Choosing Home Care in the Triad

Know What You Are Signing Up For

When you begin looking for help at home, you will find two very different kinds of companies that can sound alike. Both may advertise experienced, vetted caregivers. The difference is in who stands behind the care after the caregiver walks through your door.

What a licensed home care agency does

In North Carolina, home care agencies are licensed and surveyed by the NC Division of Health Service Regulation (DHSR). The caregivers are employees of the agency. The agency screens, hires, trains, schedules, and supervises them. It carries workers compensation and liability insurance, handles all payroll and taxes, and sends a qualified replacement when a caregiver is out. A nurse or supervisor oversees the plan of care, and the state holds the agency accountable for quality.

What a referral agency does

A referral agency, sometimes called a registry, recruits caregivers and matches them with families for a fee. The caregiver does not work for the referral agency. In most cases, you or your loved one becomes the caregiver’s employer. North Carolina law allows a registry to operate without a home care license only if it discloses to you, before any services begin, that it is not a licensed home care agency and that it makes no representations or guarantees about the training, supervision, or competence of the personnel it provides.

What families take on when they become the employer

Hiring a caregiver directly can look less expensive on paper, but the responsibilities shift to you. As a household employer, you are generally responsible for Social Security, Medicare, and unemployment taxes (see IRS Publication 926). North Carolina law does not require workers compensation coverage for domestic workers employed by a household, so if a caregiver is injured helping your loved one, there may be no coverage at all, and homeowner’s policies often exclude these claims. There is no nurse supervision, no state oversight of the arrangement, and no agency obligated to send backup when your caregiver calls out.

Questions to ask before you sign with a referral agency

Ask these questions and get the answers in writing.

Who is the employer?

1. If I hire this caregiver, am I legally the employer? Who withholds and pays Social Security, Medicare, and unemployment taxes, me or you?
2. If the caregiver is paid as an independent contractor, who is responsible if the IRS or the state later decides the caregiver was actually my employee?

Injury and liability

• If the caregiver is injured in my home, whose insurance pays? May I see the policy, and does it protect me or only your company?
• If the caregiver injures my loved one, or something goes missing from the home, who is accountable? Are your caregivers bonded?
• Does your contract ask me to waive claims against you for the caregiver’s conduct?

Oversight and quality

• Are you a home care agency licensed by the NC Division of Health Service Regulation? If not, will you give me the written disclosure North Carolina law requires, stating that you make no guarantees about the training, supervision, or competence of the caregiver?
• Who supervises care? Will a nurse ever assess my loved one, create a plan of care, or check on quality?
• Who verifies the caregiver’s training and credentials, and what happens if a certification lapses after placement?

Continuity and cost

• Who sends a replacement when the caregiver is sick, quits, or does not show up, and how quickly?
• Who handles scheduling, time sheets, and payroll each week?
• What are all the fees, including any placement fee and any ongoing share of the hourly rate? What do I receive for the ongoing portion if you are not the employer?
• If the match does not work out, will I pay another placement fee?

Accountability

1. If I have a complaint about my care, is there a state agency that oversees your company the way DHSR oversees licensed home care agencies?

Where the legal line actually is

NCGS 131E-136 exempts a nursing registry from licensure only if, before providing any services, it discloses to the client that (i) it is not a licensed home care agency and (ii) it makes no representations or guarantees concerning the training, supervision, or competence of the personnel provided. If a registry markets “vetted, credentialed, experienced professional caregivers” and touts its screening as a safety guarantee, then either the required disclosure contradicts its sales pitch or the disclosure isn’t happening.

About ComForCare Home Care

ComForCare is a fully licensed North Carolina home care agency (License HC3935) serving Greensboro, High Point, Kernersville, Burlington, and all of Guilford County. Our caregivers are our employees. We hire, train, insure, schedule, and supervise them, and our nurses oversee every plan of care. We are glad to answer every question on this list about ourselves, in writing.

3809 W Market St, Greensboro, NC 27407   |   336.617.6001   |   www.triadcaregiving.com