When our parent or grandparent falls, has a stroke, develops Alzheimer’s or Parkinson’s or, for any number of reasons loses their ability to fully care for him or herself, there are some decisions to be made.

My primary goal, of course, is to assist the family to impact the older adult’s life as little as possible and preserve as much of their independence as possible. Nursing homes are a last resort – they are only appropriate when the older adult requires near 24-hour skilled care. Home health aides are usually tasked with assisting with: light housekeeping, laundry/linen changes, food shopping, meal prep, bathing assistance, dressing assistance, transferring assistance, toileting assistance, eating/drinking assistance (ADLs), reminding their patient to take their medicines among several other non-medical tasks such as driving to doctor appointments, serving as a companion, etc...

Often, the older adult only needs assistance with chores around the house, assistance with preparing meals, and perhaps being reminded to take medications. Spouses often have
their own health problems and children may need to work. At this point, it becomes obvious that hiring a home-health care aide, nursing assistant or nurse is in mom or dad’s best
interest. A quick search online will reveal that, other than hiring someone off of craigslist, your choices are to be connected to a home health care agency or home care registry. While these names sound similar, they are quite different. 

What is the difference between a home care agency and a home care or private duty registry?

The differences between in-home health care agencies and in-home health care registries are enormous in terms of training, background checks, supervision, employment status, treatment by Medicare, and more.

Home Healthcare Agency

First, an in-home care agency employs and supervises their home-health caregivers who, at-least semi-regularly, receive training and criminal screening. Importantly, I want to focus on the fact that home-health care agencies are, in fact, employers. They handle all payroll taxes, insurance and other HR related tasks. Also, a home care agency can be reimbursed by Medicare (a nurse registry cannot). It should be noted, that home health agencies are allowed to provide some services on an independent contractor basis, so it is important to ask about this for the reasons discussed below.

Typically a home health agency will provide care-giving services starting at $18.00 an hour, for four hours a day, three days a week.

Home Healthcare Registries

Home healthcare registries will usually connect you with a caregiver who comes at a cheaper rate ($10.00 - $15.00 an hour). But that is where the benefit ends. In-home health care registries do not employ anyone providing the care-giving. Instead, they primarily make referrals - think of registries as home-health-care brokers. Sometimes screening is
done, but, due to lack of regulation, it can be hard to determine exactly what training, screening or background checks are done on the in-home health aides that they
connect to you or your loved one.

You also risk trouble with the IRS, as the home health caregiver may be deemed your employee, subject to payroll taxes. What if the home care worker is injured? They may have a workers compensation claim against you – and you (or your mother/grandmother/whoever needs the care) could be held responsible for their medical bills and any resulting disability.

Some long-term care insurances will pay for care provided from a registry, but Medicare and Medicaid will not. Medicare and Medicaid will only provide reimbursements to approved home health care agencies.

As an elder law attorney, my job is to provide my clients with options, guidance as to the pros and cons of each, but ultimately the decisions are theirs. For my family, I would only want a home health care giver to come from a reputable home care agency.

How to Find a Great Home Health Agency?

When seeking home health agencies, you'll quickly realize that there is no shortage of agencies in Florida vying for your business.

In my experience, nothing beats a personal referral from someone you trust - preferably someone who has had direct experience with the home health care agency and can give you real bonafide positive first hand reviews. I have had the opportunity to refer my clients to home health agencies in the past and am happy to provide my personal suggestions. But you should ask friends, family and other trusted advisers as well.

At the very least, even if you were to ask for my suggestion, I would give you more than one agency to interview. In fact, I recommend interviewing at least three agencies in person so you can ask questions.

Questions to Ask When Evaluating a Florida Home Health Agency

  1. Does the agency provide 24/7 customer services care in case there is a problem or emergency that needs to be addressed at night or over a weekend?
  2. Does the home healthcare agency run comprehensive criminal background checks on their care providers? 
  3. Is the Florida home health agency insured?
  4. Does the agency provide regular training to their caregivers (for example, dealing with patients with specific conditions that might require special care considerations)?
  5. What if a caregiver gets sick, will the Florida home health agency provide a backup immediately? 
  6. If mom doesn't get along with the assigned caregiver will the home health agency readily provide another (there will certainly be personality conflicts that would not be the fault of the agency, yet they should be willing and able to try to find a better fit should that be necessary).
  7. How long has the home health care agency been in operation with the current owner (some agencies are bought and sold and a prior owner may have been more involved than a successor agency business owner, which may lead to lower quality).

Elder Law Attorney Resources

Finding a home-health agency

Agency for Health Care Administration - FAQ on Home Care Nurse Registries