Agency vs Private Caregiver

She is your mom.  You want the best for her.  She needs care soon.  But, you are worried.  Finances may run out.  You don’t understand Medicare/Medicaid rules.  You aren’t sure what care the government or insurance will pay for and what you will need to hire.  The pressure is starting to feel overwhelming.

Furthermore, you sense that regardless of how much insurance or medicare will pay for, you are going to need private care soon.  So you have started to look.  Do you hire an individual caregiver at $12-$18/hr or do you go with an agency at $22-28/hr?  That’s a huge difference.  Why not just put an ad in Craigslist or Care.com,  interview them and get it going?  That might work for you, but consider some facts before you leap.

1) Your State Laws are important.  Don’t just read “general guidelines” on the internet.  Your State may have a lot to say about your decision!  Every State is different.

In New Hampshire, caregivers who will be providing personal care must be licensed individually or work for a licensed agency.  It is a state law.  No exceptions.  NH cares more about your mom than nearly every other state in the US.  Yes, there are hundreds of unlicensed caregivers giving care in NH, but it is illegal.  Hiring an unlicensed caregiver is the wrong choice, for many reasons.  Ask for their license number.  It will be issued from the NH Department of Health & Human Services, and will clearly identify them as a licensed caregiver or as a licensed agency.

2) Not following state laws could result in denied insurance claims.

Your unlicensed caregiver may believe they have liability insurance, but if the unfortunate happens, the insurance company will protect themselves by looking at the details carefully.  And they may soon discover that an unlicensed caregiver is against NH statutes, and they can deny the claim.

3) NH issues licenses to an individual caregiver, or, to a company as an agency.  Either/Or.  Not both.

In NH there is nothing in between–a caregiver either has an individual license or an agency license.  If they tell you that they can give you the flexibility of an agency but not pay for the overhead (because a friend will cover their absences), you will want to make sure they are a licensed agency.  NH Licensed caregivers cannot band together to cover each others vacation schedules, acting like an agency, but not being licensed as an agency.  Why not?  Licensed agencies in NH are required to hire all caregivers as employee’s.  This is for your protection, so that if anything goes wrong, the agency is liable and can’t pass the buck to an independent contractor.

4) Federal Law is involved in this decision as well.  The IRS.

If you hire an individual caregiver directly, Federal Law states that they are your employee, and you must pay their statutory benefits as you would for any employee: this includes withholding and filing Medicare, State and Federal Unemployment and Social Security Taxes.  Perhaps you have heard of famous cases of persons being caught by the IRS for not withholding and filing taxes on domestic employees such as nannies and housekeepers.  This applies to caregivers as well.  There is a way out of this, however, if the individual caregiver is registered with the federal and state government as a business.  Ask the individual for their Employer Identification Number (xx-xxxxxxx)–if they have one, you do not have to withhold taxes.  If all they have is a Social Security Number (xxx-xx-xxxx), you are on the hook for withholding and filing taxes and statutory benefits.

5) Ask the licensed agency or licensed caregiver for a certificate of insurance.

Point 2 above exposed the fact that an unlicensed caregiver’s insurance will be compromised, simply because they are unlicensed.  But could you still be exposed with a licensed caregiver or agency?  Yes.  You may have read elsewhere, or had a friend tell you to ask the question, “Are you fully insured and bonded?”  That’s good, but go the next step and ask for a copy of their certificate of insurance.  Every fully insured and bonded entity can readily produce a copy of their certificate of insurance, to give you the peace of mind you deserve.  If an agency employee steals from you, you want to be covered.  If they use poor judgement and your loved one is harmed, you want to be covered.  If…(you name the risk), you want to be covered.

6) Caregivers get sick and need vacation.

Inevitably, caregivers get sick, need a vacation, or just move on altogether.  Agencies fill those schedules so you are not left without care.  Agencies have a bench to draw from.  All pre-screened so they are ready to take over.  If you decide to do this on your own, it could become a part time job managing your loved one’s care.  This can become wearisome.  If you hire an agency-the headaches belong to the agency and you are free to spend quality time with your mom.

7) If you ever have to file for Medicaid, the dollars your mom spends must be carefully accounted for.

The government will require a full accounting of expenditures over the “look back period.”  If you can’t tell the government how the funds were spent because you paid wages under the table (point 4), they will assume the money went to family and require you to pay it back, before your mom is eligible for Medicaid.

8) The right agency adds tremendous value over and above caregiving.

Finally, perhaps the most important reason to choose an agency.  Expertise.  Agencies are not only experts in interviewing, hiring and training, but beyond that, the best agencies will be able to advise you regarding other critical topics that can be confounding to all but the experts.  Medicare/Medicaid regulations, choosing a nursing home, alerting you to safety concerns in your home, connect you to vetted equipment providers, Elder Care Attorneys, Trust Officers.  Great agencies can help shepherd you through a host of other decisions you will need to make in the near future.  The stress of facing the end stages of life are overwhelming.  Getting the right advice in times of stress can not only take the burden away quickly, but give you the peace of mind that you did all that you could for your family.

We know you have a difficult decision in front of you.  If we can make that decision any easier, give us a call.  Just the first phone call will give you comfort.  And by the way, we answer the phone 24/7, and not just with an answering service–you will reach a qualified agent who can help you right away.  And that first step will be to schedule a free appointment to have Judy Loubier, Executive Director and Clinical Services Director, or one of our highly skilled Care Managers come out to assess your situation.  Judy has been a highly respected licensed health professional in the state of NH for 30 years.  You and your mom will love us the moment you meet us.

Yes, it will cost a few extra dollars to hire an agency, but if you hire the right agency, you will sleep peacefully and never look back.