By JUDD MATSUNAGA, Esq.
Have you ever tried to convince an elderly Japanese American man to do (or not to do) something they really didn’t want to do? Even if they’re struggling with everyday tasks, most Nisei (even elderly Sansei) won’t admit they need help. And when you mention bringing in some “home care,” it often leads to arguments or to immedishutdown. Nothing gets done.
Let’s face it. There’s a reason why the Nisei Hawaiians called the Nisei mainlanders “kotonks” (i.e., the sound of a thump to a very hard or hollow head) during WWII. Your senior might see strangers coming into their home as a waste of money, an insult to their abilities, or an invasion of privacy.
However, if your senior insists in remaining at home, and is beginning to experience problems with the tasks of daily living, an in-home caregiver may be the answer. Today, more seniors than ever are hiring in-home care. That’s because they want to “age in place.” However, your senior refuses. You, the caregiver, desperately need some help and regular breaks. What can you do?
Fortunately, there are ways to make this transition easier. Family Caregiver Alliance gives
some helpful tips on how to make in-home care more acceptable even if your older adult initially said no. The following are highlights of key points from an article titled “Introducing In-Home Care When Your Loved One Says ‘No’”:
1. Start gradually.
Begin by having the aide come only a couple of hours each week, then add hours as your loved one builds a relationship with the helper. If you feel comfortable with the attendant running errands or preparing meals that can be brought to the house, you can start with those services, which can be done outside the home.
2. Listen to your loved one’s fears and reasons for not wanting in-home care.
Express your understanding of those feelings. If possible, get your loved one involved in choosing the aide. He or she will feel more invested and comfortable with the decision.
3. “This is for me. I know you don’t need help.”
Expressing the need as yours, rather than your loved one’s, helps maintain his or her sense of dignity and independence. You can also add that having someone stay at home allows you not to worry while you are gone. Make it clear that you will be coming back.
4. “This is prescribed by the doctor.”
Doctors are often seen as authority figures and your loved one may be more willing to accept help if she feels that he or her is required to do so.
5. “I need someone to help clean.”
Even if this is not the real reason, often people will allow someone in to clean when they “don’t need” care for themselves.
6. “This is a free service.”
This strategy may work if other family members are paying for the home care or if it is, in fact, provided without charge. Your loved one may be more open to using the service since he or she does not feel that she is spending money for it.
7. “This is my friend.”
By pretending that the attendant is a friend of yours, you are relating the home care worker to the family. This can help with establishing trust and rapport. You can also say that your “friend” is the one who needs company and that by having him or her over your loved one is helping him out.
8. “This is only temporary.”
This strategy depends on the condition of your loved one’s memory. If she often forgets what you say, then she may also forget that you said this. By presenting the situation as short-term, you will give some time for your loved one to form a relationship or become comfortable with home care as part of her daily routine and give you a chance for a well-deserved break.
Hopefully, one of the above tips works and you are successful in getting your senior to agree to give an in-home caregiver a try. Great — but proceed cautiously! Here are some common mistakes that can cause families problems from board-certified geriatrician Dr. Leslie Kernisan, MD MPH on “Common Mistakes to Avoid When Hiring an In-home Caregiver” (Source: www.betterhealthwhileaging.net):
1.Paying individual caregivers “under the table.”
It may be tempting to hire an independent caregiver or one that does not work for an agency, because of the cost savings. But doing so can leave you in violation of IRS laws if the appropriate taxes are not filed and paid. Federal laws consider paid caregivers to be “household employees,” and generally you must pay taxes and follow other rules if you pay them more than $2,000 in a calendar year.
2. Allowing the paid caregiver to have too much control or access.
It is important that family members to stay involved in their loved one’s care, even when trusted caregivers are in place. When there isn’t much family oversight, an older person can be vulnerable to abuse, neglect, and exploitation. So, it’s essential that family members stay informed and aware of what is happening in their loved one’s life.
3. Naming a paid caregiver as a healthcare or financial agent.
It may seem unlikely, but this happens all too often! A trusted caregiver that has been with a family for years will be named as the healthcare or financial agent on powers of attorney out of a desire for efficiency and with a false sense of security. Older adults may feel like their trust will not be betrayed by their loyal companion, but this situation puts the older adult in a vulnerable situation.
In general, if a trusted family member or friend can’t serve as healthcare or financial power of attorney, it’s better to choose a person who is not the usual paid caregiver. In some states, professionals can be hired for this role.
This leads me to two tips from One Medical, a membership-based primary care practice, from an article called “8 Tips for Hiring an In-home Caregiver” (July 9, 2021). It is an absolute must to do a background check to ensure their safety and the safety of their home and possessions. You want to trust the person you’re hiring, and knowing you’ve done a background check will give everyone peace of mind.
A background check for home care providers should be particularly detailed because the person works with the elderly and vulnerable. In most states, you can apply for a caregiver background check using the state’s website. If you decide to do the background check yourself, there are websites walking you through the process. an agency specializing in background checks that will do the work for you.
Get the most comprehensive type of background check, including any criminal arrests, convictions, reprimands, or warnings the applicant has received from law enforcement or the courts. The caregiver’s fingerprints will be run through a national database to confirm identity and criminal activity. In-home caregivers hired through a home care agency have already had background checks done before being hired. When working with an agency, you may request a copy of the home care provider’s background check.
Finally, the cost of an in-home caregiver is not cheap. The cost varies depending on where you live, but you can expect to pay a minimum of $25 an hour. Hourly pay is the most common and can save you money if you only require help for a few hours a day. For those who need round-the-clock care, a daily rate is sometimes used.
If you are hiring through a home care agency, understand the billing cycle clearly. Some agencies may invoice on a weekly or monthly schedule. Ask if there are late fees and if service by your home care provider could be suspended in the event of late payment. Medicare does not pay for in-home care for activities of daily living unless your primary care doctor prescribes the care or there is a medical component to the care.
You say, “But Judd, we don’t need 24/7 home care. We only need part-time care to watch Dad or Mom for 4 hours per day five days a week just to give us a break. At $25/hr, that’s $500 per week or $2,000 per month — we can’t afford that. Will qualifying for Medi-Cal help pay for part time home care?”
The short answer is “NO.” Medi-Cal will not pay for home care. However, there is a county program — In-Home Supportive Services (IHSS) — that will pay for some part-time home care. As implied by the name, the In-Home Supportive Services program provides support to persons in their homes such as personal care and assistance with household chores.
These support services are largely unskilled, meaning no special medical training is required. California allows IHSS program participants to choose who provides them with assistance. California’s program is unusually broad in the range of persons who can be hired. Siblings, adult children, nieces, nephews, friends, and even spouses can all participate in the program.
“Say Judd, are you saying that if I qualify for IHSS, I can get money to pay my adult daughter for the very same things she’s already doing now unpaid?” You bet! The only catch is that you first have to qualify for Medi-Cal. But a new law (July 1, 2022) now makes it much easier to qualify for Medi-Cal, e.g., you no longer have to be at poverty level to qualify.
In conclusion, hiring a paid caregiver can be a big transition for any family. Having a new person in your home, so intimately involved in your family’s life, is truly an adjustment. But a skilled, loving and dedicated helper can make a huge difference in your senior’s well-being. Also, if you decide to rely on just one to two individual caregivers, you’ll want a plan in case they fall sick, or otherwise can’t continue working.
Aging in place with caregivers is a great idea, but it may not be the best idea for the entirety of a person’s final years. Have a backup plan. Eventually, skilled care may be required or finding 24/7 caregivers to come to the home may be too challenging or too expensive. Every family should have a plan for when/if staying in the home no longer works. Fortunately, it’s now much easier to qualify for Medi-Cal to pay for long-term care.
Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.