Question: Our parents are in their mid-80s and live across the country from my brother and me. Mom had a stroke last year and can’t walk, but Dad won’t hear of her going to a nursing home. He has tried to care for her, but is wearing down fast. About six months ago, we hired a retired lady who was with them ten hours per day, six days each week. She charged $9 per hour, but refused to accept checks, meaning we had to arrange to pay her in cash or lose her.

Even with this care, when I last visited two weeks ago, I saw a marked decline in Dad. He fell twice, and sometimes seemed disoriented. To my dismay, I discovered a large pressure sore on Mom’s bottom that I don’t think Dad knows about. He still insists on her staying home and has agreed to round-the-clock sitters. We found three retired ladies willing to move in and share the hours. The total cost will be $8 per hour, or nearly $6,000 monthly, but none will accept checks.

Dad will have to sell most of his small stock portfolio to pay for this, and my brother and I will help him, but I still don’t think my mother will get good care from sitters even though their doctor says either they have sitters or she must go into a nursing home.

Our questions: How can we get Mom out of the house without burning our bridges with Dad? If we can’t, will we able to deduct the cost of the sitters due to our parents’ chronic illness and their doctor’s insistence that they be with sitters or placed?

Answer: First and foremost, it does not appear that your mother is getting appropriate care. The pressure sore needs treatment and without proper care, she may become dehydrated, have continuing urinary tract infections, and possibly other infections that will require her hospitalization. The wound itself seems severe enough to require hospitalization. We suggest that you contact a geriatric care manager to assess Mom’s care in the home and let him or her tell Dad that if Mom if not cared for outside the home voluntarily, adult protective services could take custody of her and place her without much input from him. This may make him realize he has done all he can do.

With regard to the caregiver expenses, if deemed necessary by a physician for chronically ill individuals, such expenses may be deductible as a medical expense if the expenditures exceed 7.5 percent of a taxpayer’s adjusted gross income. Under the law as we understand it, if you and your sibling pay the bills, you and/or your sibling should be able to take the deduction if you meet the guidelines.

However, everyone seems to be ignoring the much more important question: the responsibility to withhold Social Security and Medicare, and to report these wages to the IRS and state taxing authorities. Like your parents’ helpers, many caregivers are either retired or receiving benefits and don’t want their wages reported as taxable income, either because more of their Social Security will be taxed or they’ll lose benefits. Like you, many Americans who pay caregivers for their parents don’t pay attention to the withholding rules that, if ignored, can lead to paying taxes and interest – plus penalties.

As we understand it, if you pay a person $1,600 or more during 2008, you are obligated as an “employer” to deduct Social Security and Medicare taxes (cumulatively called “FICA”) and FUTA – the federal unemployment tax. Guidelines require that you include cash paid and also reimbursement for transportation, meals, etc.
If funds are available to pay the caregivers, to keep them working you could increase their wages enough to cover both the employer’s and the employee’s share of the withholding. If increased tax bills are the issue, you could even offer to increase their wages to cover all or part of the increase in taxes. But be careful, because assuming these obligations could be very expensive.

You could contact an agency that supplies caregivers. Agencies assume the reporting and withholding responsibilities and, while you may pay more per hour, in the long run, it may be worth it to put this obligation on the shoulders of professionals even though your hourly rate will be more.

Above all, be careful: If you unwittingly conspire to keep an individual on benefits that should not be there, you may be up to your neck in hot water.


BELOW AN EXPERIENCED READER RESPONDS!

Regarding the 06/16 column about the siblings who are attempting remote
management of the care of their parents:

I cared for my Mother, who has Parkinsonism, for a number of years.
Eventually, 'aides' were brought in, who while hired from an agency,
were not an effective solution. I found that the aides had to be closely
watched, both to maintain standards of care and to maintain honesty in
the handling of my Mom's personal property. Following a stay in a
Skilled Nursing Facility after a hospitalization, Mom was returned home,
this time with 24-hour care under the supervision of a geriatric care
manager. When that ceased to be appropriate, Mom was transferred to a
nearby long term care facility, where her quality of care (and my
quality of life) immediately improved. The proximity of the facility
means that I am able to visit every day.

Take it from someone who has inside experience in an adult care
situation; the entire situation described in the column is a time bomb
about to go off.

Number one, the children need to get very much more hands-on about their
parents' care. Either one or both of them need to relocate closer to
their parents, or the parents need to be moved closer to the children.
This is especially critical if there are no other near relatives in
close proximity to the parents who can make decisions regarding the
parents' care. A continent away is not going to cut it -- a situation
that seems pathetically static can change literally in a heartbeat and
real-time decisions need to be made by a family member who is on-scene.
Been there, done that.

It is clear that the 'retired lady' who has been looking after the
parents is either not a professional caregiver or is in need of
additional training. Her existing skill set is not adequate to the task
at hand. She is almost certainly not bonded and insured, which creates a
raft of additional problems and legal exposures. She can be held liable
for anything that happens to her 'patients' on her watch. The parents can be held liable for anything that happens to a 'sitter' while on
their property. Accidents can and do happen. Do these 'sitters' know
proper lifting techniques? Do they know -- and can they perform
correctly -- CPR? Are they trained in first aid?

The pressure sore on 'Mom' requires hospitalization. That is going to be
a major red flag for APS, who may be called in by the hospital. 'Dad'
also needs to be evaluated for dementia and ability to perform
Activities of Daily Living (ADL's). The fact of his continuing decline
is a clear indicator that the care being delivered is not adequate.

It is disturbing that the siblings' big questions are whether they can
get Mom out of the house without "burning [their] bridges with Dad" and whether they can get a tax deduction. That speaks to pecuniary motives that would also be a big concern for APS -- sadly there are those who manipulate the circumstances of an elderly relative's care to protect an inheritance, and APS screens for signs of such.

Advising the siblings to contact a geriatric care manager is an
excellent idea. From what is described, the care manager will take one
look at the situation and say, "this is changing now." Care managers are
'mandated reporters', which means that they must contact APS if they see
certain signs such as bedsores or other indicators of inadequate care.
That could backfire on the siblings, since the first question APS will
ask is, "how long has this been going on and when did you learn of it?"
The situation as described could lead to APS making a determination of
neglect and / or abuse, even if there was no intent of such. A
determination by APS that substandard care is motivated by pecuniary
concerns could result in prosecution.

In-home caregivers at this point are a non-solution. 'Mom' needs at a
minimum rehabilitation, which would require a stay in a Skilled Nursing
Facility. She could then transition either back to her home or to a long
term care facility. 'Dad' would undoubtedly benefit from adult day care, if he is assessed as still able to live at home. Otherwise, a nursing
home is the best solution for everyone. The parents will receive
professional care and they will receive care such as physical therapy
that can best be performed in a clinical setting. Importantly, they will have opportunities to socialize and may receive occupational therapy as
well.