Assessing Home Care Options

All home care is not the same.

In-home care can help seniors live safely and comfortably, but assessing options can be a daunting task. There are many home care options, and knowing the differences between the different types of services and service providers can aid you in making the right decision. Before you select an organization or individual to provide care for you or a loved one, make sure you research services and providers and ask the right questions.

Typical Home Care Services

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

• Homemaking and Companionship Care – This can include meal preparation, errands, transportation, light housekeeping, companionship and medication reminders, a variety of other services.
• Personal Care – Personal care services includes bathing, grooming and hygiene, toileting and incontinence care, feeding and special diet or meal preparation and other services.
• Specialized Services – Specialized services may include around-the-clock emergency response, live-in care, and oftentimes care for clients with Alzheimer’s and other dementia issues.

Home Care Providers’ Business Structures

The majority of in-home care providers operate under one of three business structures: independent providers, employment-based agencies and registries. Each is substantially different in how they staff and charge for services as well as who assumes the role of employer and the associated responsibilities of the employer, including employment taxes and deductions, insurance coverage for the caregiver, and liability insurance.

Independents/Private Caregivers

The biggest “plus” in hiring an independent is the hourly rate. Generally, you pay the caregiver less than what you will pay a registry or an employment based agency. However, a lower hourly rate does not always translate into the most cost efficient solution. If you secure an independent to provide in-home care, 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 such as Workers’ Compensation 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 an injury or damages sustained while a caregiver is in your employ.

Additionally, while not required it is important for your own safety and security that you procure appropriate background checks and validation that the candidate is a capable, appropriately trained, and quality care provider. There is the potential for both physical abuse and financial exploitation when work is being done on behalf of a frail, functionally limited, and often cognitively impaired individual.

You also become responsible for securing the appropriate insurance coverage such as Workers’ Compensation 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 an injury or damages sustained while a caregiver is in your employ.

Additionally, while not required it is important for your own safety and security that you procure appropriate background checks and validation that the candidate is a capable, appropriately trained, and quality care provider. There is the potential for both physical abuse and financial exploitation when work is being done on behalf of a frail, functionally limited, and often cognitively impaired individual.

This becomes especially easy when the caregiver and the recipient of care are isolated in a private home setting with little or no supervision.

Basically, in the case of an independent, clients are fully responsible for all tasks and costs normally taken on by employment-based agencies.

Beyond the finances, is there a backup caregiver in the event the primary caregiver is ill or unable to care for the individual? Is the individual trained or does he/she have access to training, to accommodate the changing care needs of a client?

On the surface, a lower hourly rate can appear to be the sensible decision, but as you begin to understand what an independent caregiver can or cannot provide, a clear message begins to emerge. A lower rate does not always translate to a more cost efficient, or highest quality, care solution.

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 that the organization takes care of all the behind-the-scenes details. It interviews prospective caregivers, conducts rigorous background checks, verifies employees’ information, validates their references, and takes care of all fringe costs (insurance, taxes, and so forth) associated with the employees. This offers many benefits for clients and their families:

• The organization employs the caregiver, so clients are not burdened with employer laws and requirements.
• The organization conducts face-to-face interviews and rigorous background, information, and reference checks.
• Caregivers are covered by Workers’ Compensation, general liability, and bonding insurance.
• Caregivers receive training prior to being placed in a client’s home.
• The organization and its caregivers comply with all certifications and other requirements.
• The organization has a large roster of caregivers who can provide care in the event the regular caregiver is unavailable.
• The organization provides ongoing supervision and caregiver training to ensure quality care.

Registries and Placement Agencies

These are organizations that build and manage databases of caregivers, but do not actually employ the caregivers. The caregivers are often independent contractors, but the employment arrangements can vary. Clients who decide to use registries may find that they are considered the caregiver’s employer and are therefore responsible for employment tax withholdings and insurance coverage. Some registries do provide Workers’ Compensation, but clients need to understand the extent of the coverage to ensure the caregiver is actually covered while working for them.

Quality registries and placement agencies typically complete background checks on the caregivers in their database. Generally, they do not provide training, nor do they ensure a level of caregiving proficiency prior to placing the caregiver. These companies act as a “match maker” and provide viable caregiver personnel options for consumers to consider. In the event a chosen caregiver cannot perform his or her duties, the registry can provide alternative caregiver solutions.

If you choose a registry/placement agency to provide an in-home caregiver, make sure you understand:

• Who employs the caregiver
• Who 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
• The type of training the caregiver may have received and certifications the caregiver may have secured
• How the caregiver is paid
• If there is any type of caregiver oversight

If you would like to learn more about your home care options, contact the nearest Comfort Keepers’® office for information. Comfort Keepers’ caregivers are fully employed by the local Comfort Keepers offices and are bonded and insured.