Home Care Agencies Versus Home Care Registries2018-11-01T14:02:36+00:00

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Don’t be misled by companies claiming to offer the best “value” in home care. Home care agencies and home care registries are vastly different in the level of service and support they provide. Knowing which to choose depends on the amount of risk and responsibility you are willing to assume.

 

Start By Knowing the Difference

At agencies, caregivers are employees, and their management, actions and compensation are all the responsibility of the agency. Registries are more like a staffing firm or job board – they have a database of names, but the client is ultimately the employer, responsible for managing the caregiver and making sure he or she has the proper training, experience and insurance.

Compare the Responsibilities and Risks

AGENCY

With an agency, you can often interview as many caregivers as you like. A typical agency relationship starts with a comprehensive assessment of the client by a Registered Nurse, leading to a plan of care that best serves the client’s needs. The agency then draws from its caregivers (who have been carefully interviewed, background checked and trained), to match the specific needs of the client.

REGISTRY

Registries draw from a pool of caregivers across the country; not all of whom they have interviewed or had any regular contact with. And by rule, without an agency license, registries are not able to train their caregivers. We encourage those considering a prospective service provider to ask if the provider takes responsibility for the qualifications and conduct of its caregivers.

AGENCY

Agencies can provide resumes, references and reviews for their caregivers, including data on each caregiver’s experience with the agency’s clients. Agency caregivers undergo a comprehensive interview, background and reference analysis, national criminal, FBI and sex offenders background check, proprietary orientation, skills assessment and training program before they are eligible to serve clients. Caregivers also receive ongoing training annually and, as employees of the agency, are closely supervised by experienced Supervisory nurses who assess skills at the point of service at regular intervals.

REGISTRY

Registries draw from a pool of caregivers across the country, most of whom have not been interviewed in person (or at all) or had any regular contact with the registry’s staff. And by rule, without an agency license, registries are not able to train their caregivers. We encourage those considering a prospective service provider to ask if the provider takes responsibility for the qualifications and conduct of its caregivers.

AGENCY

An agency sets fair, dedicated rates for caregivers to eliminate the need for negotiation; and, because caregivers are agency employees, they receive additional benefits such as paid time off and health/dental care. Agencies pay for worker’s compensation insurance and employer taxes such as social security and unemployment insurance.

REGISTRY

With a registry, the client is the employer and bears all the burdens of that role, including negotiating the rate with your caregiver. As the employer, you are also responsible for ensuring social security taxes are paid and that caregivers have appropriate insurance policies in place.

AGENCY

This is a key point of difference between agencies and registries – with an agency, pricing includes much more than just the caregiver in the home and delivers much higher value to the client. An agency offers a comprehensive list of services to support clients that may include caregiving, care management, companion services and skilled nursing. The actual services used by the client will be determined through a thorough assessment and a menu of recommended services for maximum client benefit and wellbeing. Pricing is based on a plan of care designed for the client’s needs, and should include the professional who provides care as well as engaged oversite from the assigned Client Service team, supervisory Nursing Staff and Care Management staff.

REGISTRY

Registries require the client to negotiate with a caregiver and, if the caregiver is not as advertised or does not have the skills expected or simply doesn’t show up, the client may be on their own to find a replacement. Again, much of the work involved in understanding the level of care needed by the client, the skill level of the caregiver and the going rate for those skills must be done by the client. All at what is already a very challenging time.

AGENCY

Many agencies have a dedicated team providing 24/7 support to clients and advanced technology to insure that there will always be a qualified caregiver available for full-time, temporary or fill-in work.

REGISTRY

Registries do not offer support. If a caregiver doesn’t show up for their assigned shift, it is the responsibility of the client to get coverage.  The process of finding a new caregiver must be initiated on the registry’s website, but a solution is generally not immediately available until a new caregiver is hired.

AGENCY

Agencies will utilize telephony, mobile software and other technology to track caregivers’ service hours and the tasks that they perform during those hours, and that information is available to clients and referral sources. Clients are often able to keep up to date with their loved one’s care either on-line or over the phone. The agency’s client services team has access to the entire case history and nursing notes to let clients know exactly what’s going on, and if changes in the plan of care might be necessary.

REGISTRY

Registries provide basic data such as caregiver arrival and departure time and the activities of the visit. However, the responsibility for follow up should a caregiver not arrive on time, and the burden for monitoring the activities of the visit, all falls to the client.

AGENCY

Agencies are service providers, not staffing businesses, and the level of service clients receive reflects that difference. Client service and on-call teams who are company employees (not independent contractors) are accountable and available 24/7, 365 days a year to respond to referral sources, clients and family needs.

REGISTRY

Caregivers provided through a registry don’t work for that company, they work for the client. So, when an emergency arises, who does the client call – the independent contractor they have hired as a caregiver? The phone number on the registry website? The lines of accountability are often not clear and can be confusing to clients. 24/7 coverage is generally non-existent.

AGENCY

Agency caregivers have close, ongoing relationships with the agency that employs them. They undergo extensive onboarding before they are eligible to serve clients. They also complete ongoing training annually and the care they deliver in the client’s home is carefully monitored to assure that it meets the standard.

REGISTRY

Most registries never meet their caregivers in person. If background checks are done at all, they’re done once, when the caregiver registers on their website, and never repeated. Once in the registry’s system, there is no ongoing caregiver support or training. Their skills are not monitored, they are not supervised, and there is no RN creating the care plan for the client.

AGENCY

As employers responsible for the qualifications and ongoing education of their caregiver employees, agencies staff to meet specific needs, and are more likely to have direct experience with almost all chronic diseases facing the elderly. They will track disease-specific training of their caregivers. They will have established relationships with many of the educational and information organizations that are focused on specific conditions, including the Alzheimer’s, ALS, Parkinson’s, MS, Cancer and Stroke Centers, who will share ongoing training and information sessions with agency staff that enhance and supplement their own training and education programs.

REGISTRY

Registries do not provide caregiver training and do not monitor caregiver qualifications, so if the client is looking for a caregiver with specific training or experience, the burden will be on them to find one. They will need to know what questions to ask and what qualifications to look for. And they may not know if they have the right caregiver until after they have already hired one.

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