Your Eldercare Compass
Helpful tips for family caregivers

Getting paid to care for Mom or Dad

Many families choose to have a family member care for an aging parent. It seems like the “natural” thing to do. But all too often, unspoken assumptions lead to family conflict. For instance, when is caring done “for love”? At what point should a family member get paid for their time? What if they have to cut back on income-earning activities in order to help?

A good solution is to prepare a written “caregiver agreement” before the first dollar is paid.

• Assess the need. Consider hiring a geriatric care manager. He or she can assess how much help your loved one needs. Having an impartial professional’s evaluation can temper disagreement.
• Define the job. Write a job description that identifies the family caregiver’s duties. What are the hours? The wages? Build time off into the plan. No one should be on “24/7.” Identify tasks that the family caregiver is not willing or able to perform, such as bed baths or toilet care.
• Get everyone’s input. You want all family members to be on the same page. Don’t forget to include the person being cared for!
• Check into government programs. A geriatric care manager can advise you regarding subsidies for paying family caregivers.
• Account for the money. Ideally, someone other than the family caregiver should pay the household bills and wages. And don’t forget about the IRS! There are state and federal rules for hiring a relative as a household employee.
• Look ahead and consider an exit strategy. Sometimes things don’t work out the way you think they will. Make sure each party has the ability to give notice and terminate the agreement.

Treat the caregiver agreement as a formal employment contract. An elder law attorney can add important details so you avoid problems later.

What is a hospitalist?

If your loved one gets admitted into the hospital, they may be disappointed that their primary care doctor is not the physician taking care of them. Instead, their care will be coordinated by a “hospitalist.” This is a doctor who specializes in caring for patients during a hospitalization.

Like most specialists, hospitalists have had many years of schooling (up to nine or ten). They have a medical degree and have completed a residency. They may even have gone on to a fellowship afterwards. The main difference is that they do not practice in an office in the community. They work only in the hospital.

Hospitalists are experts in handling acute illness. Unlike a primary care physician, hospitalists are part of the hospital’s staff. They can help your loved one recover faster and return home sooner because of their

• 24-hour availability. Hospitalists can respond quickly to changes in your relative’s condition
• knowledge of the hospital’s systems and procedures
• more-frequent contact with family members during the course of the day
• coordination of care with other professionals

Of course, the hospitalist won’t know your loved one’s personality or preferences. And they may not have access to your loved one’s detailed medical history. But the hospitalist’s job includes connecting with your relative’s regular doctors. And with electronic medical records, the hospitalist may be able to access the community doctors’ treatment notes.

You can help provide continuity by following these steps:

• Discuss medications. Bring the drugs from home. Or provide a complete list of everything your relative takes. Don’t forget vitamins and over-the-counter drugs. And let the hospitalist know of any drug allergies or adverse reactions in the past.
• Exchange contact information. Ask to meet the hospitalist. (There may be more than one assigned to your relative. Hospitalists work in shifts. But they are very sophisticated in their ability to transfer information to each other.) Explain that you will be handling your loved one’s care following discharge. Request to be contacted with updates during the stay. Also give the hospitalist the names and contact information of the community doctors regularly involved in your relative’s care.
• Contact community doctors. Call your relative’s regular doctors (primary care physician and any pertinent specialists). Let them know your loved one is in the hospital. Give them the hospitalist’s contact information. Most important, make an appointment to see the primary care doctor a week or two after your loved one is discharged.

When depression goes untreated

As Bette Davis said, “Old age is no place for sissies.” Aging often brings loss and change. Usually people can adjust. But sometimes the changes can be too much and trigger depression. (See last month’s article about the signs of depression.)

Left untreated, depression in older adults can lead to other serious problems.

• Slow recovery from injury or illness.
• Poor medication management, resulting in hospitalization.
• Social isolation, leading to overuse of alcohol and increased risk of falls.
• Dependence and the loss of ability to live independently.
• Suicide (which is more common in seniors than in any other adult age group).

And yet, many older adults are hesitant to talk about their symptoms with a doctor. There are several possible reasons.

• Stigma of depression. Some elders believe that becoming depressed is their “fault.” They feel it is the result of personal inadequacy. Your relative may not know that depression is an illness affecting nearly 20% of those over age 65. This information may help your relative feel more comfortable asking for help.
• Fear of an incurable disease. Your loved one may believe that his or her fuzzy thinking or lack of energy is a sign of Alzheimer’s, cancer, or some other illness. While talking with the doctor, however, he or she may be relieved to learn that it is depression and is quite treatable. The doctor may even find that the symptoms are actually something as simple as side effects of a prescribed drug.
• Hope for improvement. Wishful thinking is another reason your relative may be stalling about an appointment. He or she may believe that the blues “will just go away.” In fact, depression needs treatment.

Approach the topic with sensitivity. But also keep in mind that it’s worth it to strongly encourage your loved one to talk with a medical professional or counselor. You don’t want to leave depression untreated.