Glenn Stok helped his elderly aunt with her affairs in her final years, and writes about the social and legal issues he learned from it.
A few years before my dear aunt passed away at 98, she said she wanted to live out her remaining years in her apartment, so I hired personal care aides to help her.
I'll show you how to hire caregivers, write a healthcare agreement, and deal with elder care agencies.
Ensure Their Well-Being
I couldn’t do it alone to maintain her quality of life. I needed to hire in-home elder care aides to take care of her 24 hours a day. I hired two aides so each could cover a 12-hour shift.
They helped her get around. They took her to the grocery store, to the beauty parlor, museums in the city, to the park on beautiful days, and to the doctor when she had appointments.
Aides are expensive. You’re lucky if you can work out deals for around $12 an hour. That is not live-in. They work their shift in the client's home and then leave.
Live-in aides are cheaper because you’re giving them room and board. You’re sharing your home with them. That's something you need to consider.
My aunt only had a one-bedroom apartment, so that was out of the question anyway.
Be Prepared to Manage Their Finances
Maintaining one's finances is vital to be sure not to waste money in the wrong places.
If you're not good at that, then it's best to hire a qualified person, such as a CPA, who can take charge of the essential items.
If you already handle your own financial affairs, then you should be able to do this for your loved-one too, as I had done for my aunt.
You need to keep track of items such as:
- Paying bills,
- Depositing checks,
- Managing health insurance,
- Filing important papers as required,
- And arranging a budget to cover expenses.
I knew that the last item above was crucial to be sure her social security and pension payments would suffice so she’d be able to continue in her own home as long as she lived.
Determine Their Needs Before Choosing an Aide
Before choosing an aide, it's essential to know what your love-one expects.
- Discuss what they feel they need.
- Suggest additional concerns that they may be overlooking.
- Make a list of these needs and go over it to confirm if it's complete.
- Discuss what type of person they would be comfortable with having.
After you know what's needed, write an agreement that clarifies what work to perform.
Write an Eldercare Agreement Contract
A written agreement will make it clear what you expect of the aides, and it can be used as a contract when hiring.
In addition to specifying the work to be performed, the contract should make it clear that the aide is an Independent Contractor.
Here is what I wrote for that clause:
The Patient and the Independent Contractor agree that the Independent Contractor will perform the work as a Home Health Aide with the following Elder Care Responsibilities:
- Help the patient moving in and out of beds, baths, wheelchairs, or automobiles, such as for transportation to doctor appointments.
- Provide personal care, such as dressing, grooming, and maintenance of hygiene.
- Administer medications as instructed per “Technical Direction” below.
- Prepare healthy meals.
- Do local errands and shopping.
Interview Potential Personal Health Care Workers
When interviewing an aide, get to know them and think about the issues that may cause difficulty if it's not a good match.
- Ask for references. Don't trust the agency.
- Call the references to check their background.
- Do they understand the needs of the elderly?
- Are there cultural differences that need to be considered?
- Discuss food differences and habits that may not be compatible.
Guard Against Dishonest Agencies
Some agencies don't vet their aides well enough. They are just happy to take the money and place anyone. So you need to be aware of that. These are essential steps to take.
- Do a Google search for reviews to see if anything negative shows up.
- Search for court judgments on the agencies and workers.
After you chose an agency and hired an aide, don't let them boss you around. The following experience of mine can happen to you.
Early one day before dawn, one of the aides called me and asked why she was being fired.
I was shocked to hear that, and I told her that if anyone were doing any firing, it would be me. I told her to come in as usual. Then I called the agency.
It turned out the agency told her not to come back. They decided to send another aide that morning. I was furious, and I made my feelings known.
How can they switch people like that and expect an elderly woman to be comfortable with a total stranger once again? I told them, “To do that without warning is unacceptable! My aunt could have died from a heart attack!”
I found out later that the agency tried to fire her because they make more money by placing her with another client. That's because the first week with a new client is paid double—one payment to the aide and one payment to the agency.
By moving them around, they get more of these extra payments. Not all agencies get paid extra for the first week, but it is something to consider.
Be Aware of Abusive Health Care Aides
Sometimes things go wrong. Not all health care workers are trustworthy. You need to keep a constant eye on where the money is going and keep good records of questionable events.
Here's an example of an experience I had with abusive aides:
When my aunt's aides needed cash for groceries, they would take her to the bank to withdraw money. I noticed over time that the requests for money were steadily increasing.
They took advantage of her by telling her it’s because of inflation. The elderly tend to be gullible and believe anything.
My aunt couldn’t be eating so much and using so many of the staple items that were purchased. The aides must have been taking things home for themselves, so I decided to ask them to keep a record of the items they bought.
Other types of abuse can occur, as well. My aunt started complaining that one of the girls was yelling at her and losing her temper.
Keeping records and examining them is one thing, but any abuse should be dealt with quickly.
I had to fire two aides that were causing trouble. Then one of them sued for being fired. I had to go to court to defend this case. I won, but it took a lot of time—all the more reason to keep good records.
Get a Signed Power of Attorney (POA)
There were several times that I hit brick walls when trying to help my aunt. One time I had to call the customer service of her credit card to discuss a problem. They didn’t want to talk to me because they didn’t have my Power Of Attorney (POA) on file.
I had to handle litigation another time too, after firing one of the aides that abused her. You need to consult a business attorney if you get into this predicament. Healthcare aides are independent contractors and cannot be fired unless they fail to meet the terms of the contract. I won that case, but that’s another subject.
Having a "General" POA is useless because banks don’t accept it. I discovered that banks usually want one to file a POA using the bank's forms.
It's helpful to have an additional POA made from a standard form to use when needed. You can find many sites with a Google search where you can purchase legal forms and download a standard power of attorney form.
Include Litigation Rights on the POA:
The standard POA form has options to check-off that show which permissions you have. Make sure you include litigation rights. You never know when you might need that. It was required when I needed to defend my aunt in court for that lawsuit I mentioned earlier, brought on when I fired an aide.
Once you complete the form, you need to get it notarized. I had to bring my aunt to the bank in a wheelchair to get it notarized. If that’s what it takes, you need to do it.
Power of Attorney Expires Upon Death:
A Power of Attorney is only valid while the person is alive. It becomes null and void upon death. If you were expected to handle the estate, then you would have had to be assigned as executor in the will. That is something that needs to be done well in advance.
With all the legal issues that can arise, it’s crucial that you speak with a family attorney.
These can be the most challenging times for both an elderly loved one and the family members who look after them.
When all the issues are taken care of properly, and with foresight, you can keep things going smoothly and assure that your elderly family member is comfortable and happy. And with less stress on you.
This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.
© 2010 Glenn Stok
Glenn Stok (author) from Long Island, NY on October 08, 2012:
I'm glad things are coming along and that you have it all worked out with the aides. Giving them time off with pay once in a while will also assure that they don't get burnt out. It's good that you and your sister know how to handle things when the two of you visit because elder care requires some special knowledge and is not easy for everyone.
I am sure your mother appreciates both of you and enjoys your visits.
Thanks for checking back in with your update.
gracenotes from North Texas on October 08, 2012:
Glenn, I thought I'd return and make another comment. I see it's been 14 months since I remarked about my mother's stroke. After a few months of ladies coming about 5 hours per day, we determined that mom really did need 24-hour care at home. Also, since December 2011, mom's cognitive functions have been declining a little.
Had two or three live-ins who didn't work out (to be expected), but the situation has been stable since April. That is, we have two live-ins who come on alternate weeks. One week on, one week off. One of the ladies is a former ambulance driver who has also worked in nursing homes in the past. I'd say this has worked out well. It has a few negatives, but nothing terribly difficult. For instance, what do we do when I or my sister wants to come and visit for a few days? Simple, we give the caregivers time off with pay while we are at mom's house. This is very much appreciated by them!
I'd say it took my mother about six months, after the stroke, to accept that she could no longer live on her own, and needed someone to care for her all of the time. She didn't want to leave her home, so this was the best option we could have taken. With stability and always having the same two caregivers, they don't make mistakes with medication, etc. And the supervisors (my brother and his wife) are less than a mile away. Sometimes the caregivers need someone to talk to, and to share concerns this way is very convenient and easy for them.
Glenn Stok (author) from Long Island, NY on October 08, 2012:
It's clear that you were a very loving wife and I'm sorry about the passing of your husband. You do not have to feel guilty for putting him in a nursing home, because it's understandable that this was the best thing for him after your own resources ran out. That's the point that makes it clear how much you loved him. You were willing to do, and did, everything you could for him while you were able to.
It's understandable how depressing a situation can be and how it affects one's ability to continue to offer help. There comes a time when one can get so run down, that it is not in the best interest of the other person to continue to try to help. So, I repeat, you did the right thing.
Thanks for voting up.
Nina L James from chicago, Illinois on October 08, 2012:
This is a wonderful hub. It takes a lot of love, patience and courage when caring for an elderly parent, spouse or other relatives. I went through this same situation when my first husband was ill, unfortunately he passed in October 2006. In those years prior to his passing, I have never endured such heartbreak, frustration and so many other issues when it came to caring for my husband at that time. He had severe rheumatoid arthritis, high blood pressure, heart problems, obesity issues. During those years, I still had 2 school age children, I worked full time, handled the family finances, cooked and cleaned, and cared for my husband while he was ill. I sought the help of outside elder care services as well as other social service agencies. He had one niece who came out to help me from time to time. When it was all said and done, I ended up putting my husband in a nursing home because I felt that I could not give him the help that help he so desperately needed. To this day, I still feel somewhat guilty, but I had no other choice given the circumstances of our situation at that time. I actually thought that I was going to have a nervous breakdown because I was handling so much; but thanks to lots of prayer and faith I was able to overcome my depression. I commend you for helping your loved one when they needed it the most. I think to myself that one day, I will need that same help from my loved ones. I wish you all the best. Again, great hub!!! Voted up.
Glenn Stok (author) from Long Island, NY on July 19, 2011:
Grace, I'm sorry to hear that you recently lost your Dad. I hope your Mom recovers as much as possible from her stroke.
There is a great book written by a brain scientist who had a stroke. She wrote it after she recovered. It's very educational since she experienced her own stroke and had the education to understand what was happening, and then was able to write about it. The name of the book is "My Stroke Of Insight." It might help you understand what your Mom is going through right now.
You may need another aide or two, to take care of alternate shifts. Make sure you check their background before hiring them. Get references, but I'm sure you know that.
You are a wonderful daughter to be so concerned about her welfare. I wish you and your Mom all the best.
gracenotes from North Texas on July 19, 2011:
Well, my mom just had a stroke 3 weeks ago, and she is coming out of rehab very soon, so we need to get her house prepared. It's 325 miles from here, but I will be traveling down there to stay a while.
She lives in a small rural area, and there aren't any agencies where you could find an aide for hire. They need to be located using word of mouth. My brother is working on this. In fact, one of mom's daytime caregivers will be the woman who was taking care of my Dad during his last few months of life. So everyone already knows her really well, and she has a special appreciation for our family. We still don't know who'll take on night and weekend duties.
On a negative note, one does have to be careful and monitor the situation. My brother can do this, and being that he lives 1/2 mile away, and is home all the time, it's pretty easy to do. No one likes to think that the elderly would be taken advantage of, and you are right in bringing this to our attention in your excellent hub. Years ago, my parents had a dishonest employee who embezzled thousands over a period of time, so we know what can happen.
I'll take a look at some of the contract forms on the Internet. Thanks for writing this, Glenn.
Glenn Stok (author) from Long Island, NY on February 09, 2011:
Tina, Hopefully your mother-in-law will remain healthy for a long time to come. But while there is still the chance it is a good idea for your brother-in-law to talk with her about her desires and make sure she has a good will.
Sometimes even a will is not good enough as I discovered when my Aunt passed away six months ago. The courts still have not approved probate because her lawyer didn't consider one important issue. Leave nothing to chance and double check even the professionals. I can say that from my own experience.
Thanks for your comments and your vote up.
TINA V on February 09, 2011:
Elderly care aides or caregivers are supposed to be there to extend help to old people or even the handicap. But I guess time change; families and relatives should really monitor them. You are blessed to have a loving aunt like her. She is also lucky to have you as her nephew who cared for her a lot. She has a beautiful smile in the photo.
My mother-in-law is now 82 years old. She is healthy at her age. She is now staying with my brother-in-law without any caregiver’s help. But I think that someday they might also consider getting one for her. This hub is very useful. I’ll bookmark this and share it with them. Voted up!
Glenn Stok (author) from Long Island, NY on February 05, 2011:
Joyce, please do not think you are a bad daughter for deciding to put your father in a nursing home. I agree that there are times when this is the best thing you can do for your parent.
In your case since he has dementia a nursing home is the right place for him. My case was different because my Aunt still had a clear mind and still knew where she was.
The decision to do the best for a parent is not an easy one and I give you credit for researching and making the right decisions.
Joyce F from USA on February 05, 2011:
I'm going through this right now with both my parents. However, sometimes you have no choice but to put a parent in a nursing home. My father has severe dementia and needs 24/7 care. His body is fairly healthy and strong, but his mind isn't.
I agree though, having the proper paperwork is imperative. Nice Hub.