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Home Care

The Pitfalls Of Private Pay Caregivers

Discussions are finished and a family decision has been made. Mom has agreed she can no longer live at home alone safely. It is time to look for live-in help.

The big question: Do we hire a caregiver directly, or do we hire through an agency? Many families decide to hire a caregiver directly, (aka private pay) because it is less expensive. Before you make your decision, it is important to understand the challenges of hiring a private caregiver.

Private Pay

There are sites online that can help you find a caregiver, or you can put the word out among family and friends. Once you tap into this market, the amount of contacts you can uncover is amazing. Getting names is not hard. The real work starts when you begin the process of interviewing and vetting.

Safety and companionship are the biggest concerns. You want to know the person you are bringing into your loved one’s home is not a criminal, they are responsible and that they will care for mom as you would.

Here’s the thing. Paying for a background check on each person is expensive. Even the least expensive ones start at $50.00 and that is a limited look at a person’s background. Many caregivers come from another country, so it can be difficult to match up their given name with the name they use here in the United States.

Of course, you are going to check references. But the process is time consuming, and people are often circumspect in giving you their opinion, which makes it hard to know if the caregiver will be a good companion for your loved one.

You and your loved one should interview the person together. Body language and chemistry between your loved one and the caregiver is important, and so is asking plainly, “Did you like this person?”

The potential caregiver needs to bring any certifications (Home Health Aide (HHA) or Certified Nurse Aid (CAN)) with them, along with a valid driver’s license for reference checks.

The biggest ongoing hurdle is the lack of backup. If the private pay caregiver gets ill, has a family emergency or takes a vacation, you are back to square one, either finding coverage for awhile or starting the hiring process over again.

When you hire someone directly, to be within the bounds of the law, you will need to set yourself up as an employer. The IRS considers an individual who is paid to provide a service within a residence to be a household employee. That means you will need to get an EIN number from the government, withhold taxes and make sure you have appropriate workmen’s comp insurance coverage. It is important to consult with your accountant on the tax laws and how to set up an EIN number. There are agencies that will help set up the EIN and payroll deductions, but it can be costly as well.

And if you think Medicaid will need to be part of your future financial strategy, then hiring someone directly and paying them “under the table” puts you at risk for qualifying and may incur hefty penalties.

Hiring through an agency

Working with an accredited home care agency assures you that complete and thorough background check is done on the caregiver. And they have extensive experience in vetting references. If you want to be assured that an agency is accredited, The New Jersey Department of Consumer Affairs keeps a listing of all accredited agencies. The agency will list on their literature or web site who they are accredited by (such as Joint Commission, or CHAP).

The big worry of having to quickly find backup if your caregiver gets ill or quits is alleviated when you hire an agency. The agency will find another caregiver for you, but you need to be realistic. It may take a couple of days, you may have temporary caregivers until another full time one can be found. All of which is stressful and requires that you are prepared for backup in an emergency. But YOU do not have to look for a replacement and all the work that requires. A replacement will be found, the family needs to be patient with the process.

As the employer, the agency has vetted credentials, filed all the government paperwork, and carries insurance. An agency must check for two references and the references must be a professional entity who can fully attest to their work and background, not just a friend or colleague. One benefit of an accredited agency is that caregivers have mandatory, annual continuing education. The Board of Nursing and Division of Consumer Affairs oversee accredited agencies and they have formal policies, procedures and a grievance process if there is a concern.

Talk to several agencies before making your decision. Each will come to your loved one’s home to asses the level of care that is needed. They will be looking at Activities of Daily Living (ADL’s) and Instrumental Activities of Daily Living (IADL’s). ADL’s are basic self-care tasks that include being able to dress, bath and feed themselves. Do they need help getting to the toilette or in an out of bed? IADL’s look at your love one’s ability to live independently. Can they clean and maintain the house? Can they go shopping, manage money or take prescribed medications?

Finally, talk to more than one agency, it will give you a sense of their back office. Who is there to take your phone calls? Is there a Care Partner on staff that can help guide you through any situations that may come up like a hospitalization? A nurse on staff that will regularly check to see if something has changed and a Care Partner that can guide you to resources is invaluable to the family and your loved one.


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