The Caring Generation®  – Episode 15 November 6, 2019 On this caregiving radio program, Pamela D. Wilson, caregiving expert, talks about The Costs of Caring for Elderly Parents. Guest Liza Marquez of the American Patriot Service Corporation shares information about the Veterans Aid and Attendance Program.

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​The Cost of Caring For Elderly Parents Radio Show Transcript

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00:05 Announcer: Caregiving can sometimes feel like an impossible struggle; caregivers may be torn between taking care of loved ones and trying to maintain balance in life. The good news is that it doesn’t have to be that way. The Caring Generation with host Pamela D. Wilson is here to focus on the conversation of caring. You’re not alone, in fact, you’re in exactly the right place to share stories and learn tips and resources to help you and your loved ones. So now, please welcome the host of The Caring Generation Pamela D. Wilson.

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00:49 Pamela D. Wilson: This is Pamela D. Wilson caregiving exert. I’m your host. Good evening, everybody, you’re listening to The Caring Generation radio program coming to you live from the BBM Global Network Channel 100 and Tune In Radio. The Caring Generation focuses on the conversation of caring, giving us permission to talk and laugh, we must be able to laugh about aging, the challenges of caregiving, health, well-being, work, life, family balance, everything in between. You’re not alone. Please invite your family, your friends, and your co-workers and others to join us each week on The Caring Generation. Today we’ll be talking about the costs of caring for elderly parents, that include the obvious hard costs and the not so obvious costs. The obvious costs are things that caregivers write checks for, costs of in-home care services, assisted living, CARE community type services, health insurance, medical care, prescription drugs, over-the-counter medicines, all things like that. Then we’ll talk about the effects on family of the cost of caring for elderly parents, which are the more significant. These costs include challenges with caregiver health, caregiver wellbeing, managing careers and the less talked about aspect that family caregivers represent $500 billion in unpaid care.

02:11 Pamela D. Wilson: If it weren’t for family members, more elderly parents and loved ones would have no choice but to move to a nursing home. We’ll also talk about the effect of spouses caring for spouses and how adult children support elderly parents. In the second segment of our show, an important topic for veterans and retired military, the benefit of aid and attendance for wartime veterans that helps with the costs of care for elderly parents, or if you are the veteran, your cost. Guest, Liza Marquez of the American Patriot Service Corporation will join us to share information about the Veterans Aid and Attendance program, how to know if you qualify, what types of assistance are available, and how to apply? In my 20 years as a caregiving expert, I have helped clients who were wartime veterans. Complete these applications. It can be a daunting process if you’re not familiar with all the information that is required. The benefits of the program and how it can help with care costs are truly amazing. If you are a wartime veteran or know someone who is, be sure that you share the information about this program. Let’s start by talking about the hard costs and costs of in-home caregivers.

03:26 Pamela D. Wilson: In spousal situations, the primary caregiver is usually the healthier spouse. When adult children live nearby, and they’re available, adult children often become caregivers for aging parents. You know this if you’re an adult child who’s caring for a parent, it can take hours out of your week. If the care can’t be managed by your mom or dad and you are a working caregiver, sometimes you have to go to the option of finding outside help, which may be hiring an in-home caregiver or obtaining a caregiver through the Medicaid program, which is called a Waiver program. Some of you may have heard the term HCBS. There are caregivers available through that program for low-income consumers. We’ll start by talking about caregivers from agencies, and these are called Companion Agencies or Home Healthcare Agencies. Depending on the types of assistance that’s needed one or the other type of agency can be used. If the assistance needed is really what I call simple or day-to-day tasks, like companionship and household tasks, then the companion agency is the agency that you’re looking for. Companion agencies, if you Google them, are called in-home care agencies or chore worker agencies. These companions, they help with a lot of tasks, like light housekeeping and it truly does mean light housekeeping. So many families try to have these poor companions be full-blown housekeepers, and that is not what they do.

05:14 Pamela D. Wilson: Yes, certainly they can clean up after helping someone bathe, they can clean the bathroom. If they’ve made a meal in the kitchen, they can certainly clean up after the meal, clean the stove, clean out the refrigerator. They can also dust and vacuum. But these companions are not there to get on their hands and knees and scrub anything or deep clean anything. They can help make meals, breakfast, lunch, and dinner, do medication reminding. But it’s important unless you specify that you want a caregiver who can cook meals or specify that a loved one may have a special diet like, no salt or they have other restrictions, you might end up with a caregiver who makes peanut butter and jelly sandwiches. I’ve had this happen to my clients. And so, if cooking is a project, you want to be very specific about meals for example, that you want the caregiver to make. You want to ask if they have cooked. Companion type caregivers can also help with laundry. They can wash and fold clothing, towels. They can change and wash bedding. They can also provide stand-by assistance for showers to make sure that an elderly parent or a spouse doesn’t fall in the tub or the shower. They can help with dressing, medication reminding, and really their goal is to make sure that a loved one is safe, especially if you, as a family caregiver are leaving the house to take a break.

06:42 Pamela D. Wilson: Or if your elderly parent lives alone and no one is with them. Companion caregivers can also run an errand to the grocery store, help pick up prescriptions. They can, in some cases, take an elderly parent to a doctor’s appointment. You always want to ask about driving, though, because sometimes caregivers don’t have their own vehicles, and they may need to use the vehicle of your elderly parent. The other consideration to think about is that regardless of the type of caregiver, the person hiring the caregiver is the boss. That means that you create the list of projects that the caregivers will perform. Some caregivers are able to take the initiative to just do whatever they see that needs to be done and do it. Others need full and thorough instructions, sometimes written instructions about the tasks that you want them to do, and those that you may not want them to do. The care agency’s responsibility is to provide training for the caregiver, to supervise the employee, do background checks. It really is to your benefit to get to know the management staff, and the supervisor at the care agency very well, because this allows you to pick up the phone and know who to call if there are concerns. The better that relationship, the more helpful they will be in making sure that you’re satisfied with the caregiver or caregivers that are provided.

08:02 Pamela D. Wilson: Having the same caregiver can also be an issue. You might go through all of these steps to train a caregiver only to have the caregiver leave in a couple of months because of family issues, or they take a job with more money. There is definitely a shortage of good caregivers out there, and that’s the reality of the system. Some of these caregivers can make more money working at McDonald’s, which is a very sad truth, when so many elders, parents need good caregivers. In the second half of the show, we will talk more about in-home and community care and how family members can keep loved ones at home and out of nursing homes. Coming up after the break, Liza Marquez of the American Patriot Service Corporation joins us. The organization has been operating as a non-profit since 2011. Helpful information for caregivers and aging adults is on my website at PamelaDWilson.com, where you can also find all of the podcasts from prior shows to share with family members and friends. You’re listening to The Caring Generation live on the BBM Global Network Channel 100 and Tune In Radio. Stay with us. We’re going to be back to talk about aid and attendance for wartime veterans, how to apply, how to get the benefits, we’ll be right back.

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11:39 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to The Caring Generation coming to you live from the BBM Global Network Channel 100 and Tune In Radio. We are back to talk about the Veterans Aid and Attendance benefit with Liza Marquez of the American Patriot Service Corporation. Liza, welcome.

12:00 Liza Marquez: Thank you, thank you for having me.

12:01 Pamela D. Wilson: My pleasure. Can you explain the costs that the Aid and Attendance Program can be used to pay for care for individuals who qualify?

12:12 Liza Marquez: Yes, so if the wartime veteran and/or the spouse is eligible for this benefit, the benefit can be used for home care, assisted living, or any medical expenses that the veteran or the surviving spouse may have.

12:28 Pamela D. Wilson: And you mentioned if they qualify, can you talk about the basis for that service qualification? If there is a time requirement, service, active duty, how does all that work?

12:41 Liza Marquez: Certainly. So, when an individual contacts our office, one of the things that we ask them is if the veteran served 90 days of continuous active duty service and at least one day during a wartime period. Generally, we deal with individuals that are in World War II, Korea, or Vietnam and the veteran needs to be 65 years of age or older.

13:07 Pamela D. Wilson: And then talk about the physical or the health qualifications that are required. You and I talked, and I filled out some of these applications, and I know that there’s a lot of information that’s required, so talk about physical and health.

13:20 Liza Marquez: Certainly. A veteran, you know, oftentimes we get veterans who call in who are fine, and they’re healthy, but the VA requires that the individual need assistance from another person on a daily basis, and that could include helping with bathing or feeding or dressing. That individual also may have limited eyesight. They’re not driving, so they need to require assistance from another person in order to qualify for this benefit.

13:49 Pamela D. Wilson: And you made me think of another question. So, these, I call them activities of daily living, so help.

13:55 Liza Marquez: That’s correct.

13:55 Pamela D. Wilson: With bathing or something. Those are also qualifications for Medicaid. So, some people may be thinking, “Ah, are they going on Medicaid?” How does this benefit, or does this benefit work with the Medicaid program or does it come before Medicaid or after Medicaid?

14:12 Liza Marquez: It does not. So, either, if an individual, sorry, is on Medicaid, they would not qualify for this Aid and Attendance benefit, from what I understand. Certainly not an expert on Medicaid, but I believe Medicaid covers a lot more depending on the needs of that veteran. So, it’s either one or the other. They can decide whether they want to apply for Medicaid or if they want to apply for the Aid and Attendance benefits, they can’t have both.

14:39 Pamela D. Wilson: Perfect. And let’s talk about – there are some financial qualifications that veterans have to meet, and I think you call these asset qualifications. What are those just so that the listeners know?

14:54 Liza Marquez: Sure. The asset qualifications set by the VA are $127,000, that is excluding the home. So, if we have a veteran or a spouse, who is living in assisted living, they could still own their home.

15:12 Pamela D. Wilson: And what about, can they own a second home, can they own cars, or is this really this $127,000, is it just money that’s in a bank account?

15:23 Liza Marquez: Correct. And that money could include checking, savings, annuities, CDs, IRAs, brokerage accounts. We need to know all that. Because what’ll happen is, the VA will run an IRS check, so they’ll know exactly what the veteran or the spouse has. The vehicle is not included in that asset amount, and…

15:47 Pamela D. Wilson: Okay, and so…

15:48 Liza Marquez: An additional home would be another asset, so usually, that individual would need to have only one home.

15:55 Pamela D. Wilson: One home. And the $127,000 is funds that both the spouse and the veteran have, so it’s just not money that the veteran has correct?

16:05 Liza Marquez: It a combined amount if the veteran and the spouse are both living.

16:09 Pamela D. Wilson: Okay. And then what about, people will say, “Well, what if my income from Social Security and retirement is $2000 or $4000?” Does monthly income make a difference for this benefit?

16:24 Liza Marquez: It could make a difference. Every case is different. Should an individual exceed that amount, the VA has recently put in place, I believe in October or November of last year, that if they exceed that amount, they’ve implemented a three-year look back. So, it’s very similar to Medicaid, but this one is a three-year look back. Of course, that time frame can be reduced, depending on, if they’re in assisted living, of course, that money would probably reduce significantly just paying those costs, as well as the cost of what it is for home care. So, some people can wait three years, others will be two.

17:03 Pamela D. Wilson: Okay. Okay. And you had mentioned that you have financial counselors at the American Patriot Service Corporation, what do they do?

17:17 Liza Marquez: So, the financial advisor that we have who is actually in the building where we reside in. He doesn’t work for American Patriot, he has his own organization, but he is free of charge. So, if we have individuals who come into our office that need financial advice. He is able to provide that service for free. So, if you live in New Mexico, he can do it in person. If you live anywhere else in the US, he could do it by Skype or Zoom over the computer.

17:49 Pamela D. Wilson: And then people would just need to give him their financial information so that they could have a conversation, yes?

17:55 Liza Marquez: Correct, and we would know that information during the process of the paperwork that we submit.

18:03 Pamela D. Wilson: Okay. And then relative to the look-back period, I know people kind of hear this term “look back period” and they don’t understand what it means, can you… Do you have a simple definition that you can provide?

18:16 Liza Marquez: So, if individuals have, let’s just say they have $220,000 in assets, they can’t give away that money. They can’t gift it off to different people to try to reduce those funds (to $127,000). If that money gets reduced based on the needs that they have medically, then that amount could potentially come down, and then that look-back period would be shortened.

18:46 Pamela D. Wilson: Okay, so basically, they just need to spend the money on their own care until they get to that $127,000 limit, and then the application can move forward.

18:57 Liza Marquez: Correct.

19:00 Pamela D. Wilson: Okay. We are going to continue our conversation with Liza Marquez of the American Patriot Service Corporation after this break. Please share The Caring Generation with family, friends, co-workers, and everyone you know so that we can become more informed about health, well-being, caring for ourselves and our loved ones. Replays of The Caring Generation are on my website at PamelaDWilson.com. I’m Pamela D. Wilson. You’re listening to The Caring Generation live on the BBM Global Network Channel 100 and Tune In Radio. We’ll be right back.

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21:49 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert, you’re with me on The Caring Generation radio show. We’re back to continue our conversation with Liza Marquez of the American Patriot Service Corporation about the Veterans Aid and Attendance Benefit. Liza, so let’s say that somebody is listening and they want to start the process. First of all, what number do they call? And then can you share a little bit about how the process works?

22:14 Liza Marquez: Sure. So, they would contact our local office here in New Mexico at 505-702-8027, or they can call our toll-free number at 888-726-1772. So, once they contact our office, they will speak with a screener, and she will go through a screening checklist. She will ask the pertinent eligibility questions that are required by the VA, and we will be able to notify the family member generally who calls whether the veteran or spouse is eligible for the benefit. Once we’ve established that, we will sign them up for a workshop. So locally, we do workshops at various communities who offer their community space to us, or we have them through Zoom. The workshop lasts approximately three hours, and we send the family member an email with all the documentation needed for applying for the Aid and Attendance Benefit. And then we have someone who walks them through every single page of the paperwork.

23:32 Liza Marquez: So, we tell them how to fill it out, where signatures need to be, what documentation they may need, and then once that workshop is completed, we set them up for what we call a packet review. Generally, that happens about three weeks after the workshop, which gives them enough time to gather the information and fill out the paperwork. Then they meet back with us again, either through Zoom or in person, where we go over the packet to ensure that everything is filled out correctly. We submit it to our paralegal who submits and types up the formal application, we get another final signature, and then we send it off to the VA.

24:13 Pamela D. Wilson: And let’s talk for a minute about Zoom because I know some people listening may think, well, what are they talking about? What is Zoom, and how does Zoom work?

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24:21 Liza Marquez: Right.

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24:21 Pamela D. Wilson: Can you give a little explanation on that?

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24:24 Liza Marquez: Certainly. So, for people who might be familiar with Skype, it’s usually just an online tool where you can click a link, it’ll open up on your laptop or your tablet, or your, sometimes your phone. Which is not usually very great, but it’ll come up, and you will see the presenter, and you will see all the documentation that is given to you on the screen so that you’re able to follow along easily. Now, of course, when we send you the email we also send you the link, so you can be proactive, you can download the software onto your computer in advance, and then once the meeting starts, which is generally at 1:00 PM Mountain Standard Time, they just click the link, it automatically pulls up. I believe you can put your name in there and then the meeting starts.

25:16 Pamela D. Wilson: Perfect. Now, the website talks about the fact that there’s no fee paid to your company, but there is an outside fee of $475, can you explain how that works?

25:27 Liza Marquez: Sure, that’s correct. So American Patriot does not charge. As you mentioned, we’re a non-profit organization. We function totally on donations and memberships, and sometimes we get some grants. But back in October, November time frame when the VA made some changes, we just couldn’t keep up with demand. We have a pretty small staff, three individuals here in New Mexico. Three individuals in our Utah office and we needed to reach out to a third-party organization that works with us to do these workshops, to do the packet reviews. These individuals also have access to VA accredited attorneys who have been working with the organization for many years. And so, if the client, maybe they have legal paperwork that they want to be reviewed, it may be old, they review the paperwork. They review the packet, and so, they kind of do a legal assessment on all of the paperwork to make sure that everything is good to go to be sent off to the VA.

26:40 Pamela D. Wilson: And I’ve helped people with these applications. I mean, they’re, to me they’re daunting. There’s so much paperwork. There are so many details. What’s the average time from somebody calls you — they say they’re interested. How long does it take to actually get approved, so that consumers are receiving benefits?

26:57 Liza Marquez: So that always depends. So, of course, every single case that we have is different. So, from the time that they actually attend the workshop and they submit an intent to file, that basically starts to the clock for that client. They have a year to submit their paperwork. So oftentimes we get people who, you know, their loved one is not doing well, and it takes them a few months to get the paperwork in. Once the paperwork is submitted, it’s really up to the VA. It could last anywhere from two to six months. It could be longer because every case is different. The VA handles them differently. So really the client has one year to submit the paperwork, but we hope that people will take the initiative and do it quickly so that we can get the paperwork in fairly quickly. Of course, we have seen some get their benefit within a couple of months. I believe it’s somewhat unlikely at this point, but it does happen, but it could take up to a year, depending on that particular individual.

28:09 Pamela D. Wilson: And that benefit, does it come in the form of a check and how much can someone expect to get?

28:15 Liza Marquez: So, a veteran could receive up to $1881 that comes every month tax-free for the rest of their lives, and it comes automatically into the checking account of the veteran or the spouse.

28:33 Pamela D. Wilson: And is there… Do they ever have to reapply?

28:37 Liza Marquez: So, do they have to reply?

28:40 Pamela D. Wilson: Reapply. So, once they get the benefit…

28:41 Liza Marquez: Oh, reapply.

28:42 Pamela D. Wilson: Is it for life, or does something else have to happen?

[chuckle]

28:47 Liza Marquez: No, they get it for the rest of their lives. Now, there is a case where there are many cases where the VA will send letters to the family representatives. So, we like to deal with a family representative because it tends to be less confusing for them.

29:05 Pamela D. Wilson: Great. Liza, thank you so much for joining us. We’re going to have to go out to the next break. So, the phone numbers that you gave, correct me if I’m incorrect, 888-726-1772 or consumers can call 505-702-8027 to start the process, yes?

29:21 Liza Marquez: Correct. Or they can go to our website.

29:24 Pamela D. Wilson: Perfect, give your website address really quick.

29:27 Liza Marquez: Sure, it’s www.apscnp.org.

29:35 Pamela D. Wilson: Thank you so much, I’m Pamela D. Wilson, your host, you’re listening to The Caring Generation live on the BBM Global Network Channel 100 and Tune In Radio. We’ll be right back after this break.

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31:03 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert, I’m your host for The Caring Generation, the place where we share caregiving and health tips and things we should know about caring for ourselves and our loved ones. Help, hope, and support for caregivers are available on my website at Pamela D. Wilson, in addition to the podcast replays of the Caring Generation for you to listen and share. When we left off, we were talking about hiring and supervising, in a sense, the work of an in-home caregiver. And remember, if you were with us in the last segment, the American Patriot Service Corporation can help you apply for Aid and Attendance which actually pays for in-home caregivers. Their number is 888-726-1772. As we talked, when you hire a caregiver, you’re the boss, and you’re the person that’s providing direction to that caregiver about all of the tasks that you want them to do. This is especially important if your elderly parent lives alone, and they really can’t be the person who gives instructions to the caregiver. In that case, this is where you want to make lists. Whether it’s a checklist or you call the caregiver, and you let them know what you would like them to do on a particular day. This makes sure that what you expect to be done actually gets done.

32:26 Pamela D. Wilson: This is even more important if your loved one has memory loss because the diagnosis of memory loss can complicate having an in-home caregiver. And this is where you might want to look at a home healthcare agency instead of a companion agency, and we’ll talk about the differences. When a loved one has difficulty beyond needing help with daily tasks, a home healthcare agency, they’re sometimes also called Assistive Care Agencies if you Google them, and this is kind of an area where all these definitions can get a little complicated. But a Home Healthcare Agency or an Assistive Care Agency, they may also have companions, but they also have what are called home health aides, an HHA or a certified nursing assistant, which is a CNA. These caregivers have additional training that may not make a lot of sense until your loved one has memory loss, or they have behaviors, or they need more care than a companion can provide. So, the companion agency and the home care agency, they have these classifications, and these are called Class B. There’s another agency that’s called Class A, that you should just know that exists. Those agencies provide medical services that are paid for by health insurance. Companions and home health aides, those costs are on family members, or they’re paid for by the aid and attendance program, the Medicaid program, or long-term care insurance if you have it, but mostly private income.

34:00 Pamela D. Wilson: And so, in case you hear the words class A and class B, I wanted you to know what that meant because those are terms that all these medical providers work, I call it medical speak. Those of us who work in the industry know what they mean, but consumers don’t come across the terms that often. So, the home health aides and the CNAs have additional training beyond a companion. And the way that I explain this to caregivers and families is that if you’re hiring an in-home care agency look at the tasks that you want the caregiver to complete, and this will help you decide which you need, and then consider how comfortable you would be if at first you hire a companion agency and then, later on, you have to change agencies, because that companion can no longer meet the needs of your elderly parent and those needs that relate to healthcare, oversight, sometimes documentation. If your loved one has mobility issues, they may need to be turned in bed or repositioned in bed. It includes taking temperatures, blood pressure, other vital signs, and documentation. So, some family members want documentation of what happened every day in the home, so that they can read the documentation that might be used for medical appointments, or just monitoring care.

35:18 Pamela D. Wilson: This requires a higher level of training by the caregiver. Also, tasks like feeding a loved one, measuring and recording food, and fluid intake. These are all tasks that these higher-level caregivers can complete. They can also do things like help with oxygen equipment, manage incontinence, do hands-on bathing, including bed baths, help with mobility and transfers. Use a gait belt, so that someone doesn’t fall. These are tasks that become more common and more needed as an elderly parent, or a spouse as their health declines, as their physical ability declines and they’re also tasks that are very common to people who have memory loss, or other concerns. The costs for in-home companions and in-home care personnel, they’re different depending on where you live. I’ve seen rates as low as $12 to $15 an hour, all the way up to $30 an hour. And I’m always asked about the benefits of using a care agency versus hiring a private caregiver. That is a decision that only you can make, and I’ll share the pros and cons. The benefits of an agency include all the supervision, the training, the background check, paying taxes, backup support if your caregiver doesn’t show up, or becomes ill, decides to change jobs.

36:38 Pamela D. Wilson: You can almost compare this to having an employment agency for caregivers at your fingertips. If you establish a positive relationship with the staff, they will bend over backward to help you and your loved one. And they’ll also be honest about things that they can and can’t provide. When you privately hire an in-home caregiver, all these responsibilities are kind of your job. There’s disagreement over whether a private caregiver is an employee or a contractor, that is a discussion for you and your CPA, the person who does your taxes, and your attorney so that you understand the benefits and the risks. In some cases, in-home caregivers hired privately will accept a lower hourly rate than you would pay an agency because there’s all these other costs outside of that. The question that you have to ask yourself is, how much of the employer do you want to be that has all the responsibility of hiring, firing, evaluating caregivers who may not do their job? Hiring privately does involve the personal cost of time and emotions, because honestly, if it doesn’t work out, or the caregiver leaves, there’s no backup.

37:45 Pamela D. Wilson: Like, with an agency, there is only you. Next, I want to talk about the benefit of hiring a care manager, which is kind of like having a personal assistant to manage all the aspects of care for a loved one. Care managers can provide significant relief in situations where families have the money to pay, either as we talked privately or through long-term care insurance, and a care manager can take care of all the needs of a loved one and report to the family. This does include managing an in-home care agency and so many other projects. The availability of care managers are not always well-known, and we’ll talk about what a care manager is, the cost, and what they do after the break coming up in our next segment. Please share The Caring Generation radio show with family, friends, co-workers, employers, and everybody that you know. The podcast replays and the show transcripts are on my website at PamelaDWilson.com. You can also follow me on Facebook. My page is PamelaDWilson.page. This is Pamela D. Wilson caregiving expert. I’m your host. You’re listening to The Caring Generation live from the BBM Global Network, channel 100, and Tune In Radio. We’ll be right back.

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41:11 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert; I’m your host. You’re listening to The Caring Generation coming to you live from the BBM Global Network, channel 100, and Tune In Radio. We’re back to continue our conversation about what is a care manager? How do they help families and the cost plus the cost of services in different types of care communities? A care manager is a professional who has education and experience with a certain population, and I say this because there are care managers for babies, for the blind, the disabled, persons with special health issues, like autism and the elderly. For over 20 years, I was a care manager for the elderly and middle-aged adults. I was also a professional fiduciary, which many care managers are. This is the title of court-appointed guardian, medical and financial power of attorney, personal rep of the estate, and trustee. I’ll talk about the idea of professional fiduciaries in a future program because this is important. But today we’re talking about care managers that can help manage all aspects of care when family members aren’t available, they don’t have time, or they don’t know how to navigate the care system.

42:27 Pamela D. Wilson: On average, and this may shock you. A care manager can range from $75 to $150 an hour. I know it may sound expensive, but here’s the benefit. An experienced care manager, and I say experienced, because not all of them, not all of them are. They can save you time, money, worry, and actually improve the care that your loved one receives because of their experience and their connections in the community. The time and money savings come in when you have the choice of investigating and vetting outside services yourself, doing all the research, sometimes making mistakes, and having to do things over or do rework. Because really, you didn’t know what you were doing.

43:09 Pamela D. Wilson: The way that I explain this is by looking at other professions. So, if you have a complicated tax return, do you do your own return, and do you have somebody do it for you? Do you perform all the repairs on your car or do you take it to a mechanic so that your car runs smoothly? If you have money that you want to invest, do you do it yourself, or do you use a financial advisor? There’s a degree of education and experience that care managers have. Through the connections that they have in the community and their years of experience, they’re aware of public services, they know the good in-home care agencies, they know the good care communities, and they know how to navigate and coordinate care from hospitals to skilled nursing communities to home. They know the questions to ask doctors and, in many cases, they can prevent a lot of errors and mistakes that happen because family members don’t know what they should pay attention to.

44:06 Pamela D. Wilson: Care managers also help families plan for care, whether it’s today, next year, or three years down the road. As a care manager, I managed 24-hour care for many of my clients, where they wanted to remain at home. They didn’t have a family to assist. The benefit of having family to help elderly parents stay at home is so significant. I made an earlier reference that family caregivers actually save the care system $500 billion dollars annually. What do I mean by this? For the most part, it’s the caregivers who help parents stay at home, and they do all these tasks that caregivers aren’t even hired for. This assistance can be 20 or more hours a week for long periods of time. Sometimes even years. Family caregivers delay and keep elderly parents and spouses out of nursing homes. This saves costs to the public program of Medicaid. Care for loved ones with memory loss, dementia, Alzheimer’s. It’s very expensive.

45:06 Pamela D. Wilson: To give you a point of comparison, I’ll share a statistic. It’s an old one from 2013, but the value of family caregivers in 2013 was 470 million dollars. That was more than the cost of in-home care that people paid for. It was more than the cost of the Medicaid program. And it’s interesting that value, the $470 million, almost matched the sales of the world’s largest company. Can you guess who it was? Walmart. Talking about this is to show from a financial value, the value to society that family caregivers represent. About 45% of that $470 million was the value of family caregiver assistance to loved ones with memory loss. The fact is, family caregivers, you are priceless. You’re not only priceless to your elderly family members but to society. And the greater question is, why don’t we talk about the life transition of caregiving. It baffles me when the value is so significant.

46:08 Pamela D. Wilson: Let’s do a review of the personal cost of caring for elderly parents for working adult caregivers. More information about this is in a past podcast. If you weren’t with me for, Why is Caregiving so Exhausting? and When Work and Caregiving Collide, you can find these podcasts on my website at PamelaDWilson.com on The Caring Generation page. For family caregivers, and many of you are in this situation, there are emotional and physical costs. Caregivers experience stress that translates into physical and emotional illness. Many of you caregivers know, your health today. It’s not like it was a year ago.

46:47 Pamela D. Wilson: There are also cost to career, retirement, and savings. Women who stall their careers by reducing hours or taking time off, rarely return to the level of earnings or the position they were at when they left, which is a good reason to remain working. Caregiving families, those who are sandwiched between caring for elderly parents and children, they have extra challenges. The average costs for care for a parent are in the range of $3,000 a month, and families bear these costs. A lot of family members, 69% move parents into the home, and that can sometimes cause relationship stress on a marriage and in raising children. Agreements about money also happen between spouses. These are all the costs and the issues that we as a society don’t talk about enough, but we should. The primary person that keeps a spouse out of a nursing home is the healthy spouse. The second person, guess who? It’s the daughter. The ties between mothers and daughters are significant. For men, the presence of a wife reduces the likelihood of a nursing home placement because the wife is the main caregiver, but surprisingly, the reverse is not true.

47:58 Pamela D. Wilson: For women, having a husband does not reduce the likelihood of nursing home placement. Can you guess what does? It’s the daughter. Studies report that children have a significant effect on keeping elderly parents at home. Next week we have another great show for you. We’re going to be talking about diabetes prevention and treatment. Dr. Mayer B. Davidson joins us. He was past president of the American Diabetes Association and founder of the Venice Family Clinic in Venice, California. I’m Pamela D. Wilson, your host. You’re listening to The Caring Generation, live from the BBM Global Network, channel 100, and Tune In Radio. You can find all the past podcasts of the show on my website at PamelaDWilson.com. Please stay with me. We’ll be right back.

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51:06 Pamela D. Wilson: This is Pamela D. Wilson, caregiving expert. I’m your host. You’re listening to The Caring Generation radio program for caregivers, and aging adults, coming to you live from the BBM Global Network, channel 100, and Tune In Radio. We’re back talking about why adult children are the main caregivers who prevent mothers from going to nursing homes. This happens for the same reason that wives are the main caregivers for husbands who are usually older and in poor health. Husbands usually have to place wives in nursing homes because they physically are unable to care for the wife. Especially, if adult children are not available to help out. In the absence of having a wife – because of death – sons are the main supports to help fathers stay at home and out of nursing homes. It makes sense that sons are the main supports for fathers and daughters is the main supports for mothers. Statistics show that more family stress occurs when personal care and extended care tasks are provided by a person of the opposite sex. Even if it is a daughter caring for a father or a son caring for a mother, these situations emotionally stressful and sometimes embarrassing.

52:25 Pamela D. Wilson: Let’s talk for a moment about care community costs. If you’re unfamiliar with what is an assisted living and the other types of care communities, there’s a podcast, it’s called, guess what? What Is Assisted Living? You can find it on my website. I’ll share this information because here we’re only talking about costs and not the different types of care communities.  Independent living communities, where elderly adults are mostly caring for themselves, range from 1,500 to $4,000 a month, depending on where in the United States you live. Assisted living 3,500, all the way up to $10,000 a month for the more elaborate communities with a long list of services. Memory care is another specialty type care community. Again, 4,000 to $10,000 a month. And the majority of these communities, they’re private pay, meaning that you pay with your retirement income, retirement savings, and investments. If you were with us earlier, the Aid and Attendance Benefit can help with this, or if you were forward-thinking and purchased long-term care insurance — it’s insurance that I highly recommend purchasing — that can help pay for these costs.

53:47 Pamela D. Wilson: I recommend getting that though as young and healthy as possible so that you have a low rate and you’re actually accepted. Because with long-term care insurance, you can be declined if you already have health issues. A limited number of assisted living communities accept Medicaid for payment and nursing home costs, those are just shocking. Some of your elderly parents may have had a short-term stay but depending on where you live, 300 to $500 a day, or 9,000 to $15,000 a month. That translates to 108,000 to $180,000 a year. Not many people have that kind of money, which is why we have to make plans long before.

54:30 Pamela D. Wilson: For all of the caregivers listening, especially family caregivers, these conversations they are so important to occur earlier so that you’re not stuck in a situation where you are stressing about how you are going to pay for care. Check out the VA Aid and Attendance Program. The number to call for that is 888-726-1772. And caregivers, if nobody has told you that you are amazing or hasn’t thanked you for everything that you do this week as a caregiver, or in helping others, let me say, thank you. I also want to thank all the professional caregivers out there who are working in care communities. It’s a hard job, I know, I have helped many caregivers manage the care for aging parents. I’m Pamela D. Wilson, caregiving expert. I’m your host. Thank you for joining me on The Caring Generation radio program for caregivers and aging adults. Podcasts of all the past programs are on my website at PamelaDWilson.com. You can find them to share, download, you can read them. The transcripts are there. It’s a lot of helpful information for caregivers and for aging adults. I look forward to being with you again next Wednesday. God bless you all, sleep well tonight and have a fabulous day tomorrow.

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55:57 Announcer: Tune in each week for The Caring Generation with host Pamela D. Wilson. Come join the conversation and see how Pamela can provide solutions and peace of mind for everyone, here on Pamela D. Wilson’s The Caring Generation.

Looking For More Help With Care Costs? You’ll Find What You Are Looking for in The Caring Generation® Library in the Section Costs of Care

About Pamela Wilson

PAMELA D. WILSON, MS, BS/BA, NCG, CSA helps caregivers and aging adults solve caregiving problems and manage caregiving needs through online programs, live support groups, and an extensive caregiving library that includes articles, podcasts, videos, and webinars.