Are You Kidding Me?


In the world of elder care, there are a whole lot of self-proclaimed (and far fewer true) experts.  We listen to them all, read them all, then we process the real knowledge and value from the, well, let’s just stay polite.

One publication that sits somewhere in the middle, in our view, is the Private Duty Insider.  Sometimes there are pearls of wisdom and sometimes you go, “Whut???”  Well, in our humble (okay, okay) opinion, we just came across something that would have choked the oyster long before it became a pearl.

I am talking about an article called, “Registries can offer more independence for caregivers, clients.”  The gist of the article is that some home care agencies may want to stop being employers of their caregivers and push that responsibility on to their clients and clients’ families.  Why?  Because that model involves “fewer overhead costs and general oversight than an employee-based private duty agency.”  The article continues with the rationale that such a model “allows clients and caregivers more autonomy in the services provided.”

Again, remaining as polite as I can, what a pile of, I mean, that is a pretty weak argument.

What becoming a “registry,” as opposed to an employer of caregivers, does is place the burden of being the employer on the client and family.  That means payroll taxes, Social Security, potentially health care, liability insurance, Workers Comp insurance, unemployment insurance, dishonesty bonds, … land in the lap of the elder or her / his family.  We have met very, very few families able to handle those responsibilities and still stay out of trouble with the government. 

The fiction that the client / family can treat a caregiver as an independent contractor is just that – fiction.  Talk to any Employment Development office in your state and you will almost certainly hear the words that in home care, someone is the employer.  When you tell a person where they work, when they work, what they do and pretty much how it is to be done, you are describing an employee.  That part of the equation gets a total of eleven (11) words in the article. 

One of the items of information missing from those eleven words is that if I hire a caregiver / domestic worker, myself, my homeowner’s insurance provides no protection at all.  I would need to buy separate liability insurance.

One of the worst aspects of this “registry” model, in real life, is that the consequences — the client is the employer — are, in our experience, very rarely explained to the client or family.

Does the model work for the occasional client and family?  Yes, when they have their own business and the knowledge of how to be the employer, safely.  Those folks are few and far between, however.

Come on, privatedutyinsider.com and decisionhealth.com.  You can do much better than this.  I would love to have your comments — and those of everyone else, as well.

Best wishes.  Bert

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4 responses to “Are You Kidding Me?

  1. Bert, you’re correct for all the right reasons. I am not a registry however, converting to the registry model is becoming increasingly attractive from a profit margin perspective. The advantages that registries currently enjoy will only increase with the implementation of Obamacare. When companies with over 50 FTE’s increase their rates to compensate for the additional costs there will be an even larger disparity. So, most of us may abhor the idea of a registry but I predict that when push comes to shove some of us will “go to the dark side”

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    • Michael, believe me, I understand the issues with healthcare reform and the impact on businesses like ours. I understand the impulse, completely. None of us want to lose our viability as businesses. If we have to give up doing the right things the right way, however, I for one will go back to high tech or sell shoes. I am not going to foist what I feel is unethical on our clients. Keep facing the light, Michael. 🙂

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  2. Well said Bert. It is my experience that the employer responsibilities are not explained to clients either. Frequently elders are mislead to believe that their home owners insurance would cover any injuries on the property. This is far from the truth. Kudo’s for a post cuts through all the bull and challenging the status quo.

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