All Home Care Is Not the Same

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Each day, 6,000 U.S. citizens turn 65. One in five Americans will be older than 65 by the year 2030. This means a potentially huge number of seniors could be looking for assistance with daily living activities — either now or in the not-too-distant future.

Of course, most seniors want to stay in their own homes as long as possible. The desire to remain at home, along with the increasing senior population, has led to incredible growth in the home care service industry. In-home care can help seniors live safely and comfortably, but there are many types of home care providers that provide a variety of services. Before you select an individual or organization to provide care for a loved one, make sure you research providers and ask the right questions.

Home Care Services

In-home caregivers provide a range of services and assistance that allow seniors to remain in their own homes. The majority of agencies offer a mix of the following:

• Homemaking and Companionship Care – meal preparation, errands, incidental transportation, light housekeeping, companionship and medication reminders
• Personal Care – bathing, grooming and hygiene, toileting and incontinence, and special meal preparation
• Specialized Services – around-the-clock emergency response and, oftentimes, care for clients with Alzheimer’s and other dementia issues

Differences in Home Care Providers

The majority of in-home care providers operate under one of three business structures: independent, registry or employment-based agency. Each differ in staffing and fee structure, as well as who assumes the role of employer and the associated responsibilities of the employer.

Independents

Independents are as the name suggests — one more providers who are not part of a larger organizational structure. An independent caregiver may be someone you know personally, someone from the community or someone who advertises in-home services in the classified section of the newspaper. No matter the source, there are implications surrounding hiring an independent that should be considered before securing the relationship.

The biggest “plus” in hiring an independent is an hourly rate that is generally less than you would pay a registry or agency. However, a lower hourly rate does not always translate into the most cost-efficient solution. If you choose an independent provider, you are now the employer. That means you are responsible for all employment taxes and deductions for your employee, the caregiver. You also become responsible for securing the appropriate insurance coverage in case the caregiver is injured while providing care in the home and general liability insurance in the event the caregiver causes property damage. Most homeowners’ policies do not cover the expenses associated with injuries or damages sustained while a caregiver is in your employ. You’ll also want to check the caregiver’s background and verify information such as experience, references and licensure. The low hourly rate may not justify the extra time and money required to hire an independent caregiver.

Registries

Registries build and manage databases of caregivers but do not actually employ the individuals. The caregivers often act as contract labor, but the employment arrangements can vary. If you go this route, one of the first questions you should ask is who assumes the role of employer and is therefore responsible for employment tax withholdings and insurance coverage. Some registries do provide workers’ compensation coverage, but make sure you understand the extent of the coverage to ensure the caregiver is actually covered while working for you.

Quality registries typically complete background checks on the caregivers in their database. Generally, they do not provide training, nor do they ensure a level of proficiency prior to placing the caregiver. Registries act as a “matchmaker” and provide viable personnel options for consumers to consider. In the event a chosen caregiver cannot perform her duties, the registry can provide alternative caregiver solutions. If you choose a registry to provide an in-home caregiver, make sure you understand:

• Who employs the caregiver and is responsible for employment tax withholdings.
• What kind of background checks have been run on the caregiver and the outcome of the checks.
• Any and all insurance coverage that may apply to the caregiver in the home.
• Any relevant caregiver training and certifications.
• How the caregiver is paid.
• The type of caregiver oversight.

Employment-Based Agencies

An employment-based agency can be a corporation, subsidiary or franchise. The greatest benefit to hiring a caregiver from an organization that employs its caregivers is the oversight provided and convenience for everyone involved. Of the three options, this is the lowest maintenance. Once you have settled on a company to work with, the “back office” details are not your responsibility. The biggest distinctions with these organizations are:

• They employ the caregiver, and clients are not burdened with employer laws and requirements.
• Employees have undergone rigorous background checks, interviews and reference validations.
• Caregivers are covered by workers’ compensation, general liability and bonding insurance.
• Caregivers receive training prior to being placed in a client’s home, and there is ongoing training to ensure caregivers are educated and prepared to deliver quality care.
• Certification and other requirements are understood and adhered to.
• A large roster of caregivers can “step in” in the event the regular caregiver is unavailable.
• Ongoing oversight and involvement from the corporate staff or franchisees.

More seniors are looking to home care. Who wouldn’t prefer to stay in his own home, enjoying cherished memories and maintaining a level of privacy and independence? There are more care options available to seniors and their families than ever before, and in-home care can be that solution. However, families need to ask the right questions. If you are seeking a care solution for yourself or someone you love, take control of the situation and leverage the information that is available to you.