When it comes to providing home care for infirm elders, there are three ways to find hired help. Supposedly, the spectrum runs from “informal” and less expensive to more professional and therefore more reliable. First, you can tap into the informal local labor market, via newspaper ads, word-of-mouth, and the like. Second, you can hire independent contractors, self-employed people who are likely to be bonded and to handle their own tax and insurance paperwork. Third, and more costly, you can rely on home-care employment agencies in your area. This last option not only takes care of the paperwork but also should provide background checks on the people who will visit you or your family members. The chart below presents a broad approximation of what home care workers make relative to those in other occupations. This figure represents all home-care workers; if you find a home-care aid through an agency, it will likely cost at least twice this amount.

Nevertheless, recent events in New York State serve as a brisk reminder that even agency-based home care workers can go wrong. The March 2008 issue of the AARP Bulletin recounts the story of an 84-year-old woman who broke a bone and, following a hospital stay, needed round-the-clock in-home care. Before long, she gave her daughter an SOS call: her house had been pillaged—and, as it turned out, so had her bank accounts—and a home-care aid, “Tracy,” had disappeared. Tracy, an agency-provided aid, turned out to be a male (not the female the agency took him for) with a long criminal record.

The good news is that Tracy served 18 months in prison for the crime, while the agency, Long-Island-based All-Metro Health Care, resolved the breach-of-contract suit the family brought for $170,000 this past January. The bad news is that the New York State Attorney General’s Office (yes, that one) has found a pattern of “endemic” fraud in home health care, including, for example, a racket in which two New Yorkers peddled fake certification forms to hundreds of would be in-home aids.

In short, you can’t be too careful. Make sure any agencies you rely on are Medicaid-certified. Make sure to do your own background check on informal hires. Either way, keep a keen eye on what goes on between home aids and the dependent elders they are there to serve.

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