Meals & Board for Live-in Caregivers Can Complicate Payroll

As more and more of our elderly opt to live at home, there comes a time when they can no longer live alone safely and a live-in caregiver is the best solution.  A live in caregiver arrangement is defined as a situation where the employee lives on the premises at least 5 full days per week or 120 hours week.
Many families are not aware of these live-in caregiver-employment situations have unique payroll rules and labor regulations.  Minor mistakes can often escalate into gigantic problems without the advice of a tax expert.  Although I am not a tax expert nor can I advise on your privately hired caregiver,  I would encourage your consider these suggestions:

  1. Each city, county, and state may have its own labor laws that you will need to abide by.  Consider this when making an offer to your caregiver. 
  2.  Do not offer tenant status to your caregiver or give them a room in exchange for in-home care services.   Once you become the landlord, your tenant is given certain rights to which you may no longer have control of what goes on in your home.  Your home health aide can “live” there for a few days at a time but must remove their belongings at the end of their shift.  Do not allow them to receive mail at the home either.
  3. Allow them to sleep at least 6-8 hours.  I have heard a number of clients get upset if the caregivers want to sleep at night, expecting them to be available 24×7.  Caretakers are humans and need rest in order to be 100% for your loved one during the day. 

For the entire article: Read more here from

When should you take the car keys away from an aging parent?

While most elderly parents are never eager to give up their car keys, it is a struggle between the desire to maintain their independence while admit their declining faculties may affect their judgement.   Ego and pride are powerful emotions and can be deadly at the hands of a driving senior who have cognitive or visual impairment.  Having a home health aide may seem like a luxury that only Newport Beach, CA residents can afford yet it may be much more affordable than most think.

Children have asked me, how do I get the keys from my elderly parent?  Can you tell him he can’t drive? She is a senior with dementia, can I demand the DMV take away her keys?  Should I hire a caregiver to drive them around?

Here are some three (3) signs of when you should take away the keys to an aging senior:

  1. Declining/Impaired Vision- While this is an obvious, on many instances, senior couples work as a team. The person with the poor vision and good physical health drives while the good vision partner gives the directions. “Stop sign coming up. Turn left in 5 seconds. Slow down, red light ahead. “
  2. Cognitive Impairment. ANY dementia or Alzheimer’s diagnosis.
  3. Physical limitations that can’t be solved with a handicapped equipped vehicle. If they lack the reflexes to turn or stop the car, its time.

Three tips on how to stop an aging parent from driving:

  1. Disable the car. Remove the battery. If your parent is savvy and has the mechanic on speed dial, call the mechanic and get fill him in on your plan
  2. Inform their physician and express your concerns. The doctor is required to notify the DMV when mom or dad can no longer drive safely.
  3. File down the keys, hide them, switch them out with another set.

You can give seniors their independence back by hiring a home healthcare caregiver aka “driver” to take them to their appointments.  Senior transportation has been made easier with  Uber or Lyft.   You can establish your own account and request for a ride on their behalf.  

This Uber (click here) code will get mom/dad a free ride worth $20:  2mamo

Prefer Lyft? (click here)  & Use this code: ANN208 to get a free ride $20 free ride

To read more on the Boston Globe article (click here)

5 Tips on How to Get a Great In-Home Healthcare Caregiver

As an owner of two non-medical in-home healthcare agencies and a medical staffing agency with 5+ years experience, I can tell you that finding the right caregiver can be challenging and frustrating.  You want the best caregiver within your budget and overwhelmed (or possibly underwhelmed) with candidate options.   On average, we only hire 20% of those interviewed, so with  400+ caregivers in our files, it means that we conducted 2000+ interviews.

My staff has spent 20,000+ hours screening caregivers and compiled a list of five quick tips:

  1.  Lean on in-home care agencies:   Don’t spend precious hours of your day screening phone calls and resumes of caregivers.  Normally, only a few candidates who respond are either qualified or can work the hours/days you need. A good in-home senior care agency can pre-qualify caregivers for you. Rely on home healthcare agencies who recruit and qualify people on a daily basis to do the work for you.
  2. Don’t drag your feet on making an offer to a qualified caregiver:  Move FAST on making an offer to a qualified home health caregiver. Most will be “gone” to another job opportunity within 24-48 hours of meeting you. Often, that caregiver may find work a few hours later after meeting you.
  3. Use a “Working Interview” approach:  With our company, you can use a caregiver through Accessible Health Care and make a temp-to-hire offer through Dignity Grace if you prefer this method.  If you are using a non-medical in-home care agency or hiring on your own, offer a “try out” to a candidate that you interviewed. This prevents you from losing the caregiver to another opportunity. Try this care aide  out for a couple days to determine if they are a fit.
  4. DIRECT HIRE is often cost-effective and efficient approach to hiring:  Most families don’t “love” paying a fee for a caregiver. However, when you work with non-medical in-home care  agency that offers you a contingency fee agreement, you only pay a fee if you hire a qualified home healthcare aide. Many great caregivers are currently employed and our office knows how to find these hard-to reach candidates.
  5. Avoid resumes/interviews when bringing on temporary caregivers:  Using a temporary home healthcare aide to help for a few respite days may result in that temporary being that caregiver you are seeking. Avoid the “process slowing” actions of requesting to see resumes or interviewing temporary in-home caregivers. If you trust the home healthcare agency, try out the caregiver for a couple days.

We offer two solutions to finding that perfect caregiver, whether you need respite care, 24/7 non-medical in-home health care or custodial care, Accessible Health Care takes the burden of managing & handling payroll taxes by employing home health care aides and (2) Dignity Grace recruits caregivers for you to hire directly. ALL our caregivers go through a 25 point assessment and background check before they are hired and sent to seniors/elderly/disabled adults.  We hire, train, and screen constantly so you can get the peace of mind that you loved one is cared for.



Paying for Caregivers and In-Home Care Through Crowdfunding

Paying for Home care through crowdfundingCrowdfunding defined is a group of people (it can be strangers, friends, family) who donate money to an individual or company so it can accomplish a financial goal.  You thought crowdfunding was meant for fledgling technology companies raising money to fund their growth…or maybe you have a vague idea what crowdfunding is.  This isn’t a new concept, however home health care tends to move a bit more slowly when trying out new concepts. 

As our generation continues to age, labor and taxes continue to increase, and senior in-home health care costs have increased, families are finding it tough to pay for care.   Or if you are hit with an unexpected health problem which depletes your already not-large-enough savings, you start to wonder, “how am I going to pay for this?”

Here are two stories on how families look to a creative way to pay for caregivers, in-home care, and rehabilitative care.  Using social media, technology, and tugging on heartstrings, two familes each crowdfunded their way to $20,000 raised $60,000 for caregivers.

How to help a family when their funds are non existent and health care costs have become overwhelming?  Here is one option that allows for online medical fundraising to pay for care: is an online fundraising website for families to raise money for unexpected medical and home health care bills.

Read more on  how crowdfunding helped this individual raise $20,000 in the first day (NY Times)

Read more on how crowdfunding helped this family raise $60,000 to pay for caregivers for an ALS patient (Huffington Post)

 Large and small donations, every dollar counted. 

The Ten (10) Questions to Ask When Hiring a In-Home Senior Care Agency

Businesswoman With Question Marks

Its overwhelming with the in-home health senior care agency options.  In Orange County, CA alone, there are over 400+ senior home care agencies vying for your business. Currently in California, agencies are not regulated so there are no standard of practices to which they abide by, so you do have some extra work when you are ready to hire a caregiver.


Q: Do you have Business & General Liability Insurance?  Will you provide me with a copy if we select you?

A: Of course you want the answer to be yes.


Q: Do your caregivers drive and how much will you charge me for mileage if the caregiver drives their own car? 

A: I’ve heard rates as high as $2.96/mi and as low as $0.56/mi.


Q: Are your home health caregivers employees or independent contractors?

A:  Depending on who is responsible for taxes.  If the agency employs their caregiver, they issue W-2s.  If the agency uses independent contractors, you will need to clarify who pays the payroll taxes/workers comp insurance.   The IRS & Labor department are cracking down on these relationships between caregiver and those receiving care


Q:  Do you accept, bill and collect Long Term Care Insurance ..and will you accept Assignment of Benefits?

A:  Its a good sign if the agency (those that employ the home health aide) works with these insurances and better if they accept Assignment of Benefits (AOB). What AOB means is that you are instructing the insurance to pay the agency directly, instead of routing the payment to you or recipient of care.  This can be important because the responsibility falls on the agency to track and ensure claims are submitted correctly and collected.  As an agency owner, I have spent countless hours tracking down benefits that were not paid due to a supposed “error”.   Typical reimbursement period is 3-5 weeks once the claims are submitted.  The in-home senior care agencies who do accept AOB must have the cash flow to wait for payment.  If you have a private caregiver, have a filing binder designated for all Explanation of Benefits (EOB).  It will be handy when  it comes time to appeal a decision.


Q: What are you hourly rates?  What your live-in rates? Will you charge less for a night shift that requires minimal work?

A:  Rates vary depending on area, region, county.  You can always negotiate this.


Q:  Can I interview my caregiver(s) to select the ones for my aging parent?

A:  the answer is absolutely YES.  Call another agency that says no.  If its an emergency request (you need a home health aide to be there in 2-48 hours), this may not be accommodated for logistical timing and reasons.  if you have more than 72 hours, the answer should be YES.


Q: What are your home health caregiver/aide hiring requirements?

  • how many years experience do you require?
  • how do you find them?
  • how many references do you check?
  • how long of criminal background do you look back?
  • what training do you require or provide?
  • do you they all drive?
  • do they cook?


Q: If I don’t like my caregiver, how quickly can you change them out?

A: Depending on how quickly you want this to happen, it should take no longer than 24-72 hours to accomplish.  As long as your requirements for the replacement(s) are reasonable.  The more requirements you have, the longer it will take the agency.


Q: How often do you bill and do you accept credit cards/checks?

A: Agencies bill either weekly, bi-weekly or monthly.  Most should accept all forms of payment


Q:  Where do you operate from?

A:  The response should have a commercial/business address, not a home location.  Google Maps the address to find out.

Federal Court Rules to Strike Down Controversial Caregiver-Companion Exemption Overtime Rule

Us Supreme Court Capitol Hill Daytime Washington Dc

Great news!   If you were wondering how to budget in the extra costs you would incur for your in-home health caregiver to pay them overtime, you get  a break.  On January 14, 2015, Judge Richard J. Leon ruled (Final_District_Court_Decision- FSLA Overtime Exemption Jan 15 2015).  in favor of vacating US Department of Labor regulation that would have eliminated a companion care exemption under the Fair Labor Standards Act.   Many seniors and disabled individuals who receives home health care feared they would no longer be able to afford care once this exemption was eliminated.  This is a victory for anyone who needs in-home care and caregivers.

Below is an article published by the Home Care Association of Florida


Today, the U.S. District Court for the District of Columbia struck down the new Companionship Services/Overtime rule in a triumphant win for patients, staff, and providers of home health care. This ruling completely invalidates the rule, allowing for the current practices of payment for workers to remain in place indefinitely. This lawsuit which was strongly supported by HCAF and lead by the National Association of Home Care and Hospice was crucial to making sure patients would continue to be able to afford high-quality home care, as well as necessary for state budgets to be able to continue providing Medicaid home health.


Please read the press release from NAHC below for details on the case. It is unclear if the Department of Labor will file an appeal on this ruling, but for now, we are celebrating this fantastic success!


NAHC, along with Home Care Patients and Caregivers, Wins Huge Victory:

Federal Court Rules to Strike Down Controversial New Overtime Rule


The National Association for Home Care & Hospice (NAHC) and its members today celebrated the decision of the U.S. District Court for the District of Columbia invalidating a proposed new U. S. Department of Labor (DOL) overtime rule slated to take effect on January 1, 2015.


“This decision is a huge victory for patients and their families who will be able to continue receiving home care services without interruption. The decision is a huge victory for caregivers who will continue to be protected instead of being forced to work only part time. The decision is likewise a huge victory for the agencies that serve patients and employ caregivers, and who will see continuity in a rule that has been in effect for 40 plus years and had recently been sustained by the U.S. Supreme Court. Finally, the decision is a huge victory for the states and the federal Medicaid program.” said Denise Schrader, chairman of the NAHC Board.


This is the third victory in this lawsuit for home care interests within the last month. On December 22, the court ruled that patients are entitled to equal rights regardless of whether they or their families paid their home care bills or they were paid by the joint, federal-state health insurance program, known as Medicaid. On December 31, the court ruled for NAHC by agreeing to issue a Temporary Restraining Order (TRO) blocking the DOL from enforcing new rules related to “companionship” and “live-in” care. On January 9, the court, in considering a motion from NAHC attorneys for an injunction to block enforcement of residual parts of these rules through this date or a trial, stated that so much evidence was in the record there would be no need for a trial. The judge therefore agreed to give his decision on the case on or by January 14, when the TRO was set to expire. Today, the judge ruled for NAHC and home care interests, saying the proposed new DOL rules violated the law.


The DOL has not announced whether it will appeal this decision to U.S. Court of Appeals. NAHC President Val J. Halamandaris, stated “The home care community is prepared to defend this case before the higher court. We fought this case once before and took it all the way to the U.S. Supreme Court where we won by a unanimous vote of 8-0. We are prepared to do this again if we need to do so.”


“The victory in the case proves the power of unity,” said Halamandaris. “United, fighting on behalf of the aged, infirm, disabled, and dying, we cannot lose; divided we cannot win.” He also thanked Bill Dombi who helped lead the strategy in this case, the International Franchise Association and the Home Care Association of America which joined in the litigation and the law firm of Littler Mendelson which had been hired to bring the suit.


To read the decision, click here:

5 Ways to Save on In-Home Senior Care Costs

Cutting cost

I understand completely.  In-home care isn’t cheap and you don’t want to sacrifice quality or safety but not sure where to save or how to save on care costs.   On January 1, 2015, the US Department of Labor passed a regulation requiring direct care workers to be paid overtime (if they spend more than 20% on job duties that is not companionship.  Duties such as housekeeping, cleaning, cooking, bathing, etc.) if they work over 40 hours in a week.   Whether you are working with an agency or using your own private caregivers, these tips can help save on care costs.


  1. Your aging parent is at that point where they need 24×7 care .   There are 2 types of 24×7 care:  (a) Live-in   and (b) round the clock supervision required 24×7 care.  How could you possibly save money here, you ask?
    1. Live-In:  Ask for a 4 day/3 day caregiver.  Overtime (OT) is paid to caregiver after 9 straight regular hours and 40+ hours in a week.  This means that if you have a caregivers working 5 days/2 days, that 5th day you will pay more 5 more hours of overtime (9 hours/day x 5 days = 45 hours).  Check your state regulations for amount of OT that must be paid.
    2. 24×7 Round the clock supervision will require 3 caregivers working 8 hour shifts.  Negotiate with the agency or caregiver on the shift that requires the least amount of work, which usually is the night shift.  No cleaning, cooking, meal prep, laundry, bathing, etc.  If the agency is charging you the same rate per hour rate for 24 hours, ask if they will take $0.50-$2.00 per hour.   It isn’t much but $4 day can add up.  **You may risk losing the caregiver on that shift since they will need to take a pay cut since the agency is taking a pay cut. 
  2. Organize and plan the schedule.  Agencies usually require a 4 hour minimum but those that don’t have minimums will charge more per hour for any needs less than 4 hours a visit.  Plan appointments and errands so they are grouped together so the entire visit isn’t spent in the car shuttling from one place to the next or waiting for medications to be prepared by the pharmacy.
  3. Mail order medications.  How many hours have you spent waiting for a medication, even after called the pharmacy to refill the Rx and were informed it was ready?   Mail order these so you won’t have to pay a caregiver to wait at the pharmacy.Satisfied mature gentleman posing over a piggy bank isolated on
  4. If you cannot afford a traditional agency as an employer of caregiver fees, consider using a placement service.  A one time fee gets you the benefit of  a screened, quality caregiver(s) without paying agency overhead. 
  5. Share the Care.  If your loved one has neighbors (next door, across the street, same cul-de-sac) who needs care, ask if they would like to share a caregiver.  As an agency owner, I’ve offered this program to several clients so 2- 3 people can share in on the cost.  If they require 8-12 hour supervision in a day yet can manage on their own for 30 minutes or so, splitting the bill can help save some money

I hope my tips have helped.  Thank you for reading.


Senior Scam Warning Sign

Each day, I get about 150 emails asking me to give up personal information, in exchange, the $25 million in unclaimed funds from a long lost relative will be deposited into my bank account.  Tempting of course but we all know that this is a scam ran by Nigerians and there is no possibility of a rich, long lost uncle.  While I have dumbed down the process, scams are always alive and the easiest target are usually our seniors.

If your loved on is experiencing short term memory loss the likelihood is that they may have dementia or Alzheimer’s, given the 1 in 2 over 85 will have some form of dementia.  Don’t believe me?  See the video below by the Alzheimer’s Association.

Here are a few tips to avoid becoming a victim of scams:

  • If the “opportunity” sounds too good to be true, it probably is.  Unclaimed funds,  long lost rich uncle, a check written to you in exchange, they want cash.   ( *I myself almost became a victim of a scam and avoided it as I stood in front of the bank teller, prepared cash the scammer’s check.  I was selling a desk on craigslist and got an offer for more than it was worth.  The scammer said that a moving company would be picking it up for him and the extra $200 on the check was to cover the moving company and inconveniences he caused me.  Great, I make an easy $50…  The scammer said he would get back to me in a couple days to let me know when the mover would pick up the desk and I should be receiving a check in the mail.  The check arrived with the surplus and I waited for the moving company instructions….It then got complicated.  The scammer asked me to cash the check, go to Western Union and wire him the moving company fees [the check’s surplus= $150].  I became confused…asked him, “why don’t I just pay the mover directly with the extra funds?  Let me know when he will arrive so I can prep the desk.”  He would never answer me, since all communication was by text.  He only said the mover will contact me and to go to the bank with the check.  It was all confusing but since I was distracted with work, I drove to the bank.  On my drive there, I realized it was a scam, only verified by the bank teller that the check was a fake.   I inspected the check and then saw all the imperfections.  The Western Union location was somewhere in the mid-west…Isn’t buying a desk locally cheaper there than in OC?  Everything is cheaper outside OC and LA.  My suspicions grew.  Of course I couldn’t let this drop.  Each day I promised the scammer I would wire the funds since I already “cashed” the check and instructed him to be there in an hour.  Eventually I told him I reported him to the authorities.”   This derived from me wanting to sell a desk for $300 on craigslist.  Out of the hundreds of thousands of posts that occur daily, I was almost scammed.
  • NEVER EVER give out personal information, Social Security numbers, bank account numbers, dates of birth or money to unfamiliar companies or unsolicited callers.
  • Don’t give out names or family members to people pretending to be a relative, asking you to wire money for emergencies.  Sounds easy to avoid, right?   Callers will often ask for grandma or grandpa.  If there is hearing loss or they are not wearing their hearing aid, calling out, “Sarah, is that you?  Is that you Mike, Harry, Christine, etc.”
  • Know the companies you are working with and be suspicious if they pressure you to make a quick decision.  Many will prey on emotions or emergencies.  Have a family member or a friend help you check out the companies credibility.  The Better Business Bureau also helps protect consumers from being scammed.
  • If you need to sign a business agreement and there a terms you don’t understand, ask a competent attorney to review it.
  • Destroy any information/mail with your name on them before throwing it away.  Shredders and identity theft protection stamps work great.  I suggest getting both since the identity theft stamps don’t work so well on certain glossy papers/catalogs.

Guard Your ID Roller


Thank you for reading,


11 Tips on Finding & Hiring a Caregiver Without an Agency


Review the documents you’ve asked them to bring in.  Most caregivers will not have followed your instructions photocopy their documents you’ll need to do this for them.

Provide them with an application to fill out, including permission to perform a background check on them.  Each state’s requirements will vary.  California regulations will only allow for agency’s to do a 7 year lookback, beginning from when the last misdemeanor/felony sentence was completed

Check that they have provided 2 professional or 2 personal references, phone numbers essential, letters are a bonus.   If they cannot provide any, do not pass GO.  Professional caregivers working at least 2 years will always have references.  The good ones will.

If caregivers lack: references, proof they can work in the us (ie SS card, passport), ID, CPR card, references, or any of the requirements stated in previous posts, don’t proceed with the interview.  You will waste your time.


Check their references.  if you have 3 candidates, this will mean at least 12-16 phone calls to references.  Create a separate page to keep track of your outbound/inbound calls.  People will often return phone calls and have no idea why you called.  It may require several attempts to get a reference.  If you can’t get one, pass on the caregiver.


Run a nationwide criminal background check.  I’m not sure what the cost to run a nationwide criminal background check is since we get volume discounts, but it is worth every penny.  If you plan on the caregiver driving, run a DMV report as well.

Here are a few recommendations:



Formalize your offer once you have identified the caregiver(s) with the hours of the job,  expectations of  work and wages. Do not lie about the requirements, your loved one’s demeanor, or job difficulty.  Telling the caregiver that mom or dad is easy to get along with and 10 caregivers have been scared off will only waste your time.  Be honest.  If the caregiver declines the job, move on to the next.

I strongly encourage you check with your state’s labor board laws and/or attorney specializing in domestic worker labor laws to ensure you follow regulations mandating  rest periods, overtime, percentages of personal attendant vs housekeeping, etc.

I’d also advise that  it is never a good idea to evade payroll/IRS/state taxes.  if you control the hours, job location, how to perform the job, this makes you the caregiver’s employer.  It isn’t worth the risk to not pay the payroll taxes and should the caregiver want need to file for medicare benefits, unemployment, etc. in the future.  If you are in California, the state board is pro-employee, anti-employer…penalties are severe for avoiding paying taxes.

If you are not sure how to go about calculating payroll taxes,  there are companies who specialize in nanny/domestic help payroll that set up your caregiver quickly and easily.

Here are a couple of options below.

Use Dignity Grace Homecare Agency as the referral source to get a discount on sign up fees.


Treat the caregiver with respect.  I have seen many lose a wonderful caregiver because the children of the clients are intentionally verbally abusive and are downright nasty to them.  Yelling, screaming, and calling them names (stupid, dumb, moron, etc.  I’ve heard it all) when many are trying their best to help is a good way to send you back to Step 1 of finding another caregiver.  Clients suffering from a cognitive impairment do get a hall pass.  If the caregiver isn’t cutting it, fire them and move on.

If your loved one is extremely difficult to get along with and caregivers don’t seem to last with them, be prepared to continually interview candidates or have a good agency on standby to cover you until a replacement is found.

#12 (Bonus Tip)

It isn’t a good idea to allow the caregiver to move in lieu of paying them, or paying them an amount lower than minimum wage because you are providing room and board.  Once you have established a tenant/landlord relationship, it can be extremely difficult to get rid of an unwanted tenant who now has access to all sorts of private information.


If hiring a caregiver on your own is ultimately too overwhelming or you just don’t have the time, you can call us.  We got you covered, 24×7.

11 Tips on Finding & Hiring a Caregiver Without Using an Agency- Continued


Schedule as many interviews as you can handle.  I would suggest at least 20..  Yes, that is a lot of people and a lot of time. Double book the time slot…Some will show up, others will flake, and a few will reschedule.  If two caregivers show up at the same time, great!  Interview them separately.  Again, turn away those who are late.

On average, it takes my agency about 4-6 hours to find, interview, screen, and hire a person.  We accept about 20% of the candidates.



Ask open ended, direct, and simple questions.  I can’t elaborate on the many, many times caregivers have told me on the phone they can work on Saturday,  only to decline a job when offered on Saturday.  Do not pressure or try to convince them to work for your parent because you are desperate to find relief.  Caregivers will inevitably cancel or change their mind.

Here are a few to get you started:

  1. “Tell me how would you handle it if my mom got very agitated and wants you to leave?”
  2. “This job is 8:30am-5:00pm, Tues-Saturday.  Can you work ALL of these days? If not, what days can you work?”
  3. We have a difficult parent who is not open to receiving care.  How did you convince your last client to allow you to assist?  Have you had difficult clients?
  4. What if our other caregiver is late to relieve you, what do you do?  (listen carefully.  If your loved one can’t be left unattended and the caregiver is aware of this, their response should be, “I wait until you get here or until reliever arrives)
  5. Why do you want to do this?


Don’t discriminate and keep an open mind.  We have wonderful caregivers from all backgrounds, ages, ethnicities, and work experiences.   We get many calls in which a client describes what they want their caregiver should look like or what specific religion/race to avoid.  Doing this will eliminate a large pool of kind, compassionate, caring, reliable people who could very well win caregivers of the year award.

Caregivers don’t always express themselves clearly. Some may say the right things or interview that well.  Many don’t know how to “sell” themselves to get a job.

I wish I could say that there will be a lot of candidates to select from, but in reality, it will come down to 1 or 2, if that.