December 12, 2006
Caregivers may spend many years caring for someone with Alzheimer's disease. Whether it's a spouse, a family member, or a hired home aide, years of devoted service may deserve some kind of special "thank you" when the caregiving period comes to an end.
Writing in the December 11 Wall Street Journal, staff reporter Kelly K. Spors addresses many of the issues surrounding extra compensation for a devoted caregiver. Appropriate ways to say "thank you" to someone who has contributed so much to the care of a loved one with Alzheimer's can be a concern for any family touched by the disease.
Some families may say "thank you" with a monetary gift, such as a week's or a month's salary. Others may find a momento, like a gold watch, or a dinner out more appropriate. But, Spors emphasizes, there is no clear-cut formula for compensating a devoted caregiver, like tipping a restaurant waiter 15% to 20%.
Rather, ways to say "thank you" can vary widely, according to the length of service, who is doing the caregiving, special bonds between a caregiver and a family, and the family's financial means. Each relationship, and each family, is different. Factors to consider, from Spors' article, are summarized below.
About two thirds of professional caregivers are hired by individual families. But increasingly, more and more families are turning to home health agencies to find qualified help. Many of these agencies set restrictions on the kinds of gifts that caregivers can receive.
Spors cites one agency in New Jersey that does not allow gifts for their employees. This is done to avoid elder-abuse laws as well as any hard feelings about the amount of the gift. Instead, the agency provides special bonuses, usually about three weeks' salary, for cases of longtime service.
Another national chain of agencies allows gifts, but asks that they be submitted through the local office in order to avoid any misunderstandings or misrepresentations. About one in ten families who use this agency provide some kind of parting gift when the assignment ends.
Private Family Help
When the family does the hiring itself, the caregiving relationship is often more complex, Spors says. Some hired caretakers live in the home and become closely integrated with family affairs. Many of these workers do not get certain extra benefits, such as health insurance. Others who have spent years helping out may come to expect a piece of the family estate.
In these cases, family members should discuss appropriate ways to say "thank you." In some cases, a person with Alzheimer's may be moving to a nursing home, and it may be years before any extra funds may be available.
Length of Service
Whether someone has spent several weeks caring for a person with Alzheimer's, or many years, also influences how a family might feel about providing extra compensation. Spors cites one woman who has two caregivers for her ailing mother. One has been with her for nine years and provides daily care while she is at work; she plans to give her a month's salary as a parting gift. The other, who comes in periodically when needed, will get a smaller cash gift.
How much compensation a family member can offer will depend to a large extent on family finances. Some families can afford to offer someone a months' salary, while others may be barely scraping by. Much as someone might want to provide an extra thank you, they may not be in a position to do so.
One home health-aid specializing in home-based hospice care says she has received two substantial family gifts in the past 20 plus years. One doctor's family gave her a weeks' salary and the family's late-model Volvo automobile when the woman she was caring for moved away to be closer to her kids. Another woman gave her a $500 gift when she had to enter a nursing home. Most often, she receives a thank-you card or a small gift.
Friends & Family
Family members or close friends who devote themselves to caring for someone with Alzheimer's disease present a special case. They are often not paid directly for their services. When the caregiving period ends, they may be offended by a cash gift for a labor done out of love.
For family and friends, it may be most important to provide ongoing help along with the way, rather than a token gift at the end. Extra cash to pay for the day-to-day necessities of care would be appropriate. Family members should also step in to provide backup care so the caregiver can have regular "holidays," nights or weekends off to shop, see a show, or just relax.
In some cases, such as when other family members live far away, a devoted family member may be rewarded with an extra piece of a family estate. But, caution experts, any special arrangements should be discussed and agreed on by family members ahead of time, so that expectations can be managed.
For more information, see the article by Kelly Spors, "How Much Thanks Does a Caregiver Deserve After Years of Effort?" in The Wall Street Journal, December 11, 2006, page R9.
By www.ALZinfo.org, The Alzheimer's Information Site.
"Above and Beyond: How Much Thanks Does a Caregiver Deserve After Years of Effort?" The Wall Street Journal, December 11, 2006, page R9.