The Big Four: Common Myths About Nurse Registries, and the Facts

When families start calling around for in-home care, they often hear the same four warnings about nurse registries. Most of them come from competitors who may not fully understand how nurse registries work, though they probably should. Whether it is misinformation or disinformation, the result is the same: families are not getting the full truth. I developed this guide for the Private Care Association, together with attorney Russell Hollrah, to help families get straight answers.

Myth 1: Agency caregivers are supervised

Some agencies claim to supervise the caregivers they send to a client’s home. But no one can truly supervise a private caregiver in your home without physically being there, and in reality that seldom happens. It is impractical.

In-home care is most typically supervised by family, friends or guardians, sometimes with the help of technology. The “supervisory visits” some agencies arrange are generally an occasional drop-in of up to 20 minutes, and only periodically. Who is supervising the caregiver between visits? A monthly pop-in visit does not equal supervision.

In practice, supervision comes from the people in the home: family members, a spouse, or the client. Every nurse registry should take client requests and concerns seriously and act as the client directs, so the client receives the support and care they want.

Myth 2: Caregivers with a nurse registry are not insured

If someone tells you this, you are being misled. Professional caregivers who receive client referrals through nurse registries commonly maintain their own professional liability insurance.

You probably should request it. When you ask for a referral, let us know you want a caregiver with their own insurance, and we are happy to match you with one who carries it. It is simply one of the things we match clients and caregivers on, along with schedule, experience and the type of help needed.

We strongly encourage caregivers to carry their own private malpractice policy. It protects both the caregiver and the client they are caring for.

Myth 3: Workers’ compensation will protect you if a caregiver is injured

A nurse registry that refers independent caregivers is not required to carry workers’ compensation insurance. But workers’ comp does not always provide the protection families expect, or are led to believe by someone trying to win their business under false pretenses.

If an agency employee is injured in a client’s home, workers’ comp prevents the caregiver from suing the agency and provides some coverage for medical expenses and lost wages. It does not necessarily prevent the injured caregiver from suing the client. Workers’ comp is designed to protect the employer, not the consumer. For the full legal detail, see the complete Big Four document linked at the end of this article.

And if workers’ comp pays a claim, a client could face legal action from both the caregiver and the workers’ compensation insurer.

Myth 4: If you use a nurse registry, you will be responsible for the caregiver’s taxes

Take your tax questions to your CPA, not to a marketing representative for a home health service trying to win your business. Nurse registries refer professional caregivers who work as independent contractors. These caregivers receive 1099 forms documenting their annual earnings, which are also reported to the IRS. Caregivers are responsible for paying their own taxes.

Past IRS data shows that independent contractors who receive a Form 1099 report about 97% of that income, compared with about 99% for employees who receive a W-2. Statistically, the difference is small.

Developed by Scott Strachan, RN, BSN, with attorney Russell Hollrah, for the Private Care Association. Tax data: IRS National Headquarters Office of Research, Interactive Tax Gap Map for Year 2001 (2004); U.S. Government Accountability Office testimony. This is general information only and is not legal or tax advice. Please seek your own legal advice before taking action based on it.