One of most difficult decisions adult children make when caring for aging parents is where to turn for in-home care.  The myriad of choices can be overwhelming.  Essentially, there are three choices: private hire, domestic referral agencies and full service companies. 

With a private hire caregiver, the family or older adult becomes responsible for all steps of the hiring process.  They must advertise, interview, and conduct background checks. Once a caregiver is selected, the older adult or family member must negotiate schedule, salary and benefits.  A written contract, signed by both parties, clearly outlining all of the duties and expectations, is imperative.  Liability normally falls on the client’s lap when it comes to payroll taxes, social security, unemployment taxes and workers’ compensation cost.  It is imperative to get a rider on your homeowner’s insurance policy to protect your assets if anything should happen to the private hire in your home.  Even though a private hire may be cost effective, the safety risk is the greatest when the older adult lives alone or has impaired judgment. The risk is greatly reduced when a family member or a geriatric care manager is able to supervise the caregiver.

Domestic referral agencies are essentially registries.  A client calls for service and a caregiver is placed for a placement fee and sometimes an ongoing management fee. The referral agencies do not employ the caregiver; the client becomes the employer and, similar to a private hire, is responsible for payroll taxes, social security, unemployment insurance and workers’ compensation.  Some referral agencies have the client pay the agency and the agency then pays the caregiver, but the client is still considered the employer. Since referral agencies are not employers, they do not supervise the caregiver. This increases the safety risk.  Like a private hire, it is important that a family member or geriatric care manager supervise and oversee the care.

Full service agencies employ the caregivers. They hire, screen, train and supervise the employees.  As the employer, the full service agency is responsible for all payroll taxes, social security, workers’ comp, and unemployment insurance.  A good full service agency should be able to produce their liability insurance and carry a bond.  In California, agencies are required to have a license to operate. Confirm that they are licensed as a Home Care Organization. Supervision is done by the agency, with some agencies providing care managers who directly oversee client cases, thereby lowering the risk to the consumer.  The cost of a full service agency is normally higher than a private duty hire or a domestic referral agency due to these factors; however, the risk is essentially lower.

When choosing in-home care for yourself or an older adult, remember to take into consideration the risk level of the older adult and the familial involvement.    Educate yourself on what service is best for your situation and then interview several individuals or agencies.  Finally, don’t wait for a crisis to begin searching for the best care for you or your loved one.

Nikhil Mehta is Owner/CEO of Home Care Assistance Palm Desert. For more information visit or call (760) 345.0001.

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