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Active Care In-Home Services

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What does the law require?

When you hire a home health aide independently, you must ensure that the following taxes are being  addressed: Federal Income Tax Withholding, Social Security taxes (FICA), and State taxes. If you are using an service, make sure that they address these issues. If you are hiring a home care worker      directly, contact the IRS at (800)829-1040 to ensure proper tax payments. Remember, it is both a Federal and State offense not to pay taxes. If you are paying someone who is working as an independent contractor, contact the IRS and get a list of the requirements to make sure the aide qualifies; otherwise, their tax liability may come back to haunt you.

      Home health aides who work in your home should be covered by worker compensation and liability insurance, and they should be bonded. Once again, if you use an agency, ask that you receive documentation of the coverage provided. If you are hiring privately, you will need to address these issues.

      Frequently Asked Questions

      What is the difference between a companion or home maker and a home health aide?
A companion or home maker will prepare meals, do light housekeeping and keep the person company. Only a certified home health aide is allowed to to provide hands-on care such as bathing and dressing. A certified home health aide has completed a 76-hour training program with supervision; there are no training requirements for a home maker/companion.

      How do I decide on a schedule for home care?
Think about what time of day is most difficult for you and the older adult. Having a set routine as much as possible will benefit the care giver and the client. Make sure your needs are met by the home care schedule, but be flexible; not everyone can receive a shower and breakfast by 9:00 

      Can the home health aide drive and run errands?
Agencies vary on their policies regarding the home health aide using a car to transport the client or to run errands. Ask the agency when you inquire about services under what circumstance the aide is allowed to drive. Be prepared to reimburse mileage if the aide is using their own car.

       Am I responsible for providing food for the aide when they are preparing a meal for the client?
This depends on the schedule and the needs of the client. If the home health aide is working eight or more hours a day, then food should be included. Some clients, particularly those whose calorie intake is a problem, benefit from the socialization of sharing a meal with another. 

     What should I do if the home health aide requests a change in the terms of employment, such as schedule, time off or pay changes?
If you are using an agency, these issues must be referred to them; remember that the agency is the employer. If you are employing the aide privately, create an employment agreement that stipulates the terms of engagement and make sure you both sign it. Never make compromises that you are uncomfortable with.

     What can I expect from the Agency?
The Agency is responsible for seeing the client once a case is opened. The Agency will do a In-Home assessment and review all medications; they will also review the care plan. The Agency is responsible to supervise the care the home health aide delivers. 

     Is it appropriate to ask a home heath aide to do house cleaning?
A home health aide will do light housekeeping as it relates to the client. For example, if a bath is given to the client, the aide will clean the tub or clean the kitchen area after preparation of a meal. Home health aides are not house cleaners. To avoid any misunderstanding, it is best to make sure the client understands the difference. 

      I am considering privately hiring a companion for my mother. What are my obligations ?
Your main taxpaying responsibility will be for Social Security (FICA) and Medicare taxes. This includes withholding the employee share, as well as matching that amount as the employer. You as the employer will also pay the federal and state unemployment tax. As the employer, you and the employee need to discuss any arrangements regarding state and federal income tax withholding. It is always a good idea to consult with an accountant on these issues. 

     Can home care expenses qualify as a medical deduction?
Yes, providing you maintain adequate documentation and pay all of the appropriate taxes either  through an agency or on your own. Home care will qualify as an medical expense; once again, consult your accountant for details.

Please fell free to call 
Active Care In Home Service 
we will be glad to help find 
answers to 
your questions.

Joseph R Grimm

What is In Home Care?

Generally, In home senior care refers to the services provided by a certified home health aide or a certified nurses assistant whom a nurse or an Agency supervises. The home health aide can provide assistance with bathing, grooming, meal preparation and feeding, light housekeeping, laundry and companionship.

Who pays for Home care?

Medicare will pay for home care when the physician has ordered skilled nursing or rehabilitation services, in addition to the home health aide. Medicare home care is time-limited and ends when there is no longer a need for these skilled services. Only the patient or their family covers home care for chronic conditions, such as dementia, stroke or heart conditions. Medicaid covered services are available for eligible persons with few assets and limited income. Long-term care insurance is a newer option for paying for home care and other services.

What to look for in Home Care

Prior to hiring a home health aide, determine what the ideal schedule is for your family and the older adult. Also, think through what tasks you want the home health aide to do. A little advance planning will ensure that your needs are met and that the aide or company is not defining the needs or services.

Prepare a list of medical diagnoses, medications and a history of hospitalizations, as well as doctors’ names and phone numbers. If you have an advanced directive and/or an “At Home Do Not Resuscitate Order”, copies of these documents should be made available. You should note persons having power of attorney or health care proxy, and their contact information. These resources will help facilitate your meeting with the care provider.

The most important consideration when obtaining home care is finding a home health aide or CNA. who is a good match for the client. Have in mind the type of personality that you feel will lead to a harmonious relationship. For example, if you have a elder who likes privacy and prefers to be alone, then you do not want to hire an aide who is gregarious and views their job as providing companionship. Any reputable company 
will agree to provide an interview to determine suitability before hiring.

Upon hiring a personal aide, an individualized care plan should be developed. The care plan should cover everything the aide is to do for or with the client. The plan should include the appropriate personal care issues, medical conditions requiring monitoring, food/meal related activities, home management issues and social/leisure activities. The care plan serves as the job description for the home health aide.

Consistency is important when hiring a home health aide. A positive relationship between the client and the aide will result in the best outcome for all concerned. If you are using an company, make sure that they will guarantee the same aide for the schedule you have agreed on. 

Identify the support that will be available to you and the older adult if issues should arise. For example: is there a nurse available if a medical or behavioral problem occurs? Is there a mechanism for providing alternative coverage if something should happen to the home health aide? Is there a person or process for dealing with disagreements or misunderstandings?

Lastly, remember that you are the boss! You should not do anything that you feel uncomfortable with or permit any behavior that is unprofessional.