My sisters provide primary care, but we have a few CNAs who come in to help out. My sister read an article that it is not uncommon that dementia patients can become combative near the end of life. Mom is 90 and has had issues for the last 10 years...there are signs (sleeping 12-14 hrs a day, not eating and drinking like she did, etc). My sister asked me to check to see if there is legal responsibility, does mom's HO insurance cover, etc. Any info would be appreciated. Thanks
Don't assume your standard HO policy will cover for 'hired' CNA's getting injured.
I called our insurance agent and learned that we would have to carry a commercial worker's comp policy, at the then premium of about $750 to $1K annually, with literal guarantees the premium would increase every year.
I balked at that; it was enough to have to deal with employee issues of payment, deductions, etc., just for one part time person, but neither my father or I were willing to enter the world of commercial workers' comp liability insurance and such a large amount for premiums.
My agent emphasized that his kind of coverage can't be added to a Michigan HO policy; it's considered a commercial policy issue.
FreqFlyer, a regular poster here, had some experiences slightly different (if I remember correctly) in the DC/VA area.
This is one of the intractable issues of hiring people directly, even if you may get better help than is available through an agency.
Unfortunately, there weren't any good solutions for our situation.
I think you should contact your insurance agent directly to pose this question, but be prepared to be advised that the workers might not be covered.
Tacy addresses this issue as well, with additional information of which I was unaware.
Caregivers are expensive. If something happens though, it will end up costing more.
We use ADP for payroll. My husband will not hire folks “under the table” as he doesn’t want to risk losing our business or home due to an injured employee not being covered. That can really wipe us out (you too).
While you may saving yourself money now paying those helpers out of pocket, ask yourself is it worth it getting sued when one of those employees hurt their back and need treatment.
Not worth it.
this is a bit off topic but ask your sisters to check with mom’s doctor and see if mom would qualify for hospice care at this point. That could be a big help to your sisters.
If your mom injures someone working under the table, I promise you that they will not say it is all good and let it go. They will be loosing their ability to earn a living and that is when the feces will fly. Lots of people getting paid cash will say no worries, it is all good, until it isn't and then it is to late.
You know that your mom has issues and could potentially injure one of these people. That is negligent from the git go to not provide them with the proper insurances to protect them.
These are issues that are better dealt with up front then during a crisis. God forbid your mom needs to apply for Medicaid, all the money paid under the table will not count as legit expenses and could cause quite the penalty.
Things to think about for sure. Protect everyone involved and do this properly, whatever that is in your state.
All different ways. I recently read where a family of 14 children each took one 12-hour shift a week, and so were able to keep their aging mother in her home. As you can imagine, though, THAT is not the norm.
How many of your sisters are taking care of your mother?
I absolutely concur that you should not be paying CNAs under the table.
I keep thinking of Dorker's brother, who thought he'd save some $ by getting his friend's 17-year-old son to help trim some trees. Well, the boy hit a power line with the bucket truck, was electrocuted, and ended up losing both legs. There is a big lawsuit, and Dorker's brother could end up losing everything.
I do have a question, though...say the family here continues paying CNAs under the table. If one of them gets hurt, they could sue the mother's estate. But if there isn't much there, can they also sue the family and go after THEIR assets? They could sue the person who pays them, right?
Sonoutofstate, I understand and can almost picture your reasons for supporting home care for your mother. The view from one's own rocking chair is immeasurably comforting. But.
"My brother died a little over a year ago after spending 10 years at the nursing home. Mom rarely missed a day visiting him, and over the years, she was well known by virtually all of the staff...."
So well known, and so well liked and respected, that some of them were prepared to give her their time free of charge. And this is a place that she has seen and trusted through ten years' experience.
I know it's not home. But as nursing homes go, it's about the best substitute I've ever heard of - pretty much a home from home, no? I would think it's got to be worth reconsidering as an option.
This is based on information I learned when working for liability attorneys, decades ago. There may be updated legislation, or case law, that affects this issue.
But recently a local case arose from an issue of "invitee" or "trespasser". E.g., liability can arise from visitation, including friends, family or workers., i.e., those who are invited to the premises.
However, (again, based on experience decades ago), those who are not invited, may be considered trespassers. This may void liability for injury.
The recent case was of a man who was injured diving into a closed, restricted swimming area. It's open to members in the subdivision who pay an annual fee. I don't recall where this man lived, but he did not pay the fee, was not a member, and had no expectation of membership benefits.
He sued the subdivision; I don't remember if he sued any of the members or officers. The case was dismissed; he had no standing to sue, for the reasons stated above. As I recall, this applies to homes as well.
If so, then not every person insured at a residence has standing to sue. Nor would liability exist for any such injury.
I'm not attempting to parse words with you; I just wanted to clarify an issue, that people who are NOT invited onto a premises don't have the same rights as those who are.
"Can a caregiver be an independent contractor?
According to the IRS, if a privately hired / independent caregiver is paid more than $2,000 per year, they are considered to be a household employee, not an independent contractor. Therefore, the family hiring the independent caregiver takes on all the responsibilities of being an employer including payroll and taxes."
The above came from the link below. Review it for details (this was last updated 2017, so see next link to IRS page as well):
https://www.payingforseniorcare.com/homecare/hiring-independent-caregivers.html
While the hourly rate might be more for hiring through an agency, ALL of the nasty stuff is covered by them (taxes, SS, WC, liability, background checks, etc.) Having to factor in paying for additional liability insurance, Medicare, taxes, SS contribution, dealing with the IRS, etc, using an agency doesn't seem so bad...
Also, what you pay for these services should be tax deductible for mom. We can deduct the ENTIRE cost of MC for mom, so she is currently no tax status (we still have to file returns, BUT no taxes are deducted now and she pays none, because the cost of the facility is more than her income.) If mom is paying taxes still, getting these deductions could easily offset the 'extra' cost of hiring through an agency.
See also:
https://www.irs.gov/pub/irs-pdf/p926.pdf
If you scroll to Table 1, the limit is $2,100. Not sure who told you $3850 was the limit, but what I see is $2,100. Apparently if it is family being paid, these might not apply, but you aren't hiring family.
As for mom and needing to "know" the person, this can be handled by bringing them in for the initial visits while one of you is there. While there you can excuse yourselves for longer and longer periods, leaving the aide alone with mom for them to get used to each other. If/when she becomes more familiar with them, then you can have them come when y'all need some respite.
Another concern is the liability itself. Although some dementia patients can become unruly, how much injury could your 90 yo mother inflict? The bigger concern is one of these employees getting hurt while doing their job and/or people who scam the system by claiming injury. IF they win their case, can they also sue you and your sisters as "employers" as well? The added costs of hiring this way takes away from what you can pay as well, both financially and having to worry about anything (also, if the aides are indisposed, who covers for them? An agency would provide a backup.) As someone else mentioned, if mom ever needs to apply for Medicaid, paying "under the table", which this really is, will affect the outcome negatively. Paying through an agency should be acceptable. Also, if mom's income is limited, she may qualify for Medicaid assistance (they DO often cover some of the in-home care provided.)
Personally I would not hire someone to work for me this way. IF they were self-employed, aka a contractor who pays for their own taxes, WC, SS, Medicare, liability, etc, maybe, but probably not. This could be a pay me now or pay me later scenario, and the pay me later could be much worse...
My understanding of HO insurance is that it would cover you (the family) and visitors, but not "employees." No state was listed, so all the tax, etc information would possibly apply for the state mom lives in as well.
An insurance agent would have you completely set up to be protected from this very scenario.
Sometimes the issues overlap, and sometimes other issues intervene, then it all becomes quite confusing. Give yourself the time, space and self authorization to consider the issues, and contact people who can give you answers for your state (such as insurance agents), before making decisions.
But I do compliment you on addressing these issues now. And good luck.
Just to add to all the great responses you've gotten, if you go the route of paying worker's comp plus other expenses for your mom's CNAs, then as someone mentioned, it could be likely the same as what you'd pay an agency. Downside is there is likely some recordkeeping needed on your family's part. Thankfully, there are companies that will do the payroll admin work for senior care.
You can find caregivers or have your current CNAs register with an online referral service like Carelinx. They insure the caregiver for limited liability (1 mill property) if they crash car or damage house (check with them on personal injury). They also do criminal background checks and have valid social security card/green card holders on their rosters to choose from. You select those you're interested in and then work with an online Carelinx advisor to assist you through the next steps of interviewing and hiring. However, SSI, (fica taxes) Medicare--your standard payroll deductions/accounting--Carelinx doesn't do, nor do they do workman's comp. (But not all states require WC for senior care EEs. They'll tell you if your state requires this).
Let's say both you and your current CNAs put profiles on Carelinx and then you go through Carelinx to hire your people, you can always use a senior care payroll company like HomeWork Solutions to handle the payroll deductions part. They charge some fees, but their prices were the lowest compared to Care.com's and ADP's similar offerings. Both Carelinx and HomeWork Solutions will try and help point you in the right direction if you need a WC policy for EEs.
If you haven't already, consider looking into applying for Community Medicaid for your mom, which is ideal for disabled, ill folks who are in the home and need home care. It is typically easier to qualify for this compared to NH Medicaid, but because there's lots of state-specific rules, it's helpful to consult with an elder law attorney that does Medicaid planning for help. If your mom get's this, then there is a program where you can find/hire the caregivers you want, they register w/ the agency you choose who will administer the program, and then the agency takes care of all the insurance & payroll needs.
Good luck!
"What happened to the old days when family took care of their aging parents with the help of some neighbors, church friends, and other friends of family. For the past 5 or 6 years, mom has known everyone involved in her care."
Well, there are many factors to answering your question.
* Families are often not as large as they were in 'the old days'.
* Often people stayed in their home most of their life.
* Many neighbors did too, so long term friendships develop.
* Most of the next generation(s) lived nearby (or with the parents.)
* Jobs often were long term, allowing people to stay put.
* Most people didn't live to see ripe old near 90-100 ages.
Over time these factors have changed. Families became smaller. People move around quite a bit, upgrading homes, needing to move to secure another job, changing location due to weather/health. This degrades having long term neighbors, church affiliations. Younger generations often move away to find their own jobs/way in life. You yourself are not local to the situation.
My parents and my mother's sisters took care of her mother, taking turns. She was EASY to care for (no dementia) and was probably later 70s when she passed away (parents were still pre-retirement!)
My mother is the LAST of her generation on both sides of our family. She stopped going to any church long ago, most of her recent neighbors are just as old or infirm as she is or have already passed away. There is no one other than the descendants.
There are 3 of us children, but we are much older than the parents/aunts were. I certainly could not care for her (multiple issues, many relating to my back and her weight/inability to walk, do stairs, etc.), OB is 2 days away (and has ZERO patience - THAT would be a disaster), YB is still working and has no room in his place. There are 5 grandchildren, 2 still in college, 1 also 2 days away, my daughter works dispatch/crazy hours, my son has a 3 yo (already.) There is really no way any of us could do this, certainly not alone, and we don't live around the corner from each other. Unlike mom's mother, mom has dementia and is now 96 going on 3 (or even 2.) She can be personally difficult to care for sometimes, has difficulty getting around/up/down/dressing now. She refuses to walk now and hasn't been able to do stairs for some time.
I have been the primary non-hands on care for years now. Despite what some think (like my YB), this is much more involved than just writing a check at the end of the month. It takes a lot of my time and effort to keep track of everything, visit with her, anticipate supplies/meds needed, schedule/take her to appts, keep records for taxes, respond to "emergency" calls from MC facility, yadda yadda...
This evolved into more than I was going to write, but basically we don't live in the 'old days' anymore. It would be nice if we did, but those days are gone.
Some people CAN manage to take on the care-giving and make it work. For others it is difficult or impossible. Some want nothing to do with care-giving. As the saying goes, it takes a village to raise a child (even THAT is part of the 'old days'!), and it also takes a village, sometimes, to care for LOs with various issues, esp dementia.
P.S. If mom has dementia, I would not be as concerned about the rotation of aides. It would be best to keep it to just a few, but as the dementia progresses, she will be less likely to know who is who. Maybe you can ensure getting the same ones by picking a set time each day. It is difficult for them to staff people.
When we tried using aides, it was MWF, but no specific time. It was different people, but generally the same ones on X day of the week. Moving to M-F we ended up with more aides and not having a set time I think was part of the problem (for getting the same aides, and perhaps having mom on board - but the bigger problem was that in her mind she was fine and didn't need these people coming.)