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What Are Caregiver Assignments?

It is common for a family member to be the caregiver for an elderly or disabled loved one. A caregiver assignment is a legal document that defines, describes, and details how a loved one will be cared for by a family member or an outside party, such as a nursing home or visiting medical professional.

A caregiver assignment can help ensure that all family members agree and understand the type, cost, and legalities of keeping elderly care within the family or externally through a nursing home or other provider. The caregiver assignment can also address potential Medicaid requirements and other complex legal and financial issues that impact a person’s ability to receive Medicaid. The caregiver assignment is drafted by an attorney, signed, and notarized by all parties and family members involved, including the care recipient.

A caregiver assignment is a valuable tool to ensure that the loved one is getting the best care possible by the family or medical professional. It also helps protect the caregiver, explicitly defining how much the caregiver will be paid, the plan of action for care, and the details about care, such as timing, responsibilities, and costs. A caregiver assignment can help families avoid feuds, surprises, and financial worries. There are strict rules and complex requirements that need to be understood and addressed in the assignment, especially regarding Medicaid planning and estate planning.


How Is a Caregiver Assignment Created?

It is important to talk to all family members who will be involved to ensure they will participate in a family meeting. Find a good date and time that works for everyone. If a family member cannot attend in person, try to schedule a conference call or video meeting. If none of these options work, be sure to solicit their opinions. Everyone in the family must have a voice and be in agreement, even if they are not directly providing the care to the loved one. It is vital to communicate beforehand what will be discussed so participants know what to expect.

Common topics include the following:

  • Which family members will be responsible for care.
  • Days and hours each of these family members are available.
  • Type of care each can provide.
  • Amount of money caregiver will be paid, and whether other benefits will be provided.
  • External support or resources needed.
  • Timeline and schedule for doctor visits and other known appointments or recurring activities.
  • Where the caregiver will stay or live while providing care, and where the person being cared for will live.
  • Legal and financial considerations.
  • Start and end dates, frequency of care.
  • Back-up plans for caregiver absence.

Having a lawyer from the start can save a lot of worry about legal, financial, and estate planning issues. They can draft the caregiver assignment and other legal documents to protect the family and the person receiving care. They can also ensure compliance with Medicaid regulations.

What Is Included in a Caregiver Assignment?

A caregiver agreement should include the following:


Legal Plan

Hiring a lawyer will help one better understand the legal implications of a family member providing care. This is particularly crucial when Medicaid may be needed and when the compensation is in the form of a gift to the caregiver. An attorney can help families navigate the complex rules and strict financial requirements regarding Medicaid, estate planning, gifts, compensation, and caregiving in general. Most of all, a legal plan drafted by a lawyer can give all family members peace of mind.


Financial Plan

It is a good idea to consult an accountant to understand whether employment taxes need to be paid and where caregiver payments will come from. There may be tax and other considerations if payment is coming from the loved one’s estate in the form of compensation or a gift. The financial plan should also include how much the caregiver will be paid. Find out the going rates for caregiving services in the local area to help establish caregiver payments. Also decide how often the caregiver will be paid and whether they will receive other benefits, such as sick days or vacation time. Also address how expenses will be tracked and paid by the caregiver and how they will be reimbursed. Document the loved one’s current insurance, and make sure the caregiver understands how their income will be taxed and reported to the Internal Revenue Service (IRS).


Care Plan

A caregiver assignment should include a detailed plan of care:

  • Who will provide the care, the type of care, and the frequency of care. Establish days, hours, and other timelines and schedules for caregiving services.
  • The obligations of all family members, whether or not they provide direct care.
  • A list of external resources for medical care, medical equipment, finances, and other providers. Include contact names and phone numbers.
  • A list of all medications, including when they need to be taken and dosages. This should be provided to all family members in case the primary caregiver is absent.
  • An understanding of the loved one’s current insurance coverage, premiums, deductibles, and co-pays.


Plan for the Future

As a loved one’s physical, mental or financial situation changes, there should be a plan to address these changes, including:

  • Suitable assisted living, memory care, or other medical facilities. Note whether they accept new patients, how long the wait might be, and the costs. This will require family members to visit facilities and perform other research up front.
  • A list of external care providers and caregiving services. This includes visiting nurses, physical or occupational therapists, and other medical professionals.
  • A back-up plan. It is important to prepare for future problems.
  • A summary of medical history. A doctor’s summary of patient’s current and future medical prognoses.
  • Legal information related to estate planning, guardianships, and disability planning. This is where the counsel of a lawyer will be invaluable.


Plan for Medicaid

A lawyer can provide valuable insight into the complex and strict requirements for Medicaid, should moving into a care facility be necessary. An attorney can also assist with the Medicaid application, Medicaid fair hearings, and myriad financial requirements and limitations.


How Often Should the Caregiver Assignment be Updated?

Update the caregiver assignment whenever the needs of the loved one being care for changes. This include financial and health care needs. Also, update the caregiver assignment as family member responsibilities change. At the minimum, update the assignment yearly.


What if Family Members Will Not Cooperate or Disagree?

The subject of care of an elderly parent or other loved one is naturally filled with emotion. There may also be family-related issues or disagreements on costs of care. In these cases, an attorney can act as a resource for facts, figures, and information that is not influenced by family dynamics. In some cases, a family may even decide to hire a mediator to help navigate family disagreements.


Can a Family Create a Caregiver Assignment?

A family member can construct a caregiver assignment, but it will not be a legally binding document. Also, a lawyer knows the ins and outs of estate planning, paying for care, Medicaid limitations, and tax consequences. It is in the family’s best interest to consider an attorney.


Why Caregiver Assignments Are Important

Caregiver assignments are an invaluable tool for making sure that a loved one receives the best care possible from both family members as well as medical providers. These documents can also perform the invaluable role of protecting caregivers by performing the necessary task of describing how much a caregiver should receive as well as the plan of action for such care. Caregiver assignments also often perform a valuable role in avoiding family conflicts.


Tips to Remember When Selecting a Caregiver or Assisted Living

The reversal of roles in the parent-child relationship, from the parent being the provider to the parent being dependent on his or her child, is a change that can be difficult for both. This is made even more difficult when it becomes apparent that the parent(s) can no longer live on their own, and now need around the clock care.

Approximately 6-7 million people (friends, family, neighbors) in the US provide care to a person that is 65+ who needs assistance with every day activities, with the vast majority – 80% – of elderly people, receiving assistance at live-in private homes and not in the community. Many of those receiving care will eventually require the type of “around the clock” assistance that can only be provided by full-time caregivers and/or assisted living facilities

Caring for an elderly parent is not only physically demanding but can also have its financial burdens. It can also cause disagreements between family members over who takes care of what and deciding the best courses of action to take. Eventually there may come a time when you have to make a decision whether to hire extra or full-time help or move your parent(s) into a residential care facility.

Whether you are choosing between hiring an in-home caregiver or are researching local assisted living facilities, before taking action in most situations, it’s wise to include other members of the family in the decision-making process. Talk to your parents about any new living arrangements as well as any siblings or other family members that are planning to help. Lack of inclusion may cause potential conflict down the road. Remember, communication is the best prevention of future disagreements. Below are a few additional tips to consider when researching caregivers and/or assisted living facilities.


  1. Understand Their Needs

Before you start researching, understand what your parents needs have. Start by making a list of what their living situation is currently like:

  • Are they able to get around on their own or are you worried that they may fall when they are alone?
  • Are they mentally competent but need to be driven to appointments as well as other daily errands?
  • Can they cook for themselves or do they need someone to meal-prep?

There is a difference between what is wanted and what is needed. Understanding their everyday needs will go a long way in determining what type of care is required. Again, communication is key. The best way to understanding needs is by having meaningful conversations with your parents. Ask them what they are looking for and what they fear. Be cognizant of their opinions and accept differences in opinions without criticism. Always try to stay positive.

  1. Affordability

It is important to assess your financial situation first. In an ideal world, you would hire the best care providers for your parents that money can buy, however that is often not possible. With rising costs of care, including residential facilities, having a sound financial plan is of paramount importance. Once you have discussed with your family the plan that is in everyone’s best interests, sit down and talk about financial options with your parents and/or experienced legal counsel. If you are worried about care finances, read this previous article on helping aging parents pay for care.

  1. Watch for Red Flags

Whether you are looking at hiring a personal caregiver or are touring local senior care facilities, it is important to do your due diligence first. Remember too that you are looking at care for your parents, not for yourself. What may seem right to you, may feel completely wrong to them. When you are looking at assisted living, don’t be afraid to ask blunt questions or speak your concerns. Study the quality of the environment, talk with residents to see what living there is like for them. If something seems off, it is perfectly okay to move on to other options. Always remember to use state resources to determine if there have been complaints against facilities or those licensed to provide care. If you are looking at hiring a caregiver through an agency, ask about and review background checks that they have done: it is your right to learn all you can. If you are hiring yourself, ask around and get referrals. In other words, do your homework!

  1. Make A Decision

To reiterate a reoccurring theme, communication is the foundation to good decisions. When arriving at a decision, involve your parents, siblings, and other family members. Discuss the reasons behind the decision you have made and involve others in that decision-making process. Create a check list of positives and negatives and remind all involved that, if a decision does not appear to be working out, changes can always be made. Finally, make sure you have a timeline and action plan to ensure everything is in order to facilitate the new move.

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