they can play the role of nice niece and nice nephew ( visit, assist "sometimes') and you and get ( for less money from what I read in the comments) good services that you will have better control over and use the extra money for even more services maybe. Way harder to reprimand family for things that would go wrong than changing paid employees...Just think about how it would be if , down the road , you decide to not let them keep on living there ...
It must be hard to navigate between family relationship and business boundaries. I am sure you do not need that extra burden right now. Mixing family and business ( money) is a a well known very very delicate thing.
Have your nephew and his wife ever done anything like this before? Do they have any experience of providing 24/7 care, and living in their workplace? This isn't an ironical question - for all I know, they may both have had residential placements in hospital or nursing home settings.
But unless there are substantial reasons to believe they do both know what they're letting themselves in for, I can't see this plan working as is. Perhaps an alternative option to consider would be their living with their grandmother as her primary caregivers, assisting her at night time and supporting her as their family member, but with hands-on care provided by paid services so that they are then free to continue their usual employment.
What do you and what does your mother and what do other informed parties think of the quality of care the grandchildren are providing at the moment?
That is a deal-breaker on upstairs living.
A bedroom & bathroom must be provided on the ground floor or a stair lift installed.
Covid. She had always flatly refused to leave her 1st floor room, now she loves her ground floor room, which is tiny, and refuses to change rooms again although her mobility has improved a bit.
It seemed impossible back them to make room for her in that room, which contained an old piano, lots of junk and unnecessary spare chairs, etc. But a few hours later, with the help of 2 movers, it looked great and has been a huge help
Besides, now one of the carers or myself always sleep in a bed we've installed in the living room, very close to her, so that we can hear her if anything is wrong (she's has 3 Covid-related strokes this year).
All in all, very happy with the decision to move her.
In the end it will most likely destroy the relationship.
Someone other than a relative should do the job, ideally in a facility where there is a full staff. It’s too big of a job for one or two people.
I took Mother in mid 2017. I went a whole year before I told her I needed to be paid, and I really felt icky at the time having to ask, but I gave up a job with paid medical insurance, profit sharing and a 52k year salary. Doh!
I drew up a contract and had it notorized. She pays me $350 a week, and buys me a tank of gas each month. When I take her back home for visits she pays the travel expenses -- car rental, fuel, food, lodging. At tax time, I file as self employed, covering those taxes and taking deductions for mileage, utilities, food.
Honestly, I don't even know if how I'm doing this is how it should be done. And yes, taking care of elderly people is hard work, but I'm not going to be ridiculous about what I think I should be paid.
Is your mom still responsible for home taxes, maintenance, utilities, besides what you paid to take care of her? My sibling has lived with mom for about 14 yrs. thought it would only be to heal fo divorce, but never left. I had empathy for healing, but it has turned nightmare since. He started working within yr and half and drive her vehicle. She continued to pay the car insurance, HIS life insurance policies on his family, etc. too desired, but he feels living there for past 14 yrs, with her keeping up cleaning pretty much like a boarding house. He does car repair, if need be, but he is one driving the car, she hasn't driven! He picks up groceries when up to it. She pays for most. He does what he wants in more ways the one. I have been there daily through the yrs, do one grocery shopping, helping with paperwork, which drove me to insanity as she throws out needed documents. I brought my mom to get a trust after my dad died to help keep things in order, but she never gave me co-trustee to actually manage things. It was trying drive with my hands and feet tied. She never had ANY idea of paper work, as my deceased father always did it all. I took her to all dr appts. and with her for aftercare. It!s been a HUGE MESS, NOW burned out from the golden CB gleaning 14 yrs of saving his $ and has the financial ACE/control and threatened if my other br and I try to do anything. He finagled a new attorney and my mother does not know what she agrees to. She got scripted to talk on phone. Long story short, most of family do not know how controlling and narc he is. I'm the ostracized one now and hurt badly. My faith keeps me getting through each day. I am 70 yrs old, mom 98, and though good for her age, she really wasn't competent to understand the web LB has spun. He has whole family believing I am crazy. I went to counseling to keep sane from the lifetime of dysfunction. I m tired, and needed to vent. I resigned letting the more one has, more they think trey deserve. Pray for peace he'll have to face Judgment day. I don't know if any of this makes any sense, Very depressed , can't sleep. 😥
They can not require the same pay as an agency that is based on 3 shifts and not live in. They also need to realize that part of that rate includes licensing, bonding, insurance and taxes matched. It covers administration and oversight to ensure that the caregivers are qualified and that all of the laws are being satisfied.
If they want agency pay then they need to provide the exact same services, with the same licensing, insurance, bonding and oversight.
That means that they are shift workers and not live in caregivers. So they will lose their residence and all of those added benefits.
I would require a daily log, provided daily for a month before any contract negotiations so that you all have a true picture of what they are going to be doing. I would also include any increase in care needs, because the greed will come out when they are actually having to do hands on care.
I would get some needs assessments and care price quotes from several agencies and private hire live ins.
You would have no problem finding caregivers for the 6k, room and board that you are paying.
Unfortunately mom may not be able to afford what she wants and her needs will have to be priority if these loving family members insist on this unreasonable wage.
I worked in a factory and at the time. I quit in late 1980 I was getting $15 ann hour.that comes to 110$ a day. I say she is paying enough, she is taking care of room and board.besides $100 a day.
I personally think the grandmother needs to be in a home and that price is around $5000 a month remember insurance pays that. Or most and you know she gets fed, dressed, help in bathroom med given. Everyday. I don't think it is safe to be carried up and down stairs everyday.and it isn't healthy for nephew and wife to be doing it either.
It seems like those doing the work understand what a commitment this care is and want to be compensated for it. Especially if they have put their own career advancement on hold in order to care for Grandma. It's not a particular thrill to live in an old ladies house. It's never your own.
If everyone would just love on grandma and get her the best care, you might be abe to fall asleep without moral regret.
I live out of town and am willing to move back and take care of my mother for free. But she said she wanted my nephew and his wife to take care of her. You could be more helpful if you made a suggestion on what a fair rate that would not break the bank would be. I know it is not an easy job but it is not without its benefits too
Excuse me if this comes off rude, are they free loading? I praise them for wanting to take care of some of the needs of your mother, but demanding 5k a month seems slightly high.
-Toiletry and bathing --- toileting throughout a day and possibly a little help at night. I would call this a regular daily task, toileting alone. If she has Medicare, ask doctor to order home health which could include a bath couple times a week.
-Shopping and meal preparation ---- Niece and nephew have to do this no matter where they live. In g'mas house, they are getting meals/shopping free
-Laundry and maintaining a clean house. --- Niece and neph have to do this no matter where they live.
-Medication administered and health needs monitored. --- Medication is minimal time. Fill a daily pill box or dispense from bottles. This is no major task
-Communicating with doctors and tracking her medical needs. --- Minimal time spent unless they are talking to a doctor several times a day. Again, Medicare can send a visiting nurse, at least weekly, and communicate her health issues, ask for meds, order blood lab work, urine tests, etc.
-Communicating electronically for online doctor appointments --- Doubt this takes much time on daily basis.
-Transportation to medical appointments. -- How often is she leaving the house for a medical appt. Maybe a couple times a month? Might be able to online video visits??
-Carried downstairs out of the house in a wheelchair for appointments. ---- Are you saying her room is on an upper floor or there are stairs from front door to car area? Move her bedroom to any room downstairs to avoid falls. Have a ramp built to get from front door to car. Safety.
-At night she may need to wake up someone to help her with bathroom needs or need for additional pain or sleeping medication. This may occur 0-5 times a night depending upon her difficulties (Average is about once a night). ---- This task is probably going to be ongoing unless she is strong enough to get out of bed, sit on bedside toilet, and return to bed (no walking to a bathroom alone).
-Always have someone in the house in case of emergencies or care needs. --- I would venture to say, for the most part, you have two relatives who are hanging out in the house 'just in case' and I understand the need for that. The rest of the chores you have on your list are just off and on during the day. . . not up and at it all day long. Bet you could find a live in person, not related, who would be quite willing to make $700 a week plus free house/food/paid expenses, Most of what you listed can be completed from the house. Even groceries can be ordered and delivered. Most medical things (rx, supplies, etc) can be ordered and delivered.
I do all all those chores on my own for free. It would be pure heaven if I had another able bodied person in the house to help out with some cleaning or outside chores so someone is inside with parent all the time. Just to be able to get out for a few hours and know someone was sitting on the couch watching tv and available if parent hollered would be nice. I order groceries about 2x a month, pay all the bills and inventory pills/medical supplies to order those at first of ea month, make dr appts/call dr, take to appts. I speak from experience that most of the time, I'm sitting. Minor amts of time, I'm getting up/down to do something parent needs. Yes it interrupts my day, all day long. Another person here at same time....would be great.
Having been a caregiver several times only, there is NO mooching going on. It is tiring and endless work and minimum wage is an insult. The only thing going for the caregiver is loving the one you care for.
Home health care in my area is $17/hour. Multiply that x 24 hours a day. That would cost you $408 per day for outside the family care in your mother’s home. Multiply that 30 days a month. That’s $12,240 per month. Then subtract the cost of rent, etc...
Personally, I would expect a family member to not charge that extreme rate since they will be living there.
I do think, for the future of your entire family, everyone comes to an agreement that each feels comfortable with. Otherwise, someone in the family will hold a grudge forever.
I'm just gonna say this: How would your niece/nephew even have an inkling of an idea that g'ma would have enough money in estate to cover $15K PER MO after death? Unless you have discussed the details of her finances with them, this would indicate your sister did. Someone had to tell them there is a substantial amount of money that will probably outlive her medical expenses and personal needs for the rest of her life. Who discussed that with them? I mean at $15K per month to be paid later, let's say she lives another 5 years. You would have paid them $5K per month = 60K per year or 300K in 5 years and the estate would owe them another $900K when she passes. I doubt seriously these two would have ever made that kind of money in 5 years working outside this proposed arrangement (unless they have given up some very lucrative jobs to help grandma. . . and I find that hard to believe). As well, who is to say there would be that much left at the end of her life? Are they willing to walk away with only the $5K they made each month if the extra $900 is gone? An estate is really only the remainder of what you had.
How much is grandma's house worth? Maybe make a deal with that. Upon death, house transfers to them. Still a gamble. G'ma lives one more year they get the house, g'ma lives 10 more years they get the house (as long as they continued to be there to help). Then balance of assets distributed as indicated in will.
Now the food. Two of them plus g'ma in the house. Why wouldn't there be meals cooked that everyone eats? Think about your own budget for food. Do you spend $1K a month? Does that even sound reasonable to you?
If you have two adult relatives living in a rent free/tax free/insurance free house, I can see upping the care amount a little, but not anything near to what they are asking. No matter where these two yokels live and work, they should be paying housing expense, cleaning their own house, cooking food, washing clothes, upkeep of the yard. Agencies have expenses that private caregivers do not have. The office management and overhead push their prices up.
$20K per month works out to 2309.47 per week for each one of them. And that amt would be 13.74 per hour ASSUMING both are working 24 hrs a day, 7 days a week and that is not happening AT ALL. Both are not tending to her needs at the same time during the day or night. My guess is the niece is helping with toileting and anything to do with personal issues. In fact, with the mindset of some men, niece might be doing all the housework, laundry, and getting up as needed during the night. Very possible that nephew is hanging out all day, but not really lifting a finger - maybe he mows the yard weekly or biweekly during cold seasons? Maybe he does most of the driving errands like groceries? He's probably handy to stay in house IF niece has to run a personal errand. These two are not working 24 hrs a day - and you can bet one is working much more than the other. So at 200 per day, it comes out to $8.33/hr for 24 hrs (plus shelter and food/other living expenses for free). Tell them to keep track of their hours and they can figure out who earned how many hours per day. Maybe one of them can get a job outside the home/work from home since neither of them is actually on their feet working an entire 12 or 24 hr day.
Bottom line is these two get $700 per week each (100x7days), so total of $1400 per week. (1400x4.33 wks per month = a little over $6K per month) With no other expenses, they could even be saving.
While I realize the young people caring for her could spell one another and thus get some respite time on a regular basis, I believe if mom stays in her own home, then I believe it would be appropriate to have paid caregivers come in one day a week, or better, two days a week. Reason: caregiving, even for the closest of loved ones, is EXHAUSTIING and then some..
The $100 a day now being paid to each of the two caregivers is just $4 and change an hour. That amount would buy just four hours of help from an agency...
Assisted living in my area costs from $4000 a month and more. Skilled nursing in my area is north of $10,000 a month each person for two-to-a-room accommodations. Despite good intentions, extremely few homes are staffed to give anything close to immediate response to patient's needs as would be the case in dedicated caregiving from loved ones...
I say, forget the room and board as part of compensation...then get the average cost of skilled nursing home care in your area, and divide it by two, paying each grandchild one half. Also, allow them to alternate on a reasonable basis, so each can take off every other night from six PM until 6AM or a little later the following morning.
I reiterate: Caregiving full time is extremely hard on one's entire being, despite the love of doing it..
Grace + Peace,
Old
Bob
PS hiring one paid helper through an agency at $25 an hour would cost $18,000 per month.
Mom has diagnosed Vascular Dementia and Alzheimer’s. It took a few months to get settled but this was the best way to go! She has her own room with bathroom, meals and snacks, activities, med tech to give her medicine, and one on one care. We pay $8300. a month for full care. Plus.....peace of mind!
Hopefully this will help!