The Unexpected Costs and Gains of In Home Care

The Unexpected Costs and Gains of In Home Care

March 6, 2024

Imagine you’ve made the tough decision that you need help for you or your family in the home.  You ask trusted friends and neighbors or maybe look at your church bulletin board to find a care provider.  You look at licensed agencies, but they seem expensive, so you go with the private option.  You don’t need much, a few hours a day three or four times a week, to help with laundry or taking a shower.  Seems easy enough.  Now imagine that sweet woman you met through a friend that has been helping you for the last several months trips over your dog while doing laundry and hurts her back.  She goes to the doctor and while she is there, she informs them that she suffered an injury while she was working at your home.  She has been getting checks from you directly for her services for months now and in fact you are her employer.   This injury is a worker’s compensation claim.  You don’t have worker’s compensation insurance and since she is your employee, your homeowner’s insurance will not cover the injury.  This is now 100% your financial responsibility.    All her medical bills including therapy, missed hours of work, and pain and suffering will all come directly out of your pocket.  Sound impossible?  It’s not.  This is, in fact, a true story.  The man that hired the care aide he met through a website that is designed to connect care givers with people in need of such services ended up saddled with 1.3-million-dollar worker’s compensation judgement against him.  Immediately, his home that he had worked his entire life for was gone.  Liquidated to pay the worker’s compensation judgement.  This was only the beginning of his troubles.  Because he was this caregiver’s employer, the IRS came to him to demand back employer taxes that were owed.  This was something that he had never even considered and now tens of thousands more dollars were gone from the nest egg he had carefully saved for his care and comfort for the rest of his days.  He never thought that when he paid this caregiver to help him that he had just started a business.

This happens to thousands of people every day.  Bringing someone into your home to be involved with personal care is nothing to be taken lightly.  Without proper licensing, credentialing, insurance, and training more than just money can be lost.  Costly and dangerous health errors can occur.

So how do you protect yourself?  There are some strategies that you can employ that can help you protect yourself.  It is important not to skip this very important step of knowing who you are bringing into your home.  First, shop around.  There is no such thing as one size fits all in healthcare so shop and compare care providers.  Three or more comparisons are recommended.  There are so many to choose from so knowing where to start can be a challenge.  Start with asking friends, family, health care workers that you know in your everyday life and tap into support resources like the local senior center, your physician’s office, and organizations like The Alzheimer's Association, or your local board of aging. These groups are around these situations everyday and can lend you an experienced opinion on a starting point on your healthcare journey.  Second, prepare a list of questions to ask during your selection process.   Make sure to include things that are important to you in your home.  Ask about background checks.  State and Federal checks are a must but a national sex registry check is also recommended.  What does training consist of and how often is training done?  It is important that the people that are caring for you or your loved one are educated and are current on best practice.  Is the agency or individual insured for damage, loss, and theft and is the coverage meeting the state minimum?  Remember, this is a business and the insurance coverage provided must be a business policy and meet the state minimum requirements (currently that number is 2.6 million per occurrence).  Unfortunately, there are thousands of reports of theft by a paid caregiver every year.  This loss could range from a few dollars to thousands in cash, jewelry, etc.  It can also include identity theft.  Personal caregivers have access to a lot of personal information in someone’s home.  Is there Worker’s Compensation Insurance?  As we have already covered, you don’t want to be responsible for workplace injury costs.  Who is paying employer taxes?  If an individual makes $2,000 or more in a year, they are an employee and employer taxes must be paid to the IRS.  This is not the responsibility of the employee so make certain that this is being handled by your selected agency.  If you have hired a caregiver privately, this is your direct responsibility so don’t forget to factor that into your costs and save money to pay those taxes.  How do you report a need, change, or problem?   This is important.  It is easy to reach somebody at most places Monday through Friday during business hours but what do you do on a weekend or in the middle of the night if you need help?  Is it a call center or a live person?   Is there a Registered Nurse on staff for clinical issues and care planning?  Having clinical oversite to help focus on client centered care is paramount to a successful and safe plan of care.  Having an assessment and regular reassessments by an RN will ensure that your care plan is appropriate and reflective of your needs.  What happens if the caregiver is unable to make it to a scheduled shift?  Life happens!  People get sick, have car issues, and take vacations.  What happens if your caregiver calls out for a shift?  Is a replacement caregiver sent to fill in or are you left to sort it out on your own?  This can be stressful for an individual that is counting on care at a specific time and day.  You may have appointments, medication reminders, tasks, and treatments that just get missed if there is not a good plan in place for call outs.  If you have gone with a private option, this is magnified as there is only one person to depend on.  This may end up causing more stress and heartache than you could have ever guessed.  Are there contracts and minimums?  Know what you are signing up for.  Many agencies and even private caregivers have minimums.  This means that you may have to have at least 4 hours per shift or 12 hours per week whether you need it or not.  This can end up costing you extra money so make sure that you are planning for this in your budget.  Often there is a contracted amount of time that you must commit to care.  This means if you only need two weeks while you recover from a procedure, but you have a six-week contract you could end up paying for additional weeks of care you never needed.  If there is a contract, how do you get out of it.  Is it 24-hour notice, 30-day notice?  Every hour of care costs, so read the fine print.  Is the care giver or agency State licensed and do they have other accreditations like the Joint Commission or Provider of Choice?  Having a state license means that your care agency or provider has been audited and continues to be audited to ensure state home care provider requirements are being met.  It also means that if there are issues with the quality of care or outcomes or even theft, there is an entity to report those complaints to which also means that there is an additional layer of accountability and security for you.

The priority is you and your family’s safety and security.  There is a rich and robust care community available to you and with a little planning and homework, care providers in the home can provide respite, relief, and expertise.  Taking that important step to getting care in the home can be a game changer for the entire family by easing some of the responsibilities of direct care giving so that you can all embrace treasured moments that matter.  While it may be initially overwhelming to get care started, once you have the right care provider in place, you can return to traditional family roles of being a son, and daughter, a parent, a spouse, a friend and enjoy every second.