Thursday, December 8, 2016

Contract Can Help Family Caregivers

family caregiving personal care agreement

Having a personal care agreement between parent and child can help you avoid conflicts down the road.

When Beth’s mother, Maria, started to show signs of confusion, Beth decided to have her widowed mother move in with her. Although Beth worked full time as a hospital kitchen supervisor and wasn’t home for most of the day, Maria seemed to do OK. But soon, Maria started to become increasingly disoriented—forgetting how to make herself lunch and how to get dressed.

Beth decided she had no choice but to stay home with her mother, and Maria agreed to pay her for her caregiving. The situation was working well until Beth’s estranged sister discovered the financial arrangement and accused Beth of stealing their mother’s money—and their inheritance—and threatened legal action. Beth’s situation is not uncommon. Nearly 18 million people care for an ailing relative who is 65 or older. A majority of family caregivers is women age 50 and above, most of whom do not receive financial or other support for their services.

In Beth’s situation, one document could have helped her avoid conflict with her sister as well as meet requirements for Medicaid that her mother might need in the future. A personal care agreement (PCA) establishes a contract for care between a caregiver—in this case, a family member—and care recipient—here an aging parent who needs assistance.

Reasons to get a PCA

First, by listing the specific caregiver duties and compensation, a PCA can help avoid family conflicts later. A healthy discussion beforehand with siblings (or other involved family members) can clarify issues and assure family members that the parent is being taken care of and that the caregiver has certain responsibilities to meet. Experts advise follow-up meetings to add or subtract from the list of services if the parent’s situation changes, such as becoming more disabled and needing additional care.

The agreement also assures the parent that they will receive help and that the whole family is (hopefully) on board with this arrangement. (To ensure this, the care receiver can use the “Five Wishes” living will to explain and put in writing their wishes for caregiving.) The family caregiver can feel secure knowing they will receive compensation for their services and will not have to take on a huge financial burden.

Second, if the person receiving care needs to eventually go on Medicaid, a PCA helps establish that the disbursed funds were compensation, not a gift. Under Medicaid’s rules, the person applying for assistance cannot give away (or hide) their assets in an attempt to meet Medicaid’s limit of $2,000 in assets (spouses have different criteria). The joint federal and state program, which helps with medical costs for people with limited income, uses a “look-back” period of five years to review such activity. A PCA shows that the caregiver is receiving legitimate wages for their services.

In extreme cases, authorities may also view caregiver payments as the adult child exploiting a parent or someone in need. A PCA shows that the parent willingly entered the agreement.

What to Include in a PCA

Services. Although the agreement should clearly state the caregiver's tasks, some wiggle room might be necessary to include duties that arise after the PCA is written. To cover all the bases, you could include a phrase such as, "or similar to the services listed.” Outlining the responsibilities also makes other family members aware of the scope of what is necessary to maintain the parent’s daily life. Services could include:

  • Cooking meals

  • Grocery shopping

  • Housekeeping and laundry

  • Assistance with bathing, toileting and dressing

  • Medication reminders

  • Help with eating

  • Assistance with walking and exercise

  • Transportation to appointments, errands and other commitments

  • Managing finances (such as paying bills)

  • Overseeing healthcare (such as communicating with medical practitioners)

Compensation. To determine how much to pay the family caregiver, find out the going rate for home services in your area. If you are talking to home care agencies, remember that they charge more than a private caregiver because they take a percentage of the fee to pay for unemployment, workers’ compensation, payroll taxes and other legal responsibilities.

Although the median cost nationwide for home health aide services is upward of $125 a day, assuming 44 hours of care per week (according to the Genworth 2016 Cost of Care Study), make sure to use the median cost in your area. To avoid any later scrutiny, do not charge more than what an independent caregiver would receive.

It’s also helpful to detail how often the caregiver will be paid (weekly or monthly, for example).

Do You Need a Lawyer?

It’s not necessary for a lawyer to write the personal care agreement (PCA), although it may help in certain circumstances, such as when the caregiver also has power of attorney and must sign the contract for their parent.

Also be aware that this contractual relationship is between an employer (the care recipient) and the employee (caregiver), even when parent and child. This means the caregiver is subject to withholding taxes.

If you decide to write the PCA yourself, you can find forms (Elder Care Agreement, Form 85) in the book 101 Law Forms for Personal Use.

Hours. How many hours a week will the caregiver provide care? It’s important to make sure everyone is on the same page and has the same expectations. Write the amount as something like “20-30 hours a week” or “less than 50.” This gives everyone a starting point, but you can change it later.

Duration. Be as specific as possible. For example, choosing an end date, such as six months from the start, gives the parent, child and other interested parties the opportunity to review the agreement and make any necessary changes. As an alternative, the contract could be open-ended, with the stipulation that either party can terminate the agreement, with advanced notice of written consent, or by mutual agreement. Another option is to trigger the contract’s end by listing qualifying events, such as a hospitalization or entrance into a nursing care facility.

Help for caregiver. To avoid burnout, the caregiver will need time off for respite or sickness. Can another family member or family friend step in to provide temporary care? Or will it be necessary to hire an outside caregiver—either private or from an agency? Spell out these details in the PCA.

Be aware that care agencies generally need 24 to 48 hours to start a service agreement and provide a qualified caregiver. Another option is assisted living communities, many of which have “respite” stay options that can relieve the caregiver. Usually these communities require a minimum of 2 to 4 weeks for taking care of your loved one.

Sign the agreement. Both the parent(s) and child need to sign the contract before any service begins. For extra legal protection, it’s a good idea to have the signatures notarized.

Optional Points

While the services, hours and compensation are necessary, you can also add other sections to the agreement. Even if you don’t include this information in the contract, it’s wise to consider these scenarios.

Back-up plan: If the home caregiver situation doesn’t work or events change, consider what the next step might be. In some cases, you may choose a different caregiver or decide to move the parent into assisted living or other skilled facilities. It’s helpful to research the different options and their costs before the situation becomes a crisis. Placement/referral agencies can help families examine the options, whether that be in-homecare agencies, assisted living communities, memory care units or adult family homes.

A daily log. Keep a journal of the care recipient’s activities and what was required of the caregiver. This daily log not only helps the caregiver provide a clear picture of what is most needed but can protect the caregiver if an outside party—Medicaid or another family member—wants proof that care was provided. The PCA could include a requirement for such documentation.


Into the Matrix of Law and Caregiving,” June 2016, American Bar Association.

Personal Care Agreements Can Compensate Family Caregivers,”

How to Prepare an Agreement to Care for a Family Member,” Sept. 08, 2016,

Creating Effective Agreements for Payment of Family Caregivers,” February 2016, American Bar Association.

How to Compensate a Family Member for Providing Care,” Family Caregiver Alliance.

Blog posting provided by Society of Certified Senior Advisors

Monday, December 5, 2016

The Best Home Improvements for the Money

Best Home Improvements for the Money

If you’re considering moving and want to fix up your home, experts recommend renovations that make the most financial sense.

Maybe you’ve been watching too many home-improvement TV shows, but suddenly your kitchen is looking a bit dated—like the 1970s. At the same time, you and your spouse have been talking about finding a smaller place as you get older. You’re not ready to move now, but somewhere down the road, when it gets too difficult to climb the stairs and shovel snow. If you don’t plan on living in your home for the rest of your life, what’s the best home-improvement investment you can make?

To predict your return on investment (ROI) potential, look at your home’s value and the value of other homes in the neighborhood or city where you live. If housing prices have been low in your neighborhood, it may not pay to make upgrades. Your ROI can vary widely, depending on where you live. Remodeling offers regional comparisons.

Experts focus their recommendations on two issues: curb appeal, such as a new garage door; and maintenance/structural issues, like a new roof. Also factor in which improvements will bring you the most pleasure during your remaining time in the home.


Although decidedly unglamorous, replacing your home’s roof—at an estimated cost of $7,600—is one of the best improvements you can make. One survey found a 105 percent gain in investment, meaning that your home’s value would increase so much that you would recoup more than 100 percent of the amount you paid for a new roof. Another survey put the value at 72 percent. While a new roof might not attract buyers, an old roof can discourage them after they get the inspection report.


Upgrading your home’s insulation—at an average cost of $2,100— provides a generous cost-value ratio. One survey cited a 117 percent return at resale, while another estimated 95 percent.

Good insulation increases energy efficiency, which keeps the house warmer and reduces heating costs. Often, homeowners add fiberglass insulation to the attic and caulk around doors and windows.

Garage Door

Replacing your home’s garage door, especially if it’s the old metal variety, adds to your home’s curb appeal. One survey estimated the cost of a new garage door at $2,300, with 87 percent recovered at resale. Popular designs include carriage-style, natural-wood and windowed garage doors.

Similarly, front-door replacement can increase curb appeal and energy efficiency. One survey found a 91 percent return at an estimated cost of $2,000.


Dirty and worn siding sends a message that a house isn’t being taken care of, and prospective homebuyers often assume that the outside mirrors what’s inside. Estimates for a return on new siding vary from 75 to 83 percent at an average cost of $12,000.

Replace your home’s tattered exterior with vinyl or fiber-cement siding. Vinyl is less expensive and easier to install and maintain, but fiber-cement siding will last longer and its components are more environmentally friendly.

More Home Improvements

Although some home renovation projects may not have the great cost recoveries that others do, they can still add value to your house. Experts recommend:

Add more space. These days, people want bigger houses. In especially hot markets, adding another room can be a good investment.

Add deck, patio or front porch. These exterior additions are an inexpensive way to increase your house’s size and create additional usable space.

Finish attic and basement. This is an easy way to add space to your house.

Remove popcorn ceiling. No one wants this dated look.

Fix plumbing. If you have old plumbing that is causing problems, fix it before other superficial updates.

Beautify your front yard. This can be a cost-effective way to boost your home’s curb appeal, and you’ll probably enjoy having a home with new paving stones or plants.

Hardwood Floors

Younger people, especially, want wood floors in a home. One survey found that you can recover 91 percent of your installation costs, which average $5,500. To refinish hardwood floors, which costs $2,500 on average, you can recover 100 percent of your expense.

Choose between solid wood and engineered wood. Solid hardwood is one piece of wood, and engineered wood comes in layers. Each has advantages and disadvantages, including cost and strength.

Kitchen and Bath

Kitchens and bathrooms are typically the most expensive rooms to remodel, but they can instantly boost a home’s appearance or bring it down. One survey found a 66 percent return on fixing up the bathroom and an 83 percent return on redoing the kitchen (averaging both minor and major fixes). However, one expert warns that if your house only has one bathroom, it’s better to add a second instead of renovating the one.

The national median price for upgrading a kitchen is $30,000, with an ROI of 67 percent for a major remodeling. Although not as impressive a return as improvements such as new siding or roof replacement, a renovated kitchen or bathroom can bring a lot of pleasure while you are still living in the home.

For the kitchen, experts recommend wood cabinets, stainless steel appliances, natural wood or stone floors, and stone countertops. If you can afford it, create a more open layout, especially if your kitchen is cramped. If your budget is tight, consider refacing instead of replacing cabinets.

At the high end, bathroom fixes can include replacing tubs with walk-in showers or steam showers. However, simply regrouting the shower, adding new fixtures and repainting can make the bathroom look almost new.

For other ideas, see the sidebar.


Home Improvement Projects That Pay Off,” April/May 2016, AARP.

Which Home Improvements Pay Off?,” HGTV.

10 Investments to Boost Your Home's Value,” DIY Network.

The 6 home renovations that return the most at resale,” June 28, 2016, Bank Rate.

Home Remodeling: 6 Improvements to Increase Home Value,” House Logic.

Key Trends in the 2016 Cost vs. Value Report,” Remodeling.

New Roof Is Greatest Remodeling Value,” Dec. 09, 2015, Daily Real Estate News.

Blog posting provided by Society of Certified Senior Advisors

Sunday, December 4, 2016

Famous & 65

Look Who’s Turning 65

Dec. 1—Treat Williams

Dec. 1—Treat Williams

The actor first came to world attention in 1979, when he starred in the MiloŇ° Forman film Hair, for which he was nominated for a Golden Globe Award. Over his long career, Williams has appeared in over 75 films and several television series, including, most notably, 1941 (1979), Once Upon A Time in America (1984), Dead Heat (1988), Things to Do in Denver When You're Dead (1995) and Deep Rising (1998)

Williams got a second Golden Globe nomination for starring in Sidney Lumet's Prince of the City (1981) and a third for his performance as Stanley Kowalski in the television presentation of A Streetcar Named Desire. In 1996, Williams was nominated for a Best Actor Emmy Award for his work in The Late Shift, an HBO movie in which he portrayed agent Michael Ovitz. In 1996, he played villain Xander Drax in Paramount's big budget comic book adaptation The Phantom. Williams may be best known for his leading role as Dr. Andrew Brown in the WB television series Everwood, about a New York City neurosurgeon who moves his family to Colorado. Although the show's ratings were never spectacular, it won critical acclaim and had a devoted following.

Williams' career includes numerous stage roles. He won a Drama League Award for his work in the Broadway revival of Stephen Sondheim's Follies and another for starring in the off-Broadway production of Captains Courageous. Other notable Broadway shows include Grease, the Sherman Brothers' Over Here!, Once in a Lifetime, Pirates of Penzance and Love Letters. Williams has also worked as a director, winning two festival awards for directing Texan in Showtime's Chanticleer Films series. He is also a commercial pilot and flight instructor. In 2010, he published a children’s book titled Air Show!

Dec. 3—Rick Mears

Dec. 3—Rick Mears

The retired race car driver is one of three men to be 4-time winners of the Indianapolis 500 (1979, 1984, 1988, 1991) and the current record-holder for pole positions in the race with six (1979, 1982, 1986, 1988, 1989, 1991). Mears is also a 3-time Indycar series/World Series champion (1979, 1981 and 1982).

Mears began his racing career in in Bakersfield, Calif., with off-road racing, but switched to Indy Car racing in the late 1970s. In his initial appearance at Indy, Mears was the first rookie to qualify over 200 mph and won his first "500” in 1979. The 1981 and 1982 seasons saw two more championships for Mears. Despite facial burns during a pit fire in the 1981 Indianapolis 500, Mears' 10 race victories in the 2-year span were enough for another two Indycar championship titles. At the 1982 Indianapolis 500, he came within 0.16 of a second of adding a second Indy win. Mears scored his second Indy win in 1984 but suffered severe leg injuries later in the year in a crash. After that, injuries to Mears’ right foot slowed him down and affected him throughout the remainder of his career. Over the next three seasons, he won only two races. He completed a comeback from his injuries by winning the 1985 Pocono 500. In 1988, his team used a new car, the PC-17, to win the Indy 500. The last race of 1989 set Mears apart from all other Indycar racers as he broke a tie with Bobby Rahal for race wins and became the most successful Indycar racer of the 1980s. In August 1991, at Michigan, he won his last race. In 1992, at the age of 41, he announced his retirement from racing Indycars. Mears continues to work as a consultant and spotter for Helio Castroneves and Penske Racing, the team with which he won all of his Indycar races.

Dec. 4—Patricia Wettig

Dec. 4—Patricia Wettig

Although the actress has appeared in numerous films (including City Slickers, Guilty by Suspicion and The Langoliers), Wettig is best known for her work on television. She received critical acclaim (and a number of awards) for her role as Nancy Weston on ABC's thirtysomething (1987-1991). Her portrayal of Nancy's cancer struggle attracted considerable acclaim and attention. She also portrayed Joanne McFadden on the television program St. Elsewhere (1982-1988). In addition, Wettig appeared in a numerous popular television programs during the 1980s and 1990s, including L.A. Law, Frasier, Hill Street Blues and Remington Steele.

Wettig starred in the ABC comedy-drama series Brothers & Sisters, which aired from 2006 to 2011, where she portrayed the Walker family patriarch's mistress, Holly Harper. She also had the recurring role of CIA psychotherapist Dr. Judy Barnett on Alias. Before joining Brothers & Sisters, Wettig played the fictional Vice President Caroline Reynolds on the 2005 Fox television drama Prison Break. In 2012, Wettig joined the national tour for Larry Kramer's production of The Normal Heart. She is married to actor and producer Ken Olin; they have two children.

Dec. 5—Morgan Brittany

Dec. 5—Morgan Brittany

The actress is best known for her role as Katherine Wentworth, the scheming younger half-sister of Pamela Ewing and Cliff Barnes, in the prime time soap opera Dallas (1978-1991). Brittany began her career as a child actress in a 1957 episode of the CBS television network anthology series Playhouse 90 and was featured in the 1962 film Gypsy, as Baby June. At age 18, Brittany appeared with Gene Kelly in his Las Vegas show Gene Kelly's Wonderful World of Girls, as a dancer. After working as a model for several years, in 1976, Brittany portrayed Vivien Leigh in the biopic Gable and Lombard, the first of three occasions on which she would play the famous actress.

That was followed by TV movies and television shows, including The Amazing Howard Hughes (1977), The Initiation of Sarah (1978) and LBJ: The Early Years (1987). When she appeared again as Vivien Leigh in the 1980 made-for-TV movie The Scarlett O'Hara War, she caught the attention of the producers of Dallas, who were searching for an actress to play Wentworth. Brittany debuted on Dallas in the 1981-82 season, and her role as Katherine continued, on and off, until 1984.

She hosted over 100 episodes of the magazine show Photoplay, and has guest starred on other shows, including Married ... with Children; Murder, She Wrote; and The Nanny. In film, Brittany starred in the 1989 cult classic Sundown: The Vampire in Retreat. In the 1990s, Brittany appeared in independent films, including Riders in the Storm (1995), Legend of the Spirit Dog (1997) and Americanizing Shelley (2007).

Currently, Brittany is a conservative political commentator and author. Her first book, which was co-authored, What Women Really Want, was released in 2014. She is a recurring guest on Hannity (Fox News) and The Rick Amato Show (One America). Brittany is a co-owner and anchor for PolitiChicks, an online news site with a conservative perspective. She now spends much of her time supporting Republican political candidates and is involved in raising funds for military/veterans organizations.

Source: Wikipedia

FAMOUS & 65 is a featured article in the November 2016 Senior Spirit newsletter.

Blog posting provided by Society of Certified Senior Advisors

Saturday, December 3, 2016

Test Your Knowledge of Medicare

New approaches to Medicare, Medicaid and Social Security

As a new administration discusses a different approach to the federal health insurance program, check out some facts.

As a new administration and Congress talk about possible new approaches to Medicare, Medicaid and Social Security, how much do you know about Medicare? A quiz from the Kaiser Family Foundation tests your knowledge about the government’s health insurance program for seniors and others. For example, did you know that in 2014 half of all Medicare beneficiaries had annual incomes below $24,150 per person, including Social Security payments, pension income and earnings? Check out the quiz.

Blog posting provided by Society of Certified Senior Advisors

Thursday, December 1, 2016

Stronger Flu Vaccine Available Just for Seniors

Stronger Flu Vaccine Available Just for Seniors

Those over 65 are hardest hit by influenza,
so getting a flu shot is crucial.

It’s that time of year again—not the holidays but the flu season. You hear people coughing and sniffling all around you. Perhaps you have been hit with it yourself—staying in bed for days, your whole body aching.

How do you prevent the flu? The best way is to get a flu shot, which not only protects you but also helps prevent those around you from falling prey to this highly contagious disease. Flu protection is especially important for seniors. During recent flu seasons, between 80 and 90 percent of flu-related deaths occurred in people 65 years and older, according to the Centers for Disease Control (CDC). As we age, our immune systems become weaker and are not as able to fight the infection.

Influenza, which causes fever, coughing and muscle aches, can induce serious illness, including pneumonia and bronchitis. In older adults, respiratory disorders can lead to hospitalizations and sometimes death. A risk factor for the seasonal flu is dehydration, which is a serious condition for seniors.

Getting a Flu Shot

Studies have shown that those who are immunized are less likely to become seriously ill from this respiratory illness. One study showed that people 50 years and older who got a flu vaccine reduced their risk of getting hospitalized from influenza by 57 percent. Getting vaccinated can help prevent the flu or at least help lessen the severity and length of your illness.

Cost of Flu Shots

Seniors covered by Medicare Part B do not have to pay coinsurance or deductible fees for their flu shot, as long as they receive the shot from a Medicare provider. For others, most insurers are required to provide flu shots at no cost, according to requirements in the Affordable Care Act. Many insurers would rather pay for the flu shot than for the cost of you being sick.

If you don't have a regular healthcare provider, you can get a flu vaccine at other, sometimes more convenient, places such as a health department, pharmacy or urgent care clinic. Often, schools, college health centers or employers offer free shots to help keep their students or employees healthy.

If you have no insurance, you can get a flu shot at a chain store, such as Costco, which usually has cheaper prices than a doctor’s office. The government’s Vaccine Finder can help you find the store closest to you.

Different influenza strains circulate every year, so scientists determine which viruses will be most common that year. You need to get a flu shot every year because vaccine strains are updated annually and immunity lessens over time. Getting the shot early in the flu season is best, but you can get it anytime. Influenza season runs from October through March, but peaks in January. Time is important, because it takes the body about two weeks after vaccination to develop immunity protection.

Flu vaccines promote antibodies, which provide protection against infection. Traditional flu vaccines are made to protect against three viruses: influenza A (H1N1), influenza A (H3N2) and influenza B. Fortunately, those 65 and over are able to get an especially strong vaccine. Fluzone High-Dose vaccine contains four times the amount of antigen (the part of the vaccine that prompts the body to make antibodies) contained in regular flu shots, which should boost the body’s immune response. A study published in the New England Journal of Medicine indicated that the high-dose vaccine was 24.2 percent more effective in preventing flu in adults 65 years of age and older than a standard-dose vaccine.

Symptoms of the Flu

You may have the flu if you have some or all of these symptoms:

  • fever

  • cough

  • sore throat

  • runny or stuffy nose

  • body aches

  • headache

  • chills

  • fatigue

  • sometimes diarrhea and vomiting

How to Prevent the Flu

While vaccination is the most important flu prevention, it's only 70 to 90 percent effective, so some who receive the vaccination will still get sick. One of the scary aspects of the flu is that you can get it just by touching a contaminated object such as a door handle or shopping cart, that someone with the flu touched. Besides the flu shot, other actions can keep you and those around you safe:

  • Avoid close contact with people who are sick. When you are ill, keep your distance from others to protect them from getting sick too.

  • Stay home when you are sick to help prevent spreading your illness to others.

  • Cover your mouth and nose with a tissue when coughing or sneezing.

  • Clean your hands to help protect against germs. If soap and water are not available, use an alcohol-based hand rub.

  • Avoid touching your eyes, nose or mouth. Germs are often spread when a person touches something that is contaminated with germs and then touches their eyes, nose or mouth.

If you get the flu, make sure to get plenty of sleep and drink a lot of fluids. The CDC recommends that you stay home for at least 24 hours after your fever is gone. In severe cases, your physician may prescribe Tamiflu or Relenza, which are anti-viral medications that can limit the severity of the influenza infection and shorten symptoms’ duration. However, for these medications to be effective, you must take them within 48 hours of the onset of flu symptoms.


What you should know and do this flu season if you are 65 years or older,” Council on Aging.

Flu + You” National Council on Aging.

Senior Flu Prevention and Taking Care of the Elderly,” May 6, 2015, A Place for Mom.

The Flu: What to Do If You Get Sick” CDC.

Key Facts About Seasonal Flu Vaccine,” CDC.

Preventing the Flu: Good Health Habits Can Help Stop Germs,” CDC.

What’s New for the Flu in 2016,” Oct. 19, 2016, Next Avenue.

Blog posting provided by Society of Certified Senior Advisors

Tuesday, November 29, 2016

Choosing a Long-Term Care Residence

Choosing a Long-Term Care Residence

Ask These Questions When Choosing a Long-Term Care Residence

Making the decision to move from independent or assisted living into a long-term care residence is usually never easy. But asking the questions below can help you sort through the available choices and select the best long-term care residence for your situation.

You can find long-term care residences in your zip code area on Medicare’s website, rated for quality. A five-star quality rating system gives an overall picture of individual residences and points out meaningful differences among them:

If possible, visit residences and meet their staffs. In your conversations, be sure to cover these questions:


Facility Certification

  • Is the residence Medicare-approved (certified)?


Staff Credentials

  • Is the nursing home administrator licensed by the state?

  • Does the staff possess the necessary credentials to qualify for their professions?

  • Is licensed staff on duty, including an RN for all shifts?

  • Which level of staff is available to deal with social service needs?

  • Is a licensed physician on duty during the day and on call at night?



  • Are beds currently available? If not, how long is the waiting list?

  • Is there a memory unit for those with dementia, as well as a unit for those who depend on a ventilator?



  • Is the residence close enough for family and friends to visit?

  • What are the visiting hours?


Quality of Care

  • Is a quality of care report available?

  • How are any deficiencies being addressed?

  • Are the residents clean, well-groomed, and appropriately dressed?

  • Is the facility clean and free of overwhelming or unpleasant odors?



  • Are there enough appropriate activities?

  • Is the temperature comfortable?

  • Are furnishings comfortable, homelike, and safe for residents and visitors?

  • Are nutritious snacks available throughout the day?

  • Is water readily available at all times?



  • Does the residence conduct background checks (including criminal checks) on all staff at the time of hire?

  • Does the residence provide ongoing education and training for staff on topics such as recognizing elder abuse, fall prevention, and other age-appropriate topics?

  • How does the relationship between staff and residents appear: warm, polite, and respectful?

  • What is the staffing ratio of CNAs to residents?


Provided Services

  • Does the residence provide rehabilitative services, including physical, occupational, and speech therapies?

  • Does the residence provide activities that promote healing and quality of life, including music and art therapies?

  • Do the residents have a choice in when and what to eat or in their daily routine?

  • Does the residence have an arrangement with a nearby hospital in case of emergency?



Society of Certified Senior Advisors, Working with Older Adults: A Professional’s Guide to Contemporary Issues of Aging (2015).

The Working with Older Adults course offered by the Society of Certified Senior Advisors gives professionals a practical, comprehensive understanding of health, social and financial issues that are important to many older adults, including ethical issues specific to aging. For more information, or to enroll in a class, click here.

Wednesday, November 23, 2016

Tax Deductions for Home Health Care

Tax Deductions for Home Health Care

Many older adults want to stay in their own homes but cannot do so because of health or other reasons. A home health care agency might be able to help them find an aide to come to their homes for a certain period each day or on some other set schedule.

Who pays the home health care aide determines the tax issues for the older adult. Therefore, when an aide is hired, the method of payment needs to be discussed before the hiring occurs.

Home Health Care Aides as Agency Employees

How the aide is paid might depend on the practice in the older adult’s region of the country. Some home health care agencies pay aides as employees; contracts are then between the agency and clients, who pay the agency directly. The caregiver (the aide) is not part of the payment arrangement. The agency submits a bill to the client and prepares a paycheck for the aide.

This arrangement is the easiest way for an older adult to pay for help, and the agency’s invoices provide proof of the medical expense for tax purposes. The older person does not need to keep paperwork other than the service contract with the home health care agency and payment receipts.

Home Health Care Aides Hired Directly by the Older Adult

In some cases, the home health care agency provides the older adult with a list of possible aides; the older adult then hires an aide and pays the agency a finder’s fee.

In this situation, the relationship between the agency and the older adult usually ends there. The older adult is an independent employer and must pay the aide directly; and pay the employer’s portion of FICA, Social Security, and Medicare taxes; and withhold the employee’s portion of these taxes from the aide’s payments.

In certain cases, depending on the amount paid to the aide, the older adult must also issue a W-2. The older adult must also follow specific rules to deduct the payments to the aide as a medical expense.

The invoices submitted by the health aide must state the charges for various services; not all services are deductible medical expenses. For example, housecleaning, driving to the grocery store or completing errands, or making phone calls for the older person are not deductible medical expenses.

In all cases, remember that home health care expenses that have been reimbursed (for example, by Medicare, Medicaid or long-term care insurance) are not eligible for income tax deductions.

Consult with a qualified tax expert to identify reimbursable health care and medical expenses that you are allowed based on your adjusted gross income (AGI). Certain medical expenses that exceed 7.5 percent of AGI are tax deductible for those 65 or older who itemize through December 31, 2016; then the threshold becomes 10 percent.



Gordon, Paul. "Special Issue Brief. Medical Expense Tax Deductions: A Guide for Senior Living Providers and Residents," The American Seniors Housing Association (Summer 2012).

Internal Revenue Service.

Society of Certified Senior Advisors, Working with Older Adults: A Professional’s Guide to Contemporary Issues of Aging (2015).

"Tax Aide Program," AARP.

"Proposed New Requirements for Tax Return Preparers," Tax Information for Tax Professionals (2010).

TaxBook 1040 Edition (2012). 2012 Tax Year. Minnetonka, MN: Tax Materials Inc.

The Working with Older Adults course offered by the Society of Certified Senior Advisors gives professionals a practical, comprehensive understanding of health, social and financial issues that are important to many older adults, including ethical issues specific to aging. For more information, or to enroll in a class, click here.