Answers to your questions about caregiving
Q: My father-in-law cares for my mother-in-law, who has Alzheimer’s disease. She has recently declined and he is getting exhausted. He has agreed to consider placement but they are on a fixed income. What are his choices?
A: Every family approaches this decision in a different way. The first step is to consider what kind of placement would be appropriate for your mother-in-law, and next is to decide what is financially feasible.
Housing options include specialty dementia facilities (assisted living facilities), board and care homes in the community and skilled nursing facilities (SNF). Board and care homes are usually the least expensive.
None of these is covered by Medicare; however, Medicaid (Medi-Cal in California) will pay for a SNF if the nursing home takes Medicaid and has Medicaid beds available. Although your in-laws’ income is fixed, you don’t mention what their assets are. Some people can pay for the facility out of savings or equity in their homes. In some families, members combine financial resources to help pay for a facility. Or, if funds are not available, your father-in-law can apply for Medicaid so that your mother-in-law can go to a SNF. For these purposes, the federal government has set out guidelines through the Spousal Impoverishment Law, which allows the “at home” spouse to keep a certain amount in income and savings. Certain assets are exempt. Consulting an elderlaw attorney is helpful in helping families to apply for Medicaid.
While navigating this system, your father-in-law might consider hiring in-home help to give himself a break during the day, and discussing with physicians the medication for your mother in law so she sleeps though the night if she is keeping your father-in-law awake.
For more information, contact California Advocates for Nursing Home Reform at www.canhr.org or (800) 474-1116, or Family Caregiver Alliance, at (800) 445-8106.
Q: My grandma is 86 years old and wheelchair-bound. She needs a lot of help but gets frightened if anyone but me provides her care. Can I get paid to be her caregiver?
A: If your grandma is wheelchair-bound, she needs pretty constant attention. You might get burned out on caregiving if you are doing it 24 hours a day, seven days a week. You need a break as well as help.
First, in California, you can be paid as an In-Home Supportive Services (IHSS) worker if your grandma qualifies for Medi-Cal. However, this program is currently under review in the California state budget, and payment to family members might be eliminated in the near future. Programs differ from state to state.
If your grandma has the funds, she can pay you directly to be her caregiver under whatever agreement the two of you make. It is often helpful to make such an arrangement in writing, in case it is questioned by other family members at some future date.
Work with your grandmother’s physician to determine the cause of her fear of other caregivers. Medication might be helpful in reducing her anxiety. Introducing a new person gradually, when you’re around, might also work—people are often afraid of “strangers,” but once they know someone, that person is no longer a stranger. You can teach an attendant or others the special ways your grandma likes things done, which will also make her more comfortable.
Got questions? Write “Dear FCA” at 180 Montgomery Street, Suite 1100, San Francisco, CA, 94104, or email [email protected].
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