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Believe me when I say, when a caregiver calls out on a job very rarely if ever does the agency send a replacement. The client does without or their family has to do for them.
Most care agencies get around having to pay worker's comp if you get hurt on the job. I was seriously injured on the job but because I wasn't technically fulll-time (under 37 hours regular schedule) they agency paid me nothing. I was out of work for five weeks.
When you mentioned health insurance, I almost fell out of my seat from laughter. A homecare agency offering health insurance to their CNA's and homemaker/companions is a unicorn. I worked for several homecare agencies before I went private duty and none of them offer health insurance to their CNA or homemaker/companion staff. They offer it to nursing, PT, social work, and office staff but not the CNA and homemaker/companion. They get around having to offer it by never technically giving any of us full-time hours. I'd work sometimes 50 hours or more doing fill-ins, but fill-in work doesn't count as being a full time employee. In many states unless you have full time status you are not offered health insurance or worker's comp benefits if you get unjured.
Also, with most homecare agencies on the paperwork the aide signs every week as proof of hours and for their pay, it has a notice on the back in very fine print. Four agencies I worked for had the same one. That when the client's (or represenative) and the worker's signatures serve as a sworn statement that the agency is only liable for the sum of $1,200 in damages for any kind of incident or damage/destruction of client property. They go on to say that the client is to sue the aide personally for damages. Same flies for an aide who wants to sue.
An agency really offers no real security to clients who choose agency over private hire. They are just as unreliable and more expensive. In fact, I would say even more so because when a person is working for themselves and making good money they work a lot harder and a lot better.
Also, when hiring privately a client and their family can have very high standards about the caregiver they bring into their homes. A homecare agency will pretty much hire anything off the street. They say they do all kinds of backround checks and drug testing any everything else. That's a big crock. I can't tell you how many people I knew who were drug addicts, alcoholics, and had criminal records that were going into old folks' houses every day and agency sent.
It's no different than an employment agency that provides workers for any other industry. Believe or not, it's a legitimate business that deserves to be paid.
If you're hiring privately the pay should depend on how much care is needed.
If a person only needs some help say showering a couple times a week and someone to drive and accompany them on errands and appointments with a little light housekeeping, then I'm going to say start the wages at whatever your state's minimum wage is plus half of it.
If the care needs are daily hygiene care, transferring from bed to wheelchair, cleaning up incontinence, changing diapers, meds, all the housekeeping, and companion care (taking to appointments and other places) and dementia babysitting services, then the pay should start at your state's minimum wage doubled. So if your state's minimum wage is say $14 an hour, then the caregiver's wages should start at $28 and hour.
An agency will charge at least this and then some and the caregiver will get usually minimum wage.
Hire privately if you can and check their references out yourself.
If you are looking for caregivers and are hiring privately the best caregivers I found I got through my local Community College that has a CNA / Nursing program.
If you are paying an agency, that’ll run between 35 and 45. Beware of private pay caregivers who demand this.
A licensed CNA gets this much. Not a homemaker/companion. The agencies here normally start at about $50 an hour for CNA.
Why beware of private-pay caregivers who demand what an agency does? Why is it acceptable for an agency to make money off a CNA for doing nothing but not for the aide themselves to charge it? The aide does the work not the agency.
I've demanded pretty much equal to what an agency charges since I went private duty years ago. I usually kept it a little bit cheaper than an agency for the clients, but not much.
When I was charging top dollar for my service in private care, I delivered top shelf care. My clients were the number one priority when I was on the clock. When I got paid agency minimum, not so much.