Home Care Agency Evaluation

Now that you have a solid understanding of home care (see Types of Elder Care – Home Care), the types of people they best serve and associated costs, it’s time to hone your search and evaluate potential providers.

First, here are more details on home care, licensing, types of agencies and care-giving options to help you navigate your path to finding the right care.

Licensing and Regulation: Not all states license or regulate home care agencies and/or registries. It is important to use a licensed agency or registry in any state that licenses such companies. Agencies or registries operating without licenses are violating the law.

Agencies vs Registries: There are two types of companies that supply caregivers: agencies and registries:

  • Agencies employ their caregivers. The agency pays the caregiver, deducts withholding and pays the employer portion of Social Security, Medicare and unemployment taxes owed. The agency also carries worker’s compensation and liability insurance. Clients pay the agency for caregiver services.
  • Registries operate like employment services. They find jobs for caregivers who are listed with their registry and collect a fee from the caregiver and often the client. In these cases, it is the client who pays the caregiver, files the appropriate tax returns, pays taxes and maintains insurance in case the caregiver is injured on the job.

Hourly vs. Live-in Caregivers: Some caregivers work hourly and others live-in at their client’ homes.

  • Hourly caregivers: Hourly caregivers typically work no less than a 4-hour shift, although a few agencies will offer a 3-hour shift, and some offer shorter “bath visits”. The maximum hourly shift is usually 12 hours for one caregiver; at least two caregivers are required to cover a 24-hour period if the care is hourly. Since caregivers are subject to overtime, most clients who need continuous care will have several caregivers to cover the shifts.
  • Live-in caregiver: A live-in caregiver sleeps at the client’s home. In states where home care is licensed the client is usually expected to provide the caregiver with a private room and bath. It is also necessary to have at least two caregivers to avoid overtime pay in the course of a week.

Independent Caregivers: Independent caregivers do not work for an agency or a registry and are usually less expensive. The trade-off for lower cost: higher risk. There is the risk of hiring someone untrustworthy; there is a risk that if the caregiver becomes ill or is unreliable, the person in need of care will be left unattended or attended by a unknown substitute sent by the caregiver; there is a risk that the if the caregiver gets hurt on the job, he or she will sue. As the employer, you are required to file the appropriate tax returns and pay employer taxes for the caregiver.