Home Health Agency vs. Nurse Registry

In Florida there are three general types of companies providing home care; Home Health Care Agencies, Nurse Registries, and Homemaker Companion Services.

Home Health Agencies hire their own employees. Employees are scheduled to care for clients, under the management and supervision agency staff, including Registered Nurses and Physicians.

The agency is responsible for workers compensation insurance, the employer portion of FICA (social security taxes), Federal Withholding taxes, and unemployment taxes. In most cases Agencies also carry general liability insurance and a dishonesty bond, which afford additional coverage for employees and clients. It is rare, but not entirely unheard of for Agencies to also provide health insurance and paid vacation for their employees. The employer (agency) is responsible for all risks associated with work performed by the employee.

Agencies must assure that the employee has the right to work in the United States, is free of communicable diseases, has the requisite training to perform services required, and has a background free of criminal offenses. It is also common for agencies to competency test their employees, and to provide continuing education (depending upon the type of agency). Agencies can provide all levels of care from custodial to the highest level of skilled care in the home.

Nurse Registries

Nurse Registries arrange for the services of home care workers, on an independent contractor basis. These workers are directed to care for clients; they are not employed by the company. This means the registry is not responsible for workers compensation insurance, FICA and Federal Withholding taxes, and unemployment taxes; either the client or the independent contractor worker is responsible for these items. Workers must maintain their own employment benefits/taxes. There is no company insurance coverage for liability or theft in the home.

There is much ambiguity about the true status of registry workers. Clients, their representatives or their estates can be construed as an employer in this arrangement, and can be held liable for providing the above employment benefits/taxes. Clients still have exposure to risk when they employ individuals from a Nurse Registry.

Registries should (but are not required to) ascertain if the worker has the right to work in the United States. Registries are not required to supervise their workers.

The difference between Agencies and Registries is in the nature of the employment relationship. Agencies provide employees, with all the insurance and protections while registries provide Independent contractors which are not insured or protected, and it is unclear who exactly the employer is.