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Hiring In-Home Caregivers

Hiring in-home care providers — on your own or through an agency — is not a decision to be taken lightly. Understanding the financial and legal responsibilities of hiring a household employee is critical. Take a look at these important considerations and  case studies before making any hiring decisions.  

What You Need to Know Before Hiring Private In-Home Caregivers

by Bunni Dybnis, MA, MFT, CMC – Aging Life Care Association™ Member and Fellow of the Leadership Academy

 

For aging adults with physical and cognitive limitations who wish to remain in the familiar environment of their own home, paid in-home care workers often provide the solution. Understanding the differences in care providers and the roles and obligations of hiring are essential to create a positive experience for all involved.

In-home caregivers provide a wide range of assistance including personal care needs such as bathing, dressing, supervision, help with toileting, medication reminders; or assistance with daily living activities, such as meal preparation, light housekeeping, laundry, transportation, and companionship.

Being responsible for the care of a dependent or older adult is a demanding job that often involves many tasks. Choosing a full-service agency shifts the responsibility of care and liability away from the family and can provide respite from many of these demands.

Primarily because of cost considerations, many families seeking to hire in-home help will turn to private individuals rather than hiring through an agency. At first glance this may seem reasonable; however, it can cause numerous problems and can create unexpected liabilities for the individual who becomes the employer.  When hiring in-home care, understanding responsibilities and employer obligations is essential.

Tax Obligations

As a private employer, the individual is required to pay Social Security, unemployment, and payroll taxes. Often the in-home care providers will represent themselves as independent contractors, ostensibly relieving both themselves and the hiring individual of these tax obligations. In most situations, the worker does not meet the criteria of an independent contractor. If the aide has not met his or her tax obligations, the responsibility falls to the employer. This can have serious consequences involving back taxes, civil fines, and the possibility of criminal penalties. Recent changes in minimum wage laws, overtime, and mandatory sick days create even more potential liability for the employer.

Example Case

Mrs. S. was an 85-year-old widow who lived independently in a large condominium complex.Due to failing vision she was initially in need of assistance with grocery shopping, bathing, and some meal preparation. Occasionally, she needed to be driven to medical appointments. Her daughter hired a home care aide, who worked with other condo residents, and employed her on a part-time basis. As time went on, Mrs. S. became increasing frail and began to suffer memory loss. The family decided to employ the aide full time. This very loving relationship lasted until Mrs. S. passed away. In working for Mrs. S. full-time the aide had given up all her part-time clients. Having no other immediate employment, the aide filed for unemployment benefits.  At this point, the IRS became aware of the employer and filed a lawsuit for unemployment taxes, penalties, and fines. Additionally, the caregiver hired an employment attorney to help her become compensated for overtime and minimum wage violations, The family and mother’s estate found themselves in a legal action that took many months and thousands of dollars to resolve.

Worker’s Compensation, Disability, & Liability Issues

As the employer, the individual or family paying for private home care is held liable for any work-related injury that occurs on the job. This can include the cost of medical expenses, disability, and loss of income payments that might become applicable. Homeowners insurance is often limited in scope and can exclude direct care including tasks such as lifting, transferring or bathing. It is essential to check homeowners ’policies to understand the extent of coverage.

The employer also assumes liability that arises out of accident or injury to both the person being cared for and property. Further protections such as TB testing, influenza vaccines and other precautions that can be provided by agencies are now the responsibility of the family/employer. Families who hire an independent caregiver are also no vulnerable to theft, damage or other losses incurred in their employment.  Short of criminal prosecution, there is often little recourse.

Example Case

As a home care worker, Mary had a history of back injuries from years of assisting with the physical needs of stroke patients. Her back problems appeared stable during her last several years of employment caring for a cognitively impaired woman who required minimal physical assistance. Being very pleased with the love and compassion in which Mary treated her mother, the daughter recommended Mary to a friend whose father, Mr. H., had suffered from a minor stroke and the family did not want him to live alone.

 Initially, Mr. H. needed minimal physical care. As time went on, he suffered several additional strokes that decreased his mobility and function. Mary found herself increasingly assisting with his physical care. Transferring, dressing, and bathing put a particular strain on Mary’s back. Having become very attached to Mr. H., Mary did not express her concerns to the family that hired her.

One day as Mary bent over to assist Mr. H., her back went out and she was unable to straighten up. Mary found herself with permanent back injuries. The doctor told her she would not be able to work as an aide again. Mary filed for worker’s compensation and disability insurance. At this point, the government became aware of the employment situation and held the family responsible for medical expenses and disability coverage. The cost far outweighed expenses of working through an agency or getting the proper insurance coverage.

Abuse & Exploitation

With increased frailty, limited function, and memory impairment there is a greater potential for physical abuse and financial exploitation of the elder. While the vast majority of those who provide care for the elderly do so out of their desire to help others and provide the best care possible, there remains a small segment that use this opportunity to take advantage of this vulnerable population. When these older adults are isolated from regular contact with family or community there is often little or no supervision of workers.

Geographic distance and personal demands of family members, lack of expertise, and close ties between an aide and those receiving care all contribute to a lack of oversight. Often families who hire individuals through informal channels are so grateful to have care provided, at a below market rate, they neglect performing basic screening and reference checks — not to mention criminal background checks and on-going monitoring. The naiveties of family members, who have little experience as an employer in these situations, make the individual elder vulnerable to being manipulated and exploited.

Example 

Susan L. lives in New York while her widowed mother remains in California.  When her mother suffered a stroke and wished to remain in her home, Susan realized that she would have to hire someone to assist. Susan felt fortunate when a neighbor’s housekeeper recommended someone who was moving to California and was looking for a place to live and work.

Meeting the caregiver for only a few minutes before flying back home, Susan neglected to have the worker complete a basic employee application. Things seemed to be going well and Susan’s mother became very attached to her caregiver. Several months later Susan came to visit her mother and realized that her mother was physically and intellectually frailer. Susan learned that her mother had begun using the caregiver to assist in paying bills and other banking needs.

At that point, Susan went through her mother’s bank stubs and was shocked to find hundreds of dollars in canceled checks to grocery stores and several thousand more made out to cash. When Susan confronted the caregiver, she tearfully explained that she had a “family emergency” and would pay it back. The caregiver left for a lunch break and neither she nor the money was ever seen again. 

Supervision & Monitoring

Supervision, monitoring, and oversight of employees can make the difference between a successful and disappointing caregiver relationship.  When constraints of distance, time, expertise, or objectivity become too overwhelming this role is often best provided by a professional. An Aging Life Care Professional™ can provide this on-going supervision either as independent professionals or through a small but growing number of agencies who have integrated these Aging Life Care™ into their delivery of in-home care.  Duties can include matching caregivers by needed skills and personal qualities, helping aides to understand the changing needs of clients, providing proper guidelines for care, and mediating difficult relationship issues between families, older adults and caregivers. Not only does supervision provide benefits to the client and family, but support for the caregiver can improve job satisfaction which translates to a positive working attitude and less caregiver turnover.

Providing care to an individual in a home can result in many challenges for caregivers. It is not uncommon for care providers to be of different cultural or faith backgrounds, have different expectations in terms of eating preferences, personal hygiene, and scheduling needs. Professional oversight can clarify roles and expectations for both the caregiver and the recipient. The Aging Life Care Professional  can be particularly beneficial in providing guidance in situations where there are challenging personalities or behavioral issues due to both cognitive changes and other psychiatric symptoms. Supporting the caregiver and providing tools to understand and respond appropriately to a variety of situations results in a successful partnership.

Example

Mr. and Mrs. L. need assistance with most aspects of daily living in order to live in their home. They  depend on caregivers to help with all Mrs. L.’s  personal needs (including bathing, dressing, feeding, and toileting), as well as assisting Mr. L. with household duties.

Their daughter has been hiring caregivers through word of mouth. In the past six months, she has hired at least ten different caregivers. Each time a new caregiver arrives she has to take off work to train them. Her father complains there is no one who knows how to cook, clean, or assist in an adequate manner.  Finally, upon the recommendation of a fellow coworker, she hired a company that has a professional Aging Life Care Manager that partners with the company caregivers.

Before placing another caregiver, the Aging Life Care Manager met with both Mr. and Mrs. L. She learned that Mr. L. was unhappy because none of the aides kept the house like his wife had and he no longer felt like he was living in his own home. By going through Mr. L.’ s daily routine, his wife’s recipes, and learning about his other expectations,  the care manager was able to guide the caregiver to what was best suited for this couple. With a few follow-up conversations and additional guidance, the caregiver was able to form a mutually respectful relationship with the family. The caregiver enjoyed learning new recipes; and after she gained Mr. L’s trust, he began to enjoy some dishes that the caregiver had learned from her country of origin.

Independent or Through an Agency

Hiring in-home care providers — on your own or through an agency — is not a decision to be taken lightly. An Aging Life Care Professional can help you make the best decision taking into consideration the  following:

  • level of care needed
  • personalities of the caregiver and care recipient
  • level of family involvement
  • financial resources
  • tax and insurance obligations
  • supervision

To find an Aging Life Care Professional near you, visit aginglifecare.org. You can also search for ALCA Corporate Partners that provide in-home care or others that handle payroll and tax services for household employees.

About the author:  Bunni Dybnis, MA, MFT, CMC  is Director of Professional Services for LivHOME in Los Angeles, CA. Bunni is an Advanced Professional and Fellow of the Leadership Academy of the Aging Life Care Association. 


This blog is for informational purposes only and does not constitute, nor is it intended to be a substitute for, professional advice, diagnosis, or treatment. Information on this blog does not necessarily reflect official positions of the Aging Life Care Association™ and is provided “as is” without warranty. Always consult with a qualified professional with any particular questions you may have regarding your or a family member’s needs.

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