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My sisters provide primary care, but we have a few CNAs who come in to help out. My sister read an article that it is not uncommon that dementia patients can become combative near the end of life. Mom is 90 and has had issues for the last 10 years...there are signs (sleeping 12-14 hrs a day, not eating and drinking like she did, etc). My sister asked me to check to see if there is legal responsibility, does mom's HO insurance cover, etc. Any info would be appreciated. Thanks

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I would listen to Tacy, she knows what she is talking about.

If your mom injures someone working under the table, I promise you that they will not say it is all good and let it go. They will be loosing their ability to earn a living and that is when the feces will fly. Lots of people getting paid cash will say no worries, it is all good, until it isn't and then it is to late.

You know that your mom has issues and could potentially injure one of these people. That is negligent from the git go to not provide them with the proper insurances to protect them.

These are issues that are better dealt with up front then during a crisis. God forbid your mom needs to apply for Medicaid, all the money paid under the table will not count as legit expenses and could cause quite the penalty.

Things to think about for sure. Protect everyone involved and do this properly, whatever that is in your state.
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SonOutOfState Aug 2019
Please responses to Tacy and others...trying as quickly as I can to understand all of this. And if I could, I would change my id to yours with a 2 (too) added at the end. Thanks
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Tacy means enrolling in a workers compensation policy under your state. My husband is self employed and has a policy through the State of Maryland that covers him and his part timer.

We use ADP for payroll. My husband will not hire folks “under the table” as he doesn’t want to risk losing our business or home due to an injured employee not being covered. That can really wipe us out (you too).

While you may saving yourself money now paying those helpers out of pocket, ask yourself is it worth it getting sued when one of those employees hurt their back and need treatment.

Not worth it.
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Shane1124 Aug 2019
Each state may have a WC fund you can pay into via your payroll company that may be simpler than the above. Just saying.
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I believe if she hires privately, she would be prudent to carry a Personal Liablity Policy, or at least check on her homeowners policy to find out exactly what her liability coverage is, and what it will and will not cover. Check into Commercial Umbrella policy as well. If through and agency, make sure the agency is LB& I.

Don't assume your standard HO policy will cover for 'hired' CNA's getting injured.
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SonOutOfState Aug 2019
Thanks for the response...think we are on the same page...review current homeowners, and probably add a Personal Liability or Umbrella coverage.
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This is my experience, in Michigan.   When I investigated hiring an individual on a private basis, the options were to hire her as an employee or that she work as an independent contractor.   She wanted the former.

I called our insurance agent and learned that we would have to carry a commercial worker's comp policy, at the then premium of about $750 to $1K annually, with literal guarantees the premium would increase every year.

I balked at that; it was enough to have to deal with employee issues of payment, deductions, etc., just for one part time person, but neither my father or I were willing to enter the world of commercial workers' comp liability insurance and  such a large amount for premiums.

My agent emphasized that his kind of coverage can't be added to a Michigan HO policy; it's considered a commercial policy issue.

FreqFlyer, a regular poster here, had some experiences slightly different (if I remember correctly) in the DC/VA area.   

This is one of the intractable issues of hiring people directly, even if you may get better help than is available through an agency.  

Unfortunately, there weren't any good solutions for our situation.

I think you should contact your insurance agent directly to pose this question, but be prepared to be advised that the workers might not be covered.

Tacy addresses this issue as well, with additional information of which I was unaware.
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SonOutOfState Aug 2019
We are reviewing insurance and are being told by mom's agent that we are probably best to secure a Personal Liability rider or an umbrella policy. For some further clarity of the situation. My sisters and I have been with mom almost 24x7 the last couple of years. But at times, everyone needs a break. My brother died a little over a year ago after spending 10 years at the nursing home. Mom rarely missed a day visiting him, and over the years, she was well known by virtually all of the staff. When we had to take away car keys and begin providing care, several said they would be more than happy to come by and spend a few hours with her. This started when my brother was still at the nursing home. None of them have regular hours or schedules and it is rare that any of them exceed 30 hours per month. A few of them initially did not even want any money. When we started paying them, we were told that as long as we did not compensate anyone above some dollar amount annually (I want to say it was just under $3850) then we would not be required to provide WC, pay taxes, etc. What I thought would be a simple inquiry has suddenly open a giant can of worms. I am beginning to wonder what is coming next :-( To say all of this is overwhelming would be an understatement.
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If not using an agency (and make no mistake that this increases costs, though things like workman's comp and vetting should be in the package) you should definitely check into your policy. This is something I never thought of.
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SonOutOfState Aug 2019
Thanks, I had never thought of this before either. We have looked into agency resources, but that jumps the costs from a few thousand per month to more than $20K per month. Dad left her some money, but she would burn through that in a year or less!
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Son
this is a bit off topic but ask your sisters to check with mom’s doctor and see if mom would qualify for hospice care at this point. That could be a big help to your sisters.
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SonOutOfState Aug 2019
We are obviously monitoring with her docs, but other than dementia/Ahlzheimers, she is reasonably healthy for 90...her docs have even said she could still be with us 5-10 years or more. We have experience with Hospice (dad, brother, other family members) and she is not there yet. But we are seeing some signs - sleeping 14-16 hours a day, slower reactions, more labored walking, and not eating or drinking as much as usual.
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Tacy, is there a threshold in terms of the number of hours worked for regulations? So, say the sisters are there 24/7 and 2 x HCAs are coming in for one hour twice daily, = 28 hours per week, would that make any difference?

Sonoutofstate, I understand and can almost picture your reasons for supporting home care for your mother. The view from one's own rocking chair is immeasurably comforting. But.

"My brother died a little over a year ago after spending 10 years at the nursing home. Mom rarely missed a day visiting him, and over the years, she was well known by virtually all of the staff...."

So well known, and so well liked and respected, that some of them were prepared to give her their time free of charge. And this is a place that she has seen and trusted through ten years' experience.

I know it's not home. But as nursing homes go, it's about the best substitute I've ever heard of - pretty much a home from home, no? I would think it's got to be worth reconsidering as an option.
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"Mom has been in her home for over 70 years, she raised 8 children there, all of her adult memories are there, as are a lot of long-term neighbors and fellow church members. When we took her car keys away 3 or so years ago, her one request was that we not put her in a nursing home...she wants to be at home. How are families handling all this?"

All different ways. I recently read where a family of 14 children each took one 12-hour shift a week, and so were able to keep their aging mother in her home. As you can imagine, though, THAT is not the norm.

How many of your sisters are taking care of your mother?

I absolutely concur that you should not be paying CNAs under the table.

I keep thinking of Dorker's brother, who thought he'd save some $ by getting his friend's 17-year-old son to help trim some trees. Well, the boy hit a power line with the bucket truck, was electrocuted, and ended up losing both legs. There is a big lawsuit, and Dorker's brother could end up losing everything.

I do have a question, though...say the family here continues paying CNAs under the table. If one of them gets hurt, they could sue the mother's estate. But if there isn't much there, can they also sue the family and go after THEIR assets? They could sue the person who pays them, right?
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Son, no apologies or pleas are necessary for time to understand.  These can be complex issues in legal aspects alone, before factoring in family, location, parental behavior, etc.

Sometimes the issues overlap, and sometimes other issues intervene, then it all becomes quite confusing.   Give yourself the time, space and self authorization to consider the issues, and contact people who can give you answers for your state (such as insurance agents), before making decisions.

But I do compliment you on addressing these issues now.   And good luck.
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SonOutOfState Aug 2019
What happened to the old days when family took care of their aging parents with the help of some neighbors, church friends, and other friends of family. For the past 5 or 6 years, mom has known everyone involved in her care. Talked to several agencies and none will commit to minimizing the number of different caretakers who may be sent to help her. On the financial side, looking at all I have learned here and read, the agency makes sense because it is not that much more, it covers some of the risk, most of the things that are now taking away from actually proving care, and the regulatory bs. Still have more questions than answers, but certainly appreciate all the help and support.
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Son,

Just to add to all the great responses you've gotten, if you go the route of paying worker's comp plus other expenses for your mom's CNAs, then as someone mentioned, it could be likely the same as what you'd pay an agency. Downside is there is likely some recordkeeping needed on your family's part. Thankfully, there are companies that will do the payroll admin work for senior care.

You can find caregivers or have your current CNAs register with an online referral service like Carelinx.  They insure the caregiver for limited liability (1 mill property) if they crash car or damage house (check with them on personal injury). They also do criminal background checks and have valid social security card/green card holders on their rosters to choose from. You select those you're interested in and then work with an online Carelinx advisor to assist you through the next steps of interviewing and hiring. However, SSI, (fica taxes) Medicare--your standard payroll deductions/accounting--Carelinx doesn't do, nor do they do workman's comp. (But not all states require WC for senior care EEs. They'll tell you if your state requires this). 

Let's say both you and your current CNAs put profiles on Carelinx and then you go through Carelinx to hire your people, you can always use a senior care payroll company like HomeWork Solutions to handle the payroll deductions part. They charge some fees, but their prices were the lowest compared to Care.com's and ADP's similar offerings. Both Carelinx and HomeWork Solutions will try and help point you in the right direction if you need a WC policy for EEs.

If you haven't already, consider looking into applying for Community Medicaid for your mom, which is ideal for disabled, ill folks who are in the home and need home care. It is typically easier to qualify for this compared to NH Medicaid, but because there's lots of state-specific rules, it's helpful to consult with an elder law attorney that does Medicaid planning for help. If your mom get's this, then there is a program where you can find/hire the caregivers you want, they register w/ the agency you choose who will administer the program, and then the agency takes care of all the insurance & payroll needs.

Good luck!
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