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American Caregiver Relief Network

“Advance directive” is a term that can refer to various types of legal documents that declare an individual’s wishes for their future medical care.

These documents vary from state to state. You can obtain your state’s basic advance directive forms from many health care providers, eldercare attorneys, state health departments, your local Area Agency on Aging or download them from:

Prepare is a free service that aims to help make medical decision-making easier for people. It can be a good resource for those who need a little help walking through the process.

When creating an advance directive, it's a good idea to consult with your loved one’s doctor, geriatric care manager, or another health care provider who's very familiar with 

When your loved one creates an advance directive, be sure they:

Follow their state’s requirements so that the advance directives will be valid.

Discuss wishes with their health care provider, loved ones, and at least one person who will be able to make decisions for them should they become incapacitated (known as a health care proxy, agent, or representative).

 discussions with the doctor through their 

Some common types of advance directives are described below.

Advance Directive

Our focus here is on helping family caregivers assist a loved one to complete the advance care planning process, but really, any adult in any stage of health should go through the process of advance care planning. After all, none of us knows when an accident or unexpected event can drastically alter life as we know it!

Unfortunately, when tragedy strikes, families are all too often left struggling to figure out what to do – and often, not everyone is on the same page. Headache and heartache abound when family members disagree about how to handle tough situations.

Advance care planning lets your loved one 

make their wishes known in the event that they can no longer speak for themselves

. It makes it much more likely that they will end up receiving the kind of care that they’d like, and it can alleviate a lot of stress and strife among members of the family.

Who is Advance Care Planning Right For?

Once advance care decisions have been made, it’s vital to document them in such a way that they'll be honored by healthcare providers and financial institutions, should the need arise. The major documents you should familiarize yourself with are included here.

How to Document Advance Care Wishes

Helping your loved one with the advance care planning process entails:

Learning about which decisions may need to be made should they become incapacitated

Making decisions about possible future care scenarios

Choosing who can manage finances, if they become incapacitated

Choosing who can make medical decisions, if they become incapacitated

Discussing these decisions and wishes with key loved ones

Documenting the decisions in a legally-binding format

Storing the original documents in a safe-yet-accessible place

Providing copies of the documents to the healthcare proxy, doctor and medical providers, and other key people.

Revisiting the documents/decisions periodically (every 10 years or so, or when there are changes in health or circumstance)

What is the Advance Care Planning Process?

) document grants a person – called an agent – authority to act on your loved one’s behalf. This could allow the agent to manage bank accounts, sell property, file taxes and handle other financial matters. POAs are sometimes limited to specific matters or to a specific period of time.

A “durable” power of attorney remains in effect even if your loved one becomes mentally incapacitated.

A durable POA won’t allow the agent to make medical decisions about your loved one’s health. They’ll need a Healthcare Power of Attorney for that.

A durable power of attorney for healthcare names the person who can make medical decisions for your loved one in the event that they become unable to do so for themselves. The person they name is called their health care proxy, representative, surrogate, or agent.

Your loved one should NOT just choose whoever happens to live closest to act as their proxy. It’s important to choose the right person for the job. The person selected should:

be willing and able to advocate for them if needed.

 is a legal document that describes which types of medical treatments your loved one would – or wouldn't – want to be used to keep them alive should they become terminally ill or permanently unconscious.

Each state has its own forms and rules regarding exactly what’s covered in a living will. Generally, they address areas such as:

Cardiopulmonary resuscitation (CPR) if the heart has stopped beating

Use of tube feeding (and for how long) if unable to eat or drink

Dialysis to remove waste from the body if kidneys aren’t able to do so

Antibiotic or antiviral medication to fight infections

 (supporting comfort as the end of life nears)

 is a document intended for individuals who are seriously ill, very frail, or near the end of their life. It is an order that must be signed by a health care provider such as a doctor or nurse practitioner. The POLST instructs other health care providers – such as paramedics or hospital staff – to refrain from life-sustaining treatment, such as CPR.

The forms vary from state to state. In some 

, such as POST, MOLST, or MOST. They aren’t yet fully available in every location. You can find out more at the National 

, or talk to your loved one’s doctor about whether a POLST is available in your area, and whether it would be appropriate in your loved one’s case.

Types of Advance Directives

There are many reasons people don’t create advanced care plans – they don’t want to think about death or dying, they’re confused about the process, or they simply don’t know about it. However, there really isn’t any reason that they shouldn’t.

Like creating a will or trust, because the unforeseen can happen at any time, starting the 

 as early as possible is strongly recommended.

If your loved one hasn’t yet done this, it should rank high on the list of priorities. Fortunately, there are plenty of resources to help walk you both through the process.

Why Shouldn’t My Loved One Create an Advance Care Plan?

Explore our comprehensive guide on Advance Care Planning. Learn how to prepare, document, and communicate medical wishes for your loved ones, ensuring their care preferences are respected. Ideal for family caregivers at any health stage.

Complete Guide to Advance Care Planning for Family Caregivers

Whether your loved one needs skilled medical care or just a little help in a home-like setting, there are several options when it comes to long-term care.

Introduction

If your loved one has complex medical conditions – or needs a lot of help with mobility – a nursing home (or skilled nursing facility) may be the only place that can meet their needs. It’s also easier for those who are 

 to arrange for Medicaid to cover nursing home costs than other long-term care options.

Independent living can be a good choice for seniors who are mostly independent but would benefit from a friendly, supportive neighborhood and a little help with yard work and home maintenance.

Seniors who can manage fairly well on their own with a little help with meals, dressing, bathing, housekeeping, shopping, and companionship often do well in an assisted living apartment.

Residential care comes in a variety of sizes and setups, such as adult foster homes, group homes, and facility settings. They tend to emphasize a home-like environment and offer assistance with personal care, meals and housekeeping. Some homes are designated for special populations, like LGBTQ+, or those who share particular languages, cultures, or religions. This can make a big difference in your loved one’s sense of belonging.

Memory care offers special programming for seniors with Alzheimer’s disease and other forms of dementia. They’re especially suited to seniors who are at risk for wandering. Some focus on helping your loved one function at their best despite their challenges.

Life care communities (also called continuing care retirement communities or CCRCs) typically offer independent living, assisted living, a nursing home, and sometimes memory care on the same campus so that as your loved one’s needs change they can remain part of the same community.


 can assist with personal care, housekeeping, laundry, shopping, transportation, pet care, meal preparation, and other tasks that can help them live independently with the proper support and supervision.

Home health features licensed healthcare professionals, such as nurses and therapists, who can tend to wounds or perform other medical care in the home. Physical or occupational therapists can help modify the home for safety and independence, and help your loved one function at their best.


Palliative care helps minimize suffering and symptoms for people who live with chronic diseases. They work to stabilize conditions such as pain, shortness of breath, and other issues that make living independently a challenge. They focus on quality of life, so if your loved one wants to stay at home, they can help identify resources to support that goal. Palliative care can be provided in a home or facility setting.

People who are expected to live less than six more months are generally eligible for hospice care, which can be provided in the home or a facility. With hospice support, it’s sometimes possible to remain in the home. There are also specialized hospice group homes in some areas. These can be perfect for those who need more help than they can get at home but want to remain in a peaceful, home-like environment.

Types of Senior Care Services

There’s been an influx in online do-it-yourself (DIY) estate planning services popping up over the last few years. Promising a quick, easy and inexpensive alternative to exorbitant attorney fees, it’s easy to understand their draw.

In some cases, DIY estate planning software can be a good option. For example, individuals with very simple estates – and very simple family dynamics – who wish to leave everything to their next of kin can often get by with an online will-maker service.

However, individuals who own real property, have complicated estates, dependents, or complex family systems should consult with an attorney.

Using a DIY Service as a Starting Place Can be a Smart Approach

If you decide to opt for a DIY approach to estate planning, it’s a good idea to run the completed documents by a local lawyer to ensure they’re compliant with state law and that they reflect your loved one’s wishes accurately.

Although DIY will makers typically claim that their forms are legally binding in all states, it’s not always the case. An overlooked change in law, a typo, or small detail can end up costing the estate thousands of dollars – much more than was ever saved in attorney fees in the first place.

Furthermore, a living lawyer knows which questions to ask and can offer customized guidance throughout the process, which can really impact the estate’s value (and minimize potential future headaches) when compared to an automated one-size-fits-all approach.

Starting the will online can be smart though – it can save you valuable time in the lawyer’s office, which will minimize any hourly fees.

) include a consultation with an attorney in your state as part of an estate-planning package. This can be a good compromise that minimizes risk while keeping costs down.

Legal insurance companies also tend to cover estate planning and include consultation with legal counsel, so signing up for a month of service (or a free trial) can be a financially savvy move.

DIY Estate Planning and Online Legal Documents

How to Find Legal Aid and Pro Bono Lawyers & Representation | Nolo

How to Find Legal Help When You Can't Afford a Lawyer | Personal Finance | US News

Lawyer Referral and Information Service Policy

Making Wills Easier and Cheaper With Do-It-Yourself Options - The New York Times

Sources

Uncover the range of available senior care services to find the right fit for your loved one's needs. Our concise guide delves into essential options, providing insights and knowledge to make well-informed decisions about their care.

Exploring Senior Care Services: Types & Options - Olera

This article provides an overview of the various options available to pay for senior living, including insurance strategies, tapping into home equity, and taking advantage of government assistance programs.

Long-term care insurance, hybrid insurance policies, life insurance with an LTC rider, and annuities are all options to pay for senior care.

Reverse mortgages and liquidating assets are other ways to pay for senior living.

Veterans have access to a range of benefits and programs, and Medicaid covers long-term care for those with very little income and assets.

Article Summary

Aside from using personal savings, other ways to pay for 

 include various insurance strategies, tapping into home equity, or taking advantage of government assistance programs.

Life insurance, long-term care insurance, and annuities are often used to pay for senior care.

 can offset the costs of long-term care but it generally must be purchased quite a bit before it’s needed – it gets very expensive as people age or develop serious health conditions. Policies don’t always cover care in every type of senior living setting, so look closely at the terms of each specific policy.

combine life insurance and long-term care insurance so you can pass a death benefit on to a beneficiary if you don’t end up needing long-term care. Most hybrid policies are more limited than traditional LTC insurance, covering only five years of long-term care.

Life Insurance with an LTC Rider or Accelerated Benefits 

allows you to access life insurance benefits early if needed to cover long-term care expenses.

are special contracts with insurance companies. They provide a reliable stream of income over time in exchange for an upfront lump-sum payment. Different types of annuities exist for different circumstances, such as paying for long-term care or planning for 

Many seniors sell or rent out their homes in order to pay for senior care. In some cases, they get creative – for example, by selling to a family member who, in turn, rents it back to them.

are loans for older homeowners who owe little or nothing on their primary residence. A reverse mortgage provides a lump sum or monthly income that can be used to pay for needs like long-term care. Instead of making payments on the loan, it gets larger over time. You pay back the entire amount borrowed, plus any upfront and ongoing fees when you die, sell the home or move out.

Selling artwork, jewelry, collectibles, extra vehicles, or other assets can sometimes provide enough cash to cover long-term care needs.

have access to a range of benefits and programs. Some offset the costs of long-term care and others provide board and care in nursing homes, assisted living facilities, group homes, or other senior living settings.

covers long-term care for individuals who have very little income and very few assets – provided they haven’t compromised their eligibility by giving away assets, for example. Many seniors plan ahead for Medicaid eligibility or engage in complicated Medicaid planning strategies in order to keep their spouse out of poverty or protect certain assets to pass on to their loved ones.

What Are My Options to Pay for Senior Living?

The national average cost of care per month (Genworth Cost of Care Survey, 2021):

Period (hourly, daily, monthly, or annually)

A different number of weekly home care hours

How Much Does Senior Living Cost?

Depending on your situation, different professionals may be most helpful in helping you pay for senior living.

A CFP will look over your entire financial picture, analyze your options and help you develop a plan to pay for senior living and meet any other financial goals. Read more about finding and selecting the right CFP here.

Look for an agent specializing in the type of insurance you’re interested in exploring – long-term care insurance, life insurance with an LTC rider, annuities, etc. Learn about finding and selecting the right insurance agent here.

Find a reverse mortgage counselor at the U.S. Department of Housing and Urban Development (HUD) 

. A HUD-approved counselor can help you determine whether a reverse mortgage would be a sound move in your situation and guide you to finding a reputable lender.

The veterans' benefits available to you vary based on a number of factors such as your need, service history, and location. Learn more at the 

U.S. Department of Veterans Affairs website

If you have less than $2000 in monthly income and less than $2000 in assets, you can 


If you’re interested in planning ahead for Medicaid eligibility, there are a number of different types of professionals who can assist. The 

American Council on Aging’s Medicaid Planner Finding Tool

 can help you find the best planner for your situation.

Who Can Help me Take the Next Step?

Annual Report on Long-Term Care Insurance: 2021

Is Hybrid Long-Term Care Insurance Right for You?

Should I Get Hybrid Long-Term Care Insurance? | Policygenius

Health Savings Account (HSA) - HealthCare.gov Glossary

HSA savings can be used for long-term care in retirement | Employee Benefit News

How HSAs (Health Savings Accounts) work with HDHPs | HealthCare.gov

Explore available finance options and assistance programs to help afford senior living for your loved one. Our concise guide provides insights and resources to simplify the process, ensuring a comfortable and secure future for your loved one.

Financing Senior Living: Uncovering Options & Assistance Programs for Care - Olera

Paying for Senior Living: Exploring Finance Options & Assistance Programs

This article provides an overview of the different types of long-term care facilities available for those who need assistance with day-to-day activities, as well as the advantages of in-home care.

Long-term care facilities provide a safe and comfortable setting with professional oversight.

In-home care is an alternative to a long-term care facility, particularly when the loved one is partially self-sufficient.

There are a variety of long-term care facilities available, depending on the needs of the loved one.

When a loved one can no longer take care of themselves and needs assistance with day-to-day activities such as eating, bathing, and using the restroom, you may face a decision to put your loved one in a long-term care facility. This decision can be heartbreaking, but it is important to remember that by doing so, you are ensuring their safety in a comfortable setting with professional oversight. Further, your health and livelihood are equally as important and must be prioritized. Remember, you are not alone - millions of family caregivers around the country make the same decision every day.

Caregiving is too demanding or conflicts with work and other obligations

Loved one wanders or demonstrates other unsafe behavior

When to consider long-term care

If you are unable to provide care to your loved one, you also may want to consider in-home care as an alternative to a long-term care facility, particularly when your loved one is partially self-sufficient.

Below are some advantages of in-home care:

Removes the burden of care from you; ability to rest

Consider in-home care

There a wide variety of long-term care facilities, depending on the needs of your loved one.

For seniors who are self-sufficient with only a minimal need for medical or personal care.

Offers the ability to socialize and participate in recreational activities with their peers

For seniors who are partially self-sufficient but need help with daily activities.

24-hr supervision is provided. These include assistance with daily activities and healthcare services

Activities include: eating, using the bathroom, bathing, medication, housekeeping, dressing

Private homes where a group of residents are cared for by live-in caregivers

A more private, community-like analog of assisted living

Activities: daily activities, varies by home

For seniors living with dementia or Alzheimer's

Usually offered in assisted living facility and less often in nursing homes

For seniors in need of constant care and lack the ability to live independently

Trained professional staff provide care and assistance with daily activities

Residents typically share a room and dine in a common area

Activities include: daily activities, healthcare services, rehab services, recreational activities

Types of long-term care facilities

Explore the pros and cons of home care and senior communities, helping you make an informed choice for yourself or a loved one when it comes to care, safety, and quality of life.

Home Care or Senior Community? Which is Best for Your Love One?

This article provides an overview of how to create a Medicaid-friendly personal care agreement for family caregivers.

A personal care agreement is a written agreement between a caregiver and the person for whom they’re caring.

Payments to family caregivers without a valid personal care agreement in place may result in a penalty period of ineligibility for Medicaid.

Documentation is needed to prove services provided and payments received in order to protect Medicaid eligibility.

Long-term care is expensive. It can drain an elder’s assets at a shocking rate. Thankfully, Medicaid is available to cover costs for those who can’t afford it – as long as you follow their rules.

One common mistake people make is to give away gifts, which affects Medicaid eligibility for years to come. Payments to a family caregiver are considered gifts unless they’re done according to Medicaid’s requirements.

Fortunately, it’s not hard to set up payments properly if you know what to do. In this article, we’ll take a look at how to create a Medicaid-friendly personal care agreement.

A personal care agreement (sometimes called a caregiver contract or personal service contract) is a written agreement between a caregiver and the person for whom they’re caring. It defines the relationship with the caregiver as an employee and describes the specifics of the arrangement, such as duties to be performed, frequency of work, and rate of pay.


A personal care agreement (PCA) can prevent problems stemming from assumptions or misunderstandings among family members. It’s also a vital tool in protecting your loved one’s 

What is a Personal Care Agreement?

If your loved one pays for caregiver services without a valid personal care agreement in place, then later applies for Medicaid for long-term care, they may face a penalty period of ineligibility.

 of five years in most states, meaning that they examine all financial transactions from the date of application going back five years. They’re very interested in transfers of cash or assets.

If they find cash gifts – or assets sold for less than fair market value – the applicant is ineligible for Medicaid coverage for a period of time (unless the assets are returned). The more money transferred, the longer the period of ineligibility. The reasoning is that the assets could have been used to cover long-term care costs had they not been given away.

Without a written contract, payments to family caregivers are likely to be classified as gifts instead of service payments.

Transferring property (or selling it at less than fair market value) will likewise be looked at as a gift. If your loved one wants to trade their home for your care, it must be handled with a personal care agreement. Note that there may be special requirements for transferring property for care, so if you’re interested in this option, consult with an elder law attorney or Medicaid planner.

Many individuals aren’t initially eligible for Medicaid and must plan ahead in order to qualify for long-term care coverage. A popular part of the planning process is called 

By carefully spending one’s assets on allowable expenses, an individual can work toward Medicaid eligibility. If your loved one needs care from a family member, paying for it can be an allowable expense, as long as it's done properly with a personal care agreement and related documentation.

In addition to the personal care agreement, you should keep documentation to prove you’ve been providing the services described in the PCA. This can keep Medicaid from challenging the validity of the agreement, and help the process run as smoothly as possible.

Documentation for privately paid family caregivers includes:

 listing dates, times, and services provided for your loved one

recording dates payments were received, amounts, and reason 

(payment for services provided, reimbursement for expenses, etc)

The caregiver must report their income on their income tax return

Your loved one must report the caregiver’s compensation on a W-2 form

Your loved one may be required to pay employment taxes on the caregiver’s compensation, although if the caregiver is a family member they may be exempt from this requirement 

(you may not need one if your PCA thoroughly covers this information)

What Information Does a Caregiver Contract Include?

The personal care contract can be specified to your needs and liking, but it’s important to include some key information. Missing one of these could potentially invalidate the whole thing.


Essential key information to include in a PCA:

this date can’t be set in the past and payments can not be made for services before this date

the length can be defined as the rest of the elder’s life. There’s often a clause describing how either party can terminate the contract if desired.

describe all services to be provided, and any to be excluded. Note where they will be provided, for example in the elder’s home or various locations in the community.

Room and board (if the elder lives in the caregiver’s home)

specify how often services will be provided (for example, Monday, Wednesday, and Saturday from 8 am - 1 pm.) Listing a range can allow for flexibility if needed. (For example 2-4 days per week for 2-4 hours per day, or 10-40 hours per week based on need.)

specify the rate of pay (or alternate method of compensation, if applicable). The rate must be with local rates! Any property transfers must follow fair market value.

Describe which day(s) of the week or month the caregiver will be paid as well as the method of payment (check, cash, bank transfer, PayPal).

How Does a Personal Care Agreement Affect Medicaid Eligibility?

Explore the structure and benefits of Medicaid-friendly personal care agreements for compensating family caregivers. Our concise guide ensures a smooth process, allowing you to support your loved one while understanding the ins and outs of compensation.

American Caregiver Relief Network

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American Caregiver Relief Network

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