We must not wish for the disappearance of our troubles but for the grace to transform them.― Simone Weil, French philosopher and political activist

A question often asked of Elder Law Attorneys goes like this:  “We have decided to keep mom home as long as we possibly can.  We need a care giver.  Should I hire one myself, or go through an agency?”

The first option, hiring a care giver yourself, can be a wonderful decision, or it can go non-wonderful pretty fast.  When you hire a care giver directly, you must consider all the tax and liability issues, even if the employee is a known friend of your family.  As an employer, you are responsible for filing payroll taxes, other tax forms and verifying that the employee can legally work in the United States.  If you pay $1,900 or more in wages this year to any one employee, you need to withhold and pay Social Security and Medicare taxes.

FUTA, the Federal Unemployment Tax Act, is also something you may be required to pay.  If you paid more than $1,000 in wages during 2013, you need to pay unemployment taxes – either state or federal, or sometimes both.  A certain amount of your employee’s wages are considered unemployment wages (FUTA) You figure the FUTA amount owed based on the FUTA wages you pay.  If you pay cash wages to all of your household employees totaling $1,000 or more in any calendar quarter of 2013 or 2014, the first $7,000 of cash wages you pay to each household employee is FUTA wages.

In addition, a private care giver most likely does not carry his or her own liability insurance or workers’ compensation.  If an accident occurs on the job, you could be responsible.

I know that a sweet person from your church, or someone you’ve met at the senior center will likely charge less than a care giver from an agency.  Maybe it’s someone you’ve known for a very long time, and their spouse just died and they are looking for something to do.  Even so, you should probably do a cost benefit/risk analysis.

The benefit of hiring a caregiver directly is that you have more control over who you hire and can choose someone who you feel is right for your family.  Additionally, as I just mentioned, hiring privately is usually cheaper than hiring through a home health agency.

So, what about going through an agency to hire a caregiver for your loved one?  When you hire through a home healthcare agency, the agency is the employer, not you.  Therefore, you don’t need to worry about tax and liability issues.  The agency takes care of screening the empl9yees for drugs or criminal backgrounds.  They do the background checks and provide the insurance.

In addition, a licensed home care agency must provide ongoing supervision to its employees.  It can help the employees deal with difficult family situations or changing needs.  The agency may also be able to provide back-up if a regular care giver is not available.

A downside of going through an agency is not having as much input into the selection of your caregiver.  In addition, caregivers may change or alternate causing a disruption in care and confusion for the patient.

Additionally, Lee Lindquist, M.D., an associate professor of medicine at Northwestern University Feinberg School of Medicine, and a physician at Northwestern Memorial Hospital, says that “People have a false sense of security when they hire a caregiver from an agency.  There are good agencies out there, but there are plenty of bad ones.  Consumers need to be aware that they may not be getting the safe, qualified caregiver they expect.  It’s dangerous for the elderly patient who may be cognitively impaired.”

Lindquist headed up a troubling national study, published in the Journal of American Geriatrics Society.  The study found that some agencies recruit random strangers off Craigslist and place them in the homes of vulnerable elderly people.  Some don’t do national criminal background checks or drug testing.  Some may lie about testing the qualifications of caregivers and don’t require any experience or provide real training.

We are blessed to have many honest, hard-working and reliable home health care agencies in our area.  Check the free magazine, The Guide to Retirement Living Sourcebook, for up to date information on home health care agencies.  The magazine’s website is  www.retirement-living.com

Here are some questions to ask a home health care agency before you hire them to provide a caregiver:How do you recruit caregivers, and what are your hiring requirements?  What types of screenings are performed on caregivers before you hire them?  Do your caregivers receive any health-related training, and are they certified in CPR?  Are the caregivers insured and bonded through your agency?

There are more possible questions – a discussion for another day.  Thank you for reading.  Stay well.  See you next week.