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.

As an elder law attorney, 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.

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 will not. Medicare will only provide reimbursements to a home health care agency.

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.

Elder Law Attorney Resources

Finding a home-health agency

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