Help isn't an easy thing to ask for, especially for us Yankees.  Sometimes, help isn't an easy thing to find even if you would ask for it.  This article, written during Valentine's Week, is my Valentine for all the caregivers out there - the heroism and heart you show daily in caring for your loved one is humbling, and you should never have to go it alone.  Portions of this article were reprinted with the permission of the National Care Planning Council (www.planforcare.org).

Most caregivers are reluctantly thrust into their role without preparation because the need for care usually comes with little warning. Caregivers end up operating in a "crisis" mode--arranging medical care and living arrangements, scheduling care time, providing meals and household chores and so forth. Because they are so stressed and burdened, they rarely take time to find out what resources are available to help them. Ironically, caregivers often sever ties with family, friends and support groups about this time just when help from these people is most needed.

As a caregiver you must ask for help. The stress of going it alone is dangerous to your health. If it's difficult to ask for yourself, use an advocate--a sibling, friend or professional care manager --to arrange a meeting and get formal, written commitments from those people who are willing to help you. The extra help will give you breathing room to find all those resources that are there to help you.

What resources are available to those of us living in Southern Maine?  On the county level, The Southern Maine Agency on Aging (www.smaaa.org) provides information, guidance, education, and social, financial and home care services in York and Cumberland counties.  From Meals on Wheels to the Money Minders program, I am constantly surprised by the breadth of services and information available through this agency.  You can reach the Southern Maine Agency on Aging at 1-800-427-7211.  For state and national services, the Maine Office of Elder Services in Augusta can be accessed through their web site at www.maine.gov/dhhs/beas or by calling 1-800-262-2232.  When you are coping with caring for a loved one with Alzheimer's disease, the Alzheimer's Association, Maine Chapter, (www.alz.org/maine.) stands ready to assist all of Maine's citizens with support, information and resources.  A local support group of the Alzheimer's Association, Maine Chapter, meets at Sentry Hill in York Harbor and York Hospital also sponsors an Alzheimer's support group.

A very valuable, yet little-known resource for caregivers is a Geriatric Care Manager (GCM).  GCMs are specialists who assist older people and their families to plan for and implement ways to allow for the greatest degree of independence, safety and comfort. They meet with families, assess the client's needs, and develop a comprehensive plan with input from caregivers, professionals, and others. They then assist with any appointments, interviews, and other paperwork and make all preparations for needed in-home care or arrange for a transition to a facility. They review all options clearly and discuss them with the family. Once services are set up, they can monitor and coordinate them, and revise the plan if needed. This gives the family assurance that an objective, knowledgeable professional is available to maintain personal contact with the older person, caregivers and family. Typically, a GCM does not provide actual hands-on care for the older person, but instead arranges, coordinates and monitors this care to be provided by the most qualified professional available. The GCM may draw from a number of options to assist this process, and this is due to their knowledge of the local providers and accessibility to specialized resources.

There are many wonderful local companies that can be hired to help with home care and companionship, respite care, errands, and modifying the home to provide maximum safety for older individuals.  How to pay for these services?  See if your loved one can still buy long-term care insurance. If he or she can't afford it, see if other family members might contribute to premiums. There are also useful strategies using a reverse mortgage to buy long-term care insurance and life insurance for your loved ones. You should also consider insurance for yourself so when you need care someday, it won't be so stressful on your caregivers.

What about you getting paid for the care you provide your loved one?  Elder Law Attorney Martin Womer of the Maine Center for Elder Law, LLC in Kennebunk provided these words of caution for families that want family members to be paid caregivers.

"The MaineCare Eligibility Manual has required for a number of years that payments to caregivers who are related to the individual receiving care will be treated as gifts causing a transfer penalty UNLESS the individual and the caregiver had a written, prospective employment contract.  Prospective means that the contract must be in place before services are rendered and payments made.

New rules dated January 1, 2007 but effective on April 1, 2007, make the caregiver contract requirement much more demanding in order to avoid causing gift penalties:  An individual may only transfer assets for services provided by a relative if the transfer takes place a the time the service is rendered and:

  • A. The services must be performed after a written agreement has been executed between the MaineCare applicant and provider.
  • B. At the time of receipt of the services, the applicant may not be residing in a nursing facility or a Cost Reimbursed Boarding Home, Adult Family Care Home, Residential Care Facility or State Funded Assisted Living Facility.
  • C. At the time of the receipt of the services, the services must have been recommended in writing and signed by the applicant's physician, as necessary to prevent the transfer of the applicant to residential care or nursing facility care.
  • D. The Department of Health and Human Services will verify the agreement by reviewing the written contract between the applicant and the provider/relative which must show the type, frequency and duration of the services being provided to the applicant and the amount of consideration (money or property) being received by the provider/relative. If the amount paid for the services is above the fair market value of the services at the time the services were delivered, then the applicant will be considered to have transferred the assets for less than fair market value. If in question, fair market value of the services may be determined by consultation with an area business which provides such services.

A separate planning opportunity exists in federal Medicaid law and the MaineCare Eligibility Manual for transfer of a parent's home to a caregiver child who lived with the parent as caregiver and thereby kept the parent out of nursing home care for at least two years.  It must be documented by a physician's written statement that the parent required nursing level care at the beginning and throughout the two-year period of the live-in child's caregiving."

All in all, things are better now than they used to be in terms of finding support when you are caring for an older loved one.  Many people in the past have sacrificed some or all of their financial, emotional and physical health in the effort to provide for the love, comfort and physical needs of their aging parent or relative, but the web of support for these caregivers is constantly growing.  Use it in good health!