In-Home care of the elderly is a growing business largely in an effort to find alternatives to nursing homes and/or the costs of nursing homes. Unfortunately, this industry is unregulated and there are considerable dangers to consumers. We have attempted to summarize some of those problems.

One of the first considerations is that elders who receive in-home care are very vulnerable, subject to undue influence, abuse and financial exploitation. Often, it’s too late when problems are discovered.

Another factor is there are many labels used such as: companion, home-aide, personal care aide, housekeeper, health care aide. There is no standard for these titles. Additionally, a title does not necessarily mean that any particular technical training, certification or licensing is involved. Frequently, one "helper" cannot do all the work and it becomes necessary to hire several "helpers". It will probably be beneficial to hire a professional geriatric case manager who can assess the needs of an elder and recommend the type of care needed.

It is recommended that potential caregivers be interviewed, screened, background checked as well as a credit checked. If a caregiver handles money, it is recommended that it be on a limited basis and the care giver should still be accountable to a third party - someone other than the person requiring the care. Great care should be taken before giving power of attorney to a non-family member.

Although it is not often done, it is advisable to have caregivers sign a contract. The contract would specify exactly what services are to be rendered by the caregiver, what the salary would be, hours, holidays, reimbursements, etc. Unfortunately, the family might be under pressure to hire someone quickly and a contract goes out the window.

Then there are income tax and employment tax considerations. The IRS has guidelines as to defining whether a caregiver is an "independent contractor" or an "employee" which impacts the social security and Medicare taxes paid. Also in some states, there may be additional returns and reports. Another consideration is whether the caregiver is legal and eligible to work here. We all remember that several government appointees got in hot water for not checking their employees out.

Additionally, there is the personal liability factor in having an employee in the home. Consumers are subject to lawsuits from conditions in the home if a caregiver gets hurt. The homeowner’s policy should be reviewed and probably updated. Inversely, if a caregiver does something wrong, there is the option of suing the caregiver but all too often this is futile.

Hopefully, this has given you some food for thought if considering in-home care giving. Bottom line, there is much to consider in having an in-home caregiver. If you decide to go this route, choose employees carefully. Interview prospective employees, check references and try to build in as many protections as possible to avoid exploitation and abuse of your loved one. If you are not personally able to hire individuals, consider a professional geriatric care manager or engage a licensed home care agency that will be responsible for screening its employees. Regardless of whether you do the work or hire professionals, it is still necessary to keep appropriate records and file the necessary tax returns and reports.