Preparing to be a Family Caregiver

Hook Law News | Dec 13, 2021 | Letha Sgritta McDowell

During the holiday season, it’s common for adult family members to notice that their older adult loved ones may need care and assistance. Often, time apart during the year and the busy lives of many mask the need for assistance, but the time together and reflection of the holiday season bring these things to light. This year, as concerns about COVID continue and Americans continue to leave the workforce in record numbers, many have decided to also be a caregiver for an aging loved one with chronic illness. While it seems only natural for an adult child to care for an aging parent, caregiving comes with many stresses and burdens and in order to successfully venture into the world of full-time caregiving, it is critical to take a few planning steps before beginning the journey.

Prepare Financially

Many adults care for loved ones with no financial compensation. If the plan is for you to provide care without payment, then be certain that your personal financial situation is prepared for the loss of income from leaving the workforce. This is particularly important to alleviate stress. Caregiving is significantly more stressful than most people imagine, it involves coordinating schedules, doctor visits, timing of medication, meal planning, and physical labor (among other things). If the caregiver is also stressed because of a personal financial situation, that potentially leads to frustration and resentment and therefore requires a careful personal financial review in advance. Instead, if the plan is for the older adult to compensate the caregiver, then be sure to discuss rate of pay, how the payment will be treated for tax purposes, health insurance, and all the other discussions that would occur with a potential employer. It is also critical to have any compensation agreement in writing in the event there is ever an audit by a taxing authority or if the older adult ever needs to apply for Medicaid; the written agreement is required as proof that the payments were made for services and were not a gift. Finally, if there are other family members who are also interested in the older adult’s care, then it may be wise to share the arrangement with other family members. This prevents accusations of impropriety should the arrangement be discovered later.

Prepare a Plan of Care

Rather than simply providing that care which the caregiver thinks is appropriate, meet with the older adult’s physicians to discuss what they believe to be appropriate. Be sure to discuss diet recommendations and restrictions such as low-sodium, low-fat, soft foods, etc., medication management including dosing and timing, as well as hands on elements like balance and gate, fall prevention, skin and nail care, appropriate physical activity, and mental stimulation. If there are caregiving requirements that you are not comfortable with, such as bathing or toileting, understanding the needs in advance and knowing the caregiver’s limitations helps set everyone’s expectations. In addition, you can arrange for third party care providers to assist with those items with which you are not comfortable.


In addition to planning financially and discussing a plan of care, it is also wise to be trained as a caregiver. Caregiving is both an art and a science. Understanding disease and disease process is critical to responding appropriately to the needs of the older adult. In addition, our bodies change as they age, and an older adult may not respond the same way an adult in their prime would (think over the counter medications or skin tears). Training becomes even more crucial when a loved one has been diagnosed with dementia. It is a fallacy to think that care for a person or knowledge of how that person thinks and feels is the only skill needed to be a caregiver. It can certainly help, but most individuals need some training and education to be provide quality care. There are many training courses that are available online. While it doesn’t provide “hands-on” patient experience, it does provide knowledge which, coupled with care for the patient, can help make the care for the patient the best available.


“Hey Dan – do you think there were dogs and cats around at the first Christmas?”

Dan: Hey, reader. That’s a great question. The Christmas Story includes reference to Mary giving birth in a manger which makes one wonder whether there were animals actually present in the manger. I don’t really know since I wasn’t there, but it is probably safe to assume that there were animals around. However, in those days, it was not common for people to keep dogs and cats as domestic pets. So, while there may have been animals around, they probably wouldn’t look like you or me. Luckily for us, times have changed, and we get to enjoy holiday celebrations of all sorts.

Letha Sgritta McDowell

Attorney, Shareholder, CELA
757-399-7506 | 252-722-2890
[email protected]

Letha Sgritta McDowell is a Shareholder of Hook Law practicing in the areas of estate planning, elder law, special needs planning, estate and trust administration, asset protection planning, long-term care planning, personal injury settlement consulting, guardianships & conservatorships, and tax law. Ms. McDowell’s clients range from high-net-worth individuals with over $75 million in net worth to families with limited assets.

Ms. McDowell is a past President of the National Academy of Elder Law Attorneys and was named as a Fellow of the prestigious American College of Trusts and Estates Council (“ACTEC”) in 2020. She is certified as an elder law attorney by the National Elder Law Foundation (“CELA”) and Board Certified as a specialist in Elder Law by the North Carolina State Bar Board of Legal Specialization. Furthermore, McDowell is accredited to prepare and prosecute claims with the Department of Veterans Affairs.

Ms. McDowell is currently the chair of NAELA’s strategic planning committee, a member of the Board of Directors for the North Carolina Chapter of NAELA, and a member of the Board of Directors for the Purdue Center for Cancer Research. She is the former Chair of the North Carolina State Bar’s Elder Law Specialization Committee and is the former Editor-in-Chief of “Gray Matters”, the newsletter for the Elder Law Section of the North Carolina Bar Association. She is a consultant for InterActive Legal and has worked on several law and technology initiatives including IBM’s Watson project. Along with her experience practicing as an attorney, she has dedicated much of her time writing for national publications including, but not limited to: Wolters Kluwer,, the NAELA Journal, Trust & Estates Magazine and many more.

Practice Areas

  • Elder Law
  • Estate & Trust Administration
  • Estate Planning
  • Asset Protection Planning
  • Long-Term Care Planning
  • Special Needs Planning
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