The Pros, Cons And Inevitability Of Caregiver Registries In Home-Based Care

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As in-home care providers try to keep up with the demand for services, companies that facilitate caregiver registries are hoping to fill a gap in an employee-needy marketplace.

However, it’s been unclear how prominent caregiver registries will be in the space, as there’s been safety and regulatory concerns.

Despite those concerns, however, companies that connect individuals in need with qualified caregivers are still making their push.


“I think of [our company] as a next generation registry – tech-enabled and solution-oriented,” Philip Marxen, owner and managing partner of Hallmark Homecare’s South Charlotte location, told Home Health Care News. “Whereas old-school registries make matches and typically stop there, we deliver significant additional value.”

Hallmark Homecare is a North Carolina-based at-home care recruiting company that connects caregivers with patients.

Essentially, companies like Hallmark Homecare maintain a database or registry of caregivers who have been screened, background-checked and evaluated on their skills and qualifications.


Those companies then use referral sources to connect caregivers to patients in need of in-home care based on specific needs and preferences.

Oftentimes, that caregiver is responsible for a lot of the backend work that typically comes with being a contracted worker. Hallmark has tried to address that.

“Though we are a referral agency and our caregivers are independent, the solution Hallmark provides is comprehensive,” Marxen said. “That includes geo-tracking when people clock in and out, electronic time sheets with information for long-term care insurance reimbursement claims, tax reporting, insurance and ongoing liaison services to help troubleshoot and assist with call-outs.”

Registry companies also have the ability, when executed correctly, to lower the costs of care for families, Marxen said.

“Hallmark has a unique model for in-home care — it’s sort of a combination of the best of traditional agencies and registries,” he said. “Like a registry, we cut out the middleman. This enables us to find caregivers higher paying jobs while reducing the cost of care for families. Our consumer-direct model enables the continuity of care seniors need and that agencies struggle to deliver due to a shortage of qualified caregivers.”

Pros and cons

There are pros and cons to every model.

For caregiver registries specifically, payer diversification may prove to be a headwind.

“Registry businesses are asking themselves how they’re going to navigate what we’re seeing, which is a much more diverse payer environment,” HCP President Todd Austin told HHCN. “Private pay-based home care, although that market is growing, you’re seeing providers focus more on long-term care insurance, for instance. In that model, registries will likely be left out of that.”

The issues concerning oversight, safety and supervision are still real, Austin added.

The leaders of registry companies say the same.

“It’s a huge concern,” OndeCare CEO Nicole Paolozzi told HHCN. “We can’t send scary people into other people’s homes. I never ever want to do that. That would keep me up at night.”

OndeCare is an Ohio-based registry of in-home care services that recently expanded into the Washington, D.C. market.

OndeCare wants to be the “white-glove Uber of in-home family care,” and is taking a gig-economy approach to the way caregivers are deployed for in-home care services. In order to do that, it is critical for Paolozzi to make sure the company is doing everything it can to ensure caregivers are correctly vetted.

In order to work for OndeCare as a caregiver, applicants must have some type of applicable credential and a minimum of three years of related experience. They must also go through two rounds of interviews and have multiple references interviewed by the OndeCare staff.

“The average amount of experience on our staff is about 10 or 15 years,” Paolozzi said. “We’ve got the tenured ones. We know we can’t train them, but we can ensure that they’ve got the experience and the qualifications to do the work. After they pass the second interview, we interview the references and those quotes from references become their first reviews on our platform so that helps their NPS score, but it also helps us get an understanding about the professional. Are they professional? Are they reliable? Because we’re sending individuals into people’s homes.”

Paolozzi has also started to think strategically about how OndeCare can be used to help other employers retain their employees.

Two of the largest employers in Ohio — University Hospitals and the Cleveland Clinic — offer their employees OndeCare as a benefit. Essentially, those two systems are a referral partner.

“My long play for that is actually to have them start to subsidize this care,” Paolozzi said. “They would pay for the in-home family caregivers so that their employees are retained, essentially. That way, their nurses and other employees don’t have to opt out and add to the great resignation, or opt out because of unplanned absences of care.”

Looking ahead

For patients who could benefit from this kind of direct-to-consumer model, accessing caregivers hasn’t always been easy. Especially for veterans through the U.S. Department of Veterans Affairs (VA).

The VA has essentially blocked members from using nurse registries in the Community Care Network (CCN). However, a new bill from Sens. Marco Rubio (R-FL) and Tommy Tuberville (R-AL) would reinstate veterans’ access to caregivers operating as independent contractors by making any nurse registry eligible for the CCN.

“When our country’s heroes need medical care in their own homes, they should be able to decide what kind of service is best for them,” Tuberville said in a statement. “This bill fixes an obvious error that’s forcing veterans into one-size-fits-all home care programs instead of giving them the options they deserve. Having care in the home is an important and personal decision. Veterans deserve the freedom to choose a home care provider they trust.”

And, while registries and similar models have a purpose, it’d be a stretch to say they can help solve the caregiver shortage in home-based care, Austin said.

“I think our staffing issues are more pressing towards how we communicate what we do and how we do it rather than 1099 versus a W-2,” he said. “I think the momentum in the employment crisis in our industry isn’t associated with registries. It’s associated with communication, value creation and just intentional focus on employees and education.”

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