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Old 01-14-2010, 10:31 PM
 
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I just got word that the skilled nursing hospital my mother has been staying at for the last two years (starting her third next month) intends to raise their daily rates by $15 from $160 to $175 (second raise in two years) My mother keeps saying she wants to go home. Maybe this time I'll have to let her. Of course I'll have to hire someone to stay with her 24/7. I don't want to go through an agency because of course they will charge triple the going rate of hiring privately. Has anyone here had some experience with running an ad for and hiring a live-in aide? I know I have to do a criminal background and credit check as well as get an idea if there are any criminals in the hire's immediate family, at least the ones she will be keeping in contact with. As she will living in 24/7 the room and board should be worth some compensation but I'm figuring about 50k a year. I could use lots of guidance from people who are in the know about this stuff. Thanks much for any advice/suggestions.
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Old 01-14-2010, 10:39 PM
NCN
 
Location: NC/SC Border Patrol
21,135 posts, read 21,878,713 times
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Is she in need of constant medical help, or just someone to be a companion? If they don't need to be medically experienced, I am wondering if you might find a family who is having problems because of layoffs and maybe they would trade off living space for loving care. It might be tough to find, but if you could, it might save a lot of money.

When my sister-in-law finally put her mother in a home, she explained to us that the home cost less than the 24/7 care she required when she lived in her home.

My mil could be very difficult to deal with because she had a form of Parkinson's disease and it made her very stubborn. One worker got upset and just walked out, leaving her without care. That was when my sil decided a professional home would have to be the choice. At least there, someone would always be around. And she started giving the workers that were hired in her home presents. Luckily they were honest and alerted my sil about this.

Council on Aging is an organization that might help you make choices.

Last edited by NCN; 01-14-2010 at 10:49 PM..
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Old 01-14-2010, 11:11 PM
GLS
 
1,985 posts, read 4,846,113 times
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Quote:
Originally Posted by thrillobyte View Post
I just got word that the skilled nursing hospital my mother has been staying at for the last two years (starting her third next month) intends to raise their daily rates by $15 from $160 to $175 (second raise in two years) My mother keeps saying she wants to go home. Maybe this time I'll have to let her. Of course I'll have to hire someone to stay with her 24/7. I don't want to go through an agency because of course they will charge triple the going rate of hiring privately. Has anyone here had some experience with running an ad for and hiring a live-in aide? I know I have to do a criminal background and credit check as well as get an idea if there are any criminals in the hire's immediate family, at least the ones she will be keeping in contact with. As she will living in 24/7 the room and board should be worth some compensation but I'm figuring about 50k a year. I could use lots of guidance from people who are in the know about this stuff. Thanks much for any advice/suggestions.
Your post provides no medical background or diagnoses. If she has met medical necessity for "SKILLED" nursing facility placement, she may not be appropriate for CNA level care. I would begin with discussing her level of care with her physician. It is possible that she would be an appropriate placement for an assisted living facility. If she is ambulatory she may need to be one step down from a SNF, i.e. in an ICF. If you discharge her to home, she may need a licensed Nurse vs a CNA.

Without undue speculation, I hope I have listed enough questions to illustrate the complexity of the decision for appropriate placement. Although many family members are prompted to make a more practical financial decision when Nursing facilities increase rates, the primary consideration should be clinical. Any mistake in assessing quality of care will magnify financial burdens down the road. Another resorce to cofer with is the SNF Ombudsman and the facility's Discharge Planner. Good luck.
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Old 01-15-2010, 08:49 AM
 
11,235 posts, read 11,256,867 times
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In response to the question posed:

Quote:
Is she in need of constant medical help, or just someone to be a companion?
She's ambulatory, in control of her mental, though she has moderate short-term-memory loss (repeats a few minutes after she says something-long term is good) She needs someone to supervise her meds or she disobeys the doc's instructions re dosages. She can cook but needs someone there to make sure she turns the stove off and assist if she needs help getting in and out of shower w/o falling.

Quote:
I am wondering if you might find a family
Tried that route. Big family but nobody's interested.

Quote:
home cost less than the 24/7 care she required when she lived in her home.
At the rate they're raising costs that won't be true for long. And she's always saying she wants to go home. I figure it's just a matter of time before she demands to, especially when i mention that they raised the rates again.

Quote:
And she started giving the workers that were hired in her home presents
That's one of my main concerns---that they'd might try to get her to sign over a piece of property she has. I'd make sure i had all powers over her finances to prevent this.

Quote:
an appropriate placement for an assisted living facility.
That'd be the ideal situation but she won't consider one. She insists she's fine to go home.

So besides the criminal and credit checks and sizing up for good vibes during the interview any other considerations re the aide herself i should be aware of. one big question: can I hire her on a contract basis so I don't have to tangle with SS and deductions and things related to taxes?
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Old 01-15-2010, 09:32 AM
GLS
 
1,985 posts, read 4,846,113 times
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Quote:
Originally Posted by thrillobyte View Post
...........So besides the criminal and credit checks and sizing up for good vibes during the interview any other considerations re the aide herself i should be aware of. one big question: can I hire her on a contract basis so I don't have to tangle with SS and deductions and things related to taxes?
The CNA would have to be set up as an "independent contractor", i.e. have a business license and legally structured as a sole proprietorship, partnership, or inc. Chances are you won't find many single individuals doing this because they become responsible for BOTH the employer and the employees share of SS, etc. and there isn't enough profit on a small scale to offset the overhead and government restrictive costs.

One option is to consider a Nursing agency that sends out CNAs or LVNs. The downside is they are expensive. The upside is that they do the footwork of background screening, interviewing, hiring, and keeping track of families feedback on performance. They also are responsible for the taxes being paid.

As a person who was the primary psychopharmacology consultant for the State of California's assisted living facilities for 14 years, I can tell you that finding qualified help for a reasonable cost is a daunting task. You will need to closely monitor anyone you let in your home for clinical competence,
bedside manner, and honesty. Good luck.
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Old 01-15-2010, 12:19 PM
 
11,235 posts, read 11,256,867 times
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Quote:
Originally Posted by GLS View Post
As a person who was the primary psychopharmacology consultant for the State of California's assisted living facilities for 14 years, I can tell you that finding qualified help for a reasonable cost is a daunting task. You will need to closely monitor anyone you let in your home for clinical competence,
bedside manner, and honesty. Good luck.
Thank you much for the extremely helpful advice. Tough as this is for me it pales in comparison to what others are experiencing. I cannot imagine going through what others who don't have the means are going through to provide careful, loving care for their aged relations. Just that alone is daunting.

As an afterthought a good idea for a sub-forum here would be retirees caring for aged parents. Don't know how much traffic it'd get but it seems to me that millions are facing these exact same problems all over the world as the boomers retire and their parents get into their 80's ands 90's.

Last edited by thrillobyte; 01-15-2010 at 12:26 PM.. Reason: addition
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Old 01-15-2010, 08:09 PM
 
Location: SoCal desert
8,093 posts, read 13,227,512 times
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Maybe you can get some ideas/help from this site -- Care.com

I've never used them, but they do have guides you can read for free without signing up.

When my Dad needed help, I got a list of companies from the hospital, plus talked to the local Visiting Nurses organization and the Council on Aging and even called Hospice Care. Just talking to them helped the family to figure out what to do. And they were all up front about costs, it never hurts to ask.
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Old 01-15-2010, 11:50 PM
 
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Thanks much, Gandalara. I will definitely check out that site come Monday.
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Old 01-16-2010, 07:59 AM
 
5,090 posts, read 13,543,532 times
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Quote:
Originally Posted by GLS View Post
Your post provides no medical background or diagnoses. If she has met medical necessity for "SKILLED" nursing facility placement, she may not be appropriate for CNA level care. I would begin with discussing her level of care with her physician. It is possible that she would be an appropriate placement for an assisted living facility. If she is ambulatory she may need to be one step down from a SNF, i.e. in an ICF. If you discharge her to home, she may need a licensed Nurse vs a CNA.

Without undue speculation, I hope I have listed enough questions to illustrate the complexity of the decision for appropriate placement. Although many family members are prompted to make a more practical financial decision when Nursing facilities increase rates, the primary consideration should be clinical. Any mistake in assessing quality of care will magnify financial burdens down the road. Another resorce to cofer with is the SNF Ombudsman and the facility's Discharge Planner. Good luck.
I think you are getting good advice on this thread. This response is one of the best because you must first determine her level of care and certainly get the advice from a professional who knows the options that are available.

I strongly suggest you look into the PACE program under Medicare which will allow you to keep her at home with more financial and care assistance
Overview Program of All Inclusive Care for the Elderly (PACE)
This is an example of one type of program that a professional advocate would direct you to seek help.

My mother is now in long term nursing care, after a stroke and a heart attack. Her paralysis is permanent and extensive. It is impossible to care for her without extensive skilled nursing care.
She is now in a suite, which to me is just a little larger private room, and the cost is $255 a day plus supplies. Yes, it is expensive but when you look at the cost at an hourly basis is comes to $10.63 an hour. Semi-private is $213 a day. A private room is $230 a day which I would have selected but it was not available. That cost is reasonably considering she has multiple CNAs and Nurses immediately available that are supervised by more highly trained nurse managers. The full range of medical equipment is available, bed, lifts, emergency equipment, laundry etc. She has support of full time staff of social workers, food service, dieticians, recreation etc.

The facility that has a large rehabilitative unit that provides the more extensive skilled nursing care under Medicare SNF benefits. Consequently, there is an large in house staff of that provide rehabilitation and speech therapy. In addition, she is a Kaiser Patient which has a big contract with the facility; the MD and NP have their own office and are there every day with 24 hour full medical support from Kaiser. In addition, Pharmacy services are provided; mobile x-ray, lab work etc.

It would be impossible to provide that type of care and support at home. If you are wealthy and can hire an RN and a CNA full time, it would cost thousands a day; then you would still not have the extensive additional support. Also, you have to look at the most dire cost of support at home and that is the emotional strain of providing care at home. Yes, you can get some respite care from Medicare (and you should look into that further) but it is not extensive and is just temporary relief.

If you are poor, then you all cost will be covered by Medicaid. If you are wealthy, it is not a problem. It is the middle class that will suffer the severe financial burden for nursing home care. So, perhaps good financial planning is to remain poor. Do not think that you can spend all your money and always get Medicaid because a high monthly pension would still disallow you for Medicaid. In addition, become a Military Veteran so you will have more options for care but again your wealth/pensions with put you on the bottom on the list. If you are physically injured in the military, you will get a higher disability rating and then you will be on the top of the list for the the limited care available--which, of course, should be the case.

I have looked at many nursing homes and the range, I have seen for semi-private rooms are about $165 to $280 a day with more extreme costs at the private room and suite level of about $220-$430 a day. Just finding any room is difficult and all private rooms have large waiting list. In nursing home care, it is so clear, by sight and smell, that you get what you pay for. I was surprised to find that many non-profit are more expensive than profit nursing homes at the lower tier of rates, yet the for profit corporate homes had more superior facilities to any non-profit that I have seen. Obviously, at the higher room rates, it is all for profit. There are non-profit homes that are complete Medicaid homes that you would once call "Charity Homes"; I found these homes actually very nice---most are run by good religious communities, like the Sisters of the Poor.

I will tell you a little secret, you can find any room and it will become immediately available to you, if you have the money to be able to afford Private Pay. So, this is the time to flaunt your assets. Nursing homes can only operate on a certain percentage of Medicaid, which pays less, or they would go broke. They do not prefer if the patient is converted to Medicaid, when they exhaust their assets, because they cannot kick them out. They like and need Private Pay, which will never buy down to Medicaid, and guarantees a much higher revenue stream.

Livecontent

Last edited by livecontent; 01-16-2010 at 09:23 AM..
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Old 01-16-2010, 09:20 AM
 
Location: Oxygen Ln. AZ
9,321 posts, read 16,575,490 times
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Your mom sounds like she is in the same shape as my 94 year old mom. I watch her meds, help her with her showers and do not let her cook. I work at home so it is not a big deal for me to help her right now. My point is, she was living in an assisted living facility until she decided she wanted to make bail and come back home for awhile. You may be able to put your mom in assisted living and that would be a lot cheaper than skilled nursing. Not sure why she would be in SN if she is ambulatory and only has short term memory issues.
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