It's a fact that over 90% of people older than 65 live in residential settings, not in nursing homes or assisted living facilities. That's exactly what most seniors prefer. But what happens when illness or age threatens independence, and one's network of family and friends can't provide enough help? Welcome to the home care maze!

It wouldn't seem that complicated to arrange help for an elderly person with things like chores, cooking, bathing, dressing, safety supervision or companionship. However, there are lots of decision points and potential wrong turns.

For example, you might try hiring a home care worker directly to care for a loved one. The worker is then accountable only to you. You set the expectations, provide supervision, make scheduling arrangements-all one-on-one with your employee. On the surface, this sounds like a straightforward, simple arrangement, but it may not be ideal.

For one thing, as an employer you'll assume responsibilities you may not want. For example, if wages exceed a certain yearly threshold ($1400 in 2003), you must deduct Medicare and Social Security taxes and report the wages on federal tax forms. You may also be liable for state and federal unemployment taxes.

Another concern is worker injury. Without workers compensation coverage, serious on-the-job injury can incur substantial medical costs for which you may be responsible. Some people believe that their homeowner's insurance will offer protection, but in fact most policies exclude injury to employees. Then there are issues like pre-employment screening, background checking, liability protection, dealing with worker dishonesty and covering work absences. It's no wonder that many consumers are uncomfortable hiring home care workers directly.

A better route is to engage a private duty home care company that specializes in supportive services for seniors. Since the company is the employer, it takes care of things like taxes, insurance, bonding, screening, background checks, training and supervision.

Be sure, however, that the company actually employs its home care workers. Many companies are really registries or placement agencies that use independent contractors. In that case, you're still left with many of the responsibilities of an employer. That won't be evident from their advertising or marketing materials. You'll need to ask.

Here are some other important questions you should ask:

1) Is the company licensed by the Virginia Department of Health (or by the correspoding licensing entity in your state?) Don't be fooled by claims that a company is "licensed". This may just refer to a license to operate as an employment agency, or even just a business license, neither of which offer any safety protections for consumers.
2) Is it a member of the National Private Duty Association (NPDA)? To join, a company must use only true employees.
3) Does a qualified medical professional perform initial assessments, develop an individualized care plan and supervise the staff?
4) Are the company's employees covered by general and professional liability insurance, and in what amounts? If in doubt, ask to see the insurance binders.
5) Does the company follow state and federal employment guidelines, such as withholding appropriate taxes, providing workers compensation and other benefits?
6) How does the company screen and select its employees?

For more information on selecting a high quality home care company, contact the National Private Duty Association at (317) 844-7105 or visit their website at www.privatedutyhomecare.org.

January, 2004