Non-Medical Home Care Agency.  A Moment’s Notice Health Care fits into this category.  

Professional Non-Medical in-home care agencies provide a variety of health and custodial services in the home. These agencies are licensed and regulated by their states. They recruit, screen, hire, train and supervise their workers. The caregivers who come to your home are employees of the agency and are bonded and insured. You pay the agency, and the agency handles all payroll taxes and other human resources tasks. 

A non-medical home care agency is generally an agency that provides home care services which are not considered to be skilled care. These agencies provide what is termed non-skilled supportive custodial care that is supplied by home health aides, certified nursing assistants (CNAs) and also non-certified nurse aides, homemakers, and companions.  

These greatly needed services range from housekeeping and companion care to assistance with personal care such as bathing, dressing, toileting, and eating. Non-skilled care is not reimbursable under Medicare and therefore is paid for privately, or in some cases by private long-term care insurance. A physician’s order is not required as the need for care is not deemed medically necessary and patient homebound status not required. A professionally authorized and monitored care plan is unnecessary.

These private pay agencies are usually still licensed under authority of each state but licensure requirements and regulations vary widely from state to state unlike federally regulated Medicare certified home health agencies. Most agencies employ their workers, do background checks and manage payroll and taxes. Most of these agencies professionally supervise and monitor their staff with regards to patient care. Non-Medical home care agencies play an undeniably big role filling gaps in home care services not covered under skilled care. Non-skilled home care services such as personal care assistance or other cooking and cleaning help is often what may be needed most and by many in order to remain in their homes.

Registry or Staffing Agency

A private duty registry or employee staffing agency simply acts primarily as an employment service for a variety of skilled and non-skilled health care workers including nurses, nurse assistants (CNAs) and rehab therapists. Many states do not require these types of agencies to be licensed or conform to specific regulatory requirements.

The management of staff is the key difference between these private duty registries and both the home care and home health care agencies previously addressed. Generally home care and home health care agencies actually employ their workers that are sent into client’s homes while registries do not. The registry matches an independent health care contractor with the patient needs, refers them to the client, and then collects a finder’s fee. Consequently, the caregiver in the client’s home does not work for the registry but instead the client acts as the employer. He or she becomes the supervisor, usually pays the worker directly, and is responsible for all payroll taxes including social security withholdings.

Registries and staffing agencies can be reimbursed for their services sometimes through long-term care insurance, Medicaid and private pay. These agencies refer various types of employees providing skilled care from licensed nurses to personal care and companion assistance from nursing assistants.

Requesting an employee referral through this type of service is similar to hiring an individual privately on your own. Managing your own employee offers more independence but at same time additional responsibility without the advantage of employee background screening and licensure verification that many registries undertake.

Private Hire or Independent Providers

Private hire or independent caregivers include various types of nurses, therapists, nursing aides, homemakers, and companions. They are privately employed and managed by those who require their services. All responsibility for recruiting, hiring and supervising falls upon the client or family. Clients pay the caregiver directly; manage payroll taxes, and social security withholdings.

Agency rates are usually higher then private hire employees due to recruitment and management overhead costs incurred. Less dependence on agency staffing with the possibility of saving money may or may not be offset by the time-consuming responsibility of managing a private caregiver.

This is the key difference: When you hire from a registry, you may become the caregiver’s employer, and you might have to assume certain responsibilities, risks and liabilities

Here are 10 tasks to anticipate as you consider whether you would want to take on that role:

1. Hiring. If you work with a registry, you receive a list of potential caregivers to interview. It is up to you to perform background checks, check references, and discuss duties, expectations, salary and experience—and then, to choose the caregiver whom you hope will meet your loved one’s needs and preferences. If you work with a professional home care agency, the agency will take care of all these steps and more. They will send a bonded, licensed caregiver who is matched to your family’s needs, selected from their own employees with whom they have a relationship.
2. Training. If you hire from a registry list, the caregiver may or may not have experience in providing care for a person with your loved one’s needs. There could be a steep learning curve, requiring much of your time—and you may not feel qualified to provide that training. A professional home care agency will send a worker who has received professionally developed training and understands your loved one’s needs, whether that be physical limitations or Alzheimer’s disease. If you have questions, you can always call the agency.
3. Supervision. Once you have hired a caregiver, how do you know that the services you hired the person to perform are being done, and correctly? When you hire through a registry, it’s up to you to monitor the situation. Families experience greater peace of mind when a professional home care agency is supervising and evaluating caregiver employees on an ongoing basis. The agency will also ascertain that the caregiver shows up for their shift and performs assigned tasks—an especially valuable plus when families live at a distance.
4. Payroll taxes. Professional home care agencies take care of payroll, including federal and state taxes, Social Security, Medicare and unemployment. If you hire through a registry, you are responsible for understanding and complying with this often-confusing array of withholding taxes. And you might face civil fines and even criminal penalties if you are caught paying “under the table” without complying with tax laws.
5. Work-related injuries. Eldercare workers are at risk of injury, such as sprains and strains from lifting clients, automobile injuries and falls. What if a caregiver you’ve hired through a registry is injured while in your home? As the employer, you could be responsible for the caregiver’s medical bills and disability. Would your homeowner’s insurance cover this type of claim? In most cases, no:  Homeowner’s policies usually exclude coverage for employees in the home. It’s much safer to work with a professional home care agency that carries liability insurance and worker’s compensation for their employees.
6. Backup. Even the most conscientious caregiver will miss a shift from time to time, due to illness or a personal emergency. What if your caregiver quits on short notice? And what about those times when the caregiver is on vacation? Families may find themselves scrambling to cover their loved one’s care upon those occasions. Professional agencies are equipped to provide a backup caregiver if your regular caregiver can’t make it—even at the last minute.
7. Discipline. What if the caregiver isn’t performing up to your expectations? What if he or she arrives late, misses shifts, or isn’t caring for your loved one as requested? If you hired from a registry, you are on your own—you have to have the talk and set penalties for not improving, which is unpleasant and uncomfortable for most people. But if your caregiver is an employee of a professional agency, you can report problems to the manager so they can be handled in a less personal way. Agencies have a disciplinary system in place for helping the caregiver improve or, if it’s your preference, they will send a different worker.
8. Ensuring your loved one’s safety. It’s a subject families would rather not think about, but it’s important to know that every year unscrupulous, dishonest people abuse their position of trust to take advantage of vulnerable elders by stealing from, exploiting or even physically abusing them. Few registries perform background checks on the caregivers they place, and they are not allowed by law to supervise them—so if a caregiver you hire steals from your loved one, makes unauthorized charges with your loved one’s credit card or worse, you are on your own in dealing with law enforcement. This is a dicey situation when you’ve hired under the table! Professional home care agencies perform criminal background checks and contact previous employers before hiring a caregiver; in the rare case that a caregiver does commit an illegal act, the agency will take responsibility and deal with law enforcement.
9. Termination. What if the caregiver isn’t meeting your expectations, or your loved one does not like the caregiver, or if it just doesn’t work out? Firing an employee is seldom pleasant. And there may be unemployment claims to deal with. But if your caregiver is employed by a professional home care agency, the agency will be able to provide you with a different caregiver.
10. Cost. When you’re first comparing prices, it might seem cheaper to hire from a registry. But don’t forget the hidden costs—and potential costs—of serving as your caregiver’s employer. You may need to pay an accountant, elder law attorney or geriatric care manager to help with payroll and other human resources tasks. You may lose income when you must take time off from work to fill in when a caregiver doesn’t show up, or to deal with problems with the caregiver. And then there’s the possibility of hefty tax evasion penalties or even a personal injury lawsuit! Remember: You are paying a professional in-home care provider not only for the services of the caregiver, but also for an array of legal and human resources support tasks and protections.

For information on topics related to home care and healthcare, visit our Home Care and Healthcare Advocacy group on LinkedIn.  

The safest way:  Hire an Agency not a Registry nor Private Hire.