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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At the end of 2015, the Department of Labor (DOL) repealed two Wage & Hour Law exemptions that had been in place since 1974 – the Companion Care exemption and the Live-In exemption.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.


Do Resolutions and Estate Planning go together?

Resolutions and Estate Planning

Resolutions and estate planning are two thing that most people don’t want to think about.  While January is a great time to set resolutions for weight loss, exercising, eating better, and spending more time with your loved ones.  It is also a great time to think about those things which we tend to “put off” like estate planning.

Most people plan for “What happens when I die?”; very few people plan for “What if I don’t die, but become sick and need care for the rest of my life?”   Trust me, no one wakes up and says, “I think I will have a stroke today”.  Being prepared gives you and your family the most options to protect yourself, your family and your assets.

Another consideration is “Have you planned for the cost of incapacity (long term care)?” Do you know CURRENTLY the cost of an average nursing home (Delmar Gardens or Bethesda), is between $7,500 and $8,000 a MONTH???  You don’t have to go broke in a nursing home! Planning now not only saves you and your family thousands and thousands of dollars but also gives you peace of mind.

Did you know that a HIPAA release only allows your family to hear what is going on with you medically, but does not allow anyone to make actual decisions? What you don’t know CAN hurt you!

Make January or February your time to take control of YOUR estate plan. Make you sure you are PREPARED.  Call us today (636-394-0009) to attend a FREE workshop to learn about the above OR to schedule your FREE conference to learn what options YOU have.

Best wishes for a healthy, happy and prosperous 2017!

Resolutions and Estate Planning



Long Term Care Conversation Checklist for Families and Seniors

Having a conversation about long-term care with an aging loved one can be very difficult.  Initiating a conversation can be awkward or uncomfortable for family members or caregivers.  We offer the following hints that may help to begin a conversation about long-term care with your loved one.

A good conversation starter is to ask when their legal documents have last been reviewed

Asking this simple question is a good way to get everyone thinking about the future.  Many seniors believe that it isn’t necessary to review documents – “Oh I had those prepared years ago….I’m set.”  Helping the senior realize their life has “probably changed a lot since they were prepared” is a way to ease into “other changes” you have noticed. As we age, just like our health care needs change (we tend to take more prescriptions), our housing needs change (we don’t enjoy the 2 story house anymore), so do our legal needs change.

When you are 18, you need a Durable Power of Attorney for Health Care so someone can make health care decisions for you if you can’t.  When you have a house and are raising a family, a Revocable Living Trust is what is needed to handle a serious accident, health care crisis or an untimely death.  When we become a senior and retire, we need to protect our home and assets against the tremendous cost of long term care and estate recovery.

If your loved one says they have no legal documents or they have “a Will”, NOW, before they have a medical emergency or lose mental capacity, is the time to avoid unnecessary legal headaches and fees by getting powerful documents in place, like “The 3 Most Important Documents”.

The most important documents everyone should have over the age of 18

A Durable Power of Attorney (for finances) appoints someone to act on your behalf if you are no longer capable of handling your finances.  Without a valid and powerful Durable Power of Attorney, the family will be forced to apply for a Conservatorship through the Probate Court to pay bills and handle investments.  Without having in writing who you wish to handle your affairs, the Court may appoint someone you would not have chosen to handle things for you.  A powerful and properly drawn Durable Power of Attorney will allow the person you appoint to protect assets for your quality of life and quality of care.

A Durable Power of Attorney for Health Care Decisions appoints someone to act on your behalf to make health care decisions for you if you are no longer capable of making them yourself.  Without this document in place, the family will be forced to apply for a Guardianship through the Probate Court to make health care decisions for you.  This is vitally important if it is your desire NOT to be kept alive by artificial nutrition and hydration.

The Probate Court requires a surety Bond for the person appointed Conservator and/or Guardian.  The Bond is based on the amount of assets owned by you.  It must be renewed annually and is VERY expensive and very cumbersome.  A Conservatorship and Guardianship lasts the rest of your life, requiring two annual filings with the Probate Court (continued legal fees) and the Court must approve every dollar spent for, or on, your behalf.  The attorney’s fees for a Conservatorship and/or Guardianship, in the FIRST YEAR alone average between $5,000 and $10,000.

If your loved one wishes to avoid a Probate Estate after their passing, they must have some type of a Trust in place.  A Last Will and Testament still goes through Probate.  A Revocable Living Trust avoids Probate, but does not protect any assets from being spent on the cost of long term care and does not protect their home against Estate Recovery.  A Beneficiary Deed does not protect against Estate Recovery either.

ONLY an Asset Protection Trust, and/or some form of long term care insurance, avoids all of your loved one’s assets from being spent on a nursing home and their home being subject to Estate Recovery by the state.  This type of planning is extremely complex and requires consulting with an Elder Law Attorney.

Please call us at 636-394-0009, to see if you are eligible for a FREE no-obligation conference.

Determine if it’s time to think about long-term care assistance

Reasons to seek long-term care can vary from person to person.  Long-term care is not just about a potentially more comfortable and safer environment for your aging loved one. Long term care can and may be necessary for the mental and physical health of the elder, and for the caregiver.

To ensure your loved one is able to consider their options without feeling confrontational, introduce alternative housing options as early as possible, even when you think your loved one might be in the early stages of needing help. Ask your loved one questions about lifestyle or health-related challenges to introduce the idea that either a home-care provider or senior living community may be a positive choice.  Continuing to engage in this conversation over time by sharing your observations, concerns, and any physical or mental challenges you may notice may make the transition easier when it is time.

Remain sensitive to your loved one’s needs

Discussing long-term care may be intimidating for you, but it is a difficult topic for your loved one as well.  Most of us want to do everything possible to stay in our home as long as possible.  Since any decisions that are made will affect your loved one the most, it’s crucial to respect their needs and preferences.  Involve your loved one in as many discussions and meetings as possible, barring any health restrictions.  Being left out of a family meeting or doctor’s conference could foster feelings of exclusion or distrust.

Allow time for your loved one to become open and adjust to the idea.  If there are no immediate health risks, allow your loved one to set the pace for the discussions.  Make an effort to find solutions that will work for everyone involved.  For example, if your loved one feels strongly about maintaining a garden in a new home, expand your search for communities that would be able to provide gardening opportunities.

Some communities have Alzheimer’s patients separate from seniors who just need assisted living.  If your loved one has Alzheimer’s make sure you check into those communities with memory care.

Below you will find a checklist of different symptoms that you may have noticed your loved one is experiencing.  If there are several family members that are around your loved one on a regular basis, it might be good to discuss the symptoms they have noticed and compare with what you have seen.

Physical Symptoms

□  Are they able to move around easily given the physical layout of the home? For example, are stairs, carpet, bath/shower or door handles obstacles for mobility? Is the heating and lighting adequate for any sensory impairment including hearing, sight and circulations problems?

□   Are they experiencing balance issues, especially when changing positions? Are you concerned about them falling?

□   If they fell, are you confident he or she would be able to call for help? Is there a reliable source to respond to a call at all times? If they are living alone, is it time to think about LifeAlert?

□   Are they experiencing frequent incontinence? Can they attend to the problem when this happens or is help needed?

□   Is your loved one experiencing frequent, significant sleep disturbances?

□   Are they capable of shopping for and cooking or preparing healthy meals?

□   Do they have trouble operating gadgets or appliances such as a can opener, microwave, stove or telephone?

□   Are finances such as bill payments, deposits, and investments being handled in a timely manner?

□   Is your loved one still driving? If so, are you concerned about his/her and others well being?  Is public transportation a safe and viable option?

□   Are they capable and are they adequately doing housekeeping, laundry and wearing clean clothes?

□   Are they bathing regularly?

□   Are prescribed medications obtained and consistently taken as indicated?

Mental Symptoms

Is your loved one demonstrating personality changes, including, but not limited to:

□   Frequent irritability?

□   Insensitivity to others?

□   Disoriented to place and time?

□   Aggressive behaviors?

□   Repetitive behaviors?

□   Communication with inappropriate language?

□   Is your loved one socially withdrawn and not able or not wanting to get together with friends or family?  Are there signs of depression?

□   Do they express negative comments about him or herself?

□   Are they demonstrating an inability to make sound decisions or use good judgment?

□   Is your loved one able to understand communication or instructions from others?

Schedule a family meeting

A family meeting can move the topic of long-term care to a more focused discussion that can lead to a plan.  If your loved one agrees, here is a checklist for planning for your family meeting:

□   Determine the family members that should be involved directly or indirectly in decision making.  Always include your loved one if he/she is capable of taking part in any decision making.

□   Consider including an independent third party to play the role of mediator.  This could be a minister or other member of the clergy, a social worker, or a case manager.  If necessary, find a neutral place to hold the meeting.

□   Prepare an agenda to help you stay focused.  It may include the following:

~ A medical update

~ Sharing of feelings about the illness and caregiving

~ Daily caregiving needs

~ Financial concerns

~ Who will make decisions – are there legal documents in place for decision making

~ If there are no legal documents in place, call us at 636-394-0009, to schedule an FREE,  no-obligation conference to discuss what options are best for your loved one and family

~ What support role each person will play

~ What support the primary caregiver needs

~ What you consider the next steps of moving forward should be

~ If you are around more than other members of the family write down what you have noticed in terms of declining health or memory issues that other family members might not notice.

Continue to involve the family

The move to a long-term care community is an immense transition for any family, so it’s important to involve everyone relevant to the person(s) being moved.

Reach out to siblings to secure their input and support.  For example, share online information about long-term care communities to secure greater involvement and participation.

Is there an unequal financial or time burden to one family member? If so, acknowledge the distribution of resources and discuss a strategy for achieving a balance that appeals to everyone.

Continue to engage your parent or loved one

Have ongoing conversations at time when your loved one is feeling best and there are few distractions.

Introduce the idea of an overnight visit to a long-term care community or an extended afternoon visit to get a feel for the various available options.

Begin researching long-term care options in your area.

□   Go to to access a nationwide senior housing database.

□   Call and request a consultation with those communities that interest you.

□ Ask family members to help you prepare a list of questions and concerns for your specific situation with your loved one.

We have checklists for Home Care and Home Health Care Providers and an Assisted Living Community cost checklist available in our Resource Center. 

Stop by anytime Monday – Friday, 8:30am – 5:00pm to browse our resources.

15 Things You Can Do For A Caregiver

15 Things You Can Do For A Caregiver

  • Walk the family dog, and take to veterinary appointments as needed
  • Simply ask the Caregiver what you can do, if they say “I don’t know” give them a few days and ask again, even if it’s something small to them, it might be a big deal
  • Give a gift certificate for a day at the spa or a pedicure and manicure – make sure you arrange care for the family member or make time to sit with them yourself
  • Cook an extra main dish when you are making dinner for your own family
  • Many family members are finding themselves taking care of older family members as well as their own children. Offer to take the kids for a night or a weekend or to a special event for a few hours
  • If you are handy, offer to do a little maintenance chores around the home once a month or ask for a list to be made and sent to you
  • Remind the caregiver that they can put your number on speed dial and use it…anytime day or night
  • Gather a list of area caregiver support groups and pass them along to the caregiver…offer to stay with the care recipient if the support groups do not have an “adult day care” during the support group meetings
  • Gather the laundry, start and finish the laundry, or just offer to fold the laundry once a week, or once a month
  • Hire a housecleaning service and get the caregiver/care recipient out of the home for the day
  • Establish a daily/weekly “phone ritual” with the caregiver as a safety check
  • Allow/encourage the caregiver to rant…with no sugar coating allowed (just listen, no judgment, a safe ear for a caregiver can mean the world when everything piles up)
  • Offer to take the family car in for routine maintenance
  • Discuss with the caregiver if they would like for you to research and find out if there are any respite programs that the care recipient qualifies for or additional help around the house or modifications that can be made to make life easier

    5 Bonus Ideas

  • Make a restaurant reservation: 1) for the caregiver and care recipient, 2) for the caregiver and a friend, or 3) arrange to have a restaurant deliver a special meal to the home
  • Take a moment and really observe the caregiver and come up with one simple thing that will make his/her life easier
  • Clip coupons for the caregiver and care recipient of items they use often (or better yet, buy food staples and stock the family pantry/supply closet
  • Arrange pizza delivery on special game nights for them to enjoy
  • Offer to help decorate for the holidays with the care recipient, or take the care recipient out for the day/afternoon/evening so the caregiver can enjoy putting up the decorations without interruption and have a few hours to themselves

May is National Elder Law Month!

Many people prepare for death by having a Will or Trust drawn up.  But the real question is,

“What if I don’t die, but get sick and need care?”

Are you, your family and your assets  protected? Come to one of our free workshops and learn what can  happen to you or your clients if you aren’t prepared.

We always encourage people to “get there ducks in a row” and make sure all of their legal documents are up to date and work for each individual’s Elder Care Journey.  We believe above all other legal documents you need to make sure you have The 3 Most Important Documents. That includes a Durable Power of Attorney, a Durable Power of Attorney for Health Care and HIPAA documents.

Call us today at 636-394-0009 to register for a workshop or to learn more, or if you would like to learn more about the Elder Care Journey or The 3 Most Important Documents.


National Healthcare Decisions Day

April 16th is National Healthcare Decisions Day

 The goal is to inspire, educate and empower the public and providers about the importance of advance care planning.

Nobody wakes up and says:

“I think I’ll have a stroke today.” 

Don’t get stuck with inadequate documents.  Make sure your Durable Power of Attorney and Health Care Durable Power of Attorney are powerful yet flexible to take care of whatever life throws at you.  Don’t forget we review    Durable Powers of Attorney and Health Care Durable Powers of Attorney for FREE! Call us to schedule an appointment to have your documents reviewed.


March is Storm Preparedness month!

Whether you are new to the area or a life long St. Louisan, you know of our horrible tornados and historic flooding.

The important lesson we are reminded of every time is to always be prepared.  Make sure all of your loved ones in your life are prepared for any emergency.

Visit our Resource Center Monday – Friday, 8:30am – 5:00pm for resources on Storm Preparedness and other topics for seniors and our community.


January Resolutions

January is a great time to set resolutions for weight loss, exercising and eating better, and spending more time with your loved ones.  It is also a great time to think about those things which we tend to “put off” like estate planning.

No one wakes up and says, “I think I will have a heart attack and die today.”  Or “I think I will have a stroke today and need care for the rest of my life.”

Being prepared gives you and your family the most options to protect yourself, your family and your assets.  Make January or February your time to take control of YOUR estate plan. Make you sure you are PREPARED.

Call today 636-394-0009 to attend on of our FREE Workshops on February 18th at 10:00 a.m. or February 23rd at 6:30 p.m. or you can view all of our upcoming workshops and sign up through our Events page.

Drastic and Harsh Regulations coming to Veterans Benefits



In the next couple of months, new rules are going to be implemented by the Veterans Administration that will make qualifying for the Non-Service Connected benefit (also known as “Aid and Attendance”) very challenging.                      

The Pension Benefit helps pay for unreimbursed medical expenses (not covered by Medicare or a Medicare Supplement) for Veterans and their surviving spouse.  The new regulations will make this benefit available to fewer Veterans and/or their spouses.


For the first time, specific asset limitations for qualifying will be put in place. Under the new proposed regulations, a limit of $119,220 of ASSETS AND INCOME for either a married couple or single individual will be allowed.  While your house will continue to not be a countable asset, there will now be a TWO ACRES LIMIT on the acreage your home.  If you live on a farm or a large tract of land, this will be a huge challenge for you to receive the Pension Benefit!

The regulations will also establish a three-year look-back provision and “transfer penalty” similar to Medicaid.  Currently, if the Veteran Administration says you have to many assets to qualify for the Pension Benefit, it is an easy fix to set up a “Veterans Trust”, transfer the assets into the trust, and you will immediately qualify for the Pension Benefit.  Under the new regulations, Veterans or their surviving spouse who transfer assets within three years of applying for benefits will be subject to a “penalty period” that can last as long as TEN YEARS.

There is a complex calculation to determine the penalty period.  However, the penalty period for a surviving spouse would be almost TWICE as long as the penalty period for a Veteran who transfers the same amount of assets into a trust.


We BELIEVE, but CANNOT promise, that any “Veterans Trust” established BEFORE the effective date of the new regulations will not be subject to the new rules.

WE CANNOT GUARANTEE THIS because the regulations and the effective date have NOT been finalized! We are alerting you to these changes so that you MAY have an opportunity to create a trust BEFORE the new regulations are put into place, thereby, hopefully avoiding the new restrictions.



A VERY LIMITED NUMBER of Veteran Trusts can realistically be completed due to a time line of having the initial conferences, designing the trust, signing the trust, and for you to have time to transfer your assets into the name of the trust before the rules change and these horrible new regulations go into place.


PLEASE understand we are not trying to “drum up business.”  What we are trying to do is WARN people we have previously talked to that did not want to undertake setting up a Vet Trust in the past because they felt they had time.  We want you to know and understand TIME IS RUNNING OUT!  There is no longer the possibility of waiting to set up a trust until you or your loved one needs care!  We have special relationships with our Veteran clients and we have always been advocates for Veterans to get the benefits they deserve.

Setting up a Vet Trust NOW could mean the difference between having enough money to afford assisted living instead of moving to a nursing home!

at 636-394-0009 TODAY to schedule a FREE, no-obligation, initial conference.