Caregiving

The Challenges of Self-Directed Home Care

Self-directed home care refers to the ability of seniors and people with illnesses or disabilities to choose and control their own home care providers, including 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 own caregivers and receive services, paid by the Commonwealth, to help them get 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.

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 they are mostly on their own to make calls, screen caregivers, and determine which potential caregivers are qualified, will be a good fit, and are willing to work for the wages allowed by these programs. The process can be time consuming and stressful.

We get calls regularly from seniors and people with disabilities who are looking to select and manage their own caregivers through these public assistance programs, but need help finding the right person who has the necessary skills and qualifications and is willing to work for the wages allowed. Currently the available self-directed programs do not have processes in place to pay for our services –even though the overall cost would be less than when using a full service agency.

Families that need additional hours beyond those provided through state programs, however, can benefit from the convenience and cost savings of selecting their caregivers from our network of qualified, pre-screened PCAs, home health aides, certified nursing assistants, and homemakers.

With Meetcaregivers, families get maximum choice and control and can direct their own care without the hassles, complexities, and long term commitments that come with being set up as a household employer. Families that choose self-direction can quickly and easily find pre-screened, qualified caregivers. They can hire, fire, train, schedule, and supervise their own 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 Department of Elder Affairs to make this option a reality for families choosing self-direction through publicly funded programs.

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