Choosing In-Home Care

One of most difficult decisions adult children make when caring for aging parents is where to turn for in-home care. The myriad of choices can be overwhelming. Essentially, there are three main in-home care options: private hire, domestic referral agencies and full service companies. It’s important to understand the differences of each and what they entail for the elder and the caregiver alike.

In-Home Care: Private Hire

With a private hire caregiver, the family or older adult becomes responsible for all steps of the hiring process. They must advertise, interview, and conduct background checks. Once a caregiver is selected, the older adult or family member must negotiate the schedule, salary and benefits. A written contract, signed by both parties, clearly outlining all of the duties and expectations, is imperative. Liability normally falls on the client’s lap when it comes to payroll taxes, social security, unemployment taxes and workers’ compensation cost. It is imperative to get a rider on your homeowner’s insurance policy to protect your assets if anything should happen to the private hire in your home. Even though a private hire may be cost effective, the safety risk is the greatest especially when the older adult lives alone without supportive family available or there is impaired judgment on the part of the older adult. The risk is greatly reduced when a family member is able to supervise the caregiver. Professional geriatric care managers are also excellent supervisors when family is not available. “When choosing homecare for yourself or an older adult, remember to take into consideration the risk level of the older adult and the familial involvement.”

In-Home Care: Domestic Referral Agencies

Domestic referral agencies are essentially registries. A client calls for service and a caregiver is placed in a home for a placement fee and sometimes an ongoing management fee. The referral agencies do not employ the caregiver however. The client becomes the employer and, similar to a private hire, is responsible for payroll taxes, social security and unemployment insurance and workers’ compensation. Some referral agencies have trust accounts where the client pays the agency and the agency then pays the caregiver, and sometimes sets up a tax service for the client, but the client is still considered the employer. Since referral agencies are not employers, they do not supervise the caregiver. This increases the safety risk. Like a private hire, it is important that a family member or geriatric care manager supervise and oversee the care.

In-Home Care: Full Service Agencies

Full service agencies employ caregivers. They hire, screen, train and supervise the employees and place them in the older adult’s home. As the employer, the full service agency is responsible for all payroll taxes, social security, workers’ compensation and unemployment insurance. A good full service agency should be able to produce a copy of their liability insurance and carry some sort of bond. Supervision is done by the agency, with some agencies providing care managers who directly oversee client cases, thereby lowering the risk to the consumer. The cost of a full service agency is normally higher than a private duty hire or a domestic referral agency due to these factors, however the risk is essentially lower. “A written contract, signed by both parties, clearly outlining all of the duties and expectations, is imperative.” When choosing in-home care for yourself or an older adult, remember to take into consideration the risk level of the older adult and the familial involvement. Educate yourself on what service is best for your situation and then interview several potential individuals or agencies. Finally, think ahead — don’t wait for a crisis to begin searching for the best in-home care for you or your loved one. Barbara Schuh is the founder of Schuh and Associates in Manitowoc, WI, which offers consulting and coaching services to existing home care and care management companies, from start-up and growth to exit strategies as well as in the area of veteran benefits. Until she relocated, Barbara was the owner of Companion Care in Lafayette, CA, an integrated home care and geriatric care management company.