Is Home Care Subsidized?

When I speak with new clients and their family members the question often comes to cost, how do we pay for all of these services?  Are there any subsidies? 

There is this misconception that you can get your home care, geriatric care management or senior concierge help subsidized by the government.  I wish this were true.  Subsidies are not available (now).  There may be some low-income care management/social work availability but typically these programs are under funded and impacted.

Here's a number to let soak in.  It costs $10,000 per month for 24 hour home care. It now costs more if you have to have someone get up with you in the night.  That means a second caregiver will need to come help while the first caregiver gets 5 hours of uninterrupted sleep. The cost for care can be even higher with rates as high as  $13-$15,000 per month for one person.

There are individuals that have purchased long term care insurance but it does not normally cover the full cost of home care. It does pay a portion once you apply and are approved which can be a long and difficult process.  I have helped many of my clients through this process.

If you're low-income and you have a real need for care there is something called In Home Support Services (IHSS).  You only qualify for this if you qualify for Medicade or Medi-Cal as we call it in California. Even if you qualify for this service it's very difficult to receive these benefits unless you really need it.  One IHSS worker said that she would only approve someone that would end up in the hospital without help. So, if you're hoping for someone to take mom to the store and the library for an afternoon that's not their focus.

You know how you always hear how important it is to save your money?  Well, this is the reason you're saving and put money into IRA's and other types of savings programs.  It can be difficult to get older people to realize that this is the time in your life to start using those funds that you have worked all your life to put away.  These are very interesting conversations that you and the family members of your clients need to discuss when these kinds of bills start coming through the mail.

Happy Saving...and Happy New Year!

When You're On The Clock

There may be a misconception about how Senior Concierge professionals spend time with their clients. You may have an image of sitting on a couch next to your client reminiscing about their lives while sipping English Breakfast Tea.   If this is what you have been hired to do then yes, I can visualize that picture. The only experience close to this is one of my first clients family members hired me to play Scrabble with their parent two times per week. That was a lot of fun and a real pleasure.  This is absolutely not the norm.  

I believe that since we are on the clock work should be getting done. If I'm simply sitting and chatting about my life and theirs I can't justify billing my clients.  Unless of course that's what you have been hired to do. If you're in a waiting room with your client and there is nothing else to do then yes, this can be a time to chat. Allow your client to lead the conversation.  

Some of my clients completely understand my billing rate and want me to get to work immediately.  There are no "hellos" just start on the projects at hand like a plumber or electrician. I don't want to run up my clients bill with chatting.  My job is to be efficient, effective, and keep my clients costs down while finding the fastest possible way to safely get the job done.  

I have had situations where the client really didn't want to get into the task at hand and would rather chat.  This client I'm thinking of happened to be a hoarder of paper and my job was to go through it and make some organization of the important papers and to get rid of the rest. My client wanted to just chat and I gently moved the conversation to the work at hand.  

I sat on the couch and said "let's look through this box together to see what's here"  While she chatted, I listened with one ear and went through the box to see what I could recycle, keep, or shred. I interjected my questions about the papers in between her stories.  She was amazed at all I had accomplished two hour later and was pleased that she now had more space and less boxes to contend with.  

Again, be very conscious of their dollar and the time it's taking you to do the task.  It's also our job to look out for our clients with other vendors to make sure they are getting the most out of other people working in our clients homes.  

If Your Clients Move to Assisted Living Will More of Their Needs be Met?

When I started this business seven years ago many of my clients were considering moves into Assisted Living Communities.  I obliged their requests by connecting them with placement agencies. I continued to work with those clients once they moved to facilities and I was astonished to find that all of the same issues my clients were having at home continued when they moved to Assisted Living. This article from the NY Times confirms my analysis of this phenomenon.  


In some cases it's helpful for families to place their loved ones in Assisted Living because it's convenient to their own home and they can be of assistance regularly and continue to have a separate residence.  The key here it the family is still very much involved with their family members care and must continue to provide assistance.  

Assisted living is not the final expensive solution that will solve all of your needs.  Assisted Living facilities can be great at making meals, helping with medications, cleaning, and helping you when you fall by calling 911.  In my experience, that's about it.  For an additional price, you can get more help.  As you begin to have more needs for physical care many people hire outside home care agencies to assist in addition to the cost of Assisted Living.

I have several Senior Concierge clients in Assisted Living and they need me just as much as someone that has chosen to "Age in Place" and stay in their homes.  All of the same needs remain.  bill paying, doctor visits, opening mail, organization of stuff, correspondence, getting supplies into the apartment etc, etc.

Senior Concierge or Errand Business?

I read an article about a young woman in Denver that has started an elder concierge service.  While I applaud her for her business I'm concerned about the business model.  Anyone from her firm could be sent out to assist your parent.  That concerns me.  Senior Concierge professionals should be working alone with a family. 

Many people call me about my training program and the senior concierge profession.  They ask me if they can scale the business. What they want to know is if they can grow the business by adding a bunch of staff and taking a cut on their employees billable hours. 

Here is what I tell people.  The Senior Concierge business is a boutique business.  We are small intentionally and typically we are working alone.  As an example, if you're on the East Coast and your mother is on the West and she has needs for a Senior Concierge, are you going to want different people entering your mother's home? You probably want one individual that is there in your place that you can trust to handle things in the way that you would expect. 

Caregiving agencies work well because there are 7 areas that they are focusing on in their client's homes, the seven daily living activities.  Any trained professional can do those 7 activities.  A client can have multiple people to do those tasks because that's what they are there to focus on-just those 7 areas.  

Senior Concierge professionals on the other hand, may have any number of things that are thrown our way.  We are not simply errand people..while errands may be on the list of things to do it's not all we're doing.  If all you're doing for people are errands then call your business an errand business.  The Senior Concierge has many possible jobs and responsibilities that go beyond errands.

Look at my other blogs to find out all that we do or check out my website www.livewellsenior.com  to learn more about what we do.  

Senior Concierge In The News

This week, a young woman in Denver is calling herself a senior concierge and she was followed by PBS Newshour this week.  I'm glad to see what she is doing but I'm concerned about how the profession was portrayed by the news show.  They showed the senior concierge going shopping and to a nail salon with her client that day.  I have always conveyed to my trainees that if you're being asked to do those simple tasks, you should make sure they get a caregiver for these types of requests. The rate is less for a caregiver since these tasks are not complicated.  

An actual senior concierge would be arranging the schedule and the caregiver for that outing, while back at the house making sure bills are being paid, Medicare is called on a possible fraudulent charge, and starting the claim for the long term care policy.  These are the kinds of tasks that we do and those simple tasks are done but if it's all they are asking for a caregiver should really be doing them.  

As Senior Concierge professionals, we need to make sure we're making a distinction about what we do and what caregivers should be doing.  Sometimes there is overlap but it's up to us to re-direct our clients to spending their funds wisely. 

Get Rid of Your Crap

It's unfair to leave so much of your stuff for your family to deal with when you're gone.  Get rid of it.  

I'm sorry to sound so harsh but it's important to release on your things.  You don't need bank statements, canceled checks from 1972.  You don't need your old calendars since 1945.  No one wants it.  Your family will end up paying me an hourly rate for many, many hours putting it into a shred bag and taking it to the shredding company.  

Do your family a favor and open every drawer and go through every shelf and get rid of it now.  It's hard enough on your family to lose you, deal with their grief and then on top of that they have to go through 15 year olds incontinence pads, Alka Seltzer tablets and 1000 gift boxes that you might need. 

I understand leaving the antiques and the good china set but every Christmas Card you have ever received since the 40's...come on. No one wants this.

Work with a senior concierge before you pass on to clear things out.  It can be fun to do it together and it feels so good when it's complete.

"I think I won $1,000,000.00 and a Mercedes Benz"

She tells me she met a man in a parking lot to pay the $500.00 in taxes on the Mercedes Benz that will probably be delivered to her tomorrow.  I find thousands of dollars of receipts from the Green Dot purchases that she made and shared the numbers of the back of the card to the callers.  There are hundreds of letters about her winnings, "but it looks so real, it has my name in print and on such nice paper". In my 3 hour visit I get 20 questions about the legitimacy of these letters.  "If it's too good to be true then it probably is", I respond.  

This is the most frightening situation I have ever come upon as a Senior Concierge. Luckily, someone else was concerned too.  The police had been called and Adult Protective Services has visited in the previous weeks. Thank goodness..

Seniors are so ripe for fraud.  As a Senior Concierge it is my obligation to make sure that they are protected.  I called the Adult Protective Services contact my client had and we had a nice conversation about what I had learned.  Slight memory loss and a desire for a big win is a bad combination and these issues should be reported immediately.  

Adult Protective Services had recommended that she change her phone number so they would stop calling every 10 minutes.  They also recommended that my client continue to work with me to help to monitor this situation. We go through mail, organize it and throw away those unwanted letters.  Hopefully these solutions will help.

A cognitive study may be done and then a fiduciary may get involved to help pay her bills and assist her in managing her money.  It's dangerous for a concierge to help with finances when you're working with someone that has memory loss.  It's important to work in conjunction with your client on these issues or if they are unable, work with a family member to help them pay bills and keep the finances straight.  If there is memory loss and they are alone a fiduciary is really the only solution.  

If you need a fiduciary contact the Professional Fiduciary Association in your area.  

Yikes-Families are going to need our help

http://www.npr.org/2012/11/28/166088836/the-looming-dementia-crisis?ft=1&f=5

2 Million senior industry workers and nowhere near large enough to meet the need.

http://www.thenation.com/article/167354/can-caring-across-generations-change-world

"As of 2010, every eight seconds another American turned 65. The “age wave” is upon us—except it’s not a wave; it’s a tsunami. Just as more families are economically stretched, the number of Americans in long-term care is projected to mushroom, from 13 million in 2000 to 27 million in 2050. More of us want to stay in our homes, where care also happens to be cheaper. (The National Association for Home Care & Hospice reports that one day in a nursing home is four times as expensive as twelve hours of homecare.) But the current homecare workforce—at approximately 2 million workers—is nowhere near large enough to meet the need."

Seniors who Drive

When your clients are asked to take their driving test at the Department of Motor vehicles, this can cause a lot of anxiety.   The concern is they will be told to stop driving.  This could mean a real life change.

My clients have benefited from investing in driver training. Driver training is not just for the new driver.  You can have a driving instructor come to your home and go through the rules of the road while allowing your client to practice.  They work generally on an hourly rate about $60-75 per hour.  This can help your client to prepare for the DMV driving test.  It's best to interview a few companies to make sure they have experience working with senior drivers.

Obviously the Senior Concierge can help with driving our clients to appointments, the grocery store, etc. but if they can still manage those tasks alone, that's fantastic.

This looks like an excellent documentary film on Senior Drivers.  http://www.oldpeopledrivingmovie.com/trailer/

Stay safe!

Musings from the field

So often my clients will ask me for referrals to contractors or handy people to help them with repairs on their homes.  I stay away from asking one of my friends to do the job.  Your friend may be able to the job well and has the skills to do so. It's nice to help out your friends if they have a need to do some work. However, this is your client we're talking about.  I would stay away from this.

If anything goes wrong with your personal referral, this could sour the relationship you have with your client as well as your friend.    As concierge professionals, we want to solve our clients needs quickly by pulling a name out of your hat but this may not work well for you in the long run.  It is our job to do due diligence about who we are inviting into our clients homes.

When I'm finding a handy person to do a job I go through a process to ensure the quality of this individual.  Here are a few ideas:

• Check Yelp for people in your clients neighborhood.  www.yelp.com.  Read the reviews and take a look at their ratings.  If there have been issues, how were they resolved?
• If they have on, contact their Homeowners Association for referrals of contractors that have done good work in the past.
• Ask if they have used anyone in the past they were happy with.  Maybe they have a family friend that can do the work.
• If you select some from the Yellow Pages, go through a process of looking on-line to see if there are any reviews, negative or positive about them.

Once you select a few candidates:

• Ask for multiple bids from at least three people.  Make sure they are very detailed in their bid.  Have they included parts and labor.  Who are the members of their crew.  Will I feel comfortable leaving my client with these folks alone?  Do I need to be there when the work is going to be done.
• Contact the Contractors License Board to make sure their license is in good standing and it has not been revoked.  Also make sure they have liability insurance.
• Call some of their previous clients to get a referral.
• Make this decision with your client and make sure they are happy with the price and the persons qualifications.

Working with contractors and handypeople can be hard. The noise and dirt can be a problem for your clients.  Do whatever you can to make your clients happy.  They may even need to stay in a hotel or with family for a few days while the working is being done.