Vitalitas FamilyAs many of you may have experienced – whether directly or through someone you know – often as we age, or after a serious illness surgery or injury, we need assistance at home.

Unfortunately, many of us often don’t think about what our care needs may be in the future, and, as a result may make decisions based upon incorrect information and/or out of desperation.

Today, I’m going to spend some time explaining the options you have available for in-home care support, as well as allow time for questions & answers.

As you consider your current or future care requirements – whether for yourself or for a loved one – keep in mind that, in California, you have multiple non-medical, in-home care solutions from which to choose including:

1. Source and hire an Independent Domestic Worker yourself
2. Utilize a Home Care Organization
3. Engage the services of a Home Care Referral Agency


If you decide to source and hire an independent domestic worker on your own, you should be prepared for a lengthy and often frustrating process that includes:

1. Creating a list of job duties and requirements
2. Placing advertisements
3. Reviewing candidate resumes
4. Interviewing candidates
5. Selecting a final candidate
6. Checking references, verifying credentials and conducting background checks

• It’s important to note that there are stringent Federal & State disclosure, non-discrimination and authorization requirements for background checks and DMV records examinations.
• Once you hire the domestic worker, you need maintain detailed and accurate timekeeping, billing and payment records in the event of a subsequent dispute regarding paid time, overtime eligibility and unemployment.
• Failing to have a documented agreement with the Independent Domestic Worker could result in legal problems down the road, particularly if the worker provides live-in care.


Also known as “Agency-Directed Care,” a Home Care Organization (HCO) must be licensed by the California Department of Social Services. All Home Care Organization’s must adhere to specific regulations contained in the Home Care Services Consumer Protection Act (HCSCPA), which became effective January 1, 2016.
• An HCO is the direct employer of the in-home care provider. All Home Care Organization’s must meet established training, supervision, recordkeeping, insurance, and bonding requirements – and reputable agencies are willing and able to substantiate their compliance.
• This option is sometimes preferable to clients and/or family members who want to hand over control and oversight of the in-home care provider to the Agency, which serves as the provider of record and directs the in-home care.
• However, you should be mindful that some agencies have stringent contracts, which prohibit changes in the scheduled number of hours and/or that establish daily minimums.
• In addition, consumers often do not have a choice regarding the in-home provider(s) assigned to deliver care, nor the right to specify the level of experience and professional certifications of their assigned caregiver(s).
• Finally, using a Home Care Organization does not ensure continuity of care, meaning someone new could come to your home every week or every visit depending on frequency and how they schedule their employees; thus, you should be prepared to have caregiver turnover during the contract’s life cycle.


Many people want the freedom to choose their in-home care provider and want greater certainty they have the same person during their time of need. For these people, a Home Care Referral Agency can be a good option.

Also known as a Domestic Referral Agency (DRA), this model represents what’s known as “Consumer-Directed Care” – and places an emphasis on the rights of consumers to choose their care providers and the parameters of care they need.
• A Home Care Referral Agency can be more cost-effective than a Home Care Organization, often saving consumers upwards of 30%, and can provide clients and their family members with greater piece of mind – versus sourcing and hiring a domestic worker on their own.
• Every Home Care Referral Agency must personally interview and verify the professional experience and/or training of the professionals they refer. In other words, they are required to do the work you need before you meet the potential caregiver.
• In addition, many experienced in-home care providers prefer working through this model because it allows them to control their schedules and their earnings, as well as establish deeper relationships with the clients they support.
• Home Care Referral Agencies operate under the Civil Codes 1812.500-1812.5905 and are subject to a number of State and Federal Regulations.
• They must also include in their business name the term “agency” or “personnel service” and must specifically state in all literature and marketing communications that they are “a referral agency.”

If you engage he services of a Home Care Referral Agency, you should seek answers to the following questions:

1. Professional Requirements – What are the established criteria for an in-home care provider’s inclusion on the agency’s registry (such as two or more years of related professional experience, current certifications and/or registration on the California Home Care Aide Registry)?
2. Credentials Verification & Background Checks – What processes are in place to ensure clients’ interests and safety are heeded (such as candidate evaluation, verification of professional experience, training, and work authorization, as well as, criminal history and driving record examination)?
3. Regulatory Compliance – What are the agency’s operational, confidentiality and disclosure practices, as well as, its services, referral fees and billing/payment processes?
4. Professional Affiliations – Does the agency belong to professional organizations (such as the California Coalition of Domestic Referral Agencies or the Private Care Association, which provide agencies with legal updates and best practices that promote compliance with State and Federal regulations)?
5. Referral & Selection Criteria – What process does the agency follow to ensure it fully understands each client’s needs and preferences so that only those in-home care professionals best suited to provide support are referred; and, is the consumer empowered to make the final decision regarding which professional(s) will provide care?

While no single care model is right for everyone or for every circumstance, knowing your options and becoming familiar with what to ask about will help to ensure that if/when the time comes you need to find non-medical, in-home care for yourself or a loved one, you’re prepared to make an informed decision about which model and which provider may be the best solution for you.

For more information, please call 760-407-6505.