Variety Of Models (Certified, Licensed & Registry) Exists For Home Care–Do You Know The Difference? Article

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Variety Of Models (Certified, Licensed & Registry) Exists For Home Care–Do You Know The Difference?

An article on helping identify the various home care models available.

Author: Barbra London Lcsw Freedom Eldercare

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The Licensed Agency
In a licensed agency model, individuals are hired by the agency after careful screening, including background checks. The care staffs are employees with taxes and other employer withholding responsibilities managed by the agency. The direct care employees are supervised in the home by qualified professional staff of the agency. Licensed agencies provide additional training to their caregiving staff and most importantly, the agency supervises and monitors the care, based on a plan devised and agreed upon at the start of the care, revised as needed and followed by all parties. Licensed agencies provide back-up in the event a care provider is unavailable and usually guarantee staffing for critical care cases. Licensed Home Care Agencies are regulated and monitored by the state. Licensed Agencies can change their services to meet changing needs for care.

The Registry
The placement agency or registry model, sometimes called the nursing registry, uses caregivers who are presented as independent contractors. In the registry model, the company recruits workers and places them in the home. They do not hire, train, or supervise these workers, as they are not employees of the agency. Who actually is employing the caregiver is the biggest question. The registry serves as a matchmaker, i.e. matching the client and caregiver. In these situations the caregiver is usually characterized as an independent contractor. Because of how the worker is used in the home and how the worker is paid, the determination could be made that an employee-employer relationship is established between the worker and the client. It is important that the individual entering into this type of caregiver relationship review and understand the IRS and Labor legislation relative to employment of caregivers through a registry.

This model poses potential risks and liabilities to the family and the worker. For example, if an on-the-job injury occurs, who is responsible for the medical bills that result from that injury? Most homeowners’ policies strictly forbid coverage of employees in the home being covered for injuries. If the worker were not covered by his/her own workers’ compensation policy, then the client would most likely be responsible for the resulting costs for the injury.

The Certified Agency
Medicare services are provided to qualified individuals through a Medicare Certified Agency. Medicare, unfortunately, is not a long-term care option. The coverage under Medicare is sporadic and intermittent, and since its enactment in 1965 is the model most associated with home care. However, Medicare coverage is very limited and is primarily skilled nursing and therapy, available to the elderly and since 1973 available to certain disabled younger Americans. Some home health aide services are available in addition to the skilled services, but the skilled need must first be present. Services also require a physician’s orders and must have a rehabilitative outcome associated with the care.

About Author

Barbra London brings more than 20 years of geriatric experience as SVP, operations and education to Freedom Eldercare (http://www.freedomeldercare.com), the community’s leader in comprehensive eldercare service delivery.

In her first job as a professional social worker, she was responsible for the operation of the first federally funded Elderly Day Care Program in the state that is the model used today. Previous positions held are Assistant Executive Director of a 300-bed long-term care facility in New Jersey and General Manager of a large Marriott Assisted Living community.

For the past six years, she has practiced geriatric care management and is a a foremost educator in geriatric and aging solutions. A Licensed Clinical Social Worker and a Licensed Nursing Home Administrator, she is a member in good standing with the Academy of Certified Social Workers. London holds a Masters in Social Work from Wurzweiler School of Social Work and a BS from American University.

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