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Home Care Benefits and Risks

By Harry S. Margolis


In recent years, home care for disabled seniors has grown tremendously with absolutely no regulation. For the most part, this has been good, with millions of seniors being able to stay in their own homes as they age. But a recent series of articles in The Boston Globe highlights the risks inherent to the system both to those receiving care and those providing it.

There has been a proliferation of individuals and companies, small and large, either providing in-home care or connecting families with caregivers. Two of the biggest are Home Instead Senior Care, which franchises home care agencies, and, which has expanded its child care referral services to include senior care as well.

Risks to Seniors

Both provide at least some vetting of their care providers, including criminal background checks. Many smaller agencies do not and many people hiring individuals who they find through word of mouth do no background checks.

As an unregulated industry, there’s no training requirement for caregivers, though many agencies provide their own training. One local start up, Care Academy, offers online training for caregivers.

As reported in The Boston Globe, this has lead to elder abuse, especially to theft. In our own practice, we have had clients who have had wonderful experiences with care providers for many months or years, arrangements which turned sour when the caregivers began to steal from the seniors for whom they have been providing care.

Risks to Caregivers

On the other side, many of the caregivers are underpaid—a median of $12.77 an hour in Massachusetts —and often do not receive the benefits to which they are entitled, including payments into Social Security, workers compensation, paid leave, and overtime. They’re not paid when they don’t work, whether it’s because they’re sick or the person they’re caring for needs to be hospitalized.

Sometimes it’s the caregivers themselves who prefer to be paid “under the table” either because they don’t want a deduction in their pay to contribute to Social Security or they don’t have legal status in the United States. They may be concerned about coming to the attention of the Immigration Service and they may not expect to benefit from Social Security if they ultimately move back to their countries of origin.

Many caregivers are immigrants who have left their own families in their own countries to come to the United States to earn money to send back. Another article in The Boston Globe series tells the story of a woman from Ghana who works two grueling jobs to send money back home to support her family there. The reporter, Linda Matchan, traveled back to Ghana with the woman on one of her rare visits back home.


For consumers, the best solution is to work with recognized home care agencies. They provide oversight and training and a cadre of caregivers with whom they have experience. They will also be able to find other caregivers to fill in when the prime caregiver cannot work for any reason.

Some agencies act as employers, taking care of payroll tax and workers compensations issues. Others do not, advising families on what they need to do to fulfill these requirements. has a subsidiary, called HomePay to assist families, whether hiring nannies or home care workers, with these tasks.

These benefits, of course, come at a cost in covering the agencies’ administrative costs and costs in acting as employer. It can be less expensive for family members to hire caregivers directly, savings that can help stretch the seniors’ funds and allow them to stay at home much longer.

For the senior caregivers themselves, working with an agency can also be beneficial in terms of finding work, helping to solve any difficulties with the senior and her family, and in some cases, providing paid sick and vacation time. But, again, there’s a cost since the agency will keep some of the money paid by family members.

These are individual solutions, leaving open the question of whether this a field that should be regulated with, perhaps, training requirements for caregivers or a registry of caregivers assuring that those who are not caring or who have stolen are not rehired. What do you think?


Related Articles:

It’s Only Fair to Pay Caregivers Above the Table

Aging 2.0 Conference in Boston Paints Challenging Picture for Hub Baby Boomers

Should Seniors Downsize or Age in Place?

How Will We House an Aging Population?

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