A Caring Alternative by Phil Runyon

A Caring Alternative

This message is about what more and more of us are trying to do to make life as pleasant as possible for our venerable but vulnerable elders.  I'm sure nearly all of you have a family story about a beloved grandparent or crotchety old uncle who lived with you (or someone in your family) when you were a kid.  That was the norm a generation or more ago, when the recourse to nursing homes was much less prevalent than it's become.  

The paradigm seemed to shift in the '60s or '70s when both parents in a family had to leave home for work and there was no one left in the house all day to make sure the lovable oldster didn't fall or leave the stove on.  The trouble is, even if a nursing home seems the only alternative, the cost of such care has exploded much like college tuition, and the tab for a year in an institutional residence can now top $100,000.  Sure, there's Medicaid to pay the tuition if skilled nursing care is called for, but that usually requires the senior to deplete nearly all his or her assets first, or go through elaborate machinations to put those hard-earned assets out of their reach.  Neither of those scenarios has ever looked appealing to me, for reasons that are pretty obvious.

So, what's the solution, if there is one?  Clearly, if the elderly family member needs services we just can't provide at home - real medical procedures or care we're just not physically capable of handling - then the choices may be limited.  But if we're just talking about making sure medications are being taken when they're prescribed, making sure diets are healthy and meals are being eaten, and ensuring that emergency services are called in should the need arise, then maybe home care is something we can handle.  Still, if there's no one at home most of the day, maybe even those functions are more than we can safely provide for.

How about this, though.  What if one of the family members who's been going to a job somewhere everyday decides to take on the job of caregiver him- or herself?  And I don't mean just giving up that additional income, but getting paid to provide the home care.  Nearly any way you cut it, that's bound to be less expensive than paying for institutional care, and it keeps the cost of care in the family instead of having it fly out the window.  Not to mention the all-important goodwill factor.

So what's the catch?  There's no real catch as long as you go about this process on a business-like, arms-length basis.  That is, instead of pouring over the detailed care contract with a nursing facility, you yourself sign one with your senior family member.  The contract comprehensively spells out all the services you're going to provide at home and sets a compensation rate that's generously comparable to what you'd pay a third party to come in for the same purposes.  Then you both actually sign the agreement and keep it for later documentation, if that becomes necessary.  When might that be, you say?  Well, if it turns out that Mom or Grandpa can't stay with you right up to the end and really needs a nursing home at some point, you'll be able to establish that the funds received for your services were a contractual obligation and not just a monthly gratuity.  If the former, then those payments won't be disqualifying gifts for Medicaid application purposes, but if the latter, then no matter how much value you've provided at home, those monthly stipends will be treated as voluntary gifts - and delay, perhaps for a significant period, the ability to qualify your elder statesperson for Medicaid benefits.    

Yes, this is one area of the law where oral contracts, though often valid and enforceable under other circumstances, just won't cut the mustard.  They have to be in writing and signed up - before the services are actually provided. 

Posted 02/17/2015 - Misc.