Question: In order to be able to take better care of my father who has dementia, my mother hired a homecare assistant through a regional hospital that serves as my parents’ medical care provider. The woman has been most helpful, professional, and friendly; however, after three weeks on the job, when Mom got comfortable with her and mentioned that she had considered increasing the number of home care visits each week, the woman suggested that rather than continue to hire her through the hospital, Mom could save money by paying her directly to come in on her own time. She told Mom it would be a “win-win” situation because Mom would be paying less while she would receive more than the hospital was paying her per hour.

Thankfully, Mom asked me my opinion, and I gave it to her by making a list that we went over and that I thought might be helpful to your readers if you choose to print it:

1) I warned Mom that in addition to opening herself up to liability, I was sure there were probably tax and labor laws to consider. For example, by hiring through the hospital, if the homecare assistant hurt herself on the job, the hospital would be on the hook to take care of her through Worker's Compensation. However, if she was hired directly and got hurt, she might be able to sue Mom and Dad for her medical expenses. And, with things as they are today, who knows if the "injuries" would be real or staged in order to get a lawsuit going against elderly people who are vulnerable.

2) Even if this lady was a saint and would never do such a thing, the fact that she would be working "off schedule" for direct pay suggests to me that her availability may become unreliable. To avoid conflicts with her regular work schedule, she might not be available at preferred times of the day or days of the week.

3) My sisters and I view this behavior as a breach of ethics, which leads us to believe that since this woman would be willing to secretly take work away from her employer, she is not to be trusted. This is redoubled since our parents live in a rural area, about ten miles away from the nearest town. Even giving her the benefit of the doubt -- that this was a momentary lapse of judgment on her part -- what happens if Mom and Dad become dependent on her and she begins raising the price of her services or does something else that causes my folks to get someone new who won’t be informed about the whole situation? The last thing Mom and Dad need right now is additional stress caused by surly homecare assistants who become dominant in the relationship. Or worse, what if she has plans to hurt or rob them? They are defenseless.
My mother, I assume like many parents of today, tells me that she is not interested in me “parenting her,” and has decided that she will not terminate this woman. However, Mom is worried about the liability issues and will keep the woman on through the hospital service.
For now, I will have to leave it like that because I think I have gone as far as I can without ruining my relationship. Still, I have concerns about how convincing that woman can be because she has my mother’s attention and support. I live several hours away by car, so I can't keep an eye on things as much as I'd like. My sisters and I are trying to talk our parents into selling their acreage and moving into town where they will have more health care options, but that is also a struggle.

Now that I have done it, I'd like to know if you think I am off base with my analysis of this situation. Do I have valid concerns? Are there additional concerns that I should be aware of?

Answer: We are printing your letter, with minor edits, because we believe you have hit the proverbial nail on the head. This is first time we can remember printing the answer as the question.