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buried_lede t1_je3c1pt wrote

I also have experience with self-paid live in home care and just want to leave one important piece of info for people:

There is a big difference between a home health agency licensed by the health dept and a “homemaker companion” agency that is licensed by the consumer dept. Know the difference and supervise, don’t be supervised, by the latter. Also, don’t let them work beyond their license, which they can easily slide into, and don’t think the quality of care will remain fine if you don’t stay involved.

Edit: oh, another thing, for those families that can stay on top of it who hire in home aids to do non medical care such as meals, bathing etc, you can hire aids directly instead of going to an agency.

You must pay them as employees, not 1099 but lucky for us, payroll companies now cater to home help. ADP, for example, has a relatively affordable payroll service for families who hire home help and take care of the taxes, etc.and cut the checks. Others like Paychex, might too, not sure

I mention this because agencies get paid a lot but the workers get paid very little. If you have the ability to be hands on and get recommendations for experienced aids, you can hire one directly, pay them a truly livable wage and still save money over an agency.

In my experience, lots of aids are pretty honest and caring while some agency reps might not be and can be a pain

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DeepIntoTheInternet t1_je4t4l3 wrote

Interesting. How much does ADP charge? Any link or info you could provide?

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buried_lede t1_je61rl7 wrote

If I recall correctly it was maybe $60 a payroll, so if you pay twice a month, $120 a month. It might have been cheaper. And ADP is the granddaddy of payroll services in the country so competitors might be cheaper. I did all the research for my family which was using an agency but we didn’t switch because at that point siblings didn’t want to.

https://www.adp.com/resources/articles-and-insights/articles/n/nanny-payroll-services.aspx

They call it “nanny payroll services,” but explain that it’s for household employees.

When I went to find this link by googling, I saw that there are a lot more companies doing it now. One key element you want is for the service to handle all the irs end of year forms and accept liability for errors

Another thing to plan for when you oversee this yourself is to line up substitute caregivers when yours takes vacations or calls in sick. That takes a little work and there was an agency that was willing to provide short term like that. You just have to call around. I can’t remember the agency and there are so many, and they change a lot.

I really wanted to make the switch myself but it was a family decision

Edit:

Just some additional thoughts. “Homemaker Companion agency,” a term that is defined in statute and are companies overseen by the Consumer Dept, not the health dept, add a huge amount of overhead cost. So, for example, my family member required really major assistance because he was partially paralyzed. The agency charged over $90k a year. And almost anyone can open a homemaker agency- no credentials.

Our caregivers were paid garbage. The mark up had to be roughly 60-percent at least.

We could have given a caregiver a massive raise and still cut tens of thousands off the yearly cost of care even with the cost of a payroll service to cover payroll. To me it was a no brainer, especially if a family member is close by and can take care of managing it.

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