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If you know a CNA or people working through an agency, you can always ask if they have 'friends' you could hire directly.
What is a Certified Nursing Assistant (CNA)? | NursingAssistantGuides ...
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While some here say private care requires you/client to pay taxes, this is not true for independent contractors who pay their own taxes (as I do). I did not even know a client could pay for my worker's comp - which would be a great ins benefit to have. Although, if I required that, most in this area would not hire me-they'd fine someone else.
One has to consider all factors - the cost - the benefits of an elder staying in their own home - if 24/7 on call med staff is available in a facility. Depending on what kind of work is needed, some young people are excellent and reliable. It is a matter of finding a good fit and you screening thoroughly. I would always get references - and from the client's family, 'too' - not just the client/past history.
(1) Region where you live in the country (in Northern CA-Marin Cty, hourly for ind contractors is around $25-30)
(2) Pay independent care provider (who pays their own taxes)
(3) Above, as an employee status - you pay taxes
(4) Agency-some have more than a 4-hour minimum.
I'm an ind contractor and pay my own taxes. I could not get 'bonding insurance' myself for myself. As I offer assessments and care management, I charge according to services I provide: coordinating medical needs, research, writing, advocacy, for example.
* IMPORTANT: Get references, require a print out of police/criminal record; clearance (I had to get fingerprinted through the local police dept) and get a copy of car insurance.
Regarding agency overhead: yes, it is cheaper per hour to hire privately. But, as many have pointed out, now you are legally liable for taxes for the person you hire. If you don't care about this, then just don't tell me about it. If you work through an agency, we deal with insurance, taxes, training, etc. If the caregiver gets ill, or her car breaks down, we'll get a replacement there (a big, reputable agency will often staff an "extra" caregiver to cover unforeseen emergencies). Also, in times of stress people can sometimes behave badly, yelling at the caregiver or worse (my M-I-L with dementia one time actually physically struck her caregiver who was trying to prevent her from driving away). Our staffing managers will coach caregivers on how to deal with situations like this, and our client care managers will work with the client and his or her family to resolve conflict.
Remember - caregivers (and agency owners) are people. Some are excellent, others not so much. Shop around carefully to make sure you are working with the best, whether you hire privately or not.
And yes, as several have pointed out, a facility can be less expensive than round-the-clock care at home. That's a trade-off you need to consider.
I found them a wonderful place for a 1/3 of the cost of what it would be with home care.
Perhaps this is something to consider? Unless of course, he has plenty of money.
All the best to your dad!
If you go private--you need to have them bonded and sometimes extra insurance. Different rules in different states.
Most my clients did wind up in NH's after a while, financially, it was a better "fit". Also, they of course, deteriorated to the point that keeping them home with 24/7 care was prohibitively costly.
If you hire a person who is not part of an agency, your Dad would need to purchase "workman comp" insurance in case the caregiver got hurt on the job.
Dad found out that by home selling his house and moving to senior facility, the cost was much less then having caregivers at home.