We’ve all heard it – “I don’t need any help” or “I don’t want anybody in my home”.

Even when everybody involved believes assistance is needed, sometimes it is just simply rejected.


We previously covered the reason of “pride” and “independence” and today we’re looking at money.


Money, or the lack thereof, can be a very real impediment to receiving needed services.  People in need of home care services and supports typically fall into three groups relative to money: those who have the resources to pay for services, those who do not, and those who are on the line.

Those who do not and who have very little income or assets might qualify for Medicaid services – ElderChoices, for example.  Those who are on the line can be a challenge.  It is possible that they might qualify for other assistance from the VA (Aid & Attendance), grants, or even a reverse mortgage in some cases.

The first group has the financial resources to pay.  If they are able and if they recognize the need, they will pay for services.  As you might know, the families Home Helpers serves are 100% private pay (including those with Long Term Care insurance).  However, the ability to pay for services does not necessarily result in quality service.

Our experience is that this group of people might have a concern of outliving their savings.  This is a valid concern, but should not result in cutting corners with regard to care.  Care Plans should be structured to ensure flexibility and carefully tailored to respect budgets while meeting the most pressing needs.

One pitfall we routinely see is families seeking assistance from independent contractors.  They see the “sticker price” of an independent contractor that might be as much as $5 less per hour than Home Helpers.  It’s what they might not consider that can open them up for substantial liability and risk.

Sadly – though commonly – caregivers who are independent contractors might not realize the implications of being hired directly by a client.  If the client has outlined a service schedule, the required work, etc., it is a pretty clear that an employer/employee relationship has been established.

When a worker receives a paycheck, he/she must pay appropriate taxes, to include Social Security, Medicare, both state and federal unemployment, and both state and federal payroll taxes.

As the employer, the consumer (the person in need of care) is responsible for compliance.  The government could sue the consumer (or their estate) for back taxes, including both interest and penalties.  When this situation has existed for many months or even years, the tax responsibility could be substantial.  Beyond simply collecting back taxes, interest and penalties, the government could also pursue both civil and criminal penalties.

The situation is no brighter for the worker.  With no payment into Social Security, they could become financially vulnerable in older age.

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