nurse registry vs. home health agency

Nurse Registries compared to Home Health Agencies

Many Florida Nurse Registries compared to Home Health Agencies have not been very forthcoming in disclosures to clients related to the scope of services and nature of their business. I will highlight some of the key differences that are often not being disclosed. Recently the Florida’s Agency for Healthcare Administration has updated the regulations for Nurse Registries. Also the U.S. Department of Labor has a program to reduce the improper classification of employees as “independent contractors”

Nurse Registries often refer to themselves as a home care source or a home care services company. This is the definition From ACHA: A nurse registry as defined in 400.462, Florida Statutes (F.S.). is an agency that offers health-care-related contracts for registered nurses, licensed practical nurses, certified nursing assistants, home health aides, companions or homemakers who are paid by fees as independent contractors. 59A-18.010, F.A.C. (G 180).

The following chart illustrates some of the key differences between a nurse registry vs. home health agency in Florida for more detail click here “How Are Florida’s Different Home Care Providers Regulated, May 2015” and the “Summary of updates to Chapter 59A-18 Nurse Registries Standards and Licensing”.

Home Health Agency – Partners in Healthcare	Nurse Registry
Homemaker, HHA, CNA, LPN, RN, Social Work*. PT*, OT*, DME* Dietetics and Nutrition* Typically with Certified Agency	Homemaker, HHA, CNA, LPN, RN only
Liability and malpractice insurance is required up to $250,000 per claim – Yes	No, Nurse Registries only have independent contractors.
Supervisory visits by an RN are required. – Yes	No, the nurse registry must advise that an RN is available at an additional cost.
Director of Nursing required? – Yes!	No
Are there general quality assurance requirements? – Yes	No
Nurse on call During hours of Patient Service? Yes	No
Is staff training required on Alzheimer’s disease and other disorders related to dementia? Yes	No
Required to monitor, manage, supervise or train RNs, LPN, CNAs, HHAs, homemakers and companions. Yes	No
Must review all patient and quality records.	Nurse registry is not obligated to review the patient or client records. per 400.506(20), F.S.,
Hires or trains homemakers and Companions.	59A-18.009         Homemakers or CompanionsRemoves the requirement for hiring trained homemakers and companions, as has been done for home health agencies.
Homemaker and companions are trained, unusual incidents or changes in the client’s behavior are reported to the agency.	Changes that any unusual incidents or changes in client’s behavior are reported to the person designated by the client, and not to the nurse registry.
Homemaker and companions must understand the needs of the clients and recognize the conditions that should be reported to the Home Health Agency.	Removes the requirement that homemakers and companions understand the needs of the clients to who they are referred and recognize conditions that should be reported to the nurse registry office.
Accredited by either the ACHC, CHAP or Joint Commission. Partners is accredited by ACHC.	No

Nurse registries call this a “client centered care model”, a fancy way of saying you are the employer. As an employer you take on all the risk, management, training, and liability of an employer to comply with State and Federal laws and regulations.   Home Health agencies like Partners in Healthcare train their employees; provide professional liability and Workers Compensation insurance. Plus we pay for unemployment insurance and most importantly we manage the employees. We develop the customized care plan, update the plan, train the caregiver, introduce caregivers, review caregivers and terminate caregivers if necessary.

Do you want to be an employer and deal with employee insurance, training and development, management and monitor state and federal employee laws and regulations? The following is an example from the US Department of Labor related to employee classification:

Section F. What is the Nature and Degree of the Employer’s Control?

Example:

Scenario 1 – A registered nurse who provides skilled nursing care in nursing homes is listed with Beta Nurse Registry in order to be matched with clients. The registry interviewed the nurse prior to her joining the registry, and also required the nurse to undergo a multi-day training presented by Beta. Beta sends the nurse a listing each week with potential clients and requires the nurse to fill out a form with Beta prior to contacting any clients. Beta also requires that the nurse adhere to a certain wage range and the nurse cannot provide care during any weekend hours. The nurse must inform Beta if she is hired by a client and must contact Beta if she will miss scheduled work with any client. In this scenario, the degree of control exercised by the registry is indicative of an employment relationship.

Scenario 2 – Another registered nurse who provides skilled nursing care in nursing homes is listed with Jones Nurse Registry in order to be matched with clients. The registry sends the nurse a listing each week with potential clients. The nurse is free to call as many or as few potential clients as she wishes and to work for as many or as few as she wishes; the nurse also negotiates her own wage rate and schedule with the client. In this scenario, the degree of control exercised by the registry is not indicative of an employment relationship. 

Most Florida Nurse Registries use scenario 1 in their relationship with the client and the caregiver therefore that caregivers are treated as employees (this is not allowed by AHCA or US Dept. of Labor). You have to decide if for you or your loved one do you want to take on the “client centered model” or do you want the freedom to focus on your health or that of your loved one, and let Partners in Healthcare an accredited RN managed Home Health Agency manage your care?

The nurses or Certified Senior Advisers at Partners in Healthcare are available to speak with you about your in-home senior care needs including how to stay healthy at home with RN managed affordable care. We are a private duty home care agency that provides pediatric to elder home care services in the Orlando area; call us at 407-788-9393.

Hank Charpentier – BS Business, MBA, MA Marketing

Certified Senior Adviser, Administrator and Co-owner