Did you visit your home town this summer and wonder if your mom or dad, or maiden aunt, is really safe to be living alone without formal services or supervision?
Helping aging parents make informed choices is one of our most important tasks as Baby Boomers. Many older persons begin to need some form of assistance to remain independent in their own homes. Each community has a myriad of services from which to choose. How do we begin to know what they need?
My dad (who turned 84 in July) lives in a small town in Kansas. When we needed 24-hour care temporarily while he recuperated from a surgical ordeal, there were no professional agencies to provide that care. It just doesn’t exist in my hometown. Sure, there was one Medicare agency. Those are the people that take care of our parents when they required “skilled care” at home, but that is limited and temporary. What my dad needed was just someone to help him with activities of daily living – companion aides – private duty. Where we had to get that was from the night-shift nurse who lived down the street from my dad, his housekeeper’s sister who took care of her aging uncle last year, and her friend who also does this kind of work.
So, being a professional geriatric care manager, I asked my brother (my dad’s POA) if he had any information on these nice people who wanted to make caregiving their livelihood. Information such as... proof of liability insurance, licenses or certifications, and any information on whether they would be willing to receive a 1099 so my dad could claim the healthcare deduction he would need. At $10 per hour, 24-hour care can quickly run through one’s annuities and mutual funds. My dad agreed with me and asked my brother to talk with a CPA about having some worker’s compensation coverage for the aides.
The good news is, Toledo has many options of assistance for seniors. The bad news is, there are so many that it is difficult to ensure you’re getting the most appropriate care for your parents. Especially when it comes to the cost of care. It looked like my dad actually had a good deal getting care for $10 per hour, when compared to professional caregivers ranging from $13.50 to $18.00 per hour in the Toledo area. So, when you’re looking for home health care, or companion care, for your parents, it’s tempting to go for the cheapest rather than the most appropriate.
Why is it not always appropriate to hire the cheapest home care? Some of the answers are obvious: Is the person licensed and trained and supervised? Some of the answers are not so obvious: Do you have umbrella liability coverage to protect your property if the person you’ve hired is injured while they are working for you?
Unfortunately, lists which include individual as well as agency providers are given out by reputable companies such as hospices, hospitals, and rehabilitation facilities. And, also unfortunately, we often look at the list through dollar signs. If the hospice I was using gave me this list, shouldn’t I trust that those listed are all reputable and appropriate to use? Not necessarily.
The National Private Duty Association, a national voice for organizations that provide private duty home care services, and an advocate for services which benefit the consumers came out with a position paper in 2003 called “Consumer and Worker Risks from the Use of Nurse Registries and Independent Contractor Companies.” The paper can be accessed at: http://www.privatedutyhomecare.org/.
The first risk discussed in this position paper is that of a consumer unwittingly becoming an employer and failing to comply with federal and state employment regulations. Just because a person calls themselves a contractor doesn’t mean they really meet that criteria. And it’s the employer who is responsible for determining that designation. For example, if the person hiring is directing the person working as to what tasks to perform, when, where, and how, that is more closely related to an employer/employee relationship than a subcontractor relationship. Also, if the “subcontractor” has no other clients and is solely working for one person, that person may be considered an employee. Check with an attorney and/or a CPA to determine the correct status before incurring significant financial liabilities.
Consumers may think they’re doing the worker a favor by paying them “under the table” because the worker gets to take home more income. Actually, this does the worker a disservice by denying them Social Security benefits when they retire, no protection for periods when they are unemployed, and no Worker’s Compensation if the worker is injured.
This last risk is potentially the most costly for the perceived employer. A client of mine was recently given a list of providers which included uninsured and unsupervised workers. She hired these individuals on the recommendation of the hospice agency which had given her the list (despite the disclaimer written in small print at the bottom of the list, remanding the client as responsible for checking references, etc.). What the hospice didn’t realize, and the client didn’t consider, was the fact that her umbrella liability coverage had recently been cancelled by her homeowner’s insurance. Due to several claims in the past, this lady was only able to have the minimum coverage required by law in the State of Ohio, coverage called “Ohio Fair Plan,” and had no protection from these workers in her home should they become injured while working for her. This hospice company, while meaning well by providing these lists to their patients, is actually putting already-vulnerable patients at risk of serious liability, both personally and financially.
Also not considered by the client or the hospice in the above example was that this client wanted to tap into her Long Term Care Insurance benefit. When I researched it for her, the ltc insurance company required that workers be certified or licensed by the state, and that they be agency-related for supervision requirements. The insurance company was looking out for the client’s welfare, even if the referring source was not. The bottom line was that this client was not only put at great risk by this well-meaning practice, but she was cheated out of reimbursement from a benefit for which she had paid lots of money in premiums.
The above illustrations don’t begin to tap into the other potential risks associated with hiring someone to work for you in your home. Supervision, integrity of the worker, exploitation, and matching services to client needs, are just some of the issues to be considered. In conclusion, the NPDA lists these items to consider:
• Consumers who receive home care, and caregivers who work in the industry, face increasing risk because of the growing use of companies who refer, but do not hire, workers.
• There is inadequate information about this issue for consumers and for the professionals in the industry who refer clients for care. They need to be aware of the risks and liabilities faced when families become employers.
• Consumer choice is important and should be preserved. Clients and their families should be able to hire the workers or companies that best meet their care needs, with full disclosure from companies that are providing care workers for the home.
In Chanute, Kansas, we had no other choice than to hire private individuals for my father’s care. We supervised them closely and discussed liability with his insurance broker and his attorney. In Toledo, Ohio, there are dozens of reputable companies from which to choose: Home Instead Senior Care, Comfort Keepers, and Care at Home Services, to name just a few. Before making a decision based on price, look into these agencies and talk to their professional staff. Talk to your own attorney and financial advisor before making a costly mistake. A Professional Geriatric Care Manager can also guide and supervise your frail elderly relative in determining what services they really need in order to remain independent. To find a care manager in your area, go to www.caremanager.org and click on “find a care manager.”
For more information on the position paper, contact:
National Private Duty Association
8604 Allisonville Road Suite 260
Indianapolis , IN 46250
Phone: (317) 844- 7105
Fax: (317) 575-8751
info@privatedutyhomecare.org
www.privatedutyhomecare.org
Debra Sorensen, MSW, LISW, CMC, is a professional care manager and owner of, Debra J. Sorensen & Associates Inc., a private geriatric care management company in Maumee, Ohio. She can be reached at 419-367-8835 or e-mail debra@professionalcareforyou.com.
