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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

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.




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.

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.


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.


December 2013 – MoneyTalk Interview – Caring for your loved ones with dementia during the holiday season

Dana (Vouga) was on Bob Hardcastle’s Money Talk KTRS 550 AM radio show on Sunday, December 7th at 8:00 a.m.  She referred to post from last year on “Caring for your loved ones with dementia during the holiday season.”  Click on “more” to get acess to the Caregiver Stress Test, Activities for Alzheimer’s and Dementia Patients, Talking to People with Dementia, and Conversation Starters for Talking To People With Dementia.

Read more

Vouga Elder Law’s Resource Center

Our Resource Center has informBookcase November 2013ation on all aspects of elder care, Veterans Benefits, special needs planning, and estate planning.  In addition, there is information on Alzheimer’s Disease,  Parkinson’s Disease, and Multiple Sclerosis, as well as general information for seniors, adult children and their loved ones.  Our Resource Center is available during business hours from 8:30 a.m.—5:00 p.m., Monday through Friday.

We will be conducting monthly workshops on legal issues on the above topics.  As well as, hosting and co-hosting events with our friends in the elder care community.

Some of our publications include:

  • Caregiver information for a spouse, adult children and family members
  • Dementia
  • Elder LawHanging Wall November 2013
  • End of Life/Death
  • Estate Recovery
  • Heart Attack, Cardiac Arrest and Stroke
  • Hospice
  • Long Term Care
  • Medicaid and Medicare
  • Safety at Home
  • Senior Driving
  • Senior Exercise and Staying Active
  • Senior Health
  • Senior Housing
  • Staying at Home

    Read more

More tips for helping your loved ones with dementia through the holidays

Thank you for tuning into KTRS 550 AM MoneyTalk with Bob Hardcastle and listening to Dana give you valuable tips to help you this holiday season. (If you were unable to hear the live version, click here (and scroll down) to listen to the recorded version after December 16th, 2013)

As promised, here are a few more articles and tips for you!

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Caring for your loved ones with dementia during the holiday season

Dana (Vouga) will be on Bob Hardcastle’s Money Talk KTRS 550 AM radio show on Sunday, December 15th at 8:00 a.m. to discuss “Caring for your loved ones with dementia during the holiday season.”  Here are a few tips for you to look at now, tune in on Sunday to learn more!

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