Caregivers Topics


Tax Credits and Deductions for Caregivers - 2011:

I did not know these things before so please check it out. It is self-explanatory. I do not want to mess it up by reviewing it myself since I am not a tax person or financial planner. This is also a good website to bookmark or get on their list to receive emails.

www.eldercarelinkcom/...Tax-Plannning-Tips-for-Caregivers.htm


There is plenty to check out on the ElderCarelink website so take a peek!!!

2011 Tax Tips for Caregivers by ElderCarelink

With the tax deadline looming, be sure to include all deductible costs you pay for senior care on your returns. Whether your loved one is in assisted living facility or using in-home care services, you may qualify for deductions and credits for the associated costs of their care.

Here are some key tax points to consider:
1.Claiming your parent as a dependent. You must be paying more than half the cost of your parent's care. If qualified, there's a reduction of your taxable income. Your parent does not have to live with you. But to qualify, your parent's annual income must be less than $3,700. See IRS Publication 501: Exemptions, Standard Deduction, and Filing Information for more details.
2.Claiming modifications to your home. You may claim a medical expense for modifications made to your home in order to accommodate their medical needs. However, your parent must have been your dependent at the time (either expenses were paid or medical services were rendered). Be sure to consult your tax professional as other rules apply to claiming modifications as a medical expense.
3.Deducting the costs for medical expenses. If you are able to claim your parent as a dependent, then the IRS may allow you to claim a deduction of your parent's medical expenses. The expenses for your parent's medical care must exceed 7.5 percent of your adjusted gross income to qualify.
4.Deducting the costs for assisted living or in-home care. For your parents to qualify for tax considerations, a licensed health care practitioner must have formally determined during the last 12 months that your dependents are unable to care for themselves.
It's important to meet with a tax preparer to go over all of the requirements of deductions associated with your parent's care. Remember, in each case, you must provide adequate documentation for the IRS to qualify. Taking care of your parents can be challenging. Knowing that you can ease your own burden come tax time makes it easier to opt for the right level of care for the ones you love.


Have you noticed any changes in your loved one's health or behavior? Update your Needs Survey now so we can keep you connected to the resources that are most relevant and helpful to you.


Crossroads: Time for New Home for Mom VS The Guilt Trip

Well I guess the time has come. Mom went into the hospital again (2nd time within 2 weeks). She first went in on Easter Sunday night with another UTI -- she was tired after a busy weekend, so I helped her get into bed to take a nap. I went back after a couple of hours to check on her and she was using her hands to talk, couldn't (or wouldn't) talk. She would point to her heart so I called the rescue. She stayed for a couple of days during which her toes started to discolor. Then home with the belief it looks like her small vessels are closing. She was getting weaker and it was hard to get up or walk and said it was sometimes painful. I would end up helping her to get up from bed, chairs, etc. Sometimes even moving her in bed to get comfortable. This past week I could hear her in the bathroom making noises and shaking. This was after a couple of nights of her getting ready to go for a walk during the night.



Again I called 911; the UTI was still there. They had done a urine culture before sending her home the first time but since she is on dialysis and doesn't urinate much, the urine is always contaminated. It sounded like they look for different bacteria between a UTI and just contaminated urine. Anyway, they are treating her again with antibiotics.

The big thing though is the dramatic change in mental status -- I know it changes with a UTI in an older person; that is ONE BIG clue for one. Usually, mom 'comes back' after a couple of doses of antibiotics. But this time is different. Each time the UTI reared its head, her memory decreased but you could still have a decent conversation and she remembered things from way back. Now we are not sure where her head is, what she hears or even understands. We will visit and then then the phone will be ringing when we get home - she is asking when we are coming, she calls saying the hospital staff is trying to do things to her so they can take her stuff and her money and since I am letting them do this, I am in on it, disappointing her for my behavior. This morning we are awakened by a phone call at 5am; she is ranting about their organization telling her what she can and can't do and she doesn't want to join them, they will not let her use the phone, she wants out. She is supposed to get a vascular ultrasound (to check for bloodflow to the toes); she is yelling at them about their wanting to do surgery and asking me why my father is not answering the phone (he died 16 years ago). I think you get the idea.

I am now the bad daughter in her eyes - not telling her what the 'bad people' at the hospital want to do to her. I am siding with them so they can get her money, home and stuff. I am sure I will really be the bad daughter when she finds out that she will NOT be going back to her place. The guilt has been inching in for the past few days - I cannot take care of her 24/7. The emotional guilt has been rising with the phone calls that I am on 'their' side and don't care about her and what the staff does to her. As much as I try to tell her it is for her benefit, the response is 'oh now they have you in their pocket, you don't care about me any more. I never thought you would do this to me'. We had discussed the fact that I have my own children at home, job - that she knew I could not be with her all the time. But this was discussed when she had a clue. Now there is nothing.

My kids ask why Vovo (grandmother in Portuguese) doesn't understand or converse with us like before. It's hard to figure out the brain. I just keep telling them that it is Vovo that they are looking at but unfortunately it is not the same Vovo they know - she's changed and it is Ok. It happens to a lot of people as they get older, they just have not seen it much. They were too young to remember visiting my grandmother, their great-grandmother. She too lost her memory and it was hard for my mom, along with her brother and sister, to decide that it was OK finding a nursing home for her.

So now as I lie awake at 4 am wondering if I should take a chance and bring her home seeing if there are friends, who are CNAs, who can help or find a home for her to go to. I think of the times I was not there: her taking more medicine than she is supposed to, burning/blackening a tea kettle that she left on the stove, putting a plastic measuring cup with coffee in it on a burner (it was not turned on). I feel the final straw was trying to go for walk during the night. So now I have to convince myself that it is the best thing for her to be in a place that has professionals watching her, taking care of her. I am not a medical professional and do not know all the subtleties of conditions; just the daughter who neds to be the parent.


End of Year Thoughts:

The end of the year, as we look toward a new year, time to assess what the year has brought us: what happened and what we did about it as well as what we need to do again or change in the upcoming one. Our family situations change, health needs change (sometimes even mental health needs), legal responsibilities change. Maybe it is time to talk to a legal professional.

If you choose to speak with an attorney, make sure you find one who is versed in the type of legal issues you need help with: elder care or special needs child, healthcare Power of Attorney or Social Security -- you get the picture.

On ElderCarelink there is a page on the link - 'Ask the Expert Elder Law Page'. The article shows things to discuss (some of these pertain to both categories of those we care for):



*estate planning
*Medicare/Medicaid
*elder abuse
*age discrimination
*guardianship
*end-of-life documents

As I mentioned, some of the above can pertain to our special needs children. You may want to check out the U.S. Department of Education site and see if anything can help. Laws vary by state but you may see something there that can help. Talk to their teachers too - they can put you in the right direction.

Most of all remember - as I remember being told when I was growing up: 'the only stupid question is the one not asked'.

Ask for Help:

Short and Sweet -- As we all run around preparing for Christmas, Hanukkah, or any other holiday you may celebrate, anyone will tell you - make sure you take time for yourself, care for YOUR emotional and physical well-being. You can't help others if you are not feeling well. ElderCarelink offers 2 ways to help reduce the stress, which I am sure everyone is aware of.

*Hire in-home care to help with transportation, meals, housekeeping, companionship, and personal care.

*Adult care services so your elderly parents too can stay active and be with their peers.

Simple and easy solutions that caretakers should take advantage of. Don't feel bad about wanting to take time for yourself to go to a party or shopping or get your hair done or out for lunch with friends you haven't seen for awhile. You know what?? Sometimes your loved one enjoys time doing something different with someone else, talking about the 'old days', remembering 'the big band era', or what their family used to eat during this time of year -- all the stories WE have heard so many times. It's different with others - a new audience, so to speak. It can be a better thing all the way around for everyone involved.

In a sense, this can also go for help with your special needs child. Use respite care to step in if you need to go out. Depending on the child, he/she might not like all the hustle and bustle and loudness of shopping and parties. Respite care through a variety of agencies can help. There may be teachers or teacher assistants who can help too. I know some of Willie's teacher assistants do this. When mom passed away, Willie's Special Olympics coach stepped in to watch Willie at the funeral home during the wake hours. We wanted him nearby with the family but knew he wouldn't sit or stay still for a long time; so his coach graciously stepped in to stay with him and wander or go out to the car for a time, go to the bathroom -- whatever he wanted to do, It was such a GREAT HELP. I can tell you - use your resources; the guilty feeling goes away in a short time!!


Re-Focus:


Willie came home the other day and showed me a sheet that stated their daily trip. His program now gets the students out in the community more often. They went to a place called 'Re-Focus'. I saw the list of classes that they offer - things like cooking, creative writing, literacy, massage, yoga, music room. I wanted to know when I can sign up!! I asked Willie if he liked it there - his eyes lit up and gave me a resounding 'yes' in sign language and a shake of his head. Needless to say, we will be checking it out in person soon - he and I.

In the meantime, I checked out their website. 'Re-Focus' is a non-profit human service organization that enables people with developmental disabilities to pursue productive, healthy lives. It was one of the first group homes in the state, established to provide parents of developmentally disabled adult children with an alternative to institutions. They provide a caring and challenging environment tailored to each persons unique needs and capabilities. They re-focus on people's abilities rather than their disabilities and challenge the community to recognize our clients as contributing members of the community.

They offer residential facilities, supported living (where they help people in their own homes with a variety of daily activities), shared living (matching disabled adults with host families), family supports (provide staff support on weekends and/or evenings), and day programs.

To me, one unique things I found is that they offer people receiving services from 'Re-
Focus' something called a "Dream Grant". Applications can be filled out and submitted to the Administrative Team for review. Then applicants are selected and can receive up to $500 to make their dream come true.
(Picture from Re-Focus website)

They have a Mind, Body and Spirit Theme Team which helps to enhance the whole person with a variety of activities. This team works with other teams to develop more activities and opportunities. There are many other activities and teams to oversee the enrichment of these folks.

On the whole, this facility sounds great, offering a lot of fun, activity, companionship, and hope for the future. Can't wait to get there!!!


Keep an Eye on Elderly Parents:


This time of year is a great time to see where your elderly parents are with their health and living conditions. For those of us who live right in the area or with their parents and see them on a consistent basis, it can be hard for us to differentiate any changes. We see them in all their ups and downs, from stomach aches, back aches, headaches; not being hungry, not being thirsty, no sleep, hours of sleep. It is just another day - sometimes. 

During visits from siblings or relatives and friends who are NOT around all the time, take the opportunity to allow them to spend time with the parents. Let them see them for a few hours; whether you leave the house or not, let them cater to the folks. This way they can gain a perspective of how they are - they may see things you can't. Then sit and discuss how they find the parents - how they have changed between visits. I would find that sometimes my mom would do better with someone else -- I probable drove her crazy at times. She would be able to remember different things and carry on better conversations with someone different. She would be more apt to say 'yes' to tea and a snack, walk a little more. On the other hand, some would comment on how often she repeated herself, would lose herself in a conversation, wouldn't remember a recent visit or appointment. So I would just put all the information together in a diary for the doctor to help me see what could be going on.


The ElderCarelink has some easy things to look for while visiting.

1. Do they seem depressed? If your parents are sleeping too much, have no interest in their hobbies, or have a decreased appetite, they may be suffering from depression. Ask someone who sees them frequently about their moods when you aren't there.
2. Are they having balance problems? If a parent is walking unsteadily, insist they see a doctor. Balance problems could be an early sign of an inner ear infection, bad joints or even dementia.
3. Have they lost a lot of weight? Look in their refrigerator and pantry to make sure they have nutritious food on hand. If eating isn't the issue, suggest they get a complete physical to discover the reason behind the weight loss.


I used to keep in mind that the holidays were tough on mom since dad and my grandparents had all passed and no matter how we tried to keep things light and busy and festive, there were always incidents that brought back memories - even as simple as one of the boys doing something that my dad used to do or seeing old pictures. 


Weighing Caregivers:


There was an article in the Sunday Providence Journal on 11/25/2012 offering information on what to look into and think about when considering a caregiver for your loved one, as a lot of us are caring for parents. The article was written by Pamela Yip from the Dallas Morning News.

She follows a family who needed a caregiver for her mom and the same one stayed on for her dad. There is a lot of good information so please click on the link. I am going to try and condense it here, trying not to lose the major points. Pamela Yip gives the pros and cons of whether to pick someone who is an independent caretaker or go with an agency. Bottom line: you need to assess what kind of care your loved one needs. Is it for bathing, dressing, shopping, cleaning? Are there cognitive issues that may be a safety issue? Remember - you are asking someone to be your loved one's right hand so 'the method you use to find someone is less important than what the need is you're trying to fill'.


So - independent vs agency. Independent -- 1) hire someone based on your judgement, as suggested by Kathy O'Brien, senior gerontologist at the Met Life Mature Market Association. There may be more choices and flexible scheduling. 2) Usually will cost less than one through an agency. This way YOU are the employer and would be responsible for the pay, oversight and employment taxes. YOU do the background check and references. 3) There may be no backup if the CAREGIVER gets sick and cannot work. Something to consider according to Lue Taff, geriatric care manager at the Senior Source in Dallas. 4) Kathy O'Brien reminds us that the family may have to worry about personal liability - you could be sued if the caregiver is injured in the home. Here State Farm Insurance says that you may be covered but you need to check your policy. 5) This person may cost less per hour; according to Taff maybe $12/hour.

Agency -- 1) You'll probably pay more per hour, $20/hour or so. 2) The agency is bonded and provides oversight for the aides. 3) You always have backup so someone else can be sent if another one cannot go. 4) If an aide gets hurt, he/she is an employee of the agency.

If you want help in making this decision, you can hire a geriatric case manager who can 'make sure there is a good match and that the person understands the job'. This manager will monitor the caregiver and make sure he/she does what is expected. The case manager may cost between $95 - $150/hour on top of the caregiver. 

Families should also be aware that Medicare does NOT pay for independent caregivers. It also will NOT pay for on-going long term care through an agency. Medicare will pay for intermittent care. "Under home care, aides must be certified nursing assistants, CNAs, and come through Medicare-certified agencies with professional staff supervising their work." They will not pay once an individual is determined not to need skilled help. 

I think it cannot be said enough. No matter which way you go just be sure you are clear as to what your loved ones needs are to the caregiver.


Home vs Facility:


The question that faces a lot of families. As I talk to friends and other families at the nursing homes mom was at, it was a major concern to get to the point of using a facility and not keeping mom/dad/grandmother/grandfather at home. We all thought we could do it on our own, including me. So how do we decide: we found changes in the person's behavior, forgetting to pay bills, forgetting appointments - things like that. Mom, at one point, was trying to go for a walk in the middle of the night. As things change, you should have a trusted family member go to doctor appointments with the loved one to see what is going on, talking about personality concerns. 

I think we feel that we are no longer caregivers IF our loved one goes to rehab, assisted living, or a nursing home. Most places consider a caregiver as someone who looks after an person needing assistance with daily living.

The following I found in the June/July 2012 issue of AARP magazine. It lists options for staying at home as well as how to find facility care. Check them out to see if any fit your situation.

Staying at home: 1) A popular program for frail people is 'PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE)'. Free for those who qualify for Medicaid, others can pay about $3,000 a month. 2) SENIOR CORPS sends volunteers 55 and older to visit the homebound for companionship. 3) OCCUPATIONAL THERAPISTS can evaluate people and their homes and suggest ways to improve safety and help develop their strengths and balance so they may possibly stay home longer. 4) There are MINI APARTMENTS that attach to the main homes utilities, some with monitoring systems if you want to live close but not in the same house. I was not able to find the detached ones - only those available in apartment buildings; check with local real estate agencies or senior agencies. 5) Assistive technology helps. SIMPLYHOME has monitoring wequipment like motion sensors and GPS watches. QUIET-CARE has a motion-sensor system that learns the daily pattern of someone and sends alerts when there are major changes. 6) VILLAGES, non-profit support networks, have volunteers who perform daily tasks and help with discounted services such as plumbing to nursing care. There are annual membership fees that are listed as $300-500.


Looking for a facility: 1) The local AREA AGENCY ON AGING (AAA) has living options. 2) AARP teamed with Genworth to offer a free online caregiver search and care-coordination services. 3)SNAPFORSENIORS lists residential facilitties. 4) Look at THE NATIONAL ASSOCIATION FOR HOME CARE & HOSPICE for home-care agencies. 5) MEDICARE's website ranks local facilities. 6) LEADINGAGE, a network of aging-services agencies, can locate housing services. 7) Geriatric care managers can help with different aspects of care.

The article that accompanied the above information, Leaving Home, also mentioned that there may be grief associated with the move from home to another location; the daughters found their mom changed, was failing, after a couple of weeks - color drained from her face and not eating. They were observant enough to see that it was not from lack of care at the facility -- mom was homesick. Mom felt bored and alone, and was getting depressed because she was cut off from her neighborhood relationships. So they decided to rethink where mom should be. Long story short (you can read it) mom went to assisted living after talking to her about what would make her feel good and what would work for all of them.


Choosing a Nursing Home:

At one point, I was considering checking into nursing homes for mom in case she had to go long term. ElderCare sent me an email showing their resource for helping people look into facilities. I decided to check it out.

I filled out a short online questionnaire and 'sent' it. Literally within minutes the phone was ringing with a customer service person. A wonderful lady spoke to me for about 15 minutes. She asked questions regarding mom's medical condition, hospital and rehab stays, medical plans. We also spoke about her income and assets (NEVER asked for an amount - just asked if it was over a certain amount). She NEVER asked for a social security number. We spoke about the location of the facility (how far away from me did I want her to be). At the end of the conversation, she said she would email me a list of possibilities. I did receive a response in about 3-4 days!!

I was very happy with the service received. Due to circumstances beyond our control, she was sent to a facility that I had to check into at the last minute (not on list). It worked out WONDERFULLY tho. I love this place -- the people are wonderful, the care has been great, I received NO issues when it came to her going to her regular dialysis location and they have Certified Wound Care nurses there. 

I would suggest to anyone that you check out the resource provided. They are nationwide. All they do is provide information - you are not bound to do anything. 


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Grandma’s Pearls of Wisdom:
(picture from Caregivers Blog)

I’ve traveled paths you’ve yet to walk
Learned lessons old and new
And now this wisdom of my life
I’m blessed to share with you
Let kindness spread like sunshine
Embrace those who are sad
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And leave them feeling glad
Forgive those who might hurt you
And though you have your pride
Listen closely to their viewpoint
Try to see the other side
Walk softly when you’re angry
Try not to take offense
Invoke your sense of humor
Laughter’s power is immense!
Express what you are feeling
Your beliefs you should uphold
Don’t shy away from what is right
Be courageous and be bold
Keep hope right in your pocket
It will guide you day by day
Take it out when it is needed
When it’s near, you’ll find a way
Remember friends and family
Of which you are a precious part
Love deeply and love truly
Give freely from your heart
The world is far from perfect
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