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| Private hire or agency hire? Published/Last Modified on Wednesday, November 17, 2004 11:23 AM PST Q: I have been assisting my mother with finding in-home care for herself. We started working with a care manager from a home care agency, who led us to believe that the only safe way to hire a caregiver was to go through their agency - which is not cheap. I then remembered one of your past articles, where you discussed the fact that a person can hire a private caregiver directly, and save quite a bit of money? Did I understand this correctly? A: Yes, using an agency to hire a caregiver can be costly, and not an option, financially, for some people. Contrary to popular belief, there are several different ways of arranging in-home care, besides the use of an agency. However, to answer your question, I will only compare the differences of using a home care agency vs. hiring privately. I don't have space to discuss how to actually locate and choose a caregiver, because that is an entirely separate subject. First, there are two main types of agencies: Some agencies act much like a headhunter, and will simply locate a caregiver for a one-time placement fee (typically, 20 to 40 percent of the first year anticipated salary - not an inexpensive proposition); and then there are other agencies that actually employ the caregiver as its employee in your home, charging you two or three times what they pay the caregiver per hour - again, not cheap. Only focusing on the latter (agencies that actually employ the caregiver), there are basically two types of "employing" agencies - medical and non-medical. A "medical" care agency not only provides caregivers, but can also provide other types of medical-related services - each additional service usually comes with an additional cost. A "non-medical" agency only provides caregivers; this leaves it up to you to arrange for all other home care needs (for example, a private nurse, or a care manager). In any event, the caregivers are not allowed to handle medications. The caregiver is allowed to hand the client her pill box, but is not allowed to actually select or guide in the use of medications, or fill a person's pill box. If you are working with a medical care agency, and there is a need for medication management, the agency will schedule a nurse to visit periodically - at the cost of $75 or more per visit. With both medical and non-medical agencies, there should be a manager of the care to ensure the proper placement of a caregiver, and to oversee the care. Therefore, with a medical agency you will be assigned a case/care manager at the cost of $100 or more per hour. With the non-medical agency, they generally will supply a "case" manager who comes at no charge, but isn't really involved in the care management aspects (and is not typically proactive), but plays more of a trouble-shooting role when problems arise. If you and your mother were to hire a caregiver privately, you will take on more of the responsibility that is otherwise handled by an agency (such as administering payroll, screening and background checks, addressing wage and hour laws, for example), but many of these functions can be "outsourced" or handled by others (such as a payroll company like PayChex). This can result in substantially reduced costs and usually allows for more flexibility in the caregiver's schedules and duties. In the Bay Area, it's my experience that privately hired caregivers will expect anywhere from $12 to $16 per hour, depending on experience and skill levels and other factors. An agency will charge a minimum of $20 an hour or approximately $225 a day for live-in care. Currently, a very hot topic within the geriatric care management field is whether a care or case manager employed by the same agency that is providing the caregivers can truly be independent in her advice. It is my opinion that her primary duty is to her employer, and it is in her employer's best interest to recommend that they employ the agency's own caregivers rather than providing other alternatives. Therefore, I don't believe that you should expect to receive truly independent advice from an agency employed care manager, especially with respect to hiring directly. I would recommend that you first meet with an independent third party who is knowledgeable in senior care options. When I say "independent" I mean someone who is not part of an agency, but someone whose sole purpose is to assist you and your mother, in assessing and choosing the most appropriate means for meeting her care needs. Assistance can be found through your local senior center or by calling the National Association of Professional Geriatric Care Managers at (520) 325-7925 (www.caremanager.org). Finally, in my opinion, agencies are best used for situations in which you are in crisis and need immediate home care or in which the situation is merely temporary. However, as long as the support is available, those requiring long-term in-home care should generally consider hiring privately, as the cost savings will be substantial. Jeannine Clark is a Pescadero resident, medical social worker and private geriatric care manager with Clark Consulting. She writes a bi-monthly column for the Review on topics relating to aging and transitions associated with aging. Send questions to Clark Consulting, P.O. Box 101, Pescadero, CA 94060, or email to: clark@southcoast.net. |