The Challenges of Self-Directed Home Care

What is self-directed home care?

Self-directed home care refers to the ability of seniors, the ill, or disabilities to control their home care providers. This includes having the decision-making authority to recruit, hire, train, and supervise individual caregivers.

For those receiving assistance in Massachusetts through the MassHealth/Medicaid PCA program or Massachusetts Department of Elder Affairs Home Care program, consumers have the right to self-direction. They can hire their caregivers and receive services, paid by the Commonwealth, to help them set up as household employers with the IRS and Department of Revenue.

Fiscal intermediaries help them obtain workers compensation insurance and handle employer responsibilities such as managing payroll, withholding taxes, and paying into the unemployment insurance system. Even with these supports, though, the challenges of being an employer and withholding and filing taxes correctly can be daunting, particularly at tax time.

Home Care - An Elder And Young Person On The PhoneChallenges

People self-directing their care on these programs also often receive little help with finding qualified, pre-screened caregivers. They can access a list of potential caregivers with contact information, but it falls on them to do the work. This includes making calls and performing screenings. The search to find a potential caregiver is a time-consuming, stressful process. It is difficult to find caregivers who are qualified, a good fit, and willing to work for the wages allowed.

We regularly receive calls from those wanting to select and manage their caregivers through public assistance programs. They need assistance in finding the right person who fits their criteria. Currently, the available self-directed programs lack processes in place to pay for our services. However, the overall cost would be less than using a full-service agency.

Families that need additional hours beyond those provided through state programs, however, can benefit by selecting caregivers from our network. Doing so is convenient and saves you money. This includes qualified, pre-screened PCAs, home health aides, certified nursing assistants, and homemakers.

Support and SolutionsHome Care - Caregiver And A Nice Old Lady

With Meetcaregivers, families get maximum choice and control. For example, they can direct their care without hassle, complexity, and long term commitments that come as a household employer.

Families that choose self-direction can quickly and easily find pre-screened, qualified caregivers. Additionally, they can hire, fire, train, schedule, and supervise their caregivers, but avoid the hassles and complexities of directly employing the caregivers or worrying about insurance and tax withholdings. And they can still save significant money off the cost of a traditional full-service agency.

We are hoping to work with the Department of Elder Affairs to make this option a reality for families choosing self-direction through publicly funded programs.

For more information, contact Meetcaregivers at 1-888-541-1136 or info@

For more resources and information about caregiving and self-directed home care, check out our blog.

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