Registries vs. Agencies

Senior adults and those dealing with chronic illnesses expect to have safe and trustworthy care. Whether it is provided by family, nursing or residential facilities, or in the home, everyone deserves dependable quality care for themselves and their family members. The two main ways to find in-home care are through a registry or an agency. While at first glance a registry may seem more attractive because of the lower cost, consumers need to be aware of the liabilities and financial responsibilities associated with hiring from a registry (sometimes referred to as a referral source.) The key difference between registries and agencies is the caregiver’s employer. Registries do not employ their caregivers; they contract with them, while agencies employ their caregivers.

Source: Assisting Hands® in association with IlluminAge, © IlluminAge 2014.

Registries act as matchmakers, thus placing the responsibility of managing and supervising the caregiver on the client or family members. The registry often does not convey to the consumer that this arrangement could result in an employee-employer relationship between the caregiver and the client. Financial responsibilities such as taxes and workers’ compensation coverage therefore may fall on the client. By law, registries cannot provide supervision, training, or scheduling to caregivers.

As a result, these caregivers are often untrained and unsupervised, posing undue risk to the client. Because registries have little ongoing liability and want to avoid being an employer, they may provide inadequate or no background investigation of the caregivers. This could subject the client to physical, psychological, or financial abuse. Family members can help, but time constraints and geographical distances often prevent them from being more involved. Work related injuries are the most financially devastating liability. Without workers’ compensation insurance, medical costs and disability payments would fall on the client and could cause financial hardships even for a wealthy client.

Agencies employ their caregivers and are responsible for their training, supervision and  ensuring that they maintain the appropriate certifications, as well as all financial obligations including taxes and workers’ compensation insurance. The caregivers are bonded and insured, and generally, the agency completes a thorough background check before hiring them. When working through an agency, the consumer does not have to worry about scheduling, since the agency is responsible for insuring that there is a caregiver on site during scheduled visits. An agency also has the responsibility to provide continuing supervision of their employees. This includes mediating difficult personality or relationship issues, insuring that the caregiver understands the changing needs of the client, and assuring the proper limits on the types of care that can be provided. This is achieved through ongoing training and education of employees, which translates into a higher quality caregiver.

In-home care provided through both registries and agencies allows consumers to choose providers that meet both their budgetary and in-home needs. As the information available is somewhat limited, it is up to the consumer to do their research when selecting a provider to meet their needs.

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The family should seek the advice of an attorney and accountant, if they choose to use a registry to assure that all applicable laws are followed. As always, you may go to the Texas Department of Aging and Disabilities Services (DADS) website to get more information about licensed agencies and caregivers.