Caregiver agency vs. Direct hire: Can you get more hours for the money while staying compliant with tax/insurance requirements?

Sarah3,

I hear that. I worked at an AL and you wouldn't even believe the responsibilities I had for my whopping ten bucks an hour. Everything from bathing and showering some residents, providing them socialization, making sure they got to the dining room for meals and if they didn't bringing a tray up to their rooms, driving and attending them at doctor's appointments when needed, and managing, administering, ordering and keeping a record of the meds for 42 residents. I quit that job after only a few months because they expected ridiculously too much for what was being offered.
CNA's, homecare aides, caregivers, whatever we're called never get the credit, respect, and pay we deserve. It's all reserved for the well-paid nurses who have certified nursing assistants that do the dirty grunt work for them. I never had an experience working in a client's home where a visiting homecare nurse ever helped me change an elderly diaper, or assist with a bed bath, or help change an occupied bed or any other task that can be difficult to do alone.
On every assignment I've ever had (agency or private) where there was also a visiting nurse, they would watch me struggle to do these things like get someone in their wheelchair, reposition, bathe, change a diaper, or make an occupied bed in care situation that really required two people. Not one time did a single nurse who was ever in a client's home with me help out with any of these tasks even offer to. Not even when there was a family member there who asked them to.
In all my years of homecare and they were many, the only response I've ever heard a nurse say in these situations is, 'that's the aide's job'. Most of the time they say nothing and get back to finishing their charting in the client's home (which isn't supposed to be done in the client's home on their time, but always is anyway).

Thanks to all for your input, I appreciate it! I am hoping that using a payroll service that specializes in household employees will be sort of a middle ground as far as cost, so we can increase the care hours and still protect our caregiver and ourselves. I don't feel confident in managing taxes, withholding and workers compensation, and truly don't want to spend my time on it. I'm trying to get some more time for myself, husband and family. So tomorrow I start contacting some of the services to find out how much they will cost over the wages we pay. Hopefully we can pay a better wage and still get more hours of help. I'll let you all know how it goes...

I'm following this. Thank you for asking. I am getting confused reading the answers about employer versus contractor. I'm going to go through it again.

IMPinky: Imho, perhaps you need to retain an elder law attorney.

Direct hire costs much less, and the caregiver recieves same, or more...it is some effort to do tax compliance, not that much...agencies screen, bond, and sub where needed, so there's that too to deal with if doing it privately.

This is not what you were asking, but here is a little input you might consider. When we started my mom with caregivers, we went through an agency. We were paying almost twice what the actual caregivers were getting. Then we went to independent caregivers. That didn't work out very well as they were not reliable. We realized that part of what we paid the agency for was their network of workers who could be called to fill in when someone was sick or had car trouble. We went back to the agency. It cost more, but it saved a lot of headaches and there were far too many headaches already. There are no really great answers for hiring care unless you have stacks of money, you simply need to pick the option best suited to your needs that you can. Good luck and hugs. I know you are in a tough spot.

The IRS has determined over and over again that caregivers are not contractors because.of the employer requirements on their employment.

Caregivers are always employees. Trying to treat them otherwise will cause problems when trying to get qualified for medicaid for long term care. And it sounds like it is time to look into that.

Hire a private aide and offer them say $22 an hour (You'd be saving $10 for every hour). This way you can hire more hours and you'll also benefit from good help when you pay well.
Next visit an insurance agent and ask them how to take out a special policy for if your aides get hurt while in service and you can pay for that. Such a thing does exist.
Then talk with an accountant. Ask them what paperwork would be needed so the aide can be considered self-employed in your state and how would they go about having taxes taken out of their paychecks.
If you've found an online service to do all of this, great. Go for it.
Why does a middle-man agency who really doesn't do anything have to get a piece of the pie? A piece more than twice the size of the aide's who is the one actually doing the work?
God bless you for even thinking about hiring privately and doing right by your help.