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The Perils of In-Home Care

Many families are faced with the dilemma of caring for a family member who is unable to live alone because of a medical condition. This also may be true even when there is another family member in the residence who can provide some assistance.

Approaches to this problem include institutional care such as a nursing (or assisted living) facility or bringing healthcare providers or other help into the home. Both approaches are costly and may be beyond the means of many families. Governmental resources are available but result in the family losing much of the wealth that they have accumulated over the years. Long term healthcare insurance may be available to those who had the foresight and financial resources to avail themselves of it.

The main thrust of this guide is directed toward bringing in outside help and issues that are likely to be confronted. Such care is costly but probably less so than institutional care. If the family hires individual help directly, the arrangement will be subject to tax compliance issues and wage and hour laws. The position of the Department of Labor is that individuals who are retained directly by the family are employees and not sub-contractors. A useful reference is Administrator’s Interpretation No: 2014-1, March 27, 2014, published by the U.S. Department of Labor, Wage and Hour Division; this is available on-line. If individuals are hired directly, the family must set up a system to withhold income taxes or later face problems with the Internal Revenue Service. To avoid these employment law problems, the family can retain an agency that then is responsible for tax compliance and other collateral issues.

If death within six months is imminent, Hospice in the home becomes a possibility. Under this approach, many costs are covered by Medicare if the patient has Medicare. Unfortunately, much of home care that is not strictly medical is not covered by Hospice under Medicare. This is the role of an agency described above. The Department of Health & Human Services – USA has available a brochure entitled “Medicare Hospice Benefits”, that outlines many of the benefits that are available through Hospice. Hospice Council of Maine, 1 800-438-5963, is available to answer questions.