Elder Care and You

Margaret Newcomb, 69, is a retired teacher, and she is trying to protect her retirement savings by caring for her 82-year-old husband, who has severe dementia. At times, he has wandered away from his home. She attaches a tag to his shoelace with her phone number in case he gets lost.

Limitations in cognitive and physical health are the primary reasons why older adults need help with their daily activities. As we age, we can’t rule out the possibility that we may develop an impairment affecting our independence.

According to The National Institutes of Health, which is a part of the U.S. Department of Health and Human Services, 59% of adults between the ages of 85 and 89 receive a family caregiver’s help. That rises to 76% for those 90 or older.

Taking on the role of a caregiver can be a rewarding experience. You are stepping outside of yourself to help and serve a loved one. But it will require sacrifice, and it can be emotionally draining. If you ignore your own needs, it can exact a toll on your own health.

The financial side

According to Medical News Today, Medicare pays for caregivers when a person is under the care of a doctor, a doctor has certified a person as homebound, or the care delivered is through a written plan that’s regularly reviewed by a doctor.

Medicare may cover eligible home health services such as medically necessary part-time skilled nursing care, physical therapy, occupational, speech, and language therapy, and part-time home health aide services.

Covered home health services also include medically necessary part-time or intermittent skilled nursing care.

Medicare does not pay for 24-hour-a-day care at your home, home meal delivery, homemaker services (like shopping and cleaning) unrelated to your care plan, and personal care that helps you with daily living activities (like bathing, dressing, using the bathroom), when this is the only care you need.

Veterans or family members of a veteran, are you eligible for the Program of Comprehensive Assistance for Family Caregivers?

You may be eligible if you and the veteran you’re caring for meet these requirements.

Eligibility requirements for the family caregiver:

You must be at least 18 years old, and at least one of these must be true for you:

  • You’re a spouse, son, daughter, parent, stepfamily member, or extended family member of the veteran, or
  • You live full-time with the veteran, or you’re willing to live full-time with the veteran if we designate you as a family caregiver.

For the veteran:

The veteran you care for has a

  • VA disability rating (individual or combined) of 70% or higher,
  • The veteran was discharged from the U.S. military or has a date of medical discharge,
  • The veteran needs at least six months of continuous, in-person personal care services.

Medicaid may be an option, but please be aware that eligibility may be severely restricted by your income or assets.

Spotting trouble before trouble enters your home

Avoid hiring a caregiver who isn’t qualified, or worse, puts your loved one in a dangerous situation. If you have ever engaged with a caregiver, it’s an ever-present worry, but the risk can be minimized by taking a few simple precautions.

What are the signs of a dangerous caregiver? Let’s review several red flags provided by the Institute on Aging.

  1. Your applicant refuses to supply references, a home address, or submit to a background check. This is a huge red flag. Avoid this applicant!
  2. The person moves often. Unless there is a reasonable and legitimate explanation, this could be a sign they may be evading law enforcement, state homecare regulations, or both.
  3. A family member or friend may appear to be the solution, but is that person in over their head? Past elder care experience isn’t a substitute for education, training, certification, licensure, bonding, and proof of insurance.
  4. Follow your gut. Does something seem out of place? If so, you are under no obligation to hire that person.

What if you have thoroughly researched a candidate, and they are now assisting your senior, but something feels amiss? Let’s review some of the danger signs.

  1. Your senior has unexplained illnesses, infections, or bruises. You may have a dangerous caregiver if medical history doesn’t explain these problems.
  2. Is your loved one anxious or nervous around their caregiver? Does he or she seem to be afraid of their caregiver? The caregiver may be threatening your loved one in your absence.
  3. Look for signs of neglect. Is the home a mess or dirty? Is the aide always watching T.V. or not paying attention to your senior? Is your senior hungry or cold? These are signs of neglect.

Those looking for employment may have the best of intentions, but the Institute on Aging notes that good intentions should be “backed up with a clean criminal record, affiliation with a reputable agency, and a safe, secure feeling you get when you leave your senior in their hands.”


Scams targeting individuals 60 and older caused over $3.4 billion in losses last year. That’s up about 11% from 2022, according to the FBI.

Remind your loved one about online scams and fraudsters claiming to work for the IRS, Social Security, and Medicare.

Common schemes include romance scams, tech support scams, and the sweepstakes winner scam.

Bottom line: Be careful and be alert.

AI and the Iceberg

It has been said that only 10% of an iceberg is visible, while the remaining 90% is submerged under the water. Is that what we’re seeing in today’s market?

The S&P 500 and Nasdaq notched several all-time highs in June, according to MarketWatch, building on an impressive advance this year.

Key Index Returns
Index MTD % YTD %
Dow Jones Industrial Average 1.1 3.8
Nasdaq Composite 6.0 18.1
S&P 500 Index 3.5 14.5
Russell 2000 Index -1.1 1.0
MSCI World ex-U.S.A.** -1.8 3.2
MSCI Emerging Markets** 3.6 6.1
Bloomberg U.S. Agg Total Return 0.9 -0.7
Source: MSCI.com, Bloomberg, MarketWatch
MTD returns: May 31, 2024 – June 28, 2024
YTD returns: December 29, 2023 – June 28, 2024
**in US dollars

What’s driving the headlines?

The AI revolution is powering significant gains in technology shares and the S&P 500. Look no further than AI-chipmaker Nvidia (NVDA), which briefly became the largest publicly traded company in the world last month. Fortune.com pointed out that shares of the stock accounted for more than one-third of the S&P 500’s advance this year (through mid-June).

Here’s another interesting factoid. Nvidia accounted for 44% of the rise in the S&P 500 since the end of 2021, according to The Wall Street Journal (as of June 21).

Why? The S&P 500 Index is a market-capitalization-weighted index. The top three stocks are valued at over $9 trillion, comprising a significant portion of the S&P 500’s value of about $46 trillion.

Look no further than the lesser-known S&P 500 Top 10 Index, which consists of 10 of the largest S&P 500 companies. It rose nearly 29% in the first half of the year, according to S&P Dow Jones Indexes.

Outside of AI, other catalysts that have fueled this year’s advance include:

  1. Corporate profits that have topped expectations.
  2. Job growth is solid, the economy is expanding, and the soft-economic landing scenario still appears to be in place.

We’ve established that the largest publicly traded companies are, on average, performing admirably. That said, have investors shunned many of the equities that make up the S&P 500 Index in favor of a few firms?

Let’s review the S&P 500 Equal Weight Index.

As the name implies, every stock in the index equally contributes to the performance of the index. In this case, it is the S&P 500 Index. The equal weight index is up a respectable but modest 3.25% this year (as of July 2). Notably, the equal-weighted index was off 3.1% in Q2 versus an advance of nearly 4% for the S&P 500 market-cap-weighted index.

What might this mean?

Some market technicians have fretted over the lack of breadth in today’s market.

“This Rally Is All About a Few Star Stocks—and Some Investors Are Worried,” The Wall Street Journal opined.

Here’s another one from Barron’s: “The Stock Market’s Rally is Being Driven by a Few Stocks.”

But the WSJ story was published on June 6, 2023, and the Barron’s piece hit the wire on April 3, 2023.

The S&P 500 is up nearly 23% over the last year (ending June 28, S&P Dow Jones Indexes).

Investor’s corner

We believe the economic fundamentals—the economy and corporate profits—will have the greatest influence on the major indexes in the near and medium term. If the ever-elusive recession materializes later in the year, we’d expect volatility to return.

However, a gentle economic slowdown that supports earnings would be expected to create a more favorable environment for investors.

Over a longer period, the optimists argue that investors are underestimating the economic impact of the AI revolution. The upbeat scenario argues that technology and AI will drive productivity, fueling economic growth just as millennials are entering their prime spending years.

We’re not market seers. We acknowledge that visibility is limited. We’d never dismiss the possibility of a market pullback.

However, the market’s long-term track record provides a compelling reason stocks should be included in a comprehensive financial plan.

I trust you have found this review to be informative. If you have any inquiries or wish to discuss other matters, please don’t hesitate to contact me or any team member.

Susan R. Foard, CPA, CGMA/President of Pugh Wealth Management