Home Health Care Services Fact Sheet

The following explains the difference between home healthcare providers. It is important you understand what type of provider you are using, since there are different levels of convenience and personal liability associated with each one.

Home Health Care Agencies

Agencies hire home health care workers as direct employees. These employees are scheduled to care for clients. The home health care worker’s activities are managed and supervised by agency staff, including Administrators, Registered Nurses, and sometimes Physicians.

The agency is responsible for worker’s compensation insurance, the employer portion of FICA and Medicare, Federal Withholding Taxes, and unemployment taxes. In most cases agencies also carry general liability insurance and a dishonesty bond, which afford additional coverage for employees and clients. It is rare, but not entirely unheard of for, agencies to also provide health insurance and paid vacation for their employees. The employer (agency) is responsible for all risks associated with work performed by the employee.

Agencies must assure that the employee has the right to work in the United States, is free of communicable diseases, has the requisite training to perform services required, and has a background free of criminal offenses. It is also common for agencies to competency test their employees, and to provide continuing education.

Nurse Registries

Nurse Registries procure the services of home health care workers who are directed to care for clients on an independent contractor basis.

This means the registry is not responsible for worker’s compensation insurance, the employer portion of FICA and Medicare, Federal Withholding Taxes or unemployment taxes. Most people assume that the worker is responsible for these items. However, there are no legal requirements for workers to maintain their own employment benefits/taxes.

There is much ambiguity about the true status of registry workers. Clients, their representatives or their estates can be interpreted as the employer in this arrangement and held liable for providing the above employment benefits/taxes. Clients still have exposure to risk when they employ individuals from a Nurse Registry.

Registries should ascertain if the worker has the right to work in the United States, is free of communicable diseases, has the requisite training to perform services required, and has a background free of criminal offenses. Since many companies contract with caregivers pending the receipt of these checks, MonarchCare recommends the client require proof of a clean background check from the registry prior to employment.

Registries are not required to supervise their workers.

Independent Contractors

This is when the client (or their representative) acts as employer and obtains home health care services from a private citizen.

There is the potential that the relationship the client establishes with the independent contractor could be considered that of an employer, and all risks and duties associated with being an employer are the responsibility of the client. These responsibilities include: worker’s compensation insurance, the employer portion of FICA and Medicare, Federal Withholding Tax and unemployment taxes.

Additionally, the client/employer should ascertain if the private citizen has the right to work in the United States, is free of communicable diseases, has the requisite training to perform services required, and has a background free of criminal offenses. Clients are responsible for supervising their employees.