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Sounds like you have your hands full with your mom.
In certain states your able to take your mom to the doctor. They in turn make the decision that she needs Homecare. Then once a Homecare is set to come in there is certain things your mom my need to do to qualify for help. Meaning if she has money certain states don’t allow people with a lot of assets to quality for help. That being said she may have to pay until she cannot pay anymore or have her assets transferred to someone else in order for her to qualify for help. Once this is done she will have someone come into her home take a bunch of information then they take it back to the office and determine the amount of hours she’s allotted for. If she has money and doesn’t want to transfer it into someone else name she may have to pay for a private duty aide. They are going to be very expensive and depending on how much money your mom has it’s gone to go fast.
You need to talk to your mom about this. It’s difficult to do but if your mom is asking for someone you really need to get her the help she needs. She will probably feel much better knowing someone is there for her. She may have some underlying problems that you are unaware of.
First start with the doctor find out if she qualifies for Homecare hours. If she does then you will have to have the talk with her about her financial situation. Go from there.
I had to do this with my mom. It was exactly the same thing. I don’t know where you live. Sometimes it can be hard to get things going. Once she’s in the system though it works really well.
Good luck.Be patient get your mom’s affaires in order then the help should start with her. It takes a few steps but it’s really worth it once it’s done. I had Homecare for my mom. I had to do exactly what I told you with her affairs first. Actually this is what we where told to do by the someone ( a friend) that knew how to get help. I just did what he said and it worked. My mom had the help she needed until the end.
Good luck.
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Isthisrealyreal Feb 2019
It is unethical to transfer money so you can get welfare. People work and save so they won't be a burden on anyone in their old age.
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IF THE HOME CAN ACCOMMODATE: Go thru an online service like <Silvernest. con> and see if you can find someone who’d be willing to live on the premises in exchange for help. I have this and it’s a win/win for us both. My needs are presently only for some assistance with shopping, laundry and bed making & the like. And she does some cooking. When hardcore nursing is needed, check with the health plan, social services. Meanwhile, the live-in help can be a good solution. Monitor it, of course, be sure to get some b’gnd checks on the person. My philosophy (based on my own experience): see that basic needs are met, visit or call when you can and LIVE YOUR LIFE!
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Maybe I am not an employee since my employer does not tell me when to use a pen or a pencil or when and how to look something up on the internet?

Caregivers in the home are employees if not working for an agency. Take that a step further, an agency does not tell caregivers how to change a diaper, they train them, then they are on their own and still employees of the agency.

Hopefully private in home caregivers are provided some level of training.
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Check IRS rules on caregivers. One of the rules is if the job has to be done in the home then they are an employee.

https://www.irs.gov/taxtopics/tc756
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needtowashhair Feb 2019
No, that's not one of the rules. Just because the work has to be done in the home does not make them an employee. Directly from that link you posted. The key part is the last sentence. Which is the criteria whether it happens at home or at the donut shop.

"Household employees include housekeepers, maids, babysitters, gardeners, and others who work in or around your private residence as your employee. Repairmen, plumbers, contractors, and other business people who provide their services as independent contractors, are not your employees. Household workers are your employees if you can control not only the work they do but also how they do it."
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I think the new tax law is going to have some real surprises in this area.
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Has anyone dealt with the new tax consequences of this expense yet?
Were they deductible? All of them? Some of them?
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NYDaughterInLaw Feb 2019
Some of the expenses are deductible but definitely not all. We have a tax professional prepare my FIL's income taxes because we do not want him to be in hot water.
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Recently we started paying two aides $600 a week *each* for my FIL who now needs help from the time he wakes up until he goes to sleep. That's $62,400 a year *before* taxes.

If (when) we need to add a nightshift, that would be $1800 a week and $93,600 a year before taxes.

My FIL lives in independent living and his rent covers big expenses such as meals, all utilities, and housekeeping. Indy living already costs a fortune and the additional cost of his aides is burning through his savings at an eye-watering pace.

The other reality of having full time care in the home is when one of the aides cannot be there for any reason. Things come up. People have lives. People get sick. People have family emergencies. Someone has to scramble and find someone to fill the gap or take the day off work and do it.
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If you decide to hire individual caregivers you can use a payroll agency that will charge you a fee but they do all the work and can actually offer benefits to your caregivers. Do the math and get quotes for workers compensation insurance, we pay a minimum annual charge whether we have employees or not. We had 1,200.00 in payroll and our workers comp minimum was 1,500.00. Imagine our surprise. Then there are the qrtly and annual reports that you are required to file. It is easy if you know what you are doing, otherwise it is usually worth the fee you pay.

Please know what you are doing and what is required when you are making the decision on how to pay the caregivers. It will save you serious headaches.
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needtowashhair Feb 2019
Why did you get workers comp for someone you only paid $1,200 to in a year? I don't think by anyone's standards that person would be considered an employee unless all that was paid during the same quarter. Even then you might not need to provide workers comp. It depends on the state. Some states you never need workers comp for domestic employees. Others they have to be considered an employee. One way to determine that is by the amount they are paid. $1,200 a year definitely does not qualify for that in my state. Unless they are working for $1 an hour, even by hours worked it wouldn't qualify.

If they aren't employees then they are occasional workers. Thus they should be covered by the renters or homeowners policy for occasional workers. Other examples of that type of worker is a baby sitter or a gardener.

That's the way I understand it.
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My mother had 24/7 care in her home for exactly three years. She was just moved to the nursing home because her money to fund this care is exhausted. She had excellent care from women who we’re not even CNA’s.
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My brother in law died last weekend after receiving 24/7 in home care from an agency for the last two months, while he was bed-bound. My sister is in a wheelchair and was unable to provide his physical care, apart from actually administering medications (which only the RNs were able to do, not the carers). Usually the night carer had to be an RN for that reason. The carers were great and the agency was reliable and really good. I visited often, and it was like being in an institution, with three shifts of carers (double number during three handovers a day) very present all through the house. Often the carers were doing nothing, but they still had to be there and be paid. It was staggeringly expensive, but they could afford it. Shopping, transport to appointments for my sister, and some cooking, had to be done by other people, paid or unpaid. For most people (including me and my own husband) it would not have been possible either physically in our house or financially. If you are looking at an even longer period of time, it doesn’t sound possible from what you say.

My first husband died last June with his last couple of months in a private room in an excellent nursing home. They provided round the clock physical care, and family visited extensively, including all night at the end of life. It worked well.

My suggestion would be to do a lot of detailed research about who would do what and how much it would cost. Write out pros and cons for each option, including facilities, separately, and talk them through with your mother. Most people would prefer to stay at home, but ‘it takes a village’ and hiring a village to care for one person is rarely workable. Good luck.
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nymima Feb 2019
Great information. TY
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I stepped into the care of the aging community about two years ago. (After working in the corporate side of business in marketing & sales). In six months I worked and educated myself in care in private, facility, and care-giving companies. After my experience in working for three different care-giving companies I will NEVER put anyone I love in the care of these companies.

Speaking to the cost. Caregivers are paid just above the minimum wage from the companies they work for with very little training. I was trained by DHS which has continuing education and required certifications. While the caregiver is making above minimum wage, you will be paying the company providing the caregiver $30-$45.00 per hour. In addition your loved one will not receive the same caregiver and turn-over is high. Thus the consistency of care will change and if there are problems in the home it is difficult to nail down who or how when you have 2-4 different caregivers in your home. Training is basically watching YouTube videos which I experiences in the two of the companies I worked for. Which then signed off on "trained professionals".

I highly suggest you find a private care individual who can commit to the kind of individualized care your mother will need. Sometimes it takes having a few different people before you find the right one. Having employed house help and in home child care for my children, I see this as no different. Respectfully you are putting the trust of a loved one in the care of a stranger.

Those clients whom I have either worked with, worked for or helped find care have had the same individuals for many years. Although I have been working formerly in the elderly care industry for only two years, it has been my passion for many years in volunteering, and assisting with families to find the kind of help needed.

Work alongside your mom with the kind of schedule she would keep with a caregiver, the specific needs ( personal care, house help, errands) and then help her make a service plan, schedule, and cost break down before your first interview. You will also get better serivce and more of what your mother will need with private care as agencies who provide care givers will outline services, write out a care plan and the cost will be based on need. Be assured if you go the route of an agency and your mother needs help with incidentals outside of the written plan by an agency, there will be added costs.

With private care, those incidentals become part of the care and statements in a contract allow for the incidentals that come up. Here is an example...

Let's say your mother has spilled the milk in the frig. If "cleaning a refrigerator" is not listed on the care-plan from an agency most caregivers will not clean it up. I worked in a home briefly where I actually got in trouble for emptying the garbage. The client called the agency to thank them for sending me. She also said that she was grateful I had emptied her garbage. My job was to just "sit with her" while she healed from back surgery to see that she did not fall. The house had a foul smell and I tracked it down to the garbage, which she was not able to empty, thus I did it for her.

All to say that you can go on craiglist and look at the job qualifiations for caregivers. There are 100's of positions listed by a number of agencies. Most will say, "no experience necessary. "

My five children now promise to never place me in a facility or hire a caregiver when that time comes for me. I now work in a private home, and still maintain assisting with clients on an as needed basis. I hope this helps a little.
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texasrdr22 Feb 2019
So, if I understand what you are saying, private care is best. How does this work if your loved one needs 24-hour around-the-clock care? Do you need 3 of these individuals? Where do you find private caregivers if not through an agency?
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From Dibbern.com www.dibbern.com/home-health-care-costs/cost-for-california-home-health-care.htm
"If you or a family member needs home health care, and you live in California, plan on it costing about $22 per hour. That's the average cost in the state for a Health Aide, according to a survey published by the MetLife Mature Market Institute*. The yearly cost of $22,880 is based on an estimate of 4 hours per day, 5 days per week."

Has anyone ever done this (24/7 care)?
Yes, I was a caregiver for an elderly man for over a year, (along with other c/g's). His wife paid over $100,000 for his 24/7 care. He wanted to stay at home too and, since they had the funds, he got what he wanted. This is a very expensive way to go. In the end, he was unable to stand or walk on his own and, at the very end, he could no longer reposition himself in the bed. I went off on back strain 3 times, until I had to quit the job altogether. He died 2 weeks later.

It worked because they had a single level home and, at times, they were also doing hospice (no nursing care). We gave him bed baths, he used a urinal and we would assist him up to the bedside commode. We transferred him into a wheelchair and rolled him out to the kitchen for breakfast and lunch.

The problem is when a caregiver is sick (or any other reason to call out sick). Often the home care agency can't find a replacement (no guarantee is offered for care). It then reverts back to the family. Are you prepared for that? If you are not physically able, is there another family member that can do a shift with your mom? It is not a RELIABLE mode of care for her. I was only out when I threw my back out but the other c/g's would call off for lame reasons and there's nothing you can do.

I'd say, if you're going that route with your mom, definitely have a few people as backup.
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nymima Feb 2019
Valuable information. TY
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There's a HUGE difference between "some" in home care and 24/7 in home care. Where is your mom really on this spectrum? Does she need someone to come into the home to help her bathe and dress, manage medications, meal prep and housework? Or does your mother have the type of mobility or cognitive issues where she needs someone in the house with her all the time? Can your mother call for help if she needs it using a phone or a life alert type button?

If your mother needs someone to come into the home and help with medication management, meal prep and housework due to her vision problems, then in home care is probably manageable. Please contact your Area Counsel on Aging and find out what programs are available that may assist your mother - some of them may be free.
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nymima Feb 2019
She is needing more and more help with meal prep, laundry, probably dressing and bathing. She has chf and afib and she seems drained all the time. I can do her meds once a week and she gets meals on wheels, but she’s not very interested in cooking the meals herself. I’ve been her caregiver for over 7 yrs now and this has allowed her to remain in her home all this time. I handle everything for her like her bills, her groceries, social visits and doctor appts, but I haven’t had to do the running of her home all these years. She has been able to do it up until recently. She has a housekeeper who comes in twice a month, so I don’t have to worry about cleaning.

Ive mentioned to her about bringing in someone to help her for some things, but she is the one who jumped into the subject of staying in her home should she ever need full time care. It must be on her mind. A neighbor recently went into a nursing home because she fell and broke her pelvis. So, I suppose my mother is letting me know ahead of time that she won’t go into a NH.

I hope it never gets to that point, but there just isn’t enough of me to go around. I know the rich and famous have full time care at home - but wasn’t sure of the reality of home care like that for regular people like us. 😊
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Of four dear relatives who required full time supervision and care, two did well at home with 24/7 care and two did not.

Two considerations that arose immediately in our decision making were the suitability of the home settings and the reliability of the caregivers available.

One of the homes was a ranch ranch with two easily accessible, adaptable baths.
Two of the other homes were bungalows with no first floor bath. One of those had a complex stairway arrangement and single bath.

When reality hit, the house with the tricky bathroom proved unsuitable (at different times) for both family members. One entered a residential hospice and the other is now in AL.

The relative in the ranch was able to remain at home for several months, with an excellent caregiver who worked with a second excellent caregiver who was a personal friend. Over the course of time during their service, there were no lapses in care coverage.

The care arrangements for the house with the the upstairs bathroom were much more haphazard because the agency was often unable to provide coverage for the full time aide’s time off. That meant that for a period of several months, it was family who were on call 24/7.

We came to the conclusion that it was a good idea to develop a selection of options for care, then when possible offer trial runs. Not by any means a perfect solution, but the “perfect solution” when dealing with elder care became the exception and not the rule in dealing with our family experiences.
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24/7 n home expect 10-12k a month from an agency. Private could be less but you would need to setup mom as an employer, paying for workmen's comp, social security, withhold taxes and all the responsibility that goes along with that. And room and board for a live-in is not considered part of payment.
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You will get some good answers. Hang tight. Those who have dealt with, will chime in.
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nymima Feb 2019
Yes - Some excellent advice! Home care is going to be a difficult decision if and when the time comes I feel.
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