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, incidental transportation, light housekeeping, companionship and medication reminders.
- Personal care: Personal care services generally include bathing, grooming and hygiene, toileting and incontinence, and special meal preparation.
- 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: employment-based agencies, registries, or independent providers. The main difference in the business structures is the determination of who is considered the caregiver’s employer, and therefore, who is responsible for the associated fringe costs, such as employment taxes and deductions, insurance coverage for the caregiver, and liability insurance.
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
- The organization provides workers’ compensation, general liability, and bonding insurance for their caregivers.
- 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 oversight and caregiver training to ensure quality care.
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. 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 coverage, but clients need to understand the extent of the coverage to ensure the caregiver is actually covered while working for them.
Quality registries typically complete background checks on the caregivers in their databases. However, they generally do not provide training, nor do they ensure a level of proficiency prior to placing the caregiver. Rather, registries act as “matchmakers” to provide viable 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. Clients who choose to hire caregivers through a registry should understand
- who employs the caregiver and is responsible for employment tax withholdings;
- what kind of background checks have been conducted on the caregiver and the outcome of these checks;
- what types of insurance coverage, if any, apply to the caregiver in the home;
- what relevant training and certifications the caregiver has received;
- how the caregiver is paid; and
- if there is any type of caregiver oversight.
An independent caregiver may be someone the client knows know personally, someone from the community, or someone who advertises in-home services in the classified section of the newspaper who is not part of a larger organizational structure. No matter the source, there are implications surrounding hiring an independent that should be considered before securing the relationship.
Clients who choose an independent caregiver are legally considered the caregiver’s employer. That means they are responsible for all employment taxes and deductions for the caregiver. They are also 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 employed in the home. The client will need to check the caregiver’s background and verify information such as experience, references, and licensure. Basically, in the case of an independent, clients are fully responsible for all tasks and costs normally taken on by employment-based agencies.