Paying for Home Health Care Part One

Or better known as:

MY SISTER-IN-LAW'S CLEANING WOMAN'S DAUGHTER'S BEST FRIEND

As most everyone knows, needing an aide, CNA, or some other type of professional to come to the house to help an aging parent is expensive. It doesn't matter if the need is for someone to cook and drive or someone to provide medical care. Most people don't have insurance coverage for this type of service. So, once they gasp at the amounts quoted by agencies, registries, community organizations, etc., the typical response is to get names from friends and relatives to hire them privately.

There are definitely pros and cons, as well as some legalities and practicalities, to this approach.

The obvious first perceived advantage is cost. An agency will charge an amount per hour or per day. Some of this money is paid to the aide, the rest is retained by the agency for their services. What many people want to do is to hire the aide directly and save the amount that the agency retains for their services. The service that an agency provides is very valuable and the amount saved by hiring someone directly may turn out to be very costly. Not only does the agency screen all employees, make sure they are properly trained and supervised, they also take care of all payroll issues.

Everyone knows that when hiring household help--aides, nannies, cleaning help, etc --that payroll taxes such as Social Security and Unemployment are to be paid. The reality is that most don't do it. The help wants to be paid in cash, the person doing the hiring doesn't want to do the paperwork or incur these extra costs. Even those people trying to do the right thing end up at their wits end actually doing it.

Doreen's husband's medical issues began to get worse. It got to the point that he couldn't be left alone any longer. Doreen got the names of several aides and set-up a schedule to have coverage for 4 hour shifts each day. She called her CPA to find out how to handle paying each of the aides. He explained that she needed to pay Social Security and Unemployment for each of them, file reports on a regular basis, and calculated the amounts for her. Doreen wanted to do this the right way so she followed his instructions. Her husband's condition worsened and she needed progressively more help in the house. The paperwork associated with having multiple aides each week, different pay scales depending on day/night, weekday/weekend became a nightmare. She basically was running her own home health care agency. When just balancing her checkbook became a daunting task because of all these transactions, she threw up her hands and gave up. She had to decide whether to use an agency so they would handle the paperwork, just pay the aides in cash and forget all the paperwork, or hire someone else to do the paperwork for her.

This is the trade-off. Hiring someone directly whose name you get from a friend or relative may be less expensive if you're not paying their Social Security and Unemployment and if you're not paying an agency fee. But, you also aren't getting the screening, training, and supervision that home health care agency provides.