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The 3 Most Important Legal Documents for ANYONE Over 18

Having a powerful Durable Power of Attorney for Finances, Durable Power of Attorney for Health Care Decisions and HIPAA Releases can save you and your family an enormous amount of money, time, aggravation and heartache.

Durable Power of Attorney for Finances

Having this document in place can keep your family from having to go to Probate Court to set up a Conservatorship so that they can handle your finances.  If you are married, you and your spouse are probably on all assets.  However, tax deferred assets like an IRA, ROTH, 401(k) and most life insurance policies are in individual names.  Unless your Durable Power of Attorney specifically mentions those types of assets, your financial institution or life insurance company may not accept the Durable Power of Attorney.

Durable Power of Attorney for Health Care

Many people believe telling their family their health care wishes are sufficient.  The law says that your must put your wishes in writing and appoint someone to make decisions for you.  Just because you are married does not give your spouse the ability to make health care decisions for you.  This is especially important if you do not wish to be kept alive indefinitely by artificial means (feeding tube and ventilator).  If you don’t have a Durable Power of Attorney for Health Care, then your family will need to go to Probate Court to have someone appointed as your Guardian to be able to make health care decisions for you.

HIPAA Releases

Medical personnel can be fined between $50,000 and $1,000,000 a year for speaking to a family member that you have not given written permission for them to talk to.  HIPAA Releases allow you to designate who, over the age of 18, can know about your private medical life.  People listed on a HIPAA Release DO NOT make health care decisions for you.  They do have the ability to call the hospital to check on you and can be present when a doctor is giving a report or test results.

The HIPAA Releases should be a separate document from your Durable Power of Attorney for Health Care.  The Durable Power of Attorney for Health Care can not go into effect until a doctor declares that you are incapable of making your own health care decisions.  If you are unconscious due to a car accident, you still want your family to be able talk to the doctor without being declared incompetent.

FYI – HIPAA stand for the Hospital Insurance Portability and Accountability Act of 1996

Warning Signs to Watch for During a Holiday Visit aging parent dementia warning signs noticed at holidays
Infrequent visits can reveal subtle changes in older adults. How can family members or friends tell if it’s something to be worried about? And is it time for a move?

A holiday visit often gives you a chance to spend time with loved ones you haven’t seen in awhile. These happy occasions can provoke worry if family members notice changes that weren’t there the last time they visited. How does someone tell if it’s normal aging, or the beginning of dementia or even Alzheimer’s? Is it time to contact a care professional?

Many of the early signs of dementia and Alzheimer’s overlap. We’ve provided a list of each, with behaviors that are typical in older adults, countered with behaviors that might be found in someone beginning to show signs of disease.

Early Indications of Dementia

It’s hard to diagnose dementia in the beginning stages, because the signs are subtle and vary from person to person. However, common symptoms are:

Reduced ability to concentrate. Anyone can struggle with managing finances. Someone with dementia might not understand what numbers mean or how to use them.

Personality or behavior changes. Anyone can get tired of an activity. Someone with dementia totally loses interest in activities they used to enjoy, or needs prompting to get involved.

Loss of ability to do everyday tasks. Anyone can get distracted and burn a meal. Someone with dementia has trouble remembering all the steps involved in preparing a meal.

Increased confusion and disorientation. Anyone can get lost. Someone with dementia may have difficulty finding their way on a familiar route or be confused about where they are.

Difficulty remembering recent events. Anyone might forget an appointment. Someone with dementia forgets them more often or never remembers making them at all.

Depression or apathy. Anyone can be down or depressed. Someone with dementia may become confused, suspicious, or apathetic, or have wild mood swings.

Loss of language ability. Anyone might forget a word occasionally. Someone with dementia may forget simple words and substitute inappropriate ones, making the person hard to understand.

Poor judgement. Anyone can miscalculate the weather. Someone with dementia can see snow outside without thinking a jacket is needed to go for a walk.

Misplacing objects. Anyone can misplace the car keys. Someone with dementia might forget what the keys are for.

Be aware that many conditions, some of them temporary, can mimic dementia. Don’t think your loved one has dementia when the warning signs may be due to a stroke, depression, infection, nutritional deficiency, hormonal disorder, long-term alcohol overuse or even a brain tumor. Many of these conditions are treatable. Only a doctor can diagnose dementia. An early diagnosis is critical for treatment, support and making plans.

Is It Alzheimer’s Disease?

No one wants to discover that a loved one has Alzheimer’s, a brain disease that slowly degrades memory, thought and reason. But early diagnosis is crucial for treating the disease to get some relief from symptoms and maintain a longer period of independence. Read on for a list of 10 warning signs and symptoms, adapted from the Alzheimer’s Association’s version. A person may experience these signs at varying levels. If you notice any of the signs in a loved one, have them see a doctor for further evaluation.

Five Warning Signs of Abuse or Neglect

As many as 5 million older adults are abused every year, according to the Senate Special Committee on Aging, and yet that abuse remains significantly underreported. Elder abuse often originates with someone in a position of trust, including family members and caregivers. Here are five warning signs to watch out for:

Physical abuse. Look for burns, abrasions, pressure marks and bruises. Does your loved one have a history of sprains, dislocations or even broken bones? Sudden hair or tooth loss can also indicate abuse. Beware of odd explanations such as “She ran into a wall.” Does a caregiver or family member hover, not allowing you to visit alone? Is your loved one taken to many different medical facilities for treatment? All are red flags.

Neglect. If an older adult needs help due to cognitive or physical impairments, check for dirty clothes, soiled diapers, bedsores and unusual weight loss. Is their living environment neat and clean, or has it deteriorated? Are medical aids such as hearing aids, canes and glasses clean and available, or nowhere to be found? The neglect may be intentional, or it could be passive as the result of an untrained or overly burdened caretaker.

Verbal or emotional abuse. Does your loved one seem withdrawn, or exhibit odd behavior like biting or rocking? Are there signs of fear, stress or tension around the caretaker? Does the caretaker snap or yell at the older adult? Is there forced isolation of the older adult by a member of the family or a caretaker? Emotional abuse can be tricky to spot, because it ranges from an insult to an outright verbal attack, and the older adult is often unable to fight back or even recognize the problem. A caregiver may say, “I can’t wait until you die so I get my life back!” or curse. The abuser may also isolate the older adult so no one knows what is happening.

Sexual abuse. Age is no armor against a sexual predator, who may see an older adult as easy prey. Look for bruises around breasts or in the genital area, venereal disease, and vaginal or rectal bleeding. Your loved one may have difficulty walking or standing, and exhibit depression or withdrawal. Be suspicious if the caregiver acts flirty or seems to touch the older adult excessively or intimately when it is not warranted.

Financial abuse. Are there unpaid bills piling up? Has money “disappeared”? Does a caregiver suddenly have an unexplained purchase that seems beyond their means, such as a new car, cell phone or clothing? Does a caregiver take money to make a purchase that never arrives? Has someone new been added to bank accounts or credit cards? Is credit card use increasing? Are cash withdrawals becoming more frequent? Family members and caregivers have the greatest access to older adults’ accounts, and are often in the position of greatest trust to steal from seniors.
If you suspect severe elder abuse, call 911 to report immediate, life-threatening danger. Otherwise, report the abuse to a local adult protective services agency, the police or a long-term care ombudsman. Find a local resource at the National Center on Elder Abuse.

Memory loss that disrupts daily life. Anyone forgets names or appointments, but remembers them later. Someone with Alzheimer’s forgets important dates or events, asks for the same information again and again, and has difficulty remembering recently learned information.

Difficulty solving problems or planning. Anyone makes an error now and then balancing a checkbook. Someone with Alzheimer’s has trouble following a familiar recipe or paying bills.

Confusion of time or place. Anyone might forget what day of the week it is, but be able to figure it out later. People with Alzheimer’s can lose track of seasons or the passing of time, where they are or how they arrived.

Difficulty with spatial cues and visual images. Anyone might have reduced vision due to cataracts or macular degeneration. Someone with Alzheimer’s has vision problems leading to issues reading, judging distance and seeing color contrast, which might lead to difficulty driving.

Problems with written or spoken words. Anyone can struggle to find the right word now and then. Someone with Alzheimer’s struggles with vocabulary, and has trouble following or joining a conversation, repeating what was just said or failing to continue the thread.

Misplacing objects. Anyone can forget where they put something and have to retrace steps to find it. People with Alzheimer’s put things in unusual places, like leaving car keys in the freezer. They may be unable to retrace their steps to relocate an object, or accuse others of stealing it. This behavior typically accelerates over time.

Poor judgment. Anyone can make a crummy decision once in a while. People with Alzheimer’s may use poor judgment with money, giving large sums to people they meet over the phone. They may quit taking care of their appearance and cleanliness.

Withdrawing from work or social occasions. Anyone may feel like being alone sometimes. Someone with Alzheimer’s might quit hobbies, social outings, sports or work activities. This could be because they’ve forgotten how to complete the hobby or because of other changes from the disease.

Mood and personality changes. Anyone can get in a particular pattern and feel irritated when it is disrupted. People with Alzheimer’s can easily be upset at home or work, especially in situations where they don’t feel comfortable. They can become confused, suspicious, fearful, anxious or depressed.

Increasing the Level of Care

Perhaps your concern for your loved one isn’t about cognition at all. You may notice that Grandma prepared a delicious turkey, but she didn’t have the strength to carry it to the table. Maybe her house is dirtier than usual because her eyesight is failing, or she can’t physically sweep like she used to. There are a host of issues you may need to address while you are there or shortly afterward.

Have a conversation with the older adult about what you notice. How does the older adult feel about it? Is Grandma adamant about aging in place, or is she feeling lonely and thinking it might be time for a move to assisted living? Would she like help doing certain tasks around the house, or with errands? Is it time to stop driving?

If you decide to bring in home help, determine if the neighbor down the street would be a good fit, or if you should contact a professional caregiving service that screens and trains all of its employees. Do you simply need a cleaning service, or is your loved one ready for help with meals and shopping? What are her needs likely to be going forward, and is there someone, such as a family member or friend, who can help you assess them? Do you need to talk to her doctor to review medications and recommend changes in Grandma’s home so she can get around more easily?

Homecoming is full of nostalgia. It can be hard to face the point when you realize that your loved ones need your help, especially when they might not be willing to admit it yet. Tread gently and seek their input, then consult with professionals if you need further guidance. Above all, accept the changes with a loving spirit and the most positive attitude you can muster for the challenges ahead.


“10 Early Signs and Symptoms of Alzheimer’s,” Alzheimer’s Association.

“Dementia – early signs,” Department of Health & Human Services, State Government of Victoria, Australia.

“5 Signs of Elder Abuse,”

Blog posting provided by Society of Certified Senior Advisors

Alzheimer’s Disease Workshop – Alzheimer’s Association

Join us on Tuesday, November 14th at 6:30 for our free, educational workshop put on by the Alzheimer’s Association titled – The Basics: Memory Loss, Dementia & Alzheimer’s Disease

If you or someone you know is affected by Alzheimer’s disease or dementia, it’s time to learn the facts.  This program provides information on detection, casues and risk factors, stages of the disease, treatment and much more.

R.S.V.P is required as seating is limited.  Please call 636-394-0009 or email to reserve your seat!

Older Drivers

Are you worried about a loved one driving? Have you noticed dents in the car or scrapes across the side? Nobody wants to give up the key’s, but when it starts to become a safety factor doing the right things can be difficult.  Especially once a loved one has dementia or is diagnosed with Alzheimer’s is when you need to start taking action.  Click below to read our tips on driving safety and stop by our office Monday – Friday 8:30 am-5:00 pm to get more information on driving safety as well as other topics pertaining to aging loved ones.




VA News – NEW Presumptive Conditions for Camp Lejeune

Washington- The Department of Veterans Affairs (VA) has published regulations to establish presumptions for the service connection of eight diseases associated with exposure to contaminants in the water supply at Camp Lejeune, N.C.

The presumption of service connection applies to active duty, reserve and National Guard members who served at Camp Lejeune for a minimum of 30 days (cumulative) between August 1, 1953 and December 31, 1987, and are diagnosed with any of the following conditions:

  • Adult leukemia
  • Aplastic anemia/other myelodysplastic syndromes
  • Bladder, kidney or liver cancer
  • Multipole myeloma
  • Non-Hodgkin’s lymphoma
  • Parkinson’s disease

“We have a responsibility to take care of those who have served our Nation and have been exposed to harm as a result of that service,” said Secretary of Veterans Affairs Robert A. McDonald.  “Establishing a presumption for service at Camp Lejeune will make it easier on those Veterans to receive the care and benefits they earned.”

Environmental health experts in VA’s Technical Workgroup conducted comprehensive reviews of scientific evidence, which included analysis and research done by the Department of Health and Human Service’s Agency for Toxic Substances and Disease Registry (ATSDR), the Environmental Protection Agency, the International Agency for Research on Cancer, the National Toxicology Program, and the National Academies of Science.

Veterans with 30 or more cumulative days of active duty service, at Camp Lejeune during the contamination period are already eligible for certain medical benefits, following passage of the Honoring America’s Veterans and Caring for Camp Lejeune Families Act of 2012.

In the early 1980’s volatile organic compounds, trichloroethylene (TCE), a metal degreaser, and perchloroethylene (PCE), a dry cleaning agent, as well as benzene and vinyl chloride, were discovered in two on-base water supply systems at Camp Lejeune.  The contaminated wells supplying the water systems were shut down in February 1985.

This area included in this presumption is all of Camp Lejeune and MCAS New River, including satellite camps and housing areas.

The rule will be effective either 60 days after publication in the Federal Register, or following conclusion of the 60-day Congressional Review, whichever is later.

If you or a loved one was at Camp Lejeune during those dates or have more questions, please call us to set up an appointment at 636-394-0009



Aging in Place: Does It Make Sense to Plan to Stay at Home?




Warning signs that your aging parents may need more help to stay at home

Warning signs that your aging parents may need more help to stay home.
By Hannah Draeger Ross

Warning signs that your aging parents may need more help to stay home

What Happened to Mom?

Time and obligations have a way of interfering with the best laid plans of family members. Trips to visit an aging parent or relative become more and more infrequent. Many of our parents or grandparents have relocated to states that offer climates more conducive to shoveling sand versus snow. Or adult children have moved to distant states for better jobs or opportunities.

Many of us have limited our travel planning for various reasons, including the difficulty of taking time off from work. Our daily responsibilities often take precedent to seeing aging relatives, and another year’s plans to visit slip away.

Finally, a visit is possible, and the door to their home is opened by a very frail parent.

“What happened to Mom?” is a question I hear quite frequently these days.

“I knew my mother needed a little help around the house, and we did hire an agency to come once in a while to assist with the housekeeping. But I had no idea she had changed so much,” I recently heard a daughter lament.

How do I know about these instances? I operate a senior service designed to offer resources and assistance to families. Many of my clients live hundreds or even thousands of miles away from their parents.

An elderly person may sound great on the phone while hiding health issues. Your loved ones don’t want you to worry about them. They might also be nervous that you will suggest they move into a retirement home. The majority of senior clients I work with want to remain in their own residences.

Or they may be unaware that they need help. Over time, older adults can gradually lose some of their functioning. Their hearing gets worse, they’re more tired, they can’t remember how to turn on the shower or the stove. Slowly, they withdraw from some of life’s daily chores.

When you visit an aging parent, use your senses to evaluate whether your mom or dad needs additional care.

Warning Signs Your Parents Need Help

Watch. Do they dress appropriately for the weather or the season? Does your dad have on a soiled shirt? Is his appearance disheveled? Is he well-groomed? Do his teeth appear clean? Does your mom continue to wear make-up? Is the car dented and dinged? Is the house clean and free of clutter? Is mail all over the counters and tables?

Listen. Can they carry on a general conversation and understand what you are saying? Are they speaking too loudly? Is the television blasting in the background? Do they call you by your name? Do they engage in phone conversations with telemarketers?

Smell. Does the home have an unpleasant odor? Is there outdated or spoiled food in the refrigerator? Is the garbage can overflowing? Is the heat or air-conditioning completely off? Do you smell a litter box or other pet odors?

Touch. Do they look healthy? Do they feel cold to the touch? Is their skin supple and normal in color? Are there any bruises or skin tears? Have they lost weight? Have they gained excessive weight? Has their eyesight failed?

Observe. Are there many medications and pills around? Are there different doctors’ names on pill cases? Has their personality changed? Do you see a big supply of liquor? Are bills marked “past due” or unopened? Is there an abundance of letters from charities or contests, indicating they have been too susceptible to every appeal that comes their way?

Be proactive. If you sense a problem, take action immediately. Discuss the issues you find with your loved ones. Set up doctor appointments and determine what services are needed.

How to Help

Once you have noticed concerning changes in a loved one that may be putting them at risk physically or financially, please think about respectful and practical solutions to help them. Many elder citizens want to live life in their own way and resist changing residence. They would prefer to bring the help they need into their homes rather than move.

Put yourself in their place. Would you want to leave your own home to stay with your kids? Or would you prefer to make renovations to your place to accommodate your changing health and safety issues? Do you enjoy your neighbors and your neighborhood? Is your garden your pride and joy? Do you have a beloved pet that would not be welcomed into assisted living?

Bringing care into the home extends the time your parent can stay in the comfort of their own residence with their memories and their precious belongings around them. Your parents deserve to live their lives to the fullest. Helping them stay in their own home can often provide a less expensive alternative to special-assistance housing. Sometimes, a caregiver simply needs to come by for a few hours a day.

Of course, these solutions for enhancing at-home care are intended to address the natural stages of aging, not dementia. If you suspect that your parent’s behavior points to the cognitive decline associated with dementia then trust your gut. Before you embark on improving their lifestyle at home, where they could be at risk, get your parent to an appropriate doctor for cognitive testing and diagnosis.

How to Change the Home

My senior clients have commented about how much life has improved for them because of the addition of a ramp or bath designed for handicapped use (please make sure proper training is included). Renovating a home for special needs can also prove a wonderful alternative to geriatric housing facilities. We “baby proof” homes for safety, but rarely “senior proof” them on the opposite end of life.

Installing “nanny cams” and proper security when a senior is at risk due to cognitive issues is a smart idea. I have one client who installed this sort of security for her father, along with a phone app, so she can routinely check to make sure he is OK.

It also makes sense to have someone assist with cleaning and cooking to help ensure your parents eat properly in a hygienic home. One of my clients found a retired nurse to move in with her parents. Lucky her! Caregivers can also drive your parents to the doctor, out to lunch or to visit an old friend. Many of my clients have stayed in their homes until the very end because they took advantage of care and services from family members, caregivers and hospice.

Don’t Beat Yourself Up

If you are not able to be your loved one’s primary caregiver, take the proper precautions so that you have peace of mind. For example, make sure the caregiver and any other important people know to call you if needed. Clearly display a list of emergency contacts such as your parents’ or relatives’ financial planners, lawyers and doctors. List the medications they take and their pharmacy’s phone number. When you visit your loved one, get the name and number of one of their close friends or neighbors so that you can check with them if needed.

Finally, stop beating yourself up and schedule time for at least one phone call every week. Mom and Dad already know you have other responsibilities. In the meantime, let’s hear it for this wonderful, stubborn generation of “Golden Agers” who still watch Jeopardy, play cards with friends, sign up for dance lessons and believe that 90 is the new 80!

Author - Hannah Draeger Ross, CSA
– Hannah Draeger Ross, CSA

Hannah Draeger Ross, CSA, is the owner of Elderlinx Senior Services. She has been a geriatric homecare professional for over 15 years and resides in Myrtle Beach, South Carolina.


Let’s Talk About Death

Let’s Talk About Death

Recently, I ran into a woman I hadn’t seen since I was a little girl. When she found out I am the director of prearranged funeral planning at a funeral home that has been caring for the community for four generations she said, “Why would someone work in such a MORBID business?”

Her comment isn’t that unusual, honestly. In my work, I’ve discovered that though our society is steeped in death — school shootings and terrorism in the news, violent movies, tv shows, and video games — when it comes to the more mundane end of life, we don’t want to talk about it.

Talking about death is in bad taste. It’s morbid. It’s taboo. Our approach is never to say “die.”

Instead, we whisper that someone “passed away” or even “passed.” We talk about “losing a loved one” who “fought valiantly but ultimately lost in the fight” against a disease.

It reminds me of how we used to approach sex. A generation or two ago, people used euphemisms to talk about body parts — weewee, peepee, hooha — we’ve since learned that the cutesy names are not helpful; they make kids think that their body parts are shameful and weird. To help our kids feel in control of their bodies, we must use anatomically correct terms.

Similarly, using euphemisms for death is an attempt to protect ourselves and those around us. Many of us have a lot of anxiety in thinking about our mortality and that of those we love. It fills us with grief, and guilt, and loss. Even though it’s the only universal human experience, we fool ourselves into believing that if we don’t talk about it, it won’t happen.

The euphemisms are an attempt to keep us safe from the reality. But they also reinforce the idea that we can’t or shouldn’t talk about something that is so fundamental to our humanity. Often that leaves us unable to connect in an authentic way. And it leaves us ashamed to talk about something so very important.

There is a bereavement group in Utah, The Sharing Place. It’s dedicated to helping kids deal with the death of their parents. Did you know that 1 in 20 children will experience the death of a parent before they turn 18? When these kids attend the Sharing Place groups, they each share the circumstances of their loved one’s death using direct terminology. “My mom’s heart stopped and she died.” “My dad had an illness called depression; he used a gun to shoot himself in the head and he died.”

Talking helps us process what happened and normalize the experience. It helps us feel part of a community — less isolated and alone. It gives others permission to share their experience too.

I can’t tell you the number of times when someone meets me and finds out what I do that they say, “I have the weirdest question.” Truthfully, it’s almost never a question I haven’t heard many times before. Because we are so afraid to talk about death, we feel like there is something wrong with us for having any question at all.

Dying happens. It’s part of life. It’s often a very sad part of life, but an important one nonetheless. By accepting the fact that our lives are finite, we can live more meaningfully, more purposefully.

Recently I read a book by Dr. Paul Kalinithi, When Breath Becomes Air. He was a neurosurgeon who developed stage IV lung cancer. He wrote about his experience in dealing with dying patients and his own experience in dying. He said, “By engaging in the reality of death, we can more deeply understand and experience Life.”

Talking about the reality of our mortality can help us to be more self-assured and strong. By talking about death and preparing for the reality of it, we can be much more likely to get what we want and need. But it’s not easy to get started.

According to Ellen Goodman, creator of The Conversation Project, “people need a travel guide to take the first steps down an unfamiliar and difficult road.” The organization created a tool to help people start the discussion. It includes topics such as end-of-life care and funeral planning.

However, these cannot be just one-time conversations. They are discussions we need to revisit regularly, as circumstances change.

When my husband and I did our first Will at age 25, both of us were adamant that we not have artificial life support. Twenty years later, a close friend collapsed on the tennis court when his heart stopped. The paramedics were able to revive him and he was put on a ventilator. Though his body was recovering, he’d been without oxygen so long that his brain was not. His Living Will said not to put him on life support at all. His family, however, needed time to process what had happened. Ultimately, the ventilator was removed nine days later and he died.

With that experience, my husband and I revised our advanced directives. We discussed how we would prefer NOT to be on artificial life support. However, we wanted our loved ones to make the final decision on when to remove it if we were ever in a similar situation to our friend. We recognized that what really mattered was not what each of us might want but what the people who loved us might need.

I am a big believer in talking about funerals too. We are so death-averse, we often think that the only thing that matters is getting rid of the body. Cremation has become really popular and so many people tell me, “I don’t need a funeral. When you’re dead, you’re dead.” What they don’t recognize is that the funeral is not really for the dead person, it’s for the people that are left behind. A communal event, a time for people to get together and share their feelings is often incredibly healing. Dr. Alan D. Wolfelt, grief researcher describes this ritual as a “symbolic activity that helps us, together with our families and friends, express our deepest thoughts and feelings about life’s most important events.”

When we are told NOT to talk about something — sex, depression, death — we feel shame, embarrassment about it. We need to get better at having these important conversations regularly and from a point of strength. By talking truthfully we can take some of the power out of these issue and feel relief.

And we can use these conversations to get closer to the people we love most.

Author - Jamie Sarche

– By Jamie Sarche

Jamie Sarche is a writer, speaker, and the Director of Prearranged Funeral Planning at Feldman Mortuary. She helps people put plans in place long before they need them, when they are able to make educated decisions that are not clouded by grief. Her clients feel a sense of peace for taking care of their loved ones even when they will no longer be physically present to do so. Jamie is a TED speaker and an ELI Talks speaker. She is a mom and lives together with her husband and two boys in Denver.


Demand Increasing for Private Employment in High-Hour Senior Care Cases

Demand Increasing for Private Employment in High-Hour Senior Care Cases

privately employed caregiver solution

According to research by the AARP, about 90 percent of our rapidly-growing senior population would like to stay in their own home as they age. Furthermore, 82 percent maintain their desire to age at home – even if they require day-to-day assistance with activities of daily living. With a rapidly increasing senior population, demand for quality in-home care is beginning to skyrocket.

For the past 40 years, in-home care has been delivered predominantly by home care agencies who employ caregivers and dispatch them to homes. However, recent regulations are changing the cost structure for home care agencies, especially for certain types of cases like Alzheimer’s disease and other conditions involving cognitive decline.

These types of cases call for care continuity – one or two caregivers who work with the patient every day and fully understand the complex and unique needs of the patient. Importantly, this also serves to calm the patient as a revolving door of new faces can be very upsetting to those with cognitive decline.

These types of cases invariably have high hours (more than 40 in a week), which, under the new regulations, now triggers overtime requirements for home care agencies. In most states, first-party employers (families), are exempt from overtime requirements if the caregiver is a live-in employee or qualifies as a companion. This allows them to get the care continuity they need without the additional cost. Given that most memory disorder cases progress toward around-the-clock care, this overtime exemption can reduce the cost by as much as 50%, or tens of thousands of dollars per year. This radical cost disparity is creating a gravitational pull toward private employment.

What Exactly Has Changed?

At the end of 2015, the Department of Labor (DOL) repealed two Wage & Hour Law exemptions that had been in place since 1974 – the Companion Care exemption and the Live-In exemption. The repeals impacted only third-party employers of direct care workers (i.e. staffing agencies), no longer allowing them to pay workers less than minimum wage and forcing them to adhere to overtime standards.

July CSA Webinar:

Due to recent regulatory changes for in-home care, many cases are being driven toward first-party employment (direct hire) in order to save tens of thousands of dollars each year. Tom Breedlove, Director of HomePay, the country’s leading household employment specialist, will share information that advisors need to know in order to present care options and successfully guide their clients.

    • When:
      July 20, 2017
      2 PM Eastern, 1 PM Central, 12 PM Mountain, 11 AM Pacific

As a result, many home care agencies now handle high-hour cases differently. They either get the family to accept a rotation of many different caregivers or pay for the associated overtime with a major increase in their hourly rate.

The Private Employment Solution

Private employers are still exempt under federal law and most state law. These exemptions make private (direct) employment a much more affordable alternative to the traditional home care agency model – especially for cases that are chronic, high hour and require care continuity.

Even after adding in payroll taxes, insurance and all other employer-related expenses, the savings can be staggering.

A Simple Budget Scenario

A family needs care for a loved one suffering from dementia. Family members are able to provide care on the weekends, but during the work week, they need around-the-clock caregivers. The local home care agency had recently increased their hourly rate to $25 per hour, which meant they would need to budget for $2,000 per week ($25/hr X 16 hrs/day X 5 days/wk).

Note: This takes into account the federal sleep time exemption where employers may deduct up to 8 hours of sleep time if an employee works a shift of 24 hours or more.

With this information in hand, the family decided to compare the cost to employing privately and found several caregivers with similar qualifications that would work for around $12 per hour. Because the caregiver was required to be on-site for 120 hours per week, this qualified as a live-in employment situation in the eyes of the law, meaning the family would not be responsible for overtime – on top of the savings they’d receive from taking the sleep time exemption.

The all-in hourly cost for private employment (taxes, insurance and payroll service) ended up being $13.45. As you can see in the illustration below, this saved the family more than $48,000 – nearly half the cost of going through their local staffing agency.

Agency Costs $25 per hour x 80 hours x 52 weeks $104,000
Private Employment $13.45 per hour x 80 hours x 52 weeks $55,952
Savings Per Year $48,048

It’s important to note that cost is not the only factor to consider when deciding on a care solution. Home care agencies charge more because they manage several important aspects of the hiring process as well as the employer responsibilities. Some families will want to retain an agency for all those tasks, while others will opt for the consistency and savings of a private caregiver. For those who opt for private employment, here’s what they need to know.

privately employment vs staffing agency cost comparison

Household Employment Basics

Hiring a senior caregiver privately means the worker is now a household employee. And just like any other employment situation, payroll, tax and labor laws must be followed. There are three primary wage reporting responsibilities families have for their caregiver:

1) Withhold payroll taxes from the caregiver each pay period. Normally, this includes Social Security & Medicare (FICA) taxes, as well as federal and state income taxes. Some states are different and you can consult this state-by-state guide for more information.

2) Remit household employment taxes. These generally consist of FICA taxes as well as federal and state unemployment insurance taxes. Again, some states have additional taxes, so it’s important to consult the state-by-state guide beforehand.

3) File federal and state employment tax returns. These are due throughout the year – rather than just at tax time – and go to the IRS and state tax agencies.

In addition, there are a number of employment law matters that need to be handled at the time of hire. Depending on the state, a family may be responsible for providing things like a written employment agreement/contract, detailed pay stubs, paid time off/paid sick leave, workers’ comp insurance, etc.

The good news is there are household employment specialists, like HomePay, that take full accountability for all of the employer responsibilities so families are free of paperwork and risk – enabling them to focus on caring for their loved one.

In Conclusion

There is no one size fits all solution to caring for our older adult population. Home care agencies, assisted living facilities, independent living facilities and skilled nursing facilities all have a role to play. And, now with the recent regulatory changes, so does privately-employed in-home care – especially for those patients suffering from cognitive conditions who need many hours of consistent care.

When this type of case arises in your practice, please feel free to contact us for a free budget consultation so you can present your client with all their care options.

Author -  Carol Marak

– By Tom Breedlove, Director of HomePay

Tom brings more than 30 years of business experience, including more than a decade as Director at Breedlove & Associates – now known as HomePay – the nation’s leading household employment specialist. Co-author of The Household Employer’s Financial, Legal & HR Guide, Tom has led the firm’s education and outreach efforts on this complex topic. His work has helped HomePay become the featured expert on dozens of TV and radio shows as well as countless business, consumer and trade publications.


Publication 926 (2017), Household Employer’s Tax Guide,” 2017, IRS.

Fact Sheet: Application of the Fair Labor Standards Act to Domestic Service, Final Rule,” Sept. 2013, Department of Labor, Wage & Hour Division.

The United States of Aging Survey” 2012, AARP.

The United States of Aging Survey” May, 2016, Bureau of Labor Statistics.

Cost of Care Survey 2016” 2016, Genworth.

How to Have Crucial Conversations When Your Aging Loved One Is Resistant

How to Have Crucial Conversations When Your Aging Loved One Is Resistant

crucial conversations when someone is resistent

If you are concerned about your loved one being resistant to having crucial conversations with you about end-of-life issues, you might hesitate to bring up the subject.

Talking about aging and end-of-life issues with an ailing loved one is not easy for most of us. Many of us avoid this conversation altogether until we actually face difficult end-of-life issues and decisions for a loved one need to be made. Having crucial conversations now, while your loved one is relatively healthy, will make it easier if and when you or your loved one is faced with a sudden and unexpected health emergency. The way in which you approach having these conversations is crucial to creating a plan that spells out clearly how matters will be handled in the future. Such a plan is empowering for all involved.

In many aspects of caregiving, resistance often comes into play, and you will need to address this resistance when fulfilling the role of a caregiver. When I cared for my dad, one of the toughest challenges I faced was his resistance to care. How do you help a loved one who doesn’t want or resists your help? I had to learn and understand why my dad was resistant and develop new strategies to gain his cooperation.

This article will provide you with the necessary tools to have crucial conversations with a resistant loved one, and it will also provide tips to help you deal with resistance that comes from either your loved one or other family members.

When Your Loved One Is Resistant

Have you ever thought about why your loved one is resistant to receiving care or having crucial conversations with you and other family members? It could be due to the fact that he or she may be dealing with a personal loss, such as a spouse, physical loss, mental loss and/ or the fear of losing his or her independence. It could be that your loved one may feel that having a crucial conversation about end-of-life with you might signal he or she has to relinquish their privacy and adjust to new routines. Or it could be that your loved one doesn’t have a solid relationship with you and/or other family members. Or maybe it’s connected in some way to the fact that your loved one’s friends have all passed away. Or your loved one could be in the early stages of dementia. Or perhaps your loved one doesn’t want you to know about a chronic condition he or she is suffering from. And it could very well be because he or she is afraid of:

    • You taking away his or her car keys
    • Losing his or her way of life
    • Getting old
    • Not having any financial assets to help you
    • Being a burden on you
    • You taking all his or her financial assets
    • Having you as a caregiver
    • Being thrown into a nursing home
    • Dying

How to Help Your Loved One Overcome Resistance

To help your loved one overcome his or her resistance to engaging in crucial conversations about aging and end-of-life issues, illustrate for him or her the importance of planning ahead by asking these questions:

    • If you suddenly and unexpectedly get ill, who is going to take you to the hospital?
    • What kind of care do you want in the future?
    • Where is the money for hospital care and long-term care going to come from?
    • And finally, what are your desires regarding your funeral?
  • Who is going to pay for it?

Aging loved ones should be reminded that if they don’t have these crucial conversations with adult family members while they are still well, all hell can break loose when they are too ill to intervene, as family members may express different desires and stress each other out. As a concerned family member, keep in mind that you must be very patient and gentle with your loved one in the early stages of discussion, when they need your help the most. Trust is a major factor for your loved one—after all, your loved one is putting his or her life in your hands—and so his or her resistance may very well dissolve as trust in you grows.

Another strategy for bringing your loved one on board is to share with him or her what your wishes are for your own end of life, and to explain that you have started thinking about how your own final wishes can be realized when the time comes. After all, you should not expect your loved one to do something you have not done for yourself. You will find that the crucial conversations are much easier when you have actually contemplated your own end-of-life stage and described it to someone else.

Strategies for Effective Crucial Conversations With a Resistant Loved One

The following strategies will help you enter into that first conversation about aging and end-of-life matters with a resistant loved one and make it productive. First, tell your loved one that you would like to set a time for the two of you, plus other members of your family, to have a crucial conversation about how you are all going to prepare yourselves emotionally, financially and legally to avoid sticky end-of-life issues. Once you have agreed upon a time for the conversation, schedule a family meeting.

Remember never to hold this type of meeting on or around a holiday. This subject is too heavy for a holiday. Next, select two or three family members who are confident and qualified to lead the conversation. (Remember, this is not an easy conversation, and not everyone is equipped to do this.) Remind family members beforehand that they must have only your loved one’s best interests at heart.

Once the meeting gets under way, ask your loved one this question: “If I had to handle a sudden and unexpected health emergency for you, what is the most important concern you would have?” Allow your loved one to articulate his or her biggest concern, and then ask why this concern in particular is so important. Next, ask your loved one to relate his or her wishes for end-of-life care. Then share what your wishes are for your loved one’s end-of-life care, and allow your family members to air their wishes for your loved one, as well. The point is to allow everyone to feel that they have a say-so regarding the issues that might arise during end of life. This approach will help your loved one feel that he or she is not being pushed around by family members, and that he or she has a say regarding the care received. Making this initial crucial conversation a family affair will foster greater participation in future and will set the stage for a better outcome. And it will steer your aging loved one away from the notion that “it’s all about him or her” and toward the realization that “it’s a family affair.”

Before the meeting ends, be sure to share with your loved one and other family members what might happen if you do not come together and preplan. Share only facts, and don’t resort to scare tactics. (Do not ever threaten or use scare tactics when talking with a loved one about end-of-life issues or decisions.) These are some potential pitfalls of a lack of preplanning:

    • Family rivalries and dissension could reach an all-time high as each person tries to have his or her wishes for the loved one carried out.  If problems between family members exist, those relationships could go from bad to horrid.

If you or your family members are uncomfortable about having this crucial conversation, an alternative is to enlist the aid of a geriatric mediator or a geriatric attorney. Have them come to your home, meet with your family and provide everyone with the necessary tools and resources to help in the decision-making process. A geriatric attorney can also ensure that you have the necessary legal documents in place to protect both you and your loved one. Keep the following points in mind:

    • If there are family members who are unsupportive and who will not cooperate, definitely seek legal counsel.
    • Hire only professionals who are experts in geriatric care to assist with the emotional, financial and legal matters surrounding your loved one’s end of life
    • Caregiving Empowerment Strategy Training Courses are available online. You can get the help you need at

Other Strategies for Effective Crucial Conversations With a Resistant Loved One

    • If your loved one refuses to accept that he or she is in poor health, and thus sees no need for crucial conversations, make a dramatic case. When approaching your loved one, it is best practice to have some proof substantiating your concerns, such as pictures, letters or other documents, for your loved one to review. An example would be showing your loved one a photograph of himself or herself taken a month earlier, and then showing him or her a photograph that was taken that week or that day. Your loved one will clearly see how much thinner or unhealthy he or she appears to be in the recently taken photograph. Remember, a picture is worth a thousand words. When you use show-and-tell to convey your concerns, your loved will eventually trust you, knowing you have his or her best interests at heart.
    • Describe “caring” in a positive way. You may consider describing respite care as an activity your loved one likes. Talk about a home-care provider as a good friend. Also you might describe elder care as a seniors’ country club, or refer to your loved one as a volunteer or helper at the country club.
    • Never give up on your loved one. If he or she doesn’t want to discuss the topic the first time you bring it up, try again later.
    • When your loved one acknowledges his or her medical conditions but still refuses to tell you about them, be patient. Voice your concern and off er your help. Know that your loved one will eventually come around.
  • Enlist the help of family members. Family and friends might be able to help you persuade your loved one to accept help.

What should you do if your loved one refuses to tell you if he or she is being abused or if he or she refuses to tell you if he or she does not like his or her doctor, assisted living or long-term care facility?

    • Listen, listen and listen to your loved one. When your loved one tells you that he or she does not like a particular doctor or a staff member at a long-term care residence, make certain to ask him or her why, as abuse could be the root cause. Also, make sure you are aware of any bruises or cuts on your loved one for which there is no explanation. These could very well be telltale signs of abuse. If you believe that a doctor has abused your loved one, contact your state medical board. If you believe your loved one has encountered abuse at a long-term care facility, report, report, report your findings and concerns to the facility’s higher-ups, your state’s long-term care ombudsman and/or adult protective services. They will conduct an investigation to get to the bottom of your concerns.

Question Checklist

Reasons for your loved one’s resistance Is your loved one resistant because:

    • Your loved one is dealing with a personal loss, such as a spouse, physical loss, mental loss and/or fear of losing his or her independence?
    • He or she does not want to relinquish his privacy?
    • Your loved one does not want to adjust to new routines?
    • Is your loved one in the early stages of dementia?
    • Your loved one wants to keep his or her chronic condition a secret?
    • Is your loved one afraid of you taking away his or her car keys, losing his or her way of life, getting old, not having any financial assets to help you, being a burden on you, you taking all his financial assets, being thrown into a nursing home, dying?

Strategies to Overcome Resistance

    • Have you scheduled a family meeting?
    • Has your loved one been included in the family meeting?
    • Are you holding the meeting during a neutral time of the year (not around the holidays)?
    • Have you given your loved one an opportunity to voice what he or she believes is his or her biggest health concern?
    • Have you made your loved feel like his or her opinions matter?
    • Are you honest with your loved one?
    • Have you refused to use scare tactics to facilitate your loved one’s cooperation?

Strategies to Overcome a Refusal to Communicate

    • Have you made a dramatic case to your loved for why he or she should communicate his or her health concerns?
    • Have you described the idea of “caring” to your loved one in a positive way?
    • Have you made it clear to your loved one that you will not give up on him or her?
    • Are you patient with your loved one?
    • Have you enlisted the help of family members to persuade your loved one to accept help?
    • Have you listened to your loved one’s concerns?

Author - Carolyn A. Brent, MBA

– By Carolyn A. Brent, MBA
Author of The Caregiver’s Companion

Carolyn A. Brent is an award-winning and bestselling American author and eldercare legislation advocate. Designated as an Editor’s Choice, she was reviewed by the Library Journal as well. Verdict: excellent!

Brent is also known as a bodybuilder and Health & Wellness Guru. She is the founder of Across All Ages and two nonprofit organizations, CareGiverStory Inc. and Grandpa’s Dream. Visit:

Excerpt. © Reprinted with permission. All rights reserved.