When a loved one is in need of care, whether due to aging or illness, most people prefer to have that care provided within the comfort, privacy and familiarity of their home environment. Private duty home care, according to the National Private Duty Association, provides services that range from skilled nursing to companionship and assistance with meals, activities of daily living and mobility. Private duty caregivers may be engaged through full service agencies, employment agencies or private hiring arrangements with individuals. The explosive growth of the home care industry means that consumers have many choices – so many choices, in fact, that they may be easily overwhelmed.

June Ninneman, LCSW, Branch Manager for SeniorBridge Eldercare, Inc., in Chicago, advocates for families to make informed choices and feels that they need to be made aware of the risks involved in choosing to privately hire a nurse, companion, nursing assistant or home care aide or to go through an employment agency. Although there are often pages of advertisements in newspapers and telephone directories, listing providers with assurances that they are "licensed and bonded," Ninneman believes that this phrase can be misleading and that it carries false implications that may eventually create troublesome consequences for vulnerable families.

"Taking care of a loved one at home is already very difficult for families," she says. "When you privately hire a caregiver, you are taking on enormous additional responsibilities and risks. You are essentially becoming an employer, with all the potential complications that that entails."

Those complications include having no guarantee of quality and no oversight of the care being provided. The family has the responsibility of monitoring the care themselves, and no matter what the level of that care, they are unlikely to be qualified to provide competent supervision. Generally speaking, independent contractors and those who are hired through employment agencies have not been given pre-employment medical exams, drug screening or competency testing.

In addition, the family has to handle all the "human resource" aspects of employment, such as withholding taxes, worker’s compensation and unemployment insurance. They have to personally confront job performance issues and even fire a caregiver for an unsatisfactory performance. There is unlikely to be back-up in the event of employee illness, so that the family may be left without coverage. A caregiver may be injured on the job, leaving the family liable.

In contrast, SeniorBridge Eldercare, a full-service agency, offers the family peace of mind and the assurance that experienced professionals are managing every detail of the caregiving. SeniorBridge Eldercare takes on all the responsibility for hiring, supervising, training, scheduling, problem-solving and managing personnel issues. The caregivers are directly employed by the agency following careful screening and are then matched to right client. Ninneman and her supervisory staff make unannounced home visits to assess the quality of the care and services and are always available to clients as a resource, 24 hours a day, seven days a week. Each client receives a comprehensive assessment and an individualized plan of care.

"We recommend that families engage a full-service, experienced agency that specializes in private duty home care. We can lift the burden from the shoulders of already stressed-out families. If you hire privately, where do you turn if things go wrong? It can be very difficult to confront a caregiver in your home if they are coming late to work, calling off sick, refusing to perform some of their duties or being otherwise irresponsible. And then you may be starting all over again, trying to find a new person and having to manage all the care yourself in the meantime," Ninneman warns. "I have had clients who initially believed that they were making the smarter and less expensive choice by privately hiring caregivers. Hour for hour, it may be less expensive, in the beginning, but the financial risk is tremendous. Even after the caregiving ends, perhaps with the death of the client, the family may still be responsible for paying unemployment."

The National Private Duty Association was created four years ago to develop quality standards for the industry and to educate consumers about private duty home care. The NPDA mission is to help Americans obtain access to high-quality care in the home, when care at home is appropriate. SeniorBridge Eldercare, a member of the NPDA, is a rapidly growing national eldercare organization with 16 branches in 10 states.