I need help in determining a rate of pay for my nephew and his wife to take care of my elderly mother. My mother is 93 years old and in sound mind. She uses a walker to get around. She is on oxygen and has recently developed other major medical problems. She may need to be put on palliative care soon. She needs assistance with:
-Toiletry and bathing.
-Shopping and meal preparation
-Laundry and maintaining a clean house.
-Medication administered and health needs monitored.
-Communicating with doctors and tracking her medical needs.
-Communicating electronically for online doctor appointments
-Transportation to medical appointments.
-Carried downstairs out of the house in a wheelchair for appointments.
-At night she may need to wake up someone to help her with bathroom needs or need for additional pain or sleeping medication. This may occur 0-5 times a night depending upon her difficulties (Average is about once a night).
-Always have someone in the house in case of emergencies or care needs.
My mother wants my nephew and his wife to care for her at her house and they want to provide that care. The proposal would be that they would be living with my mother at her house rent free with a stipend paid to my nephew and his wife for personal health care and a budget to cover her food.
My mother is currently paying my nephew and his wife ( Medical Asst Training) $100 a day each. She is also paying my niece (Physical Therapist Assistant student) $50 a day. My nephew’s wife feels that they are being paid far less than the value that they are bringing to the quality of life and care for my mother. My niece-in-law went out to local “for-profit” home care providers to find out the rate they charge for home care. The rate she came up with was $20,000. A month. This is what she is asking to be compensated to care. She is requesting to be compensated at $5000 a month now and $15,000 a month from my mother’s estate when she passes. They are also asking $1000 a month to cover food costs.
Currently my mother is paying $250 a day and has 3 people caring for her ($200 day for nephew and wife). On average this works out to $7500 month, ($6000 month for nephew and wife). My mother is not a rich woman. But thanks to my late father’s investments has enough money to live comfortably. Her monthly income including social security, retirement funds, and dividends from investments totals to $5570 a month. We have had to supplement this amount by an additional $4000 a month from the stocks to cover her currently monthly expenses including the amount she pays for personal health care.
Being the Financial POA for my mother they presented this proposal to me. My mother does not want to upset anyone and is feeling caught in the middle. My brother and I both feel that the current rate of compensation is a generous amount. My sister (mother of nephew) feels for all that they are doing that they should be paid more than $100 a day each but does not know what the new rate should be. Everyone but my nephew’s wife agrees that $20,000 a month is an extraordinary amount to be compensated.
We cannot agree or move forward without a Personal Care Agreement that would include a fair rate of pay for personal health care, food compensation, and location where the care should take place.
What I need help with is:
-What a fair and reasonable rate of compensation for my nephew and his wife to take care of my mother full time.
-A reasonable rate to be recompensed for food cost.
-If she should pay for any additional outside services such as house cleaning, lawn maintenance, snow removal etc. Or should it be covered for what is paid for health care?
-If my mother is paying for personal health care, should she have the right to say where that care should take place.
Thanks for your help.
A food allowance would be a nice bonus, but is not necessary. People generally buy their own food and personal items with the money they earn from their jobs.
There should be no ties to "per month" money after your mother's death. You are paying for her care. That job ends when your mother dies. Pay what you can to ensure wonderful care for your mother, but don't let niece and nephew guilt or manipulate you into satisfying their overly ambitious wishful thinking.
Care giving is not a wrealth-building
Non live-in care thru an agency for the same services ranges from $18-25 an hour. Also keep in mind hat the agency takes a fee off the top so the care gives are not earning the full amount. At the top fee of $25 an hour, that comes to $18,000 a month. However, you need to consider that your nephew and his wife have FREE housing and a food stipend! Compared to the live-in rate with free room and board, I wouldn’t pay more than maybe $12,000 a month if they are living in your mom’s house.
As for getting a monthly fee after she passes?! Absolutely not!!
It is very kind of your nephew to care for your mom. But you have a lot to consider with payment. I wish you luck in figuring it out. I know how difficult a decision it is. You may want to pay a professional senior care consultant to figure out what is best for your mom. They charge a fee but in his case, I think it would be well worth it!
the people assigned to do the work get $15 to 18 of that for Assisted Living services as described. I have told family members that Medicaid likely would
allow $9.50 per hour for routine assisted living services as long as everything was
well documented and likely up to 12 hours a day in home. My own mother needed
assistence in her condo and had help during the day only. Then moved into
a private care home with 15 residents for $5500. per month everything included except her medications and personal products. She was 94 at the time
and had good days and not good days. My mother in law ( age 93) had 3 people
15 hours of the day and I think they were paid $15 an hour. They were not licensed but had N.H experience. So $225 a 15 hour day 3 years ago. Last client I had in a skilled nursing home was charged $7000 per month plus separate bill for rehab and personal expenses for routine living matters. She had no major problems except mild dementia and needed structured guidence. As previously suggested -call professional agencies for a quote and ask other people in similar situations. Family members do not have to work for free, But they can't get wealthy doing it either especially if she would have to justify the expensive to Medicaid if entering a nursing h ome.
Just so you have a basis for comparison. We are in NYC and pay $16,505 per month for my mom's residence in a skilled nursing facility. Her medical needs are very similar to your mother's. She is able to socialize and is happy there.
I went on line to look for Caregivers and everyone wanted $10 - $25 an hr.
I found out that tge Companies would charge $25 an hr and actually pay $10 to the Caregivers.
So, I started calling individual Caregivers myself and interviewed a couple and
I hired a lady that has her own Company and she accepted $9 hr for 24 7 Care.
She provides other Caregivers to help her so they do 12 hr shifts 7 days a week.
The cost is $1512 a week which is a little over $6,000 a month.
I order my Dad's groceries and have them delivered.
The Caregivers bring their own food.
Even at $6,000 a month, his savings is dwindling fast.
I'm now considering hiring a Live In.
The Least Expensive Live In I was $3,000 a month Plus Free Room and Board and one 24 hr period off per month tho some wanted one 24 hr off per week which means you would have to pay additional $250 for a person to spend that 24 hr time or get family members to take a shift.
It sounds to me that the Grandkids are trying to take advantage of Grandma and your mom.
They shouldn't be looking at what a Company charges per hr, they should be looking at what you can get a nice Live in will accept.
And they should even give Grandma a discount.
I would tell them to accept $3,000 a month or you'll hire a Live In yourself and they'll have to wait for their inheritance not gouge Mom and Grandma.
Theaven already got a pretty sweet deal and they're being Greedy!
Prayers
You could even call an agency and ask what they charge. Keep in mind that an agency will have "administrative fees" and the caregiver only gets a portion. So if an agency is charging 20,000 a month the caregiver is probably getting less than half that. Also, is the amount of work enough that the agency would charge you for a Nurse? That would cost far more than a caregiver. Or are they charging what they would charge for a CNA? Again more than what they would charge for a caregiver.
Also the amount would be based on the hours.
4 1/2 years ago when I was caring for my Husband I paid the caregivers a base of $20.00 per hour (contract and taxes taken out) They worked 7 Hours. Relaxed atmosphere and they had time to study. (they were in college awaiting the new term to begin)
Have a contract as to what is expected. I would review the Contract every 6 months. Things change and what someone is doing this month may change drastically and the work may require more compensation.
Other than "light housekeeping" if you want the house cleaned I would hire a cleaning company or contract the cleaning separate from the caregiving.
Same with yard work.
One of the reasons this might be important is to keep mom's personal care separate so that you have proof that "X" dollars were spent for her care in case there is a time when you have to apply for Medicaid.
As far as where the care should take place...The simple answer is Mom should be cared for where she is the safest. If mom's home is set up where she is safe being cared for there AND your nephew and his wife are safe caring for her there then there should not be a problem. HOWEVER if this is a split level house or a walk-up apartment or other home with barriers long term care for her there might not be possible. Now totally different story if we are in a Ranch House or a house with a first floor main bedroom with wide halls, no carpet......you get the idea.
Food cost would come from a "household budget" that would include food, cable, gas, electric, insurance.
If this were a different situation where mom had moved in with the nephew and wife I would say to split all the bills 3 ways to come up with the amount each should cover. In this case I would thing they should pay a portion of the household expenses as well.
"Room and Board" should not be considered "pay".
I was an unpaid caregiver for both my parents. I could have easily earned a high wage elsewhere - but chose to care for them myself at great personal cost. I would do it all again in a heartbeat. I believe that no amount of money is too much to pay someone who is caring for an elderly person. The job requirements range (sometimes switching suddenly) from grief counselor, cook, laundress, janitor, medical liaison, CNA, teacher, secretary, security guard, lawyer, accountant ... you get the picture. Having a loving family member in that position is priceless as long as that person is emotionally (and not solely financially) motivated.
That being said, because of the 24/7 aspect of care, and my other life needs (raising my own young children), I had to bring in help also. I hired several wonderful people through the years who are now (that my parents are gone) closer to me than some of my own siblings. They were much nicer to my parents than many family members. They both worked for a modest wage, not the lowest in the market, but certainly well below the highest. They truly loved my parents and my parents loved them. I found them through a help wanted website.
If the need would have arisen, I have no doubt that one of them (who was single) would have moved in with Mom to help at the end of her life when she required lots of care. I also know that she wouldn’t have charged much more than she was already earning.
When my grandmother required 24-hour care, my parents were not physically strong enough to personally care for her. They hired 3 workers to each take 8 hours per day to keep Grandma in her home. My parents selected one to work as the “manager.” She scheduled the others, figured out duties, budgeted expenses, etc. There were a couple personnel changes over the years, but this worked out very well. The pay was very modest.
If you do not feel comfortable paying these amounts trust your instincts. You have options.
If you meet these demands now, what will happen when the job gets harder, as it inevitably will?
Shop around and consider other arrangements.
If the answer is yes, it is different. I assume the answer is no. Without any education they should be getting minimum wage, that is what these agencies are paying to there workers. Everything else that you are asking them to do (medical appointments, driving mom, grocery shopping) is there compensation for living rent free. $1000 a month for food is really high, unless they consider a lot of take outs and restaurant food.
I believe what you are paying them now is very fare. The niece in law is a very greedy person. Tell her to go look for outside job and find out how much she will earn. With current unemployment rate, she will be lucky to get a job. Also, I am surprised your sister is quite about there requests. She should tell them that there compensation is more than fare already.
Many here ran into trouble with live in caregiver arrangements that weren’t spelled out. Especially since it’s in a pandemic still, rules for guests and visitors must be established. If the kids go out during the day, do they wear masks? If not, they must wear them while working with your mom. What happens when your mom passes or moves to NH etc? How long do they get to stay in the house, and what will the rent be when they aren’t working? This all has to be in a contract. Paying for their food is also compensation and is taxed for SS purposes.
At some point your mom may be incontinent and need to be bathed and have diapers changed. Make sure they are on board with this. You don’t want a caregiver crises down the road.
I’ve been here as the caregiver before, and I’ve been on the side of overseeing everything.
First, that is a large amount, but I’m thinking she got her number from having 2 people 24/7 at home with your mom.
Do they have their own home or will your mom’s be the primary residence? In our situation, we left our home to care for my in-laws, so we did have a home and they weren’t housing us because we needed a place to stay- the bills at home kept coming (as well as maintenance and everything that goes with home ownership).
They are getting a place to stay, and needs met. In return they are caring for your mom. I believe the current rate is fair if they’re not having to pay they’re own bills at home. Also, caregiving is an around the clock job (as I’m sure you know), so there’s a lot of sacrifice because they are tied down to her and her needs.
I also think there needs to be a contractual agreement on expectations so that it’s clear cut and if anything happens, all parties are protected. I’ve seen this go bad so many times with family- sometimes it’s easier to hire out.
Good luck!
This is in Maryland, which is important because I think costs vary by state
1) My FIL is paying $24/hour to an agency who is providing 24x7 home health care. The average caregiver pay in Maryland is variously reported from $13/hr to $17/hr. Let's say the average is $15/hour.
** No way should agency overhead costs be paid to family caregivers, as it seems like the niece-in-law is requesting **
OTOH, $250 a day is reasonable for 3 people as will be seen next.
2) There is only 1 of them on duty at any one time. So, I think the total pay in Maryland, if I were paying, would be $15*24*(30.4) (avg days in month) = $10,944 a month, or $360 a day.
3) $1,000 a month would not be unreasonable for a family of 3, since that's about what I'm paying. We buy organic dairy and vegetables. Let's say the grocery bill is 1/3 more because of that. That means a non-organic bill would be $769.
*** Why not let them buy their own food? Keeping food costs separate would be the norm anyway. ***
4) Rent needs to be subtracted from the total compensation.
Hope this helps.
CEB60714, please do a breakdown for your nephew showing the rate of pay x actual hours worked (I'm pretty sure all 3 aren't necessary at the same time, 24/7!) then deduct rent, utilities, etc. and show them the actual cost. If they still balk at not receiving $20k a month, find other care. There are responsible, loving caregivers out there. (And heck, if you're going to pay $20k/mo., let me know--I'll do it, lol!!!)
They did everything you wrote except shop and pay for groceries, set up doctors appointments (but they did drive her), or handle med refills. She did not require lifting or a wheelchair (didn’t have stairs) but did require a walker. They did take her on outings such as going to the park. They did not handle any outside maintenance.
MIL also had a nurse and a pt who came out once a week to handle medical end of things which was covered through Medicare. The caregiver did not take vitals and such.
This is in GA where the cost of living may differ from where you live.
Edited to add: in our case this wasn’t a two person job, so I would think you would pay for the total care not per person. (The agency we used, assigned two caregivers who switched off weeks). It seems to be that one of them could still hold a job outside the home.
Also would POA need to get extra insurances?
I feel you are being extremely fair with your current compensation package. Rate plus room and board. It’s hard being a care giver but also an honor.
From your list it looks like they are expected to provide 24/7 care. Who is relieving them for days off?
At 720 hours a month (24x30days) at $15 per hour is $10,800 per month, for the two of them. This is barely minimum wage where I live.
They should be paid their full wage each month. No waiting for the estate to reimburse them.
Yes, they would clean the house, no they should not be responsible for the exterior.
The bigger issue is what happens when she dies? How long will the kids have to move out, so the house can be sold?
Increase offer to $350 per day total. (for nephew and wife)
Hire weekly maid visit (Like a merry maid) to handle some deep cleaning, laundry help.
Offer a food budget that everyone agrees on. Help with meal planning and shopping, and include extra for occasional take out.
Have your mom try a month at an Assisted Living (I say this because my grandfather who we thought really wanted the taken care of at home option LOVED his AL once he settled in and didn't want to come home, it allowed him to thrive in with supported independence that he treasured)
Handle the doctors appointments and managing that care yourself. Let them tell you when refills are needed and you prefill med boxes yourself (do 2 weeks at a time) decreasing the med management to giving pills at proper times
Get a ramp or moving chair on stairs.
Contact your local Elder Services and pay them for whatever services they will offer (Usually $25/hr for bathing visits)
Work out a coverage plan so that 1 weekend a month your or someone else comes in to give the niece and nephew respite time off paid.
$72K per year with no benefits or time off to work or be available 18 to 24 hrs a day for a couple is just too much to ask of them. If they were a service and you had 2 people working 12 hour shifts then maybe $36K each would still be low but acceptable. I think you need to really readjust what you are asking them to do. If you can not, it might be best for family relations not to offer the positions to family members. but $100 is really only 4 hours of basic manual labor.