Monday, February 23, 2015

 Here are Some valuable tips for finding and evaluating an assisted living facility, courtesy of U.S. News and World Reports: http://money.usnews.com/money/personal-finance/articles/2015/02/13/how-to-find-the-best-assisted-living-community-for-you?


Make sure assisted living is the right choice. People who are happy where they are may do better with in-home help and community services. People with complex health problems or who need help with basic tasks like going to the bathroom may need more help than assisted living provides.
Tour any facility you’re considering. Stay for a meal so you can taste the food and talk to other residents. Look at the available apartments. After you’ve had the tour, come back again on the weekend for an unscheduled visit. Many facilities will allow you to “try before you buy” with a weekend or a week of what is called respite care.
Ask detailed questions about what services are and are not included. Is there a washer and dryer in the unit? Will the facility do your laundry and at what cost? Will you have to arrange for your own cable TV and Internet service? Saltz estimates that most facilities offer an hour a day of personal care, but you should ask about that anyway.
Drill down on costs. Ask about charges for specific services, and make sure you know about all the fees. Most administrators are well-informed about potential veterans benefits, ways to tap life insurance policies and community grants, as well as Medicaid options.
Ask what happens if you run out of money. A few facilities accept Medicaid patients, but most do not. If you exhaust your funds, you may have to move to a nursing home or another facility. Somelong-term care insurance may cover assisted living. “You cannot run out of money in assisted living and expect to stay,” Saltz says.
Ask what will happen if your health or cognitive ability declines. Some facilities will have higher levels of care on the premises, at a higher cost, and others will require you to find a new home. If you would like to stay put, find out if you can hire your own aides to provide additional services.
Ask about the staff. How many staff members are there for residents and what do they do? If nursing care is provided, what does that mean? Find out how long the staff members have been working at the home, which is a key indicator of stability. “A lot of people look at the packaging, not the staff,” Cohen says. “What really makes a community great is the staff.”
Look at the menus and activities calendar. Find out if meals are provided only at specific times or all days. Are there choices? Do the activities fit your interests?
Consider hiring a care manager, especially if you’re seeking a facility in another town. Members of the NAPGCM charge $100 to $200 per hour, and they do not receive any compensation from facilities. They will be familiar with community services as well as know the inside story on communities.
Look at options before there is a crisis. If you or your parents are having trouble managing on your own, start looking sooner rather than later. You have more choices and can spend more time on research if you’re not in a hurry.
Consider living near family. Saltz works a lot with families seeking care for parents who live far away. In some cases, it makes sense for the parents to move to a facility near their adult children, so they can see family and get help dealing with issues.
Get the contract and read it carefully before it’s time to signThe resident agreement will spell out the rules of the facilities, the charges and other issues, such as what happens if there is a disagreement. Don’t wait until signing day to look it over. Get a copy in advance, and consider having adult children or a lawyer read it over. If there is anything you don’t understand, ask questions before you sign. “Consumers really need to go through this with a fine-tooth comb,” Grant says.


How to Find the Best Assisted Living Community

Some facilities offer greater independence, while others provide a higher level of care.

http://money.usnews.com/money/personal-finance/articles/2015/02/13/ 

There are about 15,000 assisted and independent living facilities in the U.S., plus 1,500 continuing care communities, according to Andy Cohen of Caring.com, which features lists and reviews of facilities. And that figure doesn’t take into account nursing homes, group homes and active adult communities.
There is no standard definition of assisted living. What’s called assisted living in one state may be called something else in another. Many of the same communities also offer independent living for people who want communal living but need less help. One facility may charge by tier of care and another may charge for specific services, making it hard to comparison shop, which is important when you’re trying to save money.
 Most assisted living communities charge a monthly fee for basic room and board, with additional fees for special services such as managing medication or bathing. Residents have their own apartments, and there is usually communal dining, transportation and activities.
These communities are a good choice for people who need some assistance but don’t have complex medical problems, says Emily Saltz, CEO of LifeCare Advocates in Boston and a past president of the National Association of Professional Geriatric Care Managers.
Residents at assisted living communities are fairly independent, which is reflected in the rules the facilities maintain. If residents run out of money, they will need to find a new place to live unless the facility accepts Medicaid. They may also need to move out of the community if their health declines, but rules will vary by facility.
 Choosing the right facility is not easy, especially in a situation where a crisis requires families to move quickly.
“The elder care journey is fraught with lots of pitfalls, lots of crises,” says Saltz, whose agency works with families to find facilities and services. “A care manager will really know what the skinny is on these places versus the marketing fluff. … The consumer cannot know it all. It’s not just like finding a great condo and moving in.”
Because each facility is different, it’s important to ask lots of questions, says Robyn Grant, director of public policy and advocacy for the National Consumer Voice for Quality Long-Term Care. If the facility says meals are provided, ask how many, at what time and whether there is an extra charge for bringing a tray to the room. If transportation is part of the package, ask where you can go, how often, at what times and how far. What does “nursing care” mean to the facility?
“You don’t want to make any assumptions as to what will and won’t be provided,” Grant says. “Consumers have to be constantly going for the details with assisted living.”
The 2014 Cost of Care Survey by Genworth Financial estimated the average monthly cost of assisted living at $3,500 per person. Memory care units, for elders with cognitive issues such as Alzheimer’s disease, are more expensive.

Tuesday, February 3, 2015

Forbes Cites New Study Indicating Financial Abuse of Elders is Underestimated

Have We Grossly Underestimated The Extent Of Financial Elder Abuse?


Researchers, including agencies of U.S. government, have estimated the extent of  financial losses to older Americans each year from financial abuse to be $2.9B per year.  This week, Forbes magazine features a  new study by True Link, a private financial services company, that concludes that the actual figure is over twelve times previous estimates, or $36.48 billion each year.

Forbes contributor Carolyn Rosenblatt says in her recent column "What gives the study credibility to me is certainly not that it was sponsored by a financial services organization that wants you to buy its online protection tools. Rather, it’s that according to their report, the design of this survey was guided by recommendations of an expert panel of fraud researchers convened by the Financial Fraud Research Center at the Stanford Center on Longevity."

Rosenblatt believes that the True Link study supports prior conclusions:  the financial abuse problem is a whole lot worse than we thought before.

One surprising finding is that legal but misleading tactics used to get a senior’s permission to take money from them leads to losses of $16.99 billion per year.  The elder may be tricked into giving consent to credit card charges, for example and not realize how deeply or  how long that consent ends up costing them.

 A very disturbing discovery of the True Link study says Rosenblatt is  "...we may not think of an elder’s own lawyer, financial advisor,  or banker being a perpetrator of financial abuse, but they steal and manipulate too, from the so-called position of trust..." "These undue influence cases are especially galling because of how ruthlessly the person in power uses the relationship with the senior to take advantage."   

Rosenblatt points out that financial abuse causes the victim to be ashamed of being ripped off. Depression, damage to physical health and even suicide, she says have resulted.

"Too many aging parents fear losing control over their lives and they don’t want to discuss their financial affairs with their adult children," Rosenblatt says 

Communicate your concern about the risk of abuse with your parents. Share with them what the studies tell us about financial abuse and think in terms of best ways to protect the ones you love. The elder financial abuse problem is so large, it will inevitably threaten someone you know and care about.
http://www.forbes.com/sites/carolynrosenblatt/2015/01/29/have-we-grossly-underestimated-the-extent-of-financial-elder-abuse/

Wednesday, January 28, 2015

The Link Between Diabetes and Alzheimer’s



There is no doubt that there is a connection between Diabetes and Alzheimer's

Source: Alzheimers.net
Past studies have shown a strong correlation between the two and have found that 70% of people who have type 2 diabetes ultimately develop Alzheimer’s. This has lead some experts to believe that the disease may even be third type of diabetes, while others argue that Alzheimer’s could be a very advanced stage of type 2 diabetes.
Deepening the connection, researchers have observed that people with Alzheimer’s often have a lower level of insulin in their brain which may mean that brain cells are not getting the energy they need to survive, killing them, and resulting in loss of memory. This process is similar to what happens to a person’s body when they have diabetes and their body does not use insulin properly.

Diabetes Drug May Be Effective Tool in Treating Alzheimer’s

Using what we know to be true about the two conditions, a new study explored the effectiveness of a common diabetes medication on Alzheimer’s disease and had promising results. A study funded by the Alzheimer’s Society and published in the journal Neuropharmacology used laboratory mice to examine the effects of two diabetes drugs, lixisenatide and liraglutide.
Researchers were pleased to find that the two drugs were able to protect brain cells from injury or degeneration in mice that had Alzheimer’s. Dr. Simon Ridley, head of research at Alzheimer’s Research UK declared, “This study found that two diabetes drugs could slow nerve cell damage in mice with some of the hallmarks of Alzheimer’s and that the animals also performed better on a memory test.”
Also pleased with the results was Professor Christian Holscher from Lancaster University who lead this study. He said, “These are very exciting results. There are no drugs on the market for Alzheimer’s disease that actually treat the disease, all we currently have are two types of drugs that mask the symptoms for a while. Lixisenatide and liraglutide offer a real improvement by treating the basis of the disease and, therefore, preventing degeneration.”
Also, because the drugs are already on the market for people with diabetes, it could be ready for treatment quicker than other drugs that still need to be developed and licensed. The Alzheimer’s Society is moving forward and funding a clinical trial on people who have Alzheimer’s disease to determine if the drug has the same promising effects on humans as it does on mice. 

For more than 20 years, Informed Eldercare Decisions, Inc has been providing experienced and highly professional care management specialists to elders and family caregivers who seek assistance with the difficult care planning decisions in Massachusetts.
As parents age, they may need assistance with tasks such as home maintenance, getting dressed, personal hygiene, mobility, transportation and nutritious meals. And if a medical emergency occurs without a contingency plan in place, it adds to the burden of guilt and anxiety over what could happen in the family caregiver's absence. 

Our highly accomplished professionals conduct in home or hospital based evaluations and needs assessments in order to develop a comprehensive care plan that addresses the full range of medical, emotional, financial, and legal needs. Plans are customized to meet the specific needs of each family. We also provide optional, ongoing monitoring of the care plan when family members are unable to do so due to work, distance, or other conflicting responsibilities. 
LEARN MORE AT 781-461-9637/WWW.ELDERLIFEPLANNING.COM

FDA Approves Combo Pill for Alzheimer’s

The Federal Drug Administration (FDA) has approved a combination pill to treat people for moderate to severe Alzheimer’s disease. Learn more about this drug treatment and how it may be able to help your loved one living with Alzheimer’s. 
FDA Approves Combo Pill For Alzheimer's

Using Drugs to Treat Alzheimer’s Disease

Alzheimer’s disease affects over 36 million people worldwide and there is no cure in sight. While doctors and researchers continue to encourage prevention, they are also working diligently to find a cure for people who have the disease. Drugs used to treat Alzheimer’s are called cholinesterase inhibitors. These drugs have been shown to slow the progression of Alzheimer’s symptoms for about 6 to 12 months.
Different types of cholinesterase inhibitors have been approved for the different stages of Alzheimer’s, with one pill being approved for all four stages. Common side effects for all of the medications include vomiting, nausea, fatigue, insomnia, and weight loss.

The New Combo Pill

The FDA has now approved a combination pill for people with moderate to severe Alzheimer’s disease. The combination pill will be for people who are already taking both of medications which are included in the new pill. The pill is called Namzaric and combines memantine hydrochloride extended-release (also known as Namenda) and donepezil hydrocholoride (also known as Aricept).
Currently 70% of people on Namenda XR are also on Aricept. Aricept is the only FDA approved drug that is approved for use in all stages of Alzheimer’s. David Nicholson, phD and senior vice president of global brands R&D for the drugmaker Actavis said, “Both Namenda XR and donepezil have proven efficacy and safety for the treatment of moderate to severe Alzheimer’s disease.” He went on to say that people who took the combo pill have shown greater improvement than just taking donepizal (Aricept) alone.
Because the new drug combines two common Alzheimer’s medications, patients will take less pills. It will be available in a capsule form so the medication can be sprinkled on food. Namzaric is expected to be available in the United States this year.

Wednesday, January 21, 2015

Veterans Affairs Must Pay Compensation to Whistleblowers Who Exposed Faulty Care and Neglect of Vets

Source:
Fierce Health Care
 (http://www.fiercehealthcare.com/news)

Though a new year has begun, the scandal that rocked the Department of Veterans Affairs through much of 2014 has yet to fade from the headlines.
 
The U.S. Office of Special Counsel (OSC) announced Tuesday that since last April, it has offered relief to a total of 25 whistleblowers who faced retaliation for exposing wrongdoing at VA facilities. The malfeasance exposed by these whistleblowers and by lengthy investigations included extreme, deadly delays in care at some facilities that VA officials covered up through the use of secret waitlists.
 
Among those who received settlements was Mark Tello, a nursing assistant at a VA Medical Center in Saginaw, Michigan, whom management twice tried to remove from his position and who served a five-day suspension after complaining about inadequate staffing, according to the OSC. As part of his settlement, the VA placed Tello in a new position and awarded him back pay for his suspension.
In a particularly disturbing case the OSC highlighted, VA management in Syracuse, New York, threatened to fire registered nurse Rachael Hogan for her "lack of collegiality" after she complained that: a superior failed to report a patient's rape accusation against an employee in a timely fashion; another superior engaged in sexual harassment; and a fellow nurse twice fell asleep while assigned to watch a suicidal patient. Like it did with Tello, the VA agreed to place Hogan in a new position as well as revise her performance rating.
 
"OSC will continue to work with the VA to obtain relief for VA whistleblowers with meritorious reprisal claims," said Special Counsel Carolyn Lerner in the OSC statement.
Indeed, the OSC has about 120 pending cases involving reprisals against VA whistleblowers, the Washington Post reported.
 


Tuesday, January 20, 2015

For Profit Nursing Home Chains Accused of Cutting Staff and Benefits

January 14, 2015
A Chicago Law firm that specializes in cases involving neglect and abuse by nursing homes claims that the larger, for profit chains become profitable by cutting back on staffing and skimping on quality care to facility residents. 
Founding partners Steven Levin and John Perconti, of the law firm Levin and Perconti both of whom have been named among the Best Lawyers in America  and have been  selected by Leading Lawyers and Illinois Super Lawyers as among the top personal injury, elder abuse, wrongful death, and medical malpractice lawyers in Illinois. Made this accusation in a recent posting on their web site.
" The nursing home business has been a profitable one for many. As baby boomers enter their later years and require care, the customer base is undoubtedly growing. Add in the numerous insurance policies that cover nursing home and long-term care facility stays, including government programs like Medicare and Medicaid, and the sources of revenue for nursing homes are tremendous. Add to this the untenable yet unfortunately realistic incentive to cut overhead and staff levels in order to save even more money and generate greater profit margins."
"Such lower staff levels reduce the time and attention paid toward patients who need constant care, and can result in injuries, untreated illnesses, and eventually death. In spite of allegations of abuse, neglect, or fraud in accepting federal dollars for fake services or overstated services, all of which can result in criminal and/or civil charges costing millions in fines and penalties, the business of nursing homes is a profitable one, and many companies are looking to get into this business."
"There has been a trend of nursing home ownership becoming bigger and bigger. There are no longer smaller outfits or so-called “mom and pop” single homes. Rather, larger holding companies and management companies have acquired chains of nursing homes to run en masse for greater and greater profit. This has also been a similar trend for once-publicly-run nursing homes, which states are selling off to go under completely private management. .."
The complete article can be found on the firm's blog

Wednesday, January 7, 2015

Recent Study of Long-term Care Insurance Policies Shows Improved Quality of Life for Policy Holders and Their Family

 Phylis Shelton, one of the most respected authorities on the subject of private long-term care insurance recently wrote about the most recent comprehensive study of these policies and the significant value they provide-not only in paying claims to sharply reduce the
financial costs of caring for aging parents but the added value of quality of life for both policy holders and members of their family.

"...the main reason I hear from people who contact me about planning for long-term care is because they don't want to be a burden on their kids. This is in keeping with the March 2010 Age Wave study that said when asked their greatest fear about having a long-term illness, people are over five times more worried about being a burden on their family than dying, and the greatest worry of becoming a caregiver is the emotional strain—more than the financial costs."

Shelton called attention to a just published a study done by Marc Cohen and the LifePlans, Inc. team.

"What makes this study so great is that it looks at a large block of claims and tells us how people are using their LTCi plans to make their lives better.
For example, more people are able to receive care in the location of choice, usually home care, and they get a lot more care because they have a way to pay for it. Recent  Study of Long-term Care Insurance Policies  Shows Improved Quality of Life for Policy Holders and Their Family



Source: America's Health Insurance Plans 601 Pennsylvania Avenue, NW South Building, Suite 500 Washington, DC 20004

Tuesday, January 6, 2015

Long-term Care Insurance Can Prevent Catastrophic Financial Costs







Long-term-care insurance helps relieve stress

Source: Michelle Willard, The Daily News Journal 8:46 p.m. January 3, 2015


MURFREESBORO, TN – Caring for an aging parent can cause much strife within a family.

According to the University of Michigan Health and Retirement Study, daughters are two times more likely to provide care for aging parents than are sons.


The research suggests that in families with children of both genders, sons will reduce their time spent with their elderly parents while daughters increase that time to compensate for their brothers.



That lack of participation by one or multiple siblings can cause discord within a family, but proper planning can cut the family feud short, said Stacia Vetter, assistant vice president at National HealthCare Corp.



"I can tell you my brother and I have never fought about this," she said.



Vetter is an insurance broker specializing in long-term-care insurance who also has a policy for her parents.



Unlike traditional insurance, long-term-care insurance is designed to help families with the financial burdens of aging by providing funds on a daily basis for long-term care, she explained.



"We are living longer, and we are living longer with chronic illness," Vetter said.



Long-term care is needed when an individual cannot do normal daily things—like eating, bathing, dressing and driving—without some kind of help, said Vetter, a long-term-care insurance specialist.

 _____________________________________________________________________________
For more than 20 years, Informed Eldercare Decisions, Inc has been providing experienced and highly professional care management specialists to elders and family caregivers who seek assistance with the difficult care planning decisions in Massachusetts.

As parents age, they may need assistance with tasks such as home maintenance, getting dressed, personal hygiene, mobility, transportation and nutritious meals. And if a medical emergency occurs without a contingency plan in place, it adds to the burden of guilt and anxiety over what could happen in the family caregiver's absence. 

Our highly accomplished professionals conduct in home or hospital based evaluations and needs assessments in order to develop a comprehensive care plan that addresses the full range of medical, emotional, financial, and legal needs. Plans are customized to meet the specific needs of each family. We also provide optional, ongoing monitoring of the care plan when family members are unable to do so due to work, distance, or other conflicting responsibilities. 
LEARN MORE AT 781-461-9637/WWW.ELDERLIFEPLANNING.COM

___________________________________________________________________________

"Long-term-care insurance covers the assistance needed with these things …" Vetter said, explaining the insurance can pay for everything from in-home personal assistance to a nursing home. "Essentially you're buying a big bag of money."



Long-term care can be costly, a semi-private room in a nursing home averaged $205 per day or $6,235 per month in 2010; a private room in a nursing home cost $229 per day or $6,965 per month in Tennessee and care costs in many other states are twice as high.
 

The insurance can cover most if not all of the cost, but premiums for long-term care insurance can vary greatly, according to DHS.



The policy's cost is based on how old you are when you buy the policy, the maximum daily amount a policy will pay, and the amount of days (or years) that a policy will pay.



The amount per day times the number of days determines the lifetime amount that the policy will pay and monthly premiums are based on that amount. Any optional benefits, such as benefits that increase with inflation, can also increase the premium.



Vetter was hesitant to name a price range for the cost of coverage. She said for her family the up-front cost saved much in the long run.
 
 
Vetter was a nursing home administrator with NHC and became involved with long-term-care insurance after families of her residents asked about it. She said she took the idea to her bosses and "20 years later we still do it."



Aging is the one thing no one can avoid and, if it's unavoidable, then one should plan for it, local businesswoman Becci Bookner said.



Bookner, founder of Family Staffing Solutions, planned for her own aging with long-term care insurance.



She knows first-hand about travels of caring for an aging loved one. Bookner started her company after struggling to balance her own life with the care of her two aunts and then her mother.



Bookner, who also has a policy for herself, said she checked into different companies and found one that best fit her needs. She also said it's good to pick an agent that is close by to bounce questions off of.

"It's awful nice to have someone to talk to about your policy," she said.

Her big questions were: 


Caregiving can be stressful, but both Vetter and Bookner said having a plan for care and how to pay for it helps avoid family strife.

Having a plan can help manage expectations, Vetter said.



But taking the time to take care of loved ones is worth it, Bookner said.

"It's worth the investment in long-term care insurance and it's worth the investment to spend time with our aging population," Bookner said.



Contact Michelle Willard at 615-278-5164 or mwillard@dnj.com. Follow her on Twitter @MichWillard.  http://www.dnj.com/story/money/business/2015/01/03/long-term-care-insurance-helps-relieve-stress/21244641/

Tuesday, December 30, 2014

Suggestions for Caregivers When You Reach the "I can't do any more right now" Point




Learn to Control What You Can in Caregiving
Many caregivers devote their entire lives to their loved one's needs. In reality, you can't do it all
Is it ever appropriate to draw the line and say, "I can't do any more right now"? In a word, yes.

The best way to help your loved one is to pay attention to your own health and needs. Only then can you turn to your loved one's needs. It serves no one if you are worn to a frazzle because of your devotion.

What helps caregivers realize they need a break to take care of themselves? Getting a clear perspective on what you can and can't control may help more than anything.

Here are four things you can do to regain control:

"The best way to help your loved one is to pay attention to your own health and needs."
1. Take care of yourself
In order to sustain the arduous tasks related to caregiving, you need to have the personal resources to be able to give. This means not running yourself ragged. Regularly step back and nurture yourself. Try making appointments with close friends for cups of tea. Take long walks or long bubble baths. Read escapist fiction or go to lighthearted movies. If you're really feeling overwhelmed, see a trained counselor who can suggest other options. It doesn't matter what you do to take care of yourself, it only matters that you do so.


2. Learn to pace yourself
Take breaks from caregiving tasks with self-care strategies, such as those suggested above. Do your best not to feel guilty about this. Carving out personal time has three amazing benefits. It keeps you going as a caregiver. It gives you enough energy for other loved ones, such as children, who need your everyday care. And it allows you to reorient your life apart from being a caregiver.

3. Keep living, planning and looking ahead

Caregiving can be all-consuming, so it's easy to stop thinking about your own life. Continue to have goals and dreams and know that, no matter what happens to your loved one, your life will go on. You will be prepared for it — only you can take charge of that.
Remember, caregivers have needs, too. Care for yourself just as you care for all the people in your life.
 Source:  Johnson & Johnson.

Monday, December 22, 2014

Risks of Hiring Caregivers Under the Table

Hiring Home Health Care Workers :Risks of Hiring Caregivers Under the Table


Families of frail elders are often tempted to hire independent caregivers rather than using a licensed agency because rates charged by independent caregivers are typically lower. Paying an hourly wage without taking out taxes -- known as paying "under the table" -- saves you even more money while allowing the home care aide to take home a bigger paycheck. But unfortunately, it's not as simple as that. There are numerous risks and hidden costs involved in paying a caregiver under the table. 

1. You're breaking the law.
When you hire an in-home caregiver, the IRS considers that person your employee if you pay more than $1,800 in a calendar year. This means the IRS holds you responsible for withholding and paying taxes, which include income tax, Social Security, Medicare, and other state and federal taxes and benefits. Some families try to get around this by labeling a caregiver a "contractor," in which case you file a W-9 recording the annual total of your caregiver's wages.  

However, few caregiver relationships meet the IRS's definition of a contractor, and the government is cracking down on enforcing this issue. If you choose to go completely under the table, you and the caregiver together are defrauding the government of taxes and benefits. If you're considering going this route, it's a good idea to talk to an accountant or lawyer to learn about the legal and financial rules about hiring in-home help and the possible consequences of ignoring them.

2. You could pay more down the line.
As an employer, you were legally required to pay taxes for your employee. This means that if you get caught by the IRS, you'll be responsible for paying back taxes, including interest and penalties. These taxes and penalties accrue each year, so if you hire a caregiver for several years, or if you get caught years later, or both, the penalties can be very steep. You might think there's little chance of getting caught, but you'd be wrong. You can get caught during an audit of your taxes or as a result of a caregiver's future actions, such as if she seeks unemployment compensation, workers compensation or in some other way reports the job.

3. An under-the-table caregiver is harder to verify.

Professional caregivers (who typically ask to be paid over the table) are also licensed and bonded, giving you the security of knowing that they've undergone professional training and that these checks have been performed. If you hire someone on your own, you'll need to do all this yourself, and it's unlikely the results will be as satisfying. Of course you'll ask for and check references, but the less legal your arrangement, the greater the chance that your caregiver candidate could be padding her resume or faking references.

4. You're not protected from disability claims.
Many professional caregivers are bonded and carry disability insurance in case of injury. Under-the-table caregivers are unlikely to come with these safeguards. If your caregiver is not bonded and insured, you could be liable if she gets hurt or disabled from an injury or accident she suffers on the job. By hiring under the table, you have little protection if she chooses to seek damages. 

5. The risk of theft is higher.
Think about it -- if your relationship with your caregiver is illegal, which means it's in some sense secret, your caregiver knows there's less chance that you'll report abuse, theft, or other problems. The feeling of being able to "get away" with more can lead to serious problems down the line that you don't want to deal with.

6. You may have to deal with high turnover.

According to geriatric care managers and other experts in senior care, caregivers hired under the table have much higher turnover than caregivers hired through agencies or even those hired independently but employed legally. It makes sense -- there's no paperwork to document the job, therefore no hassle to leaving and finding another. Without a contract or any legal agreement, you're not protected from someone simply quitting with short or no notice. This is probably the least of your worries, given the seriousness of some of the issues above, but you don't want a frail or ill loved one left without care available.

 New rules signed into law by the president earlier this year "will provide a floor for domestic workers for generations to build toward their dreams," Ai-jen Poo, the director of the National Domestic Workers Alliance, wrote in Politico.

Previously, home health aides had been excluded from federal protections because of wording intended only to exempt informal care arrangements, like babysitting. By 2020, there will be an estimated 4 million home health care workers in the U.S. More than 90 percent of the current work force are women and 56 percent are nonwhite. Almost 40 percent of these workers qualify for federal benefits such as food stamps or Medicaid. And while a majority are already paid more than the federal minimum wage, many work more than 40 hours a week without receiving overtime pay.

Some industry leaders welcome the changes and believe they will benefit companies that have always paid their workers responsibly.

"It levels the playing field with companies that don't pay minimum wage and overtime to these workers," Ben Bledsoe, president of Consumer Direct Management Solutions, which operates health-care agencies in 11 states, told The Wall Street Journal. The businesses that will be hurt by the new rules, he said, are those that "haven't been doing this all along."

Sources: https://www.caring.com/articles/hiring-under-the-table
http://www.nextavenue.org/blog/new-rules-hiring-home-health-aides
National Domestic Workers Alliance,