Family Care Agreements - Opportunities for Aging Life Care Professionals® and Our Clients

by Deborah Liss Fins

Most Aging Life Care Professionals will recognize the following scenario:

Mr. and Mrs. K. are in their early 90s and live alone in their own home. Mrs. K. Is physically frail but cognitively intact following a stroke and requires assistance with bathing, dressing, medication management, meal preparation, groceries and toileting. Mr. K. has mild-to-moderate dementia, macular degeneration, and prostate problems and requires on-going supervision and cuing to complete tasks.

They have three children: daughter, Mary, provides assistance daily from 6:30 a.m. to 8 p.m. and one son, Mike, does all of the financial management tasks. A third son lives out of the area but does provide emotional support. Mary had been working part time as a school occupational therapist but has given up her job to care for her parents. The family had been unhappy with the care their parents each received during stays in rehabilitation facilities, and they are committed to keeping their parents home as long as possible.

Mary and Mike meet with an elder law attorney seeking guidance regarding estate planning and also speak openly about Mary’s need for some income and respite. They want to understand other community care options for which the K’s may be eligible. Mr. and Mrs. K. have stated that they understand what Mary has sacrificed, and they want to compensate her.

As elder care has become more complex, families are doing more and families are considering compensation for care that they or other family members provide to elderly loved ones. In addition, care recipients often want more control in choosing their care providers. States such as Massachusetts and others recognize the wish for consumer-directed care and have initiated programs to support this. The Personal Care Assistant (PCA) and Adult Family Care programs, both here in Massachusetts, provide state funds to allow recipients to either hire their own caregivers or for caregivers to be paid for care that they are providing. Care providers can be family members other than spouses or persons legally responsible to provide care, such as parents of minor children or legal guardians.

If the states are paying family members to provide care to loved ones, why shouldn’t elders privately enter into similar arrangements with family members? This article will review family care or personal service agreements, explore the supporting assessment and valuation of services, and discuss the collaborative possibilities for Aging Life Care professionals and elder law attorneys. The personal service agreement may be a formal contract. Contracts are legal documents. Given the space constraints, all of the potential legal issues will not be discussed, and readers are advised to obtain legal counsel before proceeding with a personal care contract on behalf of a client.

What is a family care agreement or contract? It is an agreement between two people, the provider of the services and the recipient of services, which defines the services to be provided and the compensation to be paid. Contracts or written agreements are recommended because they clarify the expectations of both parties as to the care to be provided, the responsibilities of the caregiver, and the compensation to be paid. It also provides documentation for other family members to avoid misunderstandings, especially when estates are settled after the death of the elder. These contracts or agreements may also be used to document that payments to caregivers are wages, not gifts, if there is a Medicaid application in the future.

Agree,emts may be initiated by the attorney, the Aging Life Care Professional during the course of work with a family, the caregiver, the caregiver’s family, or the care recipient.

What is the role of the Aging Life Care Professional in family care agreements? Because the agreement must outline the services to be provided and the price to be paid, it should be based on a professional assessment which describes

• The care recipient’s current situation - a narrative description of the client’s situation and background, the family response, the need for services and how they have been provided to date. This is the place for the Aging Life Care Professional to tell the client’s and caregiver’s story.
• The care recipient’s functional capacity to perform ADLs and IADLs - assessments should break these out in some detail.
• How services are provided and by whom, including how much time that it takes to perform these services, and whether tasks are shared with others.
• The costs to the caregiver including financial, time, health, lifestyle changes.
• The valuation of the services provided using local cost comparisons - assessments may offer several different models to consider (hourly, daily, weekly costs; live-in versus awake/overnight; agency vs. private rates); this is probably the most important piece of the assessment as it is used to set the compensation in the agreement.

The assessment process also offers the opportunity to discuss other possible services that could benefit the client and can turn into ongoing care management work. The ability to produce concise, useful assessment documents and valuations is a niche for Aging Life Care Professionals to consider adding to their practice toolbox and to market to elder law attorneys in their service area.

Debora Liss Fins, LICSW, CMC is President of Deborah Fins Associates, PC