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Human Nature and its Disparity Within American Home Health Care

We are full of true stories. Here’s another one.

Several years ago, there was an elderly man who was being discharged from the hospital from a bad car accident. He suffered brain injuries and was instructed to be provided a home health aide upon returning home. The licensed agency provided a certified aide along with a nursing assessment to start the initial plan of care. The caregiver was very well liked because of the cultural and racial similarities of the client which put the family at ease. At first, the client was appreciative, but as the months went by, the home health aide started becoming a member of the family, and often shared information about how she was not paid enough. (She was paid $120 per day as a live-in on weekday shifts). The family knew what they paid the agency, and the caregiver openly shared what she was making, complaining that her take home pay after tax was less than $100 per day. The family called the agency to threaten to sue if their home health aide wasn’t paid more. They added to the threat by stating that everyone in the family was an attorney and that they understood how the home health agency business worked.


Or did they?


Let us explain.


The agency charged the client $200/day. For those who hear in the news how lucrative this business is, let us show you the numbers in its simplest form:

Daily rate charged to clients: $200.00

Less Expenses:

Caregiver wages per day: 120.00

Employer Payroll Taxes (6.2%): 6.20

Business and compulsory insurance: 28.00

Regulatory compliance costs (licensing, training, accreditation, etc.): 15.00

Indirect expenses (operations, rent, staff payroll, tax, etc.): 28.00

Net profit: $2.80


The home health aide actually deserved to be paid at least $150 per day which is what she earned as a private duty caregiver. But there is hardly a market for such high priced caregivers. Would you play $225 per day for a live-in caregiver who is legally not allowed to work more than 8 hours per day without overtime pay? Also, states like New Jersey, prohibits caregivers from working for a client privately if he/she/it is placed through an agency. To avoid using a home health care agency, you would have to find the caregiver on your own. You would still have to withhold taxes, pay employer taxes for any caregiver you compensate wages over $2,000. That also means filing a tax ID number and filing tax returns. The moment you let a home health care agency provide their own employee, liability over the caregiver shifts from you to the agency. That, and all the required nursing supervision and other overhead costs over the aide results in the big bamboozle shift of transferring wages out of the caregiver’s pocket and into the government and insurance companies. The health care agency is last priority based on return on investment. (caregiver makes the most, followed by insurance companies and government. Agency profits are smallest).


The home health aide’s complaint was valid. For the difficult work performed with such a bright conscientious attitude, she deserved more than $15.00 per hour. She deserved to earn at least 20 to $25 per hour. One simple way to make that happen was to place the caregiver as the family’s employee. Why does anyone need C.Y.A. procedures like nursing assessments, time sheets, and accreditation if the agency simply screened the caregivers correctly? A non-human business entity that plays in the middle of a family affair is impersonal and unnatural. Caregivers should have the right deserve to work for themselves. The families should have the right to hire a home health aide directly through an employment agency. The natural progression of capitalism will allow for smarter and more educated caregivers to earn competitive wages unlike the Walmart model of today, where caregivers are like hamburgers that look the same and do everything the same way as their co-workers. Imagine if you know someone that looked and behaved the same as you? This simply does not exist. God made all of us unique for a reason.


In conclusion, the family was not wrong with expressing how they felt. They just didn’t know what they didn’t know, and the truth is, it was all human nature boiling from within and exploding like a volcano against an overly regulating establishment.

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