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Currently an agency is being paid for my dad’s private in home care (using his own funds). They provide the whole package — the employees, training, background check, payroll, wmc, and liability insurance. The reality is the employees they send are not so great. In turn I have become quite good at networking and have done my own search to find great caregivers and giving them to the agency, (plus provide all the training). It would be a significant savings each month to cut them and simply hire a service the does the background check, payroll, wmc, and liability insurance. I can’t think of a downside but would appreciate learning from others their experience going this route.

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We used both options - Independent Consultant (they’re responsible for their own tax burden) and through an agency. Using a staffing agency is helpful for backup and swapping out - indeed agency contract calls for either party to terminate with no notice at any time - no reason needed. In this way we have flexibility and always have a backup plan. For now this is through private pay. Once Medicaid eligibility kicks in then will need different agency and their workers - though most also accommodate a person of your choosing if qualified - including family member as long as they are NOT already taking care of the person in need or assitance. Laws and regs vary by state
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Seek Elder Law Attorney advice. You will essentially be operating as an " employer" and accountable therefore for all HR functions. This is a lot of responsibility. Also, if you go with your own 1:1 hiring, remember that just like with childcare in the home, any worker can call out at the last minute and, then you are the one having to replace that person or disrupt your schedule. All the way around, using an agency removed a ton of legal and HR responsibility from you and if a person does call out , the agency must provide another person for you. There is no perfect solution; but there are many many considerations and
" risk management " aspects to being the " employer". Perhaps could speak again and consistently with the agency supervisor/ administration and share the good, and not so good with the help they send and get the ones you want consistently assigned or have the agency share with the other less than perfect ones what improvements need to take place for your site of caregiving.
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TKZMTJ: Perhaps an elder law attorney could provide you with an answer and/or outline an employment contract.
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You will be in charge of reporting pay, taxes. Paying taxes. Not only does the employer pay certain taxes, but the employee pay certain taxes. Insurance needs to be paid if that employee gets hurt they need to be insured. You will be in charge of the W-2 for your employee at the end of the year. Also, contract you will need to have a detailed contract as to what you expect and what they will expect which includes and not limited to - hours, exact physical expectations, days off, wages, paydays, breaks, days off, meal breaks. Here in California an employee must have a meal break within the first five hours of working.
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If both parties agree that this is a cash-only transaction, then there is no tax or compensation to worry about. Just make sure you pay the caregiver in cash. No checks.
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emccartt Sep 2023
Wrong!
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One downside to be aware of is that it is very likely that any employee of an agency has signed off on a non-compete within the various forms they did in the employment process. Now to what degree that non-compete is pretty much defined by State laws and how big of a company the Agency is. Even if you are in a “right to work” State non-compete can get slapped as you can still work but someone will get dunned. And you did the same within the contract with the Agency.

So if you as POA for mom try to hire a worker directly, and the old Agency finds out, they can bill you &/or the worker due to the non-compete. & the workers all flat just chat with each other.

Tends to be a 6 month window after the employee leaves the Agency totally before they can work for an old client. It will get turned over to debt collectors. & as 99.99% of the time these involve folks who own a home they will pay it as they do in NO WAY want it to get to the point of having this go to a judgement with a lien place on the home. Home health agencies like any other type of company (contractors, plumbers, interior designers) that does work on or in your home has this ability should you not pay your bill. It’s a workmans lien and actually fairly simple to place onto a property.

This can work both ways. You can strike (draw a line thru) this part of the contract. & just initial at the end of that paragraph. I’m not an attorney but have done that on contracts and it seems to suffice. Usually they won’t balk as they want the job. Just sayin’.
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I assume you are talking about a payroll service that ensures ALL employment laws and requirements are being met. If you are, you don't have to worry about anything except finding and keeping qualified aids as the company takes care of the rest. We only had to send the time sheets for each employee, oh and of course, the check to the company to pay everyone. No tax work required or concerns about labor laws. You can find some that even do all the screening and background checks. It was far cheaper than doing in-house payroll and all that entails.

I, personally, can't figure out why more people don't go this route, protects everyone involved, saves money for the client and increases the pay for the caregiver, win-win, imo.
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Worriedspouse Sep 2023
Where I live, agencies are much more expensive than direct pay. Much more!
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The downside is that at the end of the day it might cost you just as much AND you will still need to find your own last minute subs (for sick days) and replacements for holidays, vacations. If you are an employer, do you need to also provide them with benefits of any sort: healthcare, paid days off, etc.?

Bookkeepers (even private ones) are in short supply right now. I can attest to the fact that there are crappy bookkeepers out there so "caveat emptor" (buyer, beware).

Please check the employment laws for your home state.

If I were you I'd try to find 2 good people and give them each enough hours to keep them coming back to work for you. This way you'd have a trained and familiar sub, should the other person call in sick (and hoping that Aid #2 is available at the last minute).

Make sure you have a well-written employment contract.

Make sure that no matter how saintly your hire seems to be that wherever the care is taking place is secured from prying eyes and opportunistic theft (including prescription meds). My family has been there, done that.
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Igloocar Sep 2023
The laws that regulate this are federal laws and don't vary by state for the most part.
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Depends upon how good you are at keeping records, doing the tax work, and etc. It can indeed be a savings and it can in fact be done well. I myself would consider hiring a licensed Fiduciary who would train me in managing care; then take it over on my own. They charge just around 100.00 an hour and you could consult with one in your area. Short of that consider a consult with an elder law attorney to make certain all your bases are covered and you are comfortable to take over.
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