As the founder of ElderCare at Home, as well as the previous owner of what is now one of the largest nurse registries in the state of Florida, it’s safe to say that after 25 years in the nurse registry business, I might know just a bit about the laws, the rules, the regulations, the facts, and laughably, the fallacies, that surround this wonderful nurse registry business model.
As ElderCare at Home continues to grow and capture more and more market share, I’ve noticed a couple of interesting things happen. First, our nurse registry competitors continue to focus on running their own businesses and have never resorted to unprofessional or unethical behavior. They know that for those of us that own and operate good nurse registries, there is more than enough business out there for everyone.
The second thing I’ve noticed is that the successful home health agencies we occasionally compete with, those that are professionally managed and operate with integrity, could care less about ElderCare at Home. As one of the owners of a local home health agency franchise told me not too long ago, “Nurse registries are not my competitors. We may pass each other in the halls and see each other at events, but they serve an entirely different market than me”.
The third thing I noticed, is that even though there are approximately 122 Nurse Registries and 73 home care agencies (non-Medicare certified), in Palm Beach County, it’s always the same 3-4 agencies that get the stupid-stuff going once again.
Although I am the founder of ElderCare at Home and continue to serve as it’s President, for well over a year now I have spent the majority of my time working with my team at the Alzheimer’s Care Resource Center, a non-profit I formed a couple of years ago. For the most part, I’ve had to keep my head down and learn all I can about this new non-profit world. I also lead a still fairly new group of amazing and dedicated employees who spend their time meeting the constant and ever-changing needs of the Alzheimer’s caregivers we serve right here in our community.
I’ve got to say, it’s been over a year since I’ve felt moved to put on my “ElderCare at Home” hat and write a blog post about stupid-stuff, but some of you folks have asked me to address your concerns, and I’ve got some free time tonight and your concerns are valid. So if you’ve got a cup of coffee, depending on where you sit on the fence, you might want to trade it in for something stronger, because the truth hurts and can be a pretty bitter pill to swallow.
Stupid Myth #1 – “When you hire an independent contractor from a nurse registry, YOU are the employer”.
Fact – Under Florida statute, workers referred by nurse registries are deemed independent contractors. A client who accepts a referral of a CNA, HHA, LPN, RN, or companion, from a nurse registry, does not magically become that independent contractors new employer! The next time someone actually says that to you, just do yourself a favor and run. Or ask them to show you the evidence that actually backs up such a ridiculous statement. The last time we checked, neither the local, state or federal government has changed any law or issued any final ruling whereby an “independent contractor referred by a nurse registry is immediately converted to the status of employee”. Just plain stupid-stuff.
Stupid Myth #2 – “If the independent contractor doesn’t pay their taxes, YOU are responsible and might have to pay the taxes yourself.” So let me get this straight, you think the IRS is going to call the nurse registry or better yet, knock on their door and say, “We need the names of all the clients that you referred that independent contractor to because he/she didn’t file their tax return or pay their taxes. We thought we’d give those clients a call and see if they’ll pay the taxes instead”!
The next time someone is stupid enough to make this statement to you, just ask them to back it up with proof. When they won’t, because they can’t, just smile and walk away.
Fact – The IRS also doesn’t like it when either an employee or and independent contractor fails to file a tax return, but it happens each and every year and it’s unlikely to change. But it’s not their usual policy to go about collecting their money the way in which some of these folks think your stupid enough to believe. So the next time someone makes that statement to you, tell them to go sell it to someone else or to show you the facts behind the fiction. Oh, and you can remind them that the IRS, in a report submitted to Congress, confirmed that that when a nurse registry files a 1099 for informational purposes, independent contractors reported 97% of the amounts as income.
Note: We found one South Florida case, in the past decade, of a person being sued for employment taxes; and it was due to the failure of the nurse registry to abide by the IRS guidelines for the proper use of independent contractors.
Stupid Myth #3 – “The independent contractors have no liability insurance and no supplemental insurance.”
Fact – There are approximately 122 licensed nurse registries in Palm Beach County. The vast majority of which not only have general and professional liability insurance that extends to the independent contractors while acting within the scope of their duties, most registries also require the independent contractors to purchase additional medical malpractice insurance. Clients: Just ask the nurse registry to give you a copy of their policy showing the coverage regarding the independent contractors is in place. Ask them to also give you a copy of the independent contractors certificate of insurance showing the additional insurance coverage they’ve obtained.
Stupid Myth #4 – “The quality of the nurse aides (CNA’s/HHA’s) referred by nurse registries is less than those employed by home health agencies”.
Fact: The CNA/HHA that walked into your home health agency today, and who is subject to the same required screening process when they leave your agency and walk directly into our nurse registry tomorrow, didn’t just pop into the bathroom and drop-off her “quality” or “professionalism” or “dedication” along the way. Every agency and nurse registry in Palm Beach County pulls from the same pool of available workers and many work for both business models simultaneously. More stupid stuff.
Stupid Myth #5 – “If you have Workman’s compensation coverage, you can’t be sued and the client is protected”.
Fact – We live in Florida. Speak to any personal injury attorney and you will find that regardless of whether a Worker’s Compensation insurance policy is in place, when someone is hurt on the job, everyone is sued. The client is no more exposed by using a registry than they would be if they used a home care agency. Even though a home care agency carries worker’s compensation the client can still be sued by either the caregiver and/or the workers compensation carrier, and unfortunately, usually is. At ElderCare at Home, the independent contractors that register with our agency have agreed to provide their own worker’s compensation insurance and have also agree that should they fail to do so, they will not hold their clients liable in the event they’re injured on the job. But at the end of the day, in the event of a claim, it’s likely that despite it all, and regardless of whether a worker is an employee or an independent contractor, everyone will be a target.
Stupid Myth #6 – “Most long-term care insurance policies do not cover nurse registry’s (sp) due to the danger of this model because of the lack of accountability”.
Fact: You’ve got me rolling on the floor laughing over this one! Can you please just go educate yourself once and for all? For over a decade Florida law has required all long-term care insurance companies who do business in our state to cover nurse registries. Here, let me help you…
Florida Statute-627.94071 Minimum standards for home health care benefits.—A long-term care insurance policy, certificate, or rider that contains a home health care benefit must meet or exceed the minimum standards specified in this section. The policy, certificate, or rider may not exclude benefits by any of the following means:
(5) Requiring that a licensed home health agency provide services covered by the policy that can be provided by a nurse registry licensed under chapter 400.
Stupid Myth #7 “Nurse registries don’t do….. background checks, testing, screening, blah blah blah….”
Fact: This is exhausting and I’ve definitely learned that for some people in this industry, you just can’t fix stupid. Go read the regulations. The laws. The statutes. Or better yet, don’t! Just try focusing on figuring out a better way and more professional way to play in the sand-box. Because like it or not, ElderCare at Home will continue to grow and expand and take more and more of your market share, by providing Better Care, at a Better Price, with Better Value, than YOU!
Now I’m going to go back to work, put my head down, and continue to spend my days doing what I love with the professionals who share my passion for meeting the needs of those in our community who are trying to just get through one more day of living and coping with Alzheimer’s disease. And let’s all hope that we can go at least another couple of years before another blog post shall we?
Founder & President
P.S. Now before those of you that think this is all about “you” go do more stupid stuff or fall back into craziness, just take a deep breath. I’ll be happy to throw up the white flag and concede any errors contained in this post, just as soon as you pop on over to my office and, in a calm and professional manner, present me with the written facts to back up your current fiction.