Easing the cost of caregiving

Ways to help ease the costs: Government aid and community services

Whether it’s a medical bill, home modification or prescription drugs, caregiving is expensive. It’s no surprise that nearly half of caregivers have experienced a personal financial setback — like dipping into their savings or pulling from their retirement account.

As a first step to managing costs, Adams recommends making a budget. Tracking caregiving expenses and creating a detailed record of spending can help understand the full financial impact. “Knowing where your money is going can help identify potential savings,” he says.

As a next step, a caregiver can look into government programs and community services they and their charge qualify for. It can help lower the cost of caregiving dramatically.

The largest government programs include the following:

• Medicaid is the public health insurance program for people with limited income and resources. A person may qualify depending on their age, finances and medical needs. Along with free or low-cost health insurance, Medicaid benefits can cover the cost of long-term care facilities, transportation to medical care, and dentures, prosthetics, eyeglasses and more. In some circumstances, Medicaid will pay family members for caregiving as well.
• Medicare is public health insurance for people who are 65 years or older as well as younger people with disabilities. Depending on the type of Medicare a person chooses, they may qualify for skilled care at a nursing home, home health care, meal delivery and other services.
• Social Security Disability Insurance provides monthly payments to people who are out of work for one year or longer because of a disability. Additional family benefits are sometimes available for spouses, ex-spouses and children, too.
• Supplemental Security Income is monthly income for low-income older adults and people with disabilities. This program often goes hand-in-hand with the Supplemental Nutrition Assistance Program (SNAP), which helps lower the cost of food and groceries.

Depending on where a person lives, they may have access to state-funded programs. These might include home modification loans or free legal services through a disability law center. “Local nonprofit organizations, community centers or religious groups may offer services such as transportation, meal delivery or respite care,” says Adams.

For example, the senior center in town might loan out wheelchairs, walkers or raised toilet seats. Some nonprofits also offer assistance to pay for services and products — from home internet to books.

Denise Brown, founder of the online caregiver community CaringOurWay.com, acknowledges that searching for assistance can seem like another chore — as if caregivers aren’t already crunched for time. She recommends using sites like BenefitsCheckup.org and FindHelp.org to search for programs based on ZIP code. (These two websites are not owned or operated by CVS Pharmacy. Use of their sites is subject to their privacy policy and terms of use.)

A person can also connect with a social worker or elder care advocate, who might be aware of programs that aren’t yet on their radar.

Can family members be paid as caregivers?

Caregiving can seem tougher than a full-time job. Much of that work goes unpaid. But caregivers can be compensated for their care in some cases:

• State Medicaid programs sometimes allow a person to become a paid caregiver. Rules on eligibility and benefits differ from state to state. Some states require the caregiver to be a family member, while others exclude people who live in the same house. Contact the local Medicaid office to learn more.
• Long-term care insurance covers personal care for those who need it. Since most long-term care benefits don’t require a licensed professional to be the one providing the care, a person’s policy may pay someone for their help.
• Veterans’ programs empower veterans to hire and pay their caregivers.
• Families may also choose to pool resources to hire someone, says Brown. It may be helpful to speak with an elder-law attorney and financial planner about how to approach these situations to ensure everyone involved is on the same page.

Save at the pharmacy

The cost of prescriptions and personal care items can add up fast. It’s a good idea to maximize programs that can help keep these expenses to a minimum. Here are a few ideas that might work for a caregiver and their charge:

• Find lower-priced drugs. Talk to their doctor or pharmacist about prescription medication options that come at a lower cost. “When available, generic medications have the same active ingredients as the brand-name medication and are often significantly cheaper,” says Adams. To check options for the caregiver, search for savings at CVS.com. A caregiver can also add their charge to their CVS account to review their payments and preview medicine costs to avoid surprises at checkout.
• Explore savings programs. Discount programs can help reduce the cost of medication as well. Caregivers can explore coupons that may be available for their charge here. Eligible people may also qualify for copay assistance programs through nonprofits. Some pharmaceutical companies sponsor patient assistance programs (PAP), too.
• Consider 90 day supplies. “Pharmacies often provide a 90 day supply of a medication at a lower cost compared to a 30 day supply from a local pharmacy,” says Adams. Plus, opting for 90 day supplies (often available by mail order) can save a trip and help support medication adherence.
• Take advantage of health insurance and other employer benefits. A person may have benefits their caregiver isn’t aware of that the caregiver can use on their behalf. For example, if someone has a Medicare Advantage plan, there’s a good chance their plan has an over-the-counter (OTC) benefit. This is a use-it-or-lose-it allowance (often up to $100 each quarter) that enrollees or their caregivers can spend on eligible OTC items like toothpaste, pain relievers, eye drops, shower chairs and more. Brown adds that if a person has a flexible spending account (FSA) or a health savings account (HSA) benefit, these benefits may be used to pay for eligible drugstore items, as well.
  

Make smart medical decisions

Medical expenses account for a significant chunk — nearly 20 percent — of caregivers’ costs. Adams says that one of the best ways to lower medical expenses is to stay on top of preventative care. “Many community health centers and free clinics provide access to low-cost health care services,” he says.

MinuteClinic^® is an option for preventative care that includes access to annual vaccinations, physicals, screenings and tests. Another option is a managed care system like Oak Street Health, which focuses on personalized primary care for older adults.

Brown adds that it’s important to make the most of each doctor’s visit. Ahead of any procedure or treatment, have an open dialogue with the health care provider about costs. Talk through the options to balance the finances, potential benefits and the impact on quality of life.

If a hospital stay is required, a caregiver should be proactive and set up for success when they go home. “Start working on a discharge plan the day of admission,” Brown recommends. Ask the discharge planner to request equipment to take home. Order an evaluation for home health, which can provide short-term, in-home care to give a caregiver some relief. Good recovery is better and less costly than a hospital readmission.

Sue Berger, PhD, research associate for the Center for Social and Demographic Research on Aging at UMass Boston, also recommends checking insurance coverage for occupational therapy benefits. Occupational therapists can help uncover ways to make caregiving easier, which can reduce the need to pay for extra help. “We look at body mechanics and the environment and help someone figure out safe strategies where it’s less of a burden on you,” she says.

Balancing caregiving and a career

For those who work, caregiving and a career can be difficult to juggle. Data shows that 73 percent of caregivers have had to leave work early or unexpectedly — and one in four loses at least one day of work due to caregiving duties each month. “One of the biggest expenses is that people who are caregiving have to cut back on their work,” says Berger. “I know so many caregivers who have had to change jobs or stop working.”

There is some good news: “Employers are really becoming proactive about providing support for family caregivers,” says Brown. Some employers have concierge services that help employees secure and pay for backup care, while others offer free counseling sessions to improve mental health. Caregivers can check with their human resources department or employer about their benefits.

If possible, Adams also recommends communicating with their employer about caregiving responsibilities up front. “Some employers are more willing to offer accommodations if they understand your needs,” he says. A caregiver may be able to ask for flexible hours, remote work or a modified schedule. Adams says that it’s also important to maximize paid time off: “Make sure you’re using any vacation days, personal days or sick leave to handle caregiving emergencies or to recharge mentally.”

For certain family and medical circumstances, the Family and Medical Leave Act (FMLA) allows eligible workers to take up to 12 weeks of unpaid leave each year. A person may not be paid during this time, but their job is guaranteed to be there when they return. Some states also have paid leave programs, and private employers can offer this benefit, as well.

Financial planning for the future

When Brown was giving care for her two aging parents, she says that she often felt like her tank was empty. That got in the way of thinking about her own future. “It just feels like you have to use all of your resources and energy on caregiving,” she says. However, it’s critical that caregivers safeguard their bank accounts to avoid damaging their own financial stability for the years to come.

“It’s always a good idea to talk with a financial planner or lawyer,” Brown says. Doing so can help caregivers navigate decisions about current and future spending and establish estate planning. They can also help someone decide whether long-term care insurance is right for them and help them avoid compromising federal benefits like Medicaid.

For caregivers who manage their charge’s finances, Adams recommends consulting an attorney. They can make sure a person has the right legal documents in place, including financial power of attorney and medical power of attorney. “It’s not a conversation that anyone wants to have. But caregivers should talk to their charge about their preferences for end-of-life care, including decisions about hospice care, living wills and advance directives.”

The hidden costs of caregiving

Caregiving is an act of love that can nourish the heart — but there can be health costs too. “Caregiving can take a toll on caregivers’ physical and emotional health. Stress, anxiety and burnout can lead to health issues,” says Adams.

A caregiver wants to avoid those for everyone’s sake. It can be challenging to prioritize themselves, but it’s essential for their well-being. Brown recommends setting up what she calls a “solutions fund” that the caregiver can contribute to each month. “When you need a solution like extra help, an activity for yourself or a cleaning service because it was just that kind of a week, you can tap into your fund to pay for it.”

This content is for informational purposes only and is not medical advice. Consult your health care provider before taking any vitamins or supplements and prior to beginning or changing any health care practices.