Caregivers

Support for Caregivers

Eleven steps to take when caring for a loved one

1. Understand the situation and what caregiving means.

It can be difficult to know whether or not your parent, grandparent or other loved one is in need of assistance with care. As a new caregiver, you’re focused on helping your loved one live safely and well, while still giving them the independence they need. Before you’re well into a care-giving arrangement, you need to assess your situation and understand the type of care you might need to give and how that care may change over time.
When you create an assessment, look at your loved one’s:
  • Medical health and history, including mental health
  • Medication use, prescription and over-the-counter
  • Legal situation and the status of legal documents
  • Financial situation
  • Physical appearance and hygiene
  • Daily routine, including social life and interests
  • Home and community resources
  • Safety
  • Physical and emotional support system
You can do this assessment independently, but you don’t have to. Some hospitals and clinics offer geriatric assessment centers or evaluation units in which a medical and social work team that specializes in this kind of work. The center will work with you on communicating the results of the assessment and connect you with local agencies providing services and housing. You also may choose to work with an individual geriatric care manager. You can locate professionals at Baxter Regional Medical Center who can help you.
Whether you complete an assessment with professional help or own your own, your goal should be to have information that can help you plan for meeting your loved one’s needs. As you do an assessment, ask your loved one to participate and complete a self-assessment, so he or she is involved during the process and is part of deciding any steps to take.

2. Start having conversations with your loved one

Health, finances, independence and emotional well-being are sensitive subjects — so conversations about caregiving aren’t easy. Start having conversations with your loved ones about their long-term care early, well before caregiving becomes an issue.
You can look for opportunities to talk with your loved one about things like his or her: 

List of Services

Have conversations early and have them often. Start with casual conversations that don’t get into extremely sensitive subjects in the beginning. Over time, start talking about more difficult topics. Listen with respect and be sensitive to your loved one’s feelings and opinions. This will allow you to build a trusting relationship with your loved one so that when the more difficult conversations come up, you will be able to talk with each other openly and honestly.

3. Gather and review legal and financial documents

When you start to discuss future plans with your loved one, it’s a good time to review any legal or financial documents they have prepared to make sure they are up-to-date — wills, trusts, powers of attorney, health care proxies or health care powers of attorney. Especially if your loved one is coping with an illness, his or her health directives need to be in order. An estate lawyer can help prepare, review or update the right legal documents.
Here are some basic legal and financial actions you can take to help your loved one plan ahead:

Consult an estate-planning attorney

Trained estate-planning attorney are skilled with helping you and your loved one deal with the complexities of legal documentation. We recommend working with an estate-planning attorney to make sure your loved one’s affairs are in order. Be sure to read up on the specifics of your state to make sure any documents you fill out are legally valid. There are legal self-help guides and on-line resources:
If your loved one hasn’t done so already, meet with a trained estate-planning professional to make sure his or her affairs
are in order.

Name beneficiaries

A beneficiary is someone your loved one will choose to get assets and take over accounts after he or she is gone. Help your loved one name the right beneficiaries on all IRAs and retirement plans, any bank accounts or property. Most people rarely change beneficiaries after opening their accounts or even know exactly who their beneficiaries are at any given time.

Fill out an advance health care directive

Also known as a living will, your loved one will use this document to describe his or her preferences for health care — how far to go in trying to revive him or her and when to stop. After your loved one creates this document, he or she has to make it accessible. One way is to email a copy to family members and emergency contacts. The health care directive should be clearly documented and copies of those plans delivered to those carrying out his or her wishes.

Complete and name a medical power of attorney

Complete and name a medical power of attorney to speak on your loved ones behalf in the event he/she is unable to speak his/her wishes. This is probably one of the most important documents to sign. The living will and medical power of attorney are free of charge documents. Call 870-508-1771 for details.

File a financial power of attorney

This power of attorney acts similarly to a health care power, but it gives a designated person the right to act on your loved one’s behalf in legal and financial matters. Work with an estate lawyer to create this document. This is a particularly critical document if your loved one has been diagnosed with an early stages or signs of dementia.

Make or update a will

Your loved one will use a will to document his or her intentions at the time of death. The will can go into specifics about assets and other elements of your loved one’s estate — how they are managed and distributed after death. It’s a good idea for your loved one to review his or her will to make sure it is still accurate or make any necessary updates. If your loved one doesn’t have a will, help him or her make one by contacting an estate lawyer.

Safeguard your loved one’s documents

Your loved one should put all of his or her key documents and important stuff in a fireproof, storm-proof, theft-proof and waterproof place. A bank safe deposit box is a good option. Help your loved one scan these documents and store them on a secure server. Send physical or digital copies to other family members who should have them. Examples of these kinds of documents are: life insurance policies, originals of wills and trusts, health powers of attorney, health directives, deeds to a home or other property, car or boat title certificates, paper U.S. Savings Bonds — anything that documents legal and financial accounts and assets.

4. Consult a financial professional

When you provide care for a loved one, we recommend you work with a tax professional to assist you with preparing and filing taxes correctly. As a caregiver, you may be eligible for certain tax benefits based on your care-giving status. If you provide the majority of your loved one’s support, you may be able to claim him or her as a dependent on your taxes. If your loved one has high medical expenses, he or she may be able to itemize those expenses to take a tax deduction. If he or she is your dependent, you may be able to itemize those expenses for a tax deduction.

You also may be charged with helping your loved one with his or her tax preparation, which can be an added stress. A tax professional can help you know what documentation you need to take the appropriate deductions and help you file correctly come tax time.

In addition to taxes, you may be required to manage your loved one’s retirement accounts and income, his or her Social Security income and other general financial needs. A Certified Public Accountant (CPA) can assist you with both your tax preparation and other financial needs. A Certified Financial Professional (CFP) can help with general financial planning and you can work with a tax attorney on specific tax-related needs.

These financial professionals can be helpful allies to you in managing your loved one’s care.

5. Consult a lawyer who specializes in caregiving and elder care attorney

In addition to any attorneys who might help you with estate planning and tax law, you may want to seek help from an attorney who specializes in caregiving and eldercare issues like Medicaid planning. These attorneys can help you navigate the legal issues that arrive around aging and health care — which can be an incredible help both in managing your loved one’s care and reducing your stress as a caregiver.

6. Keep an expense diary and write a budget

It’s not uncommon for your daily expenses to increase when you take on care of a loved one. These costs break down into things you actually pay, money that you might lose in lost time and wages from work or in needing to reduce your own savings to help pay for your loved one’s care.

 As you take on added responsibilities and costs of care, we recommend you track your care-related expenses in an expense diary. Account for anything you pay for that you might not otherwise cover — include food, clothing, medical costs and housing costs. As you track your expenses, keep receipts. Over time, you will have a record of expenses that will help you adjust your own household budget in order to cover these added costs. Caregiving costs also tend to increase over time, so if you have room in your budget, we recommend you start to put away extra money each month into a dedicated savings account where you can build up funds to draw from for your loved one’s care.

 Track all your receipts and expenses, both for budgeting purposes and also in case any factor into your annual tax preparation.

Make sure you calculate and track:
  • Everyday expenses costs
These include your daily expenses — from transportation, groceries, utilities, housing costs — as well as any monthly, quarterly or annual expenses. Account for anything you pay out-of-pocket for on your loved one’s care. As these costs increase, you’ll have a better sense of the kind of financial commitment that you’ll have to make as a caregiver.
  • Opportunity costs
As your caregiving responsibilities increase, so do the demands on your time. Often, this can result in lost time at work, using vacation time for care and, in cases where your care is full-time, possibly having to reduce work hours or leave work altogether. Document these opportunity costs — the potential income that you might miss out on as you increase in your caregiving responsibility. This will help you to determine what your priorities are and what you are willing to and can afford to give up as you increase your caregiving role.
  • Non-monetary costs
Caregiving also can be stressful and wear on your own physical and mental health. The sacrifices you make as a caregiver may result in your needing to give up things you enjoy — which can affect your well-being. Plan ahead for time off, counseling and support and other things you will need to do in order to balance your own life and well-being with your loved one’s.

7. Know your loved one’s health status and medical history

Health is a private matter and your loved may choose whether or not to share medical information and documentation with you. This information will help you be able to plan ahead and budget for care, so you want to talk with your loved one early about this need. Ask for permission to have access to medical records and to be able to ask your loved one’s physician about his or her health status. If you don’t have permission, you won’t be able to review medical documents.

 Health conversations can be difficult, so ask questions, listen and be sensitive to your loved one’s feelings. Look for natural opportunities to discuss health, such as when a health care provider:
  • Mentions your loved one’s treatment when you’re present.
  • Talks with you about your loved one’s condition when he or she is undergoing a medical procedure.
  • Discusses your loved one’s medical bill when you are present.
  • Tells you how to care for your loved one after a procedure, including how to administer prescription medication.
If your loved one does give you permission to access his or her health information, get the permission in writing — the best way is to sign a health care power of attorney or durable health care power. Often, health care providers also have documentation you can sign that they will keep on record to allow you to access your loved one’s records at any time. Sometimes you have to sign these forms in front of a witness or notary, so arrange for that if it is required. It’s also a good idea to sign extra copies or make notarized copies and keep them someplace safe.
Anytime your loved one sees a new health care provider, you’ll want to complete the same documentation and also file your health care power of attorney or durable healthcare power with them.

 As you go through this process, keep a list of your loved one’s health care related information and contacts. This includes:

Current providers
Make a document that tracks current provider names, specialty areas, office numbers, emergency numbers, hours of operation, locations and other information you may need.

 Health insurance
Keep a file with health insurance documentation and any letters, receipts or other notices you receive. Also keep a list of insurance contact numbers, descriptions of past conversations you’ve had with contact information for the agent you worked with and any other information you need in case something comes up.

Prescription medication and other medicines
Make sure to review all the medication documentation and potential side effects for any existing or new prescription medications your loved one is taking. Also make sure you understand how often the patient needs to be monitored — blood tests, etc. — to safely remain on that medication. If the medication requires routine evaluation, schedule those doctor’s appointments before you leave the office with the new prescription in hand.

Family medical history
Since you’re going through the effort of gathering medical information, it’s a good idea to have a conversation about family medical history and make a list of anything that has come up. This will help you communicate with your loved one’s health care providers and anticipate any unexpected medical needs.

Potential providers
If you know a certain medical need is coming up or you know of a family history of a particular condition, research the available providers you would be interested in seeing and check to see if they are covered under the terms of your loved one’s health insurance. Narrow your list down to a select few providers that you keep on hand in case anything comes up. If a medical need arises and you require a physician referral to a specialist, take that list with you to your next appointment.

 As your loved one’s health situation changes, you’ll want to update this documentation and any legal documents. If you live far from your loved one, it may be good idea to name a few local contacts who know to reach you in the event of an emergency.

8. Review insurance policies and make sure they are up-to-date

Review your loved one’s insurance policies with him or her to make sure the plan details, contact information and named beneficiaries are correct and up-to-date. Health and long-term care insurance will help you manage the cost of your loved one’s care. Life insurance can help cover any end-of-life expenses that you may anticipate.
Health insurance
 
It’s wise to make sure your loved one is covered by some form of private health insurance — either under a group plan or an individual plan. Health insurance coverage is the only way to avoid financial setbacks that can come from high medical costs —even for routine doctor’s visits and procedures.
 
Health insurance is expensive, especially if purchased as an individual plan. For individuals who cannot afford the cost of care, Medicare is federally sponsored health coverage that the government provides for individuals over age 65, people younger than 65 with certain disabilities and individuals with permanent kidney failure who require dialysis or a transplant.
 
Medicare typically helps cover:
  •  Hospital visits
  •  Home care, nursing facilities and hospice
  •  Doctors' services
  •  Hospital outpatient care
  •  Preventive services
  •  Prescription drugs (in some cases)
 Medicare will not cover homemaker services or personal care services provided by a home health aide. It also will not cover medical costs such as deductibles and co-payments.
 
In addition to Medicare, you can also purchase a Medicare Supplemental Insurance Policy (Medigap) through a provider in your area. Medigap policies are available to Medicare beneficiaries, who can purchase supplemental Medigap insurance to help pay for additional medical costs not covered by Medicare. Medigap will pay for co-payments and deductibles not covered by Medicare.
 Medicaid may pay for some of the services not covered by Medicare. Medicaid is a government-sponsored program that is administered through your state — each state sets its own rules and limitations. Medicaid is only available to people with limited income.
 
Whether your loved one is eligible for and can afford a private insurance plan or a government-sponsored plan, we recommend you learn the details of the policy. This will help you be an advocate for your loved one’s care.

Life insurance
Life insurance can help protect anyone who relies on your loved one for financial support. It also can help you cover the costs of your loved one’s debts, his or her funeral and other end-of-life expenses.

If your loved one has a life insurance plan, review the terms and make sure everything is up to date. Make sure the policy has up-to-date personal information and the correct beneficiaries. Also, make sure your loved one isn’t purchasing too much life insurance — which can cost him or her extra in monthly premiums that could be set aside for savings. If your loved one is buying too much life insurance, consider adjusting the policy
 
Keep copies of your loved one’s life insurance policy in a safe location and provide copies to members of your family who also are entrusted with his or her care.

Long-term care insurance
If your loved one is eligible for long-term care insurance and has not purchased a policy, talk with them about it. Long-term care insurance can help you and your loved one cover the rising costs of health and personal care related to aging. If he or she qualifies for long-term care insurance, it’s a good idea to purchase a plan tailored to his or her unique personal and physical situation. How much coverage you need depends on physical health, family medical history, his or her financial situation and other factors.
 
A long-term care insurance policy can cover costs when Medicare runs out. Note that Medicare will pay for only part-time or "intermittent" care from a home health aide. This may mean three 90-minute visits a week during a period when she's receiving home physical therapy.
 
The following resources can help you learn more about long-term care insurance and different policy options:

9. Find caregiving agencies in your community

There are many kinds of local caregiving agencies set up to support caregivers with home care, with housing for the elderly and with daily services, such as transportation and personal care.
 
Retirement communities
A retirement community is a community that has housing and lifestyle amenities for a range of retirees and seniors. The definition of a retirement community is very broad, but it typically includes restrictions on who can buy or rent a home within the community — it is a private community with homes for rent or sale to qualified residents.
 
A retirement community typically is designated as an active community or supportive community, or both. Supportive communities provide a higher lever of customized support, based on the unique needs of community residents.
 
Assisted living
Assisted living is typically an apartment-style residential property for senior citizens and retirees. Residents live in apartments and have access to common areas and community sponsored amenities and events. Assisted living communities often provide residents some access to on-site health or hospice care, but aren’t designed to provide round-the-clock medical care.
 
Skilled nursing facility
A Skilled Nursing Facility (SNF) is a residential property for senior citizens who have health conditions and cannot be cared for at home. Often called convalescent or nursing homes, SNFs provide constant medical care and attention to residents who have ongoing medical needs and difficulty with maintaining their own daily care. Nursing homes provide on-site health and hospice care.
 
Home care
There are many home care agencies and medical professionals who provide in-office or home visit services. Depending on the care needed, you can arrange for a nurse, doctor or physical therapist to provide skilled care and medical services.
 
Hospice
Hospice is a type of care that is available to patients and families with life-limiting illnesses who are no longer responding to medical treatment. Hospice care specializes in increasing the patient’s comfort with pain management and providing mental health support to families. Hospice can be provided in home or in a facility.
 
Community centers and support groups
Many non-profits, churches, community centers and other local organizations offer activities and support for senior citizens and retirees, which can be a big help to caregivers. Medical facilities often have free education programs to help caregivers learn about their role and resources in their area. These centers also often provide support groups for caregivers, which can be an important part of maintaining well-being.
 
Your local agency on aging should be able to help you find resources in your area. There also are many online resources for caregivers to connect and get help:

10. Discuss short- and long-term living arrangements

Over time, your loved one’s ability to live independently may change and his or her housing needs may change. It can be difficult to manage the many different options —from living with you, continuing to live independently, moving into an active or supportive retirement community, seeking out assisted living and beyond.
 
It’s a good idea to look at the short and long term and discuss with your loved one his or her wishes for where and how to live. Talk with other family members about these different options and what level of care they may be able to provide, if any. Knowing the cost of these different options and your loved one’s unique personal, medical and financial situation will help you determine a short- and long-term plan that will work for you.

11. Talk with your employer

Becoming a caregiver can mean you face increasing demands on your time — which may take away from your work time. You may need to take more vacation time to deal with your loved one’s personal and health care. When facing this, we recommend that you talk with your employer and explain your role as a caregiver and the demands that it puts on you. Explain what that will mean in terms of your need for schedule flexibility and time off.
 
Many employers are sensitive to caregivers and some even have programs to help caregivers find community services and agencies, legal and financial assistance and caregiver support groups and counseling. Other offer flexible work schedules and caregiver leave.

Know company policies
Your company probably has details about their policies related to time off and flexible scheduling in its employee handbook. It may even have specific information for caregivers. If you can’t find the information you need, talk to your human resources department. Also ask about any benefits your company may offer, such as an employee assistance program, telework options and flexible spending accounts.
 
 
Understand your legal rights
The Family and Medical Leave Act (FMLA) was a law enacted to give workers access to 12 weeks per year of unpaid leave for family caregiving, without the loss of job security or health benefits.

Here are a few online resources you may find useful
 
• AARP caregiving resource center: www.aarp.org/relationships/caregiving
 
 
• Caregiving.com: www.caregiving.com
 
• National Alliance for Caregiving: www.caregiving.org
 
• Today's Caregiver: www.caregiver.com
 
• National Family Caregivers Association (NFCA): www.thefamilycaregiver.org
 
• Family Caregiver Alliance: www.caregiver.org/caregiver/jsp/home.jsp
 
 
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