16 Facts About In-Home Care
1. Often home care agencies are confused with home health agencies. Home care agencies provide personal care and home making services. Home health agencies provide medical services and employ licensed health care staff including nurses and therapists.
2. Home care agencies are now required to be licensed by the State and their care givers registered with the State. Licensing requirements include criminal history checks, health screening, structured orientation, then on-going training, and full insurance coverage. Families and the care givers they hire are not subject to these requirements.
3. Providing in-home care requires learned skills that includes home sanitation, safe lifting and transferring, first aid, and gaining the cooperation of an elderly person with reduced cognitive senses. A care giver who has had Certified Nurse Assistant training has been taught these skills.
4. Home care workers rarely meet the legal requirements for self-employment or "independent contractors”. Therefore somebody must be their employer and pay them through a payroll process that includes reporting earnings and withholding for Social Security, Medicare, State Disability Insurance, paying unemployment insurance and workers’ compensation premiums. In addition, three days of paid sick days must be available each year after about first month of employment.
5. California’s minimum wage is now $11.00/hour. It must be paid for all hours worked including those when the care giver is required to be present in the home including when asleep. In California it is uncertain if 8 hours can be deducted for sleep on 24-hour assignments. It is best to pay the care giver for all hours required to be present.
6. Care givers must be paid overtime after the ninth hour of work in one workday,or more than regular 40 hours in a 7-day work week. A 24-hour care giver's minimum pay is therefore $368.50/da. After the 4th hour on the fourth day all remaining hours must be paid at minimum of $16.50/hr. There is no double time. About $500/wk is saved employing five care givers assigned 12-hour shifts, two or three days per week for 24/7 coverage.
7. Care givers’ pay must be computed by the hour, not a set amount for the day, night, or the week. Their daily work hours must be recorded and their pay checks show the hours worked, hourly wage, period paid, total earned, and deductions for any meals, lodging, and taxes, and among other things.
8. Some in-home care providers are really registries referring care givers to clients for employment. Registries can give the appearance of being home care agencies. They place care givers, collect fees, and distribute pay but consider the care givers "independent contractors” and don’t pay taxes or have insurance. This leaves families subject these taxes and liabilities. Some individual care givers do the same, getting their friends to fill in for them, then collecting distributing to pay but do not report income or pay taxes either. This also leaves families liable.
9. Hospitals must offer patients choices for home health and home care services. Typically this is done with lists of names and telephone numbers. Rarely do they confirm the competence of the agencies or individuals they list or check on the quality of services.
10. To legally work in the United States a person must be a citizen or have a "Green Card.” Hiring someone not eligible to work in the United States subjects them $1,000 fines. A valid California driver's license and original a Social Security card are evidence of eligibility. Copies of these and a completed I-9 form must be retained by the employer.
11. Employers are responsible for work related injuries, regardless of who is at fault. A back injury claim averages $75,000. Employers must have workers' compensation insurance. Homeowners’ insurance policies may offer coverage but often is limited to one employee, or the hours worked.
12. Workers who apply for government aid such as student loans or grants, food stamps, or health insurance must sign affidavits stating their income. These are checked against tax reports and estimated living costs. Inconsistencies trigger audits. Unpaid taxes, penalties, and fines are
usually assessed against those who paid the worker. These can equal or exceed the wages paid.
13. Medicare and Medi-Cal rarely cover personal, in-home care services. Medi-Cal recipients should contact County Social Services about In Home Supportive Services (IHSS).
14. If you have long-term care insurance, know your eligibility requirements, confirm your service will be covered, learn what the documentation requirements are, what is the reimbursement rate you will receive, how to send them the documentation, and the waiting time before coverage takes effect.
15. Using a reputable home care agency relieves you of tax liabilities, supervisor responsibilities, and provides professional and workers' compensation insurance coverage. A good agency will also develop a service plan, supervise their staff at least weekly, and bill your insurance.
16. If you decide to hire a care giver you should:
* Plan a broad recruiting search, CraigsList, paid job posting web sites, church bulletin boards, and friends and family members can be sources for non-agency care givers. Expect to interview at least five applicants to select one. Agencies typically select one in ten.
* Diligently look into their backgrounds. Use internet services to check for criminal convictions, speak to past employers, get full explanations of the tasks the care giver performed, hours and days worked, were they dependable and trustworthy, the period they were employed, and why employment ended.
* References for home care workers can be easily be misrepresented. Some care givers use their family or friends but not tell about the relationship. Their friends may say their relative received care when they did not. Drug screening kits are available at drug stores.
* Keep in mind that what you see is what you get. Do not hire an applicant expecting to change them. Keep social distance from the care givers. Treat them fairly and with respect but avoid becoming involved in their lives. It is best not to loan or give them possessions or money. If you do, tell your relatives.
* Create a written agreement with each care giver stating their hourly wage, expected tasks, days and hours they are to work, likely tasks, and the day and time they will be paid.
* Be able and willing to direct them, accurately compute their pay, and fire them if needed.
Updated January 10, 2018