Date: December 6, 2019

Author: Arthur Moseley


The Nurse Registry Model

In order to bring you the highest value at the lowest cost possible, we use the nurse registry model. The caregivers we refer are independent contractors. We occasionally get some questions concerning the model. Below are some of the most frequent, with our position on each. If  you have any concerns, we encourage you to read the notes below and then go to our websites and and check out our background, services, and more. While there, please read our reviews. We are very proud to have over 50 reviews between Google, Facebook, and GatherUp with a combined rating of 4.9 out of 5! Regardless of model used, you won’t find another home care company in Tampa Bay that compares.

Nurse Registries aren’t licensed, bonded, or insured

This is not true for our Griswold Home Care office.

Licensed: In Florida, the Nurse Registry is licensed just like the non-medical home health agencies. Most of the regulations are the same. In fact, a few are looser for the HHA vs. the registry.

Bonded: This is a company by company thing. We have elected to pay for bonding and it covers the caregivers as well as our staff.

Liability Insurance: This varies by company. We have chosen to insure our office at a level similar to most competitors, $1m per occurrence and $3m in aggregate. This covers us for all acts of the staff and the caregivers we refer. About 50% of the caregivers we refer also carry their own liability insurance. If that is something a client wishes to require, all they have to do is make it one of the referral requirements and we ensure it is in place before referring any caregivers.

Worker Comp: We carry workers comp on our staff. WC is not available to the referred caregiver since they are independent contractors. However, they can purchase or obtain Occupational Accident and Health Insurance. It covers them if injured on the job. Most caregivers do not carry this, but it can be obtained within a matter of days. It costs the caregivers about $9 per week so what most do is add 50 cents an hour to their normal rate. Note: Some of our competitors like to influence prospects by saying “Oh, you don’t want to work with a nurse registry. They use independent contractors. They don’t have workers comp so if they get hurt helping you they can sue you.”

Three comments here:

  1. The only entity someone can’t sue is the company giving them the worker’s comp. In the case of a Home Health Agency, it is the agency itself. So, there is nothing stopping the caregiver that gets hurt from suing a client regardless of whether they are an Independent Contractor or an Employee!
  2. One would think the Home Health Agency caregivers would be less inclined to sue since their injury was being taken care of but that is not necessarily the case. We have been in business for 12 years, worked with over 1000 clients, referred over 400 different caregivers to cover over 150,000 shifts (over 2 million hours) and never had a caregiver sue a client.
  3. One of the reasons for the above results is the caregivers know they aren’t covered by worker’s comp and are very selective about who they work with. They will turn down a referral for someone they think may put them at risk rather than risk injury. Likewise, one of the reasons we spend so much time with the caregivers we refer and our clients is so we minimize the opportunity for injury to happen to begin with.

Their caregivers aren’t trained

While it is true a Nurse Registry cannot train the caregivers it refers, it is NOT true that the caregivers are not trained. Our whole reputation is built upon how well we screen the caregivers in our pool, how well we know their skills and experiences (their prior training), and how well we match them with the requirements of our clients. You don’t receive a 4.9 Five Star Rating with over 50 reviews by referring untrained caregivers to 1,000 clients over 12 years. One follow up note: most of the caregivers we refer are 40-60 years old with 7-15 years of experience. A large portion have been on our registry for 4-5 years.

Home Health Aides (HHA): In some cases, you may argue that the caregivers we refer are better trained than those employed by a Home Health Agency. CNAs are licensed and have a standard curriculum. That is not true of HHAs that are employed by a Home Health Agency. They actually can make a caregiver a HHA just by their nurse giving them a certificate! This leaves the quality of the HHA subject to the standards/Integrity of the Home Health Agency. With Nurse Registries, we can only refer HHAs to perform personal care that have graduated from a state approved school meeting the curriculum set out by the state.

They refer and defer/They don’t follow up

That is not how we operate. We start by understanding the client’s needs and requirements, we relay them to the caregiver on their behalf,  and then we follow up with the client and their family/care manager to ensure their needs are being met. The two nuances are:

  • We follow up with the client (not the caregiver)
  • And, we do it from a client satisfaction basis (vs managing the caregiver)

If a caregiver calls out, the client has to secure their own replacement

That is not true. We work to the client’s requirements.

  • Some clients tell us they want the caregiver to call us and they always will need a replacement referral
  • Other clients work everything out with the caregiver
  • Still other clients have us call them and give us direction by occurrence.

You (the client) have to manage the caregiver

Two notes:

  • It doesn’t matter whether someone is working as an independent contractor or as an employee, it is often better for the person affected (the client or family member) to deliver the coaching. They know what is working and what isn’t and can deliver real time feedback.
  • The above, however, is not always practical. So, while a registry should not be managing an Independent Contractor, they can act as the Client’s Agent and deliver messages on their behalf. “The client called and they have asked that you do the following.” “The Client is making a change and will no longer require your services.”  Our clients are never left to handle these things on their own. We assign each client their own Referral Coordinator and they assist the client as needed.

Use of a Care Manager/Aging Life Care Professional

Our model, as executed by us, works well for 85-95% of the families requiring service. And, it does so in a very cost-effective manner. There are a small number of instances where there is no family support and the client’s needs require real supervision (not client satisfaction calls/visits). In those instances, we either have to refer the client to a home health agency that can provide the requisite supervision or we need the client to secure the services of an Aging Life Care Professional to provide the missing level of supervision.

Date: December 6, 2019