By Machelle Thompson, PT, CMC Geriatric Care Manager, Keen Home Care

Finding the right in-home care for your loved one requires asking the right questions about costs and services, as well as evaluating your risks and duties. Consider the following options when conducting your search.


Full-service Home Care Agencies

provide non-skilled caregivers who are employees of the agency. Although this may be the most costly option, it is often the most desirable, since the agency assumes full responsibility for the caregivers. This includes payroll liabilities, worker’s compensation, liability insurance, and unemployment insurance.

Verify that the agency performs pre-hire background checks, provides training and oversight and will replace staff if necessary. You may also request a copy of the agency’s insurance records to make sure it carries the proper insurance. Some agencies require a minimum number of hours or minimum period of engagement of services. If

you have a long-term care insurance policy, your provider will most likely require that you use a full-service agency.


Direct Referral Agencies (DRAs)

save consumers approximately 20% when compared with full-service agencies, but they also saddle them with more responsibility. The agency provides pre-screened caregivers for you to interview and charges approximately 20%-25%of the caretaker’s wages to process payroll and provide required reporting to state and federal agencies. Be aware that California does not recognize in-home care workers as independent contractors (1099). Therefore,

if the agency does not pay the payroll liabilities, you are liable. You can obtain worker’s compensation coverage for caregivers by purchasing a rider on your homeowner’s insurance (typically $200-$500/year).

You assume responsibility for scheduling caregivers and for finding replacements when necessary.


Private caregivers

are the option many choose because this initially seems the most cost-effective. Although private caregivers may file as independent contractors (1099) and pay their own payroll liabilities, California does not recognize them as such, and you are ultimately responsible. Most consumers who choose this option are unaware of the extraordinary risk they are assuming: Caregivers can sue for worker’s compensation, lost wages, wage and hour disputes, and unemployment insurance. Additionally, you are responsible for all penalties, including payroll and misclassification liabilities if the state or federal government finds out. The California Department of Labor is typically lenient to workers, even if they are undocumented and will typically side with them in disputes.