“Susan” was burned out. Nine months earlier, she had taken what she thought would be a temporary leave of absence from her job to care for her 85-year-old mother, who was recuperating from surgery after falling and breaking her hip.

Her mother never fully recovered. She still needed help with bathing, dressing, cooking, cleaning and almost everything else. In the last couple of months, she had become forgetful and confused. She neglected paying her bills, and Susan had to take over managing the checkbook.

Susan found that she was spending almost all of her time taking care of her mother. She was close to using up her savings. She hadn’t spent an evening with a friend or visited her daughter, son-in-law or grandson for over six months. She was lonely, exhausted, scared and often angry. She wasn’t sleeping well. Her back was bothering her. She seemed to catch every virus that was going around.

“Susan” is a composite case, but her suffering is similar to that of many of the family members, companions and friends caring for disabled loved ones with whom we have worked over the last decade. Stress, isolation, impoverishment, exhaustion, increased vulnerability to illness and injury are too often the costs of such care.

Securing the services of a professional home health or personal care aide is usually the single most effective way of alleviating caregiver burnout. Often, an aide allows the caregiver to get some rest, return to work, visit other family members and have a social life.

You can secure the services of an aide by calling a licensed or certified home care agency. Long-term care insurance will usually pay for home care. Medicare and other health insurance programs will sometimes pay for limited amounts of home care.

Medicaid will pay for home care. If your loved one’s income or assets are above the financial limits, a knowledgeable social worker, geriatric care manager or elder care attorney, in most cases, can show you legal ways to reduce assets and shelter “surplus” income to receive full Medicaid benefits.

Roy Herndon Smith is with Community Geriatric Care Management, a subsidiary of Foremost Home Care.

A: Long-term care insurance is custodial care insurance. It covers care generally not covered by health insurance or Medicare insurance. Long-term care insurance generally covers home care, assisted living, adult day care, respite care, hospital care, nursing homes and Alzheimer’s facilities. When home care coverage is purchased, long-term care insurance pays for home care from day one. It will also pay for a visiting or live-in caregiver, companions, housekeepers, therapists or private duty nurse.

Why should you consider long-term care insurance? If you have assets to protect and you want to leave these assets to your children or other family members, it’s a good insurance to have. Your medical insurance or Medicare insurance will not cover custodial care. If you have assets, you must pay out of your own pocket for the care. When you have spent down to your last $3,500, then you will qualify for Medicaid. At this point, you will not have much choice in the type of care you are given, or where the care is given.

You will qualify for benefits when you need substantial assistance with at least two of the six activities of daily living. They are bathing, eating, dressing, toileting, continence and transferring (getting in and out of bed, the shower, etc.). In addition, it is expected that you will need substantial assistance for at least 90 days, or you need supervision because you have a severe cognitive impairment. Your own doctor, nurse, licensed social worker certifies from time to time that you need the supervision.

The cost of long-term care insurance basically depends on your age, the amount of daily or monthly insurance you want, the elimination period (the amount of time before your benefits go into effect) and any options you may select. Naturally, the younger you are, the lower the premium.

Long-term care insurance premiums are tax deductions in your federal and New York State and City tax returns. The premiums can save you tax dollars. You may think that the cost of the insurance is high, or that you will never need it, but it is a great way to protect your assets because nursing home stays in New York City are about $15,000 per month.
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Gary E. Reska offers individual and business taxes, and complete bookkeeping and business forms service. Contact him at 212-249-2525 or gary@garyreskatax.com.

For most of her seven-year career as a nanny, Anna has been fortunate to work for two families that have paid her a decent wage for roughly nine hours of work a day. Her duties usually include taking the children for a stroll or to play dates, cooking dinner in the evening and cleaning.

But even with good employers, Anna has still been denied something as basic as proper time off. The first family that hired her, she said, never provided paid sick days. Luckily for her, they weren’t needed. In fact, she was unaware that such perks were common until she interviewed for a position with a woman—a lawyer—who promised one a month.

“There’s no right to complain,” the West African nanny said.

Mary, a 60-year-old nanny who is also from West Africa, was recently let go because of the tough economy. She received no severance from the family other than a one-day-per-week cleaning gig, though she hopes the family will help her find another nanny position. She claims European families are more inclined to give severance pay. A French family in Manhattan that hired her in the late 1990s paid out $2,000 when they had to let her go.

Earlier this year, a rally on the steps of the Capitol in Albany pushed for legislation in both the State Senate and Assembly that would protect the rights of domestic workers.

While these women talk lovingly of the families that hired them, they also hear the stories other nannies tell each other in the playground coffee klatch.

“You go to a play date or park, they talk about their boss,” says Mary, a domestic worker since 1995. “I never have the problems, but some complain.”

The complaints include simple annoyances, like being barred from eating inside the boss’ home, or having to take the children outdoors every day. But other grievances are more serious: the family goes on vacation and refuses to pay the nanny for time away, or the nannies are denied paid sick days. For people on a tight budget, this lost work adds up and can force them to look for consistent employment elsewhere.

“They can’t pay rent, can’t pay for food,” Anna said. “They’ll go find another job.”

Domestic workers are guaranteed the federal minimum wage, but there are no guidelines for working conditions and rights, and few avenues to complain. Given that most of the metropolitan area’s 200,000 domestic workers are undocumented immigrants, and with job opportunities becoming scarcer, few are willing to voice an objection.

“They have to change the law,” Mary said.

Now, a coalition of domestic workers, labor unions and human rights organizations is waiting for the State Legislature to return to Albany this fall, hoping to do just that.

Patricia, a Caribbean immigrant who has been a nanny for just more than a decade, sees great value in her job. If she is late, so is her boss.

“We make other work possible,” she says proudly.

She is currently unemployed and has worked for families in New Jersey and the West Side. Throughout her career, she has seen the vulnerability of domestic workers and even the abuse that can be inflicted—intentionally or negligently—by the families that rely on their service.

Patricia says she has been a victim of physical and verbal abuse, and was denied overtime pay and much-needed time off. And because every major labor law fails to cover domestic workers or splits hairs between those who live inside and outside the family’s home, it is near impossible to recoup money.

She became involved with Domestic Workers United, a group started in 2000 that has been lobbying Albany for a bill to provide basic labor rights to these employees.

Since the bill’s first introduction in 2004, the legislation got little traction. But last year’s Democratic takeover of the State Senate brightened prospects when Staten Island State Sen. Diane Savino, a former labor leader, became the main sponsor. However, the coup this past June and month-long stalemate that ensued have shelved progress until the next session this September, at the earliest.

Depending on which bill makes it to the governor’s desk (see box)—the meatier Senate version, the basic legislation proposed by the Assembly or a combination of the two—the law aims to drastically change working conditions for a majority of nannies in the city and surrounding suburbs. The state’s labor department and the attorney general would have enforcement power over these new laws, and could prosecute employers who stiff their nanny. Most nannies are undocumented workers and thus most vulnerable to mistreatment because they are reluctant to report abuse and risk exposing their immigration status.

Workers march on the Upper East Side on April 25.

The bill legally defines a domestic worker as a person of legal age who cares for a child or elderly person in someone’s home, so as to not inadvertently cover babysitters and minors. Rights outlined in the legislation will likely include a guarantee of at least one day off a week, sick days, a yearly weeklong vacation, paid holidays and time and a half for overtime.

“We’re not asking for more than any other worker,” Patricia said.

Actually, they are not asking for anything more than the rights already given to the small percentage of legally documented nannies who are placed through agencies (a Domestic Workers Union study found that only 16 percent of those surveyed were placed through an agency).

The New York Nanny Center, Inc., for example, screens both the families and the nannies and draws up an agreement between the two before the match is made. This agreement spells out the number of days the nanny will work with a maximum of five days a week, responsibilities, two weeks paid vacation and major holidays, plus any other conditions the nanny and family want to make.

“I think that in most licensed agencies, there is an expectation that there is a fair job description for the nanny,” said Carol Solomon, director of the New York Nanny Center, Inc. “Agencies are trying to establish what’s fair for everybody so nobody is taken advantage of in these situations.”

The change would be a significant one for non-agency nannies. Domestic Workers United released a survey that showed that the majority of nannies interviewed don’t get overtime pay, health insurance or contracts that outline their responsibilities. The survey is one of the few glimpses legislators in Albany have into this profession, because the government provides so few statistics.

“The workforce isn’t registered anywhere,” said Ai-Jen Poo, lead organizer for Domestic Workers United. “All this invisible labor…is not accounted for and makes it difficult for us to advocate for protection because it’s not even seen.”

In an April rally at the Capitol, author Barbara Ehrenreich, who documented her own undercover work in unskilled professions, held a press conference to promote the cause. Former nannies gave testimonials about their mistreatment, and some even showed legislators photographs of physical abuse victims.

“We had to educate them on exploitation and present cases to them,” said Joycelyn Gill-Campbell, a former nanny and full-time organizer with Domestic Workers United. “Give them first-hand information.”

Passing a law is only the beginning, though, as enforcing regulations that govern workers inside the home could prove problematic as well. The bills currently under consideration would have the state labor commissioner report on the feasibility of implementing paid vacation and sick days, severance pay, collective bargaining and other provisions for domestic workers. A state task force would also be created to study how to reach out to employers and nannies.

Domestic Workers United, the lead group lobbying for the law, also plans to launch an education campaign with help from the state’s justice department.

“We have to do creative outreach. We have to work with churches and synagogues,” Poo said. “The industry is very decentralized.”

Perhaps it is unfathomable for famously liberal Manhattanites to deny supporting paid time off and overtime for their nannies. There are many that do so already. While the new law would hit families in the wallet at a time when they may be evaluating if they can afford such help at all, the benefit would be clear rules on paying and treating nannies, decreasing reliance on parent blogs, forums and neighbors for second-hand, unverifiable advice. Online communities are rife with questions about paying a nanny on the books, when to give raises and compensating nannies who accompany the family on a vacation.

“There are people—Mr. and Mrs. Smith who hire a housekeeper and nanny—who feel the work they do is so vital to their family and that they deserve basic protection under the law,” Poo said. “People won’t have to go to friends or chat rooms to find out what is fair.”

*Pseudonyms were used in this article to protect the identity of nannies who are employed or looking for work.

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The Bills at a Glance

State Senate Bill
• At least one day off a week; the employee can choose to work that day, but at an overtime rate
• Six paid holidays
• Seven sick days
• Five vacation days
• Employer must give a two-week notice of termination
• Imposes civil fines or imprisonment
• Allows domestic workers to sue for underpayment or lost wages; the attorney general or Department of Labor can bring a lawsuit on behalf of a domestic worker

Assembly Bill
• Overtime pay after eight hours of work per day
• At least one day off a week
• Grants disability insurance to part-time domestic workers
• Collective bargaining rights
• Gives the Department of Labor and domestic workers wage and hour enforcement powers
• Directs the Department of Labor to form a task force to educate domestic workers and employers on new law

“I think you’re better off putting $50 in a bank account with your pet’s name on it,” said Natasha Cotter, office manger for East Side Veterinarian Dr. Patrick Cotter.

Based on her experience, she has found that insurers typically pay about 50 percent, “and you have to really work for it to get that reimbursement.”

ConsumersReports.org also says that putting the equivalent of the insurance premiums in a savings account is a better idea over your pet’s lifetime. And the odds that your pet is going to need some incredibly expensive treatment are small.
But Dr. Mike Marder of Westside Veterinary Group disagrees.

“I used to advise clients to self-insure,”—essentially setting aside money in a savings account for pet health care—“but now $3,000 to $4,000 for a sick pet is not unusual, so insurance is a definite help,” he said.

Still, insurance companies only reimburse a percentage of what they consider reasonable costs—and New York City tends to have its own definition of “reasonable.”

“Insurance usually pays 80 percent of their schedule of legitimate costs,” Marder said. “A basic exam in New York City is $80 to $100. In Oshkosh, Wisconsin, it may be $35 to $50. If the insurance company establishes $50 as the cost of a basic exam and pays 80 percent of $50, that’s just $40. But if the exam cost $100, the client still has to pay $60.”

Currently, only about 5 percent of pets in this country are insured, estimates Dr. Robin Brennen, vice president of program operations and chief of veterinary services for Bide-A-Wee.

“Pet insurance is a growing industry, though, and increasingly offers more options to owners,” Brennen said. “There used to be just two or three companies for people to choose from; now there are 20 to 30 options.”

With the economic downturn, middle- and lower-income pet owners, especially, may not have a lot of disposable income, so insurance may help them make better decisions for their pets, Brennen explained. Owners of adopted or shelter animals also may want to make sure they have coverage for a previously existing condition.
“Their pets may have diseases that weren’t apparent or uncovered at the time of their adoption,” Brennen said.

Another non-insurance option is called Care Credit, a short-term health care credit card with a line of credit you can apply for and get on the spot. Bide-A-Wee does not recommend any particular plan, and Brennen advises pet owners do research to figure out what makes the most sense for their individual needs.

I went prowling online to compare insurance packages. PetsBest.com offered a real range of plans with optional wellness coverage (like cleaning your pet’s teeth).
Although there was a $75 deductible for illness and accidents, after which they paid 80 percent of the vet’s actual bill, there was no deductible for wellness care; teeth cleanings were reimbursed a flat $100, with an annual limit of $505 for “Wellness Care.”

Another website, Petcareinsurance.com, also offered a wide range of plans and optional routine care coverage, but their annual cap for Wellness Care was $105.

The ASPCA also offers plans, including optional Wellness Care. The deductible for illness or accident is $100, but it’s a one-time deductible, not per illness or accident.
The details and exact benefits and limitations of all insurers vary, so you really have to burrow in there to find out which one is best for you.