Source:, The Academy of Special Needs Planners

Attendees of the April 2024 National Conference of the Academy of Special Needs Planners (ASNP), held in Austin, Texas, heard from experts in the special needs planning field on such diverse topics as divorce and child support, pooled special needs trusts, and tax awareness.

In a comprehensive session titled “Maximizing Benefits, Hiring Appropriate Caregivers, and Other Practical Advice,” presenters Ann Koerner and Cheryl Severson covered issues related to the costs of caregiving as well as effectively hiring and managing caregivers. The following highlights offer a glimpse into their talk.

Paying for Caregivers

Amid a shortage of direct care workers, caregiver costs have only increased across the country since the COVID-19 pandemic. Today, the average hourly cost of a private-pay caregiver is between $20 and $25, though it can run higher in cities like New York and Los Angeles.

As Koerner, CEO and founder of National Care Advisors, explained, there are several ways to pay for and staff caregivers, including through public funding or a trust. Oftentimes, she pointed out, families must rely on a combination of third-party benefits, family caregivers, and private-pay or trust-funded caregivers.

Some clients resist the idea of public benefits and working with programs like Medicaid. Yet, she said, “the reality is that we need to help people navigate those programs because their value is significant.”

Hiring Private-Pay Caregivers

Koerner, along with Severson, who serves as chief customer officer and head of human resources for TEAM Risk Management Strategies, offered up a refresher on various public benefits programs in the context of long-term care. They also provided tips on maximizing third-party payer sources and benefits; discussed how different funding sources may end up dictating the structure of a client’s employment relationship with caregivers; and examined ways to minimize employment-related risk overall.

First and foremost, they stressed, the focus must be on making sure that the individual requiring care will get their needs met.

As a starting point, National Care Advisers works with families, their advisors, and others to complete a caregiver analysis. This involves reviewing medical documentation, talking in depth with the family and medical providers about the individual’s functional ability and care requirements, and projecting what funding sources will be available for their care in the future.

If a family member will potentially be hired as the caregiver, this stage is just as important. The analysis helps “determine if that family member really is going to be able to serve as the best possible caregiver,” Koerner said.

When moving on to engage in the hiring process for potential caregivers – including for family members – some of the best practices Koerner and Severson recommend are the following:

Planning Stage
  • Clearly outlining all job duties and expectations
  • Identifying the qualifications needed in an ‘ideal’ candidate
  • Writing out interview questions in advance

Set expectations for the family as well, Severson advised. No matter what, the family will need to train the caregivers. “Even if they’re a skilled nursing or someone with lots of experience,” she said, “they don’t know how Mom and Dad like things done.”

Interviewing and Vetting Candidates
  • Asking every applicant the same questions
  • Rating all applicants against one another
  • Avoiding assumptions
  • Checking references
  • Running background checks (including for family caregivers) as a final step

“We all have a vision. We want 24/7 care and the best caregiver we can find,” said Koerner. “But a lot of times, we can’t actually afford that, No. 1; and No. 2, there’s a shortage out there.”

Managing Caregivers: Employment Relationships and Liability

Once a caregiver employee has been hired, the client should ensure they have a detailed care plan in place. It should document everything from specific day-to-day tasks to policies to the methods the employee and employer will use to communicate.

One of the most important aspects of supervising employees relates to payroll, which Koerner and Severson also discussed. Collecting timecards for employees, paying at an hourly rate, and paying at least minimum wage are all as essential to managing an employee relationship as mitigating any risk.

“When we’re managing private-pay caregivers,” Severson told attendees, “there is inherent risk involved.”

For instance, maintaining records of when caregivers are working can be the “best defense” in an unpaid wage claim. “You should be able to match up, essentially, your pay stubs with your timecards, and adhere to all the various overtime and minimum wage laws,” Severson said.

She also cited one real-life example where a caregiver seriously injured herself falling at the home of the family who was employing her. In this particular case, the family had no choice but to cover the caregiver’s medical costs using trust assets meant for their loved one with the disability.

“There’s no such thing as ‘just’ payroll,” Severson said. “There are strings attached when there are regular payments going to an individual who is providing services.”

When problems arise, their best advice is: “Do not brush these under the rug.” Address any issues right away and with discretion – and know when to bring in a professional. When necessary, Severson said, “find a trusted expert and engage the services of an employment attorney.”