Frequently Asked Questions Caregiver FAQ

In-home care offers support in three major categories: companionship, light housekeeping and personal care. Companionship can be defined as everything from conversation and social interaction to support for the client who formerly participated in an activity, but no longer feels confident in participating alone. Do caregivers pot flowers? Yes. Count butterflies in backyards? Oh, yes. Go to museums, movies, wedding rehearsals, doctor appointments, pharmacies, grocery stores? All, yes. The caregiver can drive the client’s car or drive the caregiver’s car. Driving the caregiver’s car incurs a small mileage fee (at Encore Caregivers that fee is $.55 per mile).

The state of Texas allows caregivers to spend as much as 20 percent of their time doing light housekeeping. Basically they keep clean, sanitary and organized the areas where the senior predominantly lives: bedroom, bathroom, kitchen and living room. Caregivers change sheets, do laundry, vacuum, prepare light meals and snacks, etc.

The last area is personal care. Not every client needs personal care, but when they do a skilled caregiver should be trained and ready to offer help with what the state of Texas calls ADLs, activities of daily living. A skilled caregiver can help a client with eating, walking, showering, dressing, grooming, toileting and so many other tasks.

Yes, if you are referring to initial out-of-pocket expenses. However, both the tangible and intangible benefits of engaging a licensed agency justify any additional costs. If you hire caregivers yourself, you are the employer and as such you are responsible for not only their wages but also for some things that you perhaps haven’t thought about:

• Paying all federal and state payroll taxes (Medicare, FICA, and unemployment taxes – at least 10% of wages)
• Worker’s compensation insurance (10% of wages)
• Depositing payroll deductions
• Filing quarterly and annual state and federal payroll tax reports
• Complying with federal immigration hiring laws as well as a host of other employment laws
• Recruiting, hiring and firing employees
• Scheduling employees and then rescheduling employees when the first are late, sick or need time off

We have encountered cases where families or executors hired their own caregivers and chose to consider the employee an “independent contractor” – thereby ignoring payroll taxes or work-related accident insurance. Typically, this becomes a serious issue when the employee is terminated and subsequently files an unemployment claim.

This sets in motion a state and federal payroll tax audit resulting in a claim against the employer (the family in this case) wherein the family is required to pay both accrued employee and employer payroll taxes from the date of hire, plus accrued employee and employer payroll taxes for all other employees, plus penalties and interest.

The same problem results if the family chooses to ignore worker’s compensation insurance or accident related insurance. Homeowners’ insurance policies specifically exclude work-related accidents. Thousands of dollars in expenses can result from an employee being injured on the job (e.g., a back injury resulting from transferring the client) and then filing a claim with the state, suing the family (employer) and successfully collecting medical expenses, including an allowance for pain and suffering, legal fees and the legal expenses to defend the litigation action.

Encore Caregivers, a Licensed Agency, is the employer of our caregivers and is responsible for all expenses and costs associated with state and federal employment laws, work related injuries, and all other employer obligations. No worries.

The state of Texas allows caregivers to spend as much as 20 percent of their time doing light housekeeping. Basically they keep clean, sanitary and organized the areas where the senior predominantly lives: bedroom, bathroom, kitchen and living room. Caregivers change sheets, do laundry, vacuum, prepare light meals and snacks, etc. The last area is personal care. Not every client needs personal care, but when they do a skilled caregiver should be trained and ready to offer help with what the state of Texas calls ADLs: activities of daily living. A skilled caregiver can help a client with eating, walking, showering, dressing, grooming, toileting and so many other tasks.

One factor in determining a high-quality in-home care agency from the herd of “just adequate” agencies – does the agency do a driving record check? At Encore Caregivers, we pull each and every caregiver’s driving record. They are called on so often to drive our clients on errands and to events, you bet we are going to make sure they are safe drivers.

A caregiver registry is just that – a list of people or agencies willing to provide a service. Close attention should be paid to safety and security by anyone tempted to use a registry. Standards vary greatly in the world of registries — sounds convenient, looks convenient, per hour charge may be appealing – but at what potential long-term cost? Also, home care registries that host a selection of agencies on their site do so for a fee. It is simply another marketing channel for the agencies – a way to create a potential marketing “hook” that may snag unsuspecting families.

Questions that you should answer before hiring an in-home care agency: Has the agency been in business for an extended period of time? Are they licensed, bonded, and insured? Are they a franchise? Are they small? Are they large? Are their services respected in the industry? Are they award-winning? Contact a few. Do they quickly answer your questions at warp speed without taking a breath? Do they take time with you and establish a modicum of comfort and rapport? Are they service-oriented or do they seem to be uber-profit driven? Ask about an assessment. Is it offered at no charge? Who completes the assessment? A marketing staff member? A nurse? Do they even have a nurse on staff? Do they have the depth and breadth of the caregiver pool to ensure that they will be able to find a close fit for your loved one? Can they offer a caregiver at the time required? If a caregiver cancels, do they have a back-up?

It’s very simple. Services can be canceled prior to the beginning of a caregiver’s scheduled shift, without penalty or charges. Our phones are answered around the clock by an Encore Caregivers’ professional staff member. We are very flexible in our scheduling so most requests can be honored. We understand that events and circumstances may result in disrupted schedules or in a situation in which fewer or additional hours are required. We will comply with your requests to the best of our abilities. We ask only that you provide as much advance notice as possible to minimize the impact on our caregivers.

Note: As a licensed Home and Community Support Service Agency, our clients will sign the “Individual Service Plan and Consent Form” which details the type, frequency, rates and other delivery practices for services requested. No surprises.

Of course. You may notify our office that you wish for your caregiver to drive you in your car to your appointments. This is documented by signing the appropriate permission form. If you do not own a car, then your caregiver can drive you in his or her own personal vehicle. You will be billed for the mileage incurred to and from your residence at the rate of $.55 per mile. All of the mileage charges billed to the client are paid to the caregiver.

In Houston, TX the cost of a home care aide depends on whether the home care aide is working for a licensed, bonded and insured agency or whether the home care aide is hired privately. Our experience shows that an agency, on average in Houston, TX will charge between $21 and $24.50 per hour for a four-hour schedule or more. The Genworth Cost of Care Survey 2020 indicates that the median cost of a home health aide in Texas in 2020 was $22.50 per hour.

Of course, costs rise significantly when the home care aide is asked to help for just an hour or two. A privately hired caregiver can charge significantly less for their services, however by hiring privately, the patient/client/family takes on the role of employer and must have targeted insurance and handle all tax and workman’s compensation filings.

Under a Personal Assistance Service (PAS) license with the state of Texas, a personal care assistant can remind a client to take medications and can assist a client in taking medications, but cannot administer medications. A personal care assistant can never touch or dose the medication – including putting prescribed medication in a pill dispenser. That should be left to the client, the family, or failing that, to a nurse.

We are experts at Encore Caregivers, but we fully recognize that we are experts only in our area of focus – in-home care. We wouldn’t presume to offer you tax advice. We know that the best advice that we can give to someone seeking answers to tax questions is to go straight to the horse’s mouth for information. Please avoid all the paid advertisers belched out as a result of an Internet search, and go directly to https://www.irs.gov

A caregiver can work as many hours as desired. The first 40 hours are paid straight time and any hours greater than 40 (with the same client) must be paid at time and one half.

On-line research must be the first step in hiring in-home care. Several quality print references are available as well: Senior Resource Guide and New Lifestyles being the industry leaders. Perusing a copy could be very insightful and what do you have to lose? The publications are free to the public and available throughout the Metro area. A quick check on-line will tell you where. Questions that you should answer before hiring an in-home care agency: Has the agency been in business for an extended period of time? Are they licensed, bonded and insured? Are they a franchise? Are they small? Are they large? Are their services respected in the industry? Are they award winning? Contact a few. Do they quickly answer your questions at warp speed without taking a breath? Do they take time with you and establish a modicum of comfort and rapport? Are they service oriented or do they seem to be uber-profit driven? Ask about an assessment. Is it offered at no charge? Who completes the assessment? A marketing staff member? A nurse? Do they even have a nurse on staff? Do they have the depth and breadth of caregiver pool to ensure that they will be able to find a close fit for your loved one? Can they offer a caregiver at the time required? If a caregiver cancels, do they have a back-up? Express your desires for a good caregiver meeting your preferences – because the right fit is critical. The small details can be so very important. Lastly, give the agency a chance. If the first caregiver doesn’t work out, do they make it right? Work with them to polish the experience for both client and caregiver. The time you spend in finding a good fit will be well worth the effort.

In Houston, TX the cost of a home care aide depends on whether the home care aide is working for a licensed, bonded and insured agency or whether the home care aide is hired privately. Our experience shows that an agency, on average in Houston, TX will charge between $21 and $24.50 per hour for a four-hour schedule or more. The Genworth Cost of Care Survey 2020 indicates that the median cost of a home health aide in Texas in 2020 was $22.50 per hour. Of course, costs rise significantly when the home care aide is asked to help for just an hour or two. A privately hired caregiver can charge significantly less for their services, however, by hiring privately, the patient/client/family takes on the role of employer and must have targeted insurance and handle all tax and workman’s compensation filings. Overnight home care will cost less than the hourly rate if the caregiver has live-in status. That cost is determined by the agency and ranges from $300 – $450 per 24-hour period.

So many seniors make the choice to stay in their homes over relocating to a seniors-only community, or an independent or assisted living facility. Their home is familiar, in it they are surrounded by memories. It can be reassuring and a real comfort. Children often feel more comfortable visiting their parents in their home as opposed to a facility of some kind. Privacy is another big issue. In a facility, it can be at a minimum. At home, friends and family come and go as the senior desires. Also, pets have so much more freedom at home than in a facility. All of these arguments are quality of life issues and seniors recognize this and are acting on this and choosing to stay in their homes in record numbers.

In the case of Encore Caregivers, we define respite care as temporary care provided by one of our skilled and trained professional caregivers for a senior in order to give relief for the senior’s regular caregiver. I can think of a family that we help on the west side of the city. The family is husband and wife and the husband’s mother lives with them. They take such good care of her. But, from time to time, Encore Caregivers gets a call saying, “We are going to the hill country this weekend, could we have a caregiver from Friday noon until Sunday evening at 7 p.m.?” Or, they might say, “We are going to the Rodeo on Tuesday night. Could you send a caregiver at 4 p.m. on Tuesday and have her stay until Wednesday morning at 7 a.m.?” Every request, we honor. That’s what we do – providing relief for good sons and daughters and good friends and family members, throughout the Metro area – every day.

An in-home caregiver offers support in three major categories: companionship, light housekeeping and personal care. Companionship can be defined as everything from conversation and social interaction to support for the client who formerly participated in an activity, but no longer feels confident in participating alone. Do caregivers pot flowers? Yes. Count butterflies in backyards? Oh, yes. Go to museums, movies, wedding rehearsals, doctor appointments, pharmacies, grocery stores? All, yes. The caregiver can drive the client’s car or drive the caregiver’s car. Driving the caregiver’s car incurs a small mileage fee (at Encore Caregivers that fee is $.55 per mile).

The state of Texas allows caregivers to spend as much as 20 percent of their time doing light housekeeping. Basically they keep clean, sanitary and organized the areas where the senior predominantly lives: bedroom, bathroom, kitchen and living room. Caregivers change sheets, do laundry, vacuum, prepare light meals and snacks, etc. The last area of focus for an in-home caregiver is personal care. Not every client needs personal care, but when they do a skilled caregiver should be trained and ready to offer help with what the state of Texas calls ADLs, activities of daily living. A skilled caregiver can help a client with eating, walking, showering, dressing, grooming, toileting and so many other tasks.

At Encore Caregivers, we truly believe that the most valuable skill of a professional caregiver taking care of an Alzheimer’s patient is flexibility. The day that a caregiver planned is often not the day that unfolds. You are behind schedule. So what? Take your time. The activities planned won’t get completed. So what? Try them again tomorrow. The patient calls blue, pink and breakfast, dinner. So what? Agree with them. Enjoy eggs and bacon for “dinner”, at 8 a.m., smiling all the while. A caregiver needs to be light on her feet. Patience and creativity are skills called on daily to reduce frustrations in both the senior and the caregiver. Go with the flow – be flexible.

A skilled caregiver works to include a senior in decisions and activities. A skilled caregiver will use non-traditional ways to accomplish this. “What would you like for breakfast?” morphs to “Would you like eggs or cereal for breakfast?” The latter question allows the senior to have confidence in the answer, without having to rely on recall that they may not have. The senior can just repeat a part of what the caregiver said and both parties are happy and the goal of involvement is achieved. Provide controlled choices.

A skilled caregiver will establish a routine. That comforts the senior and can make the day so much smoother. The client likes to have her bath at night? If at all possible, accommodate her. The client likes to go to the doctor early in the morning. If at all possible, accommodate her. Lessen agitation and confusion. Set-up a comfortable routine.

Everyone, healthy or not, has likes and pet peeves. Personally, I cannot stand blaring electronic noises or tolerate high-volume conversations. It is no different with anyone else. But, when a senior has Alzheimer’s Disease, focus can become a scarce commodity. A skilled caregiver will turn off the television and minimize other distractions and begin to reintroduce them slowly into the environment to gauge the senior’s tolerance. That knowledge becomes very useful throughout the day as the caregiver needs the senior’s focus at meal-time or while dressing, for instance. Reduce distractions.

Don’t be overwhelmed by the tasks at hand. The senior may not be the only one who needs special care. Caregiving is a demanding calling and may require your attention 24/7. You must not ignore yourself. Don’t allow yourself to get burned out – that helps no one and the potential hurt is great. Use available resources to lessen the burden, whether it is professional caregiving from Encore Caregivers or top-notch classes from the Alzheimer’s Association. We are here to help.

Encore Caregivers, LLC
7925 Katy Freeway Suite N, Houston, TX, 77024
(on the south side of I-10, between Antoine and Chimney Rock)

Office Hours: 9 AM to 5 PM – Weekdays
Phone Answered by a Professional Care Coordinator Around the Clock.