Nobody likes to make a decision about getting extra care for an aging parent, patient or client, but studies indicate that most older adults have at least one chronic condition, and some have multiple illnesses that require in-home assistance.
While nursing home care is often an option for serious medical conditions, more and more consumers are opting for in-home caregivers. Older adults choose to stay home as long and as safely as possible and expect to have safe, dependable and trustworthy care whether it is provided by family, licensed residential facilities
or licensed private duty agencies.
The number of consumers utilizing in-home caregivers is continuing to grow in the United States, and by 2030, the population of older adults will more than double to about 71.5 million. While the number of older adults grows, the pool of family caregivers is decreasing, from 11 family members for each older adult to a ratio of just 4:1 estimated in 2050.
So what steps can fiduciaries take to ensure safe, dependable at-home care?
First or all, what is a fiduciary and am I a fiduciary?
A fiduciary duty is the highest standard of care for equity or law. A fiduciary is expected to be extremely loyal to the person to whom he owes the duty he must not put his personal interests before the duty, and must not profit from his position as a fiduciary, unless the principal consents. (Wikipedia)
Financial, legal and healthcare professionals have a responsibility to their clients. A question to ask yourself, if I am not a fiduciary, do I have to live up to this standard?
Have you heard any stories about seniors having issues with caregivers? Have you noticed more press dedicated to senior elder abuse, the vast majority of the time the transgressor is a family member or a privately paid caregiver.
Even though Illinois has had licensing legislation for four years, some well meaning healthcare professionals and fiduciaries still refer to “unlicensed caregivers” because of cost.
Because of abuses by private caregivers, concerned local home care agencies and legislators partnered to pass the Illinois Home Health, Home Services and Home Nursing Agency Licensing Act, effective September 1, 2008.
All home care agencies are required to be licensed and supervised by the Department of Public Health and comply with legislation.
The Act requires defined safeguards that attempt to provide three stages of protection related to the hiring
and use of in-home care.
First, it puts in place legal requirements and
minimum standards to ensure that the quality of
patient/client care is consistently maintained by
Second, it aims to protect both skilled and unskilled
in-home workers as “employees” of licensed agencies
by providing them with more
defined legal recourse and workers’ compensation
for on-the-job injury.
Third, it serves as a guideline to help those with fiduciary responsibility make in-home hiring choices that protect the personal well-being and financial interests of the client or loved one while also effectively minimizing the legal and financial risks to the fiduciary associated with
the hiring of unqualified, unlicensed caregivers.
In essence, the licensing statute forces the up-front
definition of who’s who in the relationship and each
entity’s respective roles and accountability.
What is the differnce between licensed and non-licensed?
A licensed home care agency has the responsibility to provide continuing supervision and management of their employees. This includes mediating different personalities and insuring the caregiver understands the changing needs of the client as illnesses and needs change. This is achieved through ongoing training and education of employees which translates into a higher quality of caregiver. Licensed home care agency caregivers are also bonded and insured.
Registries or placement companies act as initial matchmakers, and that’s where the responsibility to the older adult ends. Since Registries, contract or placement companies do not actually employ the caregiver the ongoing responsibility for management, supervision and financial obligations of the caregiver is placed solely on the older adult or family members. The registry or placement company is required by law to clearly notify the client and caregiver of their rights and responsibilities.
When the consumer is the employer, they are responsible for compliance, payroll taxes including social security, Medicare, federal and state unemployment must be paid or the government may sue the consumer. The most financially devastating result of consumers unaware of the employer-employee relationship is worker related injuries. If no workers compensation protection is provided as mandated by law and the worker sustains an on-the-job accident, the liabilities can be substantial. Medical costs and disability payments for workers could cause a financial hardship for even the wealthiest of clients. For clients who cannot afford to pay, the worker will be left with no help for a devastating injury.
Many consumers incorrectly assume homeowners insurance will cover this type of loss.
Directly employing a worker through friends, advertisements or internet ads provide that consumer with even less protection than utilizing registry or placement companies, without the assurance that the caregiver has a background check.
Fiduciaries can be legal, financial or healthcare advisors and can minimize the legal and financial risks associated with the hiring of unqualified, unlicensed caregivers by referring to licensed home care agencies.
How do you check? Is the agency a member of the NPDA? The NPDA only accepts licensed home care agencies that employ their caregivers and provide insurance. Ask for their license and proof of insurance? In Illinois, ask a local hospital or skilled nursing facility discharge planner or social worker, most are required to refer only to licensed home care agencies.