Potentially a senior can save significant money by hiring a companion recommended from church or their neighbor’s friend who has been out of work. It’s a win/win for everybody – right? Wrong! What is their recourse if this win/win situation starts going badly? There is no boss or company where they can voice concerns.
Last week, I attended the Care Revolution Conference in Anaheim, CA and met over 20 home care company owners and managers. One manager shared that the majority of her potential caregiver applicants do not pass the drug screening. I was shocked. Another home care owner shared that 40% of the remaining applicants don’t pass the criminal background check. Reputable agencies have a vetting process so a senior can have confidence about who is in their home providing care.
Home care owners shared with me that seniors who hire a caregiver “under the table,” become employers and are responsible for taxes and social security of their employee. Seniors should check with their accountant and consider the ramifications of paying quarterly taxes for an employee. Initially, it may sound like a bargain to pay a caregiver “under the table.” Seniors need to consider the long-term financial consequences and legalities. It seems crazy to me that a senior needing help would become an employer and have to pay quarterly taxes.
If a caregiver claims a work injury while working for a senior, costs can climb upwards to $300,000 after surgery, therapies and loss time from work. Some caregivers work for multiple companies, so one never really knows if the injury was from working for the senior or another employer.
Here’s a shout out to those reputable home care companies who provide great care to seniors! I had no idea how hard it was for you to find and hire quality caregivers.
This is an excerpt from my new guide book for seniors, “Selecting Senior Housing for Seniors in the Silver Tsunami.” It will be coming soon to Amazon.com. If you sign up for my weekly newsletter on the right side of this blog, you will be notified when my new book becomes available. Check out my new website: Tips2Seniors.com or please follow me on Facebook
Photo credit to Moretimeforyou.com
Diane Twohy Masson writes this weekly blog to support and engage with other senior housing professionals. Her first book is Senior Housing Marketing – How To Increase Your Occupancy and Stay Full. Many sales teams and organizations have used the 12 keys contained in this book for their weekly book review.
If you are hiring someone “under the table,” that generally means that you both agree not to file or pay taxes on the money exchanged for services. This is obviously illegal. If you do hire a caregiver without using an agency and you file and pay taxes properly, this is not considered hiring “under the table.” It is true that it is helpful to have an agency screen applicants and help you with the tax and other legal aspects of having an in home caregiver. However, not all caregivers found without an agency are bad or are avoiding drug screenings or background checks. I, myself provided excellent care for a senior and did not go through an agency. This usually works best when you have a personal referral or use a site like care.com to find a caregiver. The senior I cared for was able to run a background check on me online. There is also accounting software or online services that help seniors navigate tax issues and generates pay stubs for their employees.
Good point Mariann! Most seniors do not know the the tax implications of hiring someone on their own. It is wonderful that you help advise your clients through this process and explained how they could properly check your references. Please read the other comments. It shows both sides.
As a 30+ year Employee Benefit/HR professional, I completely agree with the legal dangers of hiring a caregiver “on the side”. However, as a 60-year old working mom and daughter caring for three elder relatives, I have experience with Assisted Living staff and home health/companion services and, frankly, most of the folks I’ve worked with are nice but just not the caliber I’d like. When I ask how much they are paid, I see why the profession is where it is. $9-15 per hour. And no guaranteed hours per week. That comp arrangement does not draw people with a high level of skills. So, if you can hire a talented retired nurse you know from your church, an “empty nester” mom in your neighborhood, someone who has cared for a friend of yours’ parents for years, etc who you know and respect and you can pay them $25 per hour or more for top notch care, it is soooooo tempting!
Ahh, tempting. Each situation is unique. You know more than most as a HR professional. A senior with dementia does not have the cognition to process whether someone is quality or not. Elder abuse out there is rampant. One of my co-workers had a client who had over $300,000 in jewelry stolen by a caregiver. The family fired her, but they never recovered the heirlooms.
The problem is also that if you are a true blue, all good credentialing private care person, you can’t live on 9.00 or 8.00 per hour that the home care companies want to pay you under their “home care”.
Good point. Good caregivers are not paid enough. How do we fix this?
By compensating properly is a good start.
This is so true, and for qualified care workers that are called to this the burn out rate is 6 years…..add to that the money spent on gas and driving time from client to clients home in a day,makes this unprophitable.The health care agencies make a good wage or there wouldn’t be so many,wich is unfair to the frontline worker,they feel taken advantage of.
Great article! Your observations are spot on. Awareness of these potential hazards are often learned after it’s too late and much of the damage is already done!
Be careful and have a rock solid vetting process! We just had a wonderful applicant that interviewed by 4 of our staff and we all loved her. Even though we explained our background screening process in advance, it was clear that she was betting on the fact that we would not follow through on our own internal screening process. Wow were we surprised to the the list of felonies that popped up on her Criminal Background Check…..Be Careful!!
Interesting story Allen. You did everything right and were still surprised.
From Linked In – Senior Care Services Company
Diana Beam
Founder, Keeping In Touch Solutions | Elder Care Strategist & Problem Solver
This is buyer beware if not using a reputable home health care agency.
Those drug and criminal background check numbers are alarming.
Jenette Laidlaw
Seniors Care Professional/Companion to Seniors
I agree totally with the article. However, there are private individuals like me who work with seniors (not under the table) but will provide them with weekly invoices so that they can claim income tax back from the government. Weekly progress reports are also submitted to the client’s family. Most importantly, they are provided a police background check and health report from my physician. I believe that it is utterly wrong to take advantage of the elderly.
Stanton Lawson
Co-owner & CFO at Sequoia Senior Solutions, Inc. Home Health Care Providers
That’s great, Jenette. Do your clients also withhold Income Taxes, Social Security, and all those other things that employers MUST withhold? Caregivers are household employees and as such, their clients are actually employers and must, by law, follow all of the rules and regulations of all us other employers.
It is a tricky issue and one that makes a huge difference on how much agencies must charge their clients compared to how much a private caregiver must charge. If done correctly, the difference isn’t huge. When the caregivers do things incorrectly, people can be fooled into thinking that they’re saving a lot of money…only to wake up one day with a huge liability.
Shekhar Gupta
Global executive mgt experience from early stage startups to established PLM- currently involved in LBS, IoT, & Big data
Hit it spot on. Covered most all points. I would also like to add that if that individual gets sick, you are out of luck vs going with an agency, the agency will not leave you hanging.
yvonne woody
Principal, Best in-Home Care
Under the table caregivers compete with us for our caregiver jobs. We are inspected by the state every 2 years, go through the cost of the state license and the reams of regulatory compliance the State expects from you or you lose your expensive license. These rogue caregivers do not have to go through any state regulations, no continuing education hours, no back ground checks. Yet for the difference of $5.00 an hour or less, these people are allowed into the Seniors home by the same state that puts us through rigorous and expensive inspections. Can someone explain to me why this is allowed. There should be a law against these rogue caregivers giving care without a license.
Jenette Laidlaw
Seniors Care Professional/Companion to Seniors
Sorry folks, as a Canadian, what I am doing is entirely legal and I have my preferences whether or not I choose to work for an Agency. It’s not the average private caregiver as you are thinking. I do have a degree in Gerontology and choose to care for the elderly (by the way, I am retired and enjoy doing this). I have gone through the process of contacting the Province and was given the green light to do so as long as it’s treated as a business and not “under the table” as some people are doing. If I earn a certain amount per year I must pay the GST portion to the government. When my accountant does my income tax return I have to pay the required CPP, UIC or any other taxes due to Revenue Canada. So, before anyone judges me, these are the facts. Thank you for your comments.
Pat Rapp
Owner, A Better Solution Of Venice
Great topic one more thing if they fall in your home or on your property the owner is responsible for medical and potential lost wages. With an agency that has w-2 employees not 1099, carries workers comp and liability! That way the senior is protected from any liability.
Anita Redline
A. L. Redline Law Office
When the vulnerable adult suffers an incident under the “caregiver” that results in serious injury or death: What can the family do to receive possible damages via a lawsuit? What happens when the State gets involved through the various vulnerable adult administrations? How will insurance policies provide benefits or compensation? What legal and financial protection is there for the “caregiver” as well? Although more costly, hiring a caregiver through legitimate process will, usually, prove to be the safest and smartest choice.
From Linked In – Home Care and Healthcare Advocacy
Scott Greenberg
president at ComForcare Senior Services
Dr Vigeant your good experience notwithstanding hiring privately is a risk no one should assume for all the reasons stated above. Just look at the statistics across the country and read the accounts. They’re heartbreaking. If you wouldn’t let a plumber or electrician in your house without proper licensing and insurance why would you allow a caregiver for your loved one not to mention that taxes due aren’t being paid raising my taxes and I might add yours. Don’t do it and don’t support the practice please
Vladimir Aizikov
Director at Staffmed Solutions Inc.
The public awareness and knowledge regarding personal care is important. We deliver to families the message to hire professional services as we are fully aware of outcomes of hiring “strangers” for low under table pay. The industry standards require certain qualifications as we are dealing here with family members, loved ones and wish the best for them.
Dr. J. Vigeant
Founder/Executive Director of Non-Profit at Ron Sills Memorial Ministries Hospice
Fortunately Mr. Greenberg, I have the courage and conviction to do what I feel and believe is right at the time and it works out well to everyone else’s astonishment.
Scott Greenberg
president at ComForcare Senior Services
Ahhh Dr Vigeant, if it only it were so for everyone else. Congrats on your good fortune but this forum I believe addresses the needs of the community as a whole and so I will have to continue to disagree but everyone is entitled to their story. I hope your good fortune continues
Brett Frankenberg
Program Director at RehabCare
The discussion should be framed from the point of the Senior needing care, as opposed to the one providing care. So, with all due admiration and respect to Dr. Vigeant, hiring unlicensed, independent contractor is a practice that exponentially increases the risk to Seniors who do so at a time when they should be as risk adverse as possible.
There will always be those whose intentions are truly altruistic, however there are also people who knowingly and willingly seek out vulnerable populations to exploit. This just a reality of the world we live in. To deny that this evil exists is beyond naive – it is flat out dangerous.
Ron Baker (CSA) Certified Senior Advisor
Asset Preservation, Medicaid Exempt Funeral Trusts, VA Accredited Aid & Attendance Advocacy, Life Care Funding Options
A what if: And a senior who falls into need for medicaid Nursing home; Has consideration been Given: that Medicaid may consider this $$ gifting and how it relates to ineligibility , without a caregiver contract and proof of services….
Diane Masson
Regional Marketing Director at Freedom Management Co.
Top Contributor
Great discussion. One of my colleagues recently had a client that lost over $300,000 in jewelry to an unlicensed caregiver. The family fired her, but they did not recover any of the jewelry. I know there are good caregivers who want to serve seniors. There are also a lot of people out there trying to make a buck off a vulnerable senior who may have dementia.
From Linked In American Society on Aging
Thomas M. Lorenz
Gerontologist, Owner of BeHome4Ever, Inc.
Very good points Diane. Thanks for sharing. I don’t have any problem with seniors having to pay the taxes on money they pay a private caregiver. This is commonly called Patient Directed Care, and it is a legitimate employment situation. It also levels the playing field for all of the home care agencies whom cannot skirt around taxes. One benefit of paying an agency or at legitimizing the employment of a family member or friend is that the money paid to them is tax deductible.
Kelly Fitzgerald
REST (Respite Education and Support Tools) Program Manager
I think that this happens because individuals have no where to turn, they need the help, they lack funds or resources, and they can trust their friends or church members who are willing to help! Caregivers are building their own networks of support. But you are right, often times these individuals are unqualified to safely take on the responsibilities. Training volunteer respite workers is an option for individuals and community organizations. We offer a train-the-trainer program called REST (Respite Education and Support Tools) (http://www.restprogram.org) We are currently working with many congregations, non-profit orgs, and more at creating networks of support for caregivers.
Diane Masson
Regional Marketing Director at Freedom Management Co.
Top Contributor
Thomas, do you believe a senior with dementia has the cognitive abilities to become an employer when they need help themselves? What happens if that caregiver gets injured and sues them? Most seniors don’t know the consequences of hiring a private caregiver. Some great comments have been posted directly on my blog from caregivers who do make sure the taxes are paid.
From Linked In – Home Care and Healthcare Advocacy
Edith Allen
Student at Walden University
I am a Caregiver and have been for over 20 yrs. I have in hospitals and nursing facilities as well as worked both with agencies and also as a private contractor. It is really comes down to intergrity and one’s work ethics and most of all eliminating the middle man. Because agencies usually do not pay caregivers what they are actually worth. Therefore I can better provide for my family based upon my quaility of care given to my client. And last but not least it is the satisfied family members who makes the future referrals when they know of someone needing home healthcare. Thank you!
Edith Allen Home Healthcare Provider
Lesley J Vestrich-Hudanish
Vice President Business Development/Marketing Professional in Healthcare Industry
Agencies pay care givers very well – infact they are contributing to the social security of the caregiver Many caregivers don’t understand the safety net the Agency creates for them
67 comes up pretty quickly . Itis nice to have a decent SS check each month to live on.
In addition if a care giver falls which happen to us on a live in case they are covered. The caregiver shattered the bones in her shoulder. Workmens Compensation covered her. What a blessing that is for our caregiver employees and at the same time protecting our clients from any law suits. Agencies get an A+ . As a business model agencies make far less profit because of the protection they are providing their caregivers and clients!!!!
Diane Masson
Regional Marketing Director at Freedom Management Co.
Top Contributor
Edith, it sounds like being a private caregiver is good for your family. What about a senior with dementia who has to become an employer and pay taxes? What about caregivers with multiple jobs who claim and injury and a senior now has a liability that can wipe out their limited assets?
From Linked In – Senior Assisted Living Sales, Marketing and Operations
Michael Connors- LVN, WCC, RNPC, RAC 3.0, RCFE
Client Services Coordinator at Harmony Home Care Sacramento
Hiring under the table, while at first might be cheaper then using a service.
You won’t have the same levels of scrutiny to this strangers background as you will find with an agency like ourselves.
Additionally you have no clue of the real skills set this person brings to the workplace where a company again like ours screens and will educate a good caregiver not only thru book learning but actual hands on training with a licensed professional nurse.
Cant say all companies have nurses to do this but some make do with laypersons doing the education.
Finally this person brings no protection in the forms of workers compensation, liability etc..
Using a company Like HARMONY HOME CARE is always well warranted for you and your loved ones safety.
harmonycaringservices.com
From Linked In – Elder Care Professionals
Kevin Stewart CFE, CSA
Owner, FirstLight HomeCare of North Dallas
Good article, but one key thing overlooked is Unemployment. If that caregiver is let go, the senior could be on the hook for paying that caregivers unemployment for its duration. If the senior passes away, their family (or estate) might have to pay it.
Roberta
Roberta Smith
—
I am very sympathetic to the high cost, especially when using an agency such as ours. I know I can never afford this arrangement. HOWEVER I have seen so many horrors from the ‘under the table private caregivers’ that even the idea makes me shudder. Money disappears, abuse, neglect, broken everything, law suits after ‘injuries’,moving others in, improper medication management …. on and on it goes! Try residential care in a licensed facility instead, or assisted living, or sell something so you can afford a supervised care giver covered by insurance and a background check!!!
James Kershaw
Reminiscence Facilitator
Presently I pay a friend to drive me to appointments. He’s fully insured and these are not long trips. Sometimes I take a Go bus which is almost free. compared to other kinds of senior bus travel. Other than that I live independently. In Canada if you need assistance in your home a health care professional will visit you. If you make under 30K you don’t pay taxes and whatever you might believe you can still live a good life with that.
Michael Elder
I know the temptation when looking at hiring a caregiver is to think of an “under the table arrangement”. The reality is that this can be risky business. Here are some things to consider: unemployment compensation; workers compensation; social security contribution; state and federal tax; and the list goes on. As the employer of this under the table employee you are responsible for these items and more.
Here is a practice example: Your under the table employee strains their back while helping you off the commode. Needs to have PT for 6 weeks. Who is responsible: you the homeowner since it happened in your home. Your guest medical coverage (if you have homeowners insurance) would come into play. Let’s say they fall down the steps and end up with a very serious spinal break and need immediate surgery to stabilize their back and months of PT and equipment during rehab. You guessed it. You are on the hook.
Who cover the cost/replacement of items the worker breaks or steals. If the worker is not an employee and adequately insured for theft and damage you may be out in the cold. Your homeowners coverage may cover but you will have to meet the requirements of the policy- police report, press charges, satisfy deductible and the pain just keeps going…
Recall the issues about paying for domestic help under the table that got several federal nominees in trouble. Rule is that employment tax must be paid on anything over $600 and you must issue am earning statement at the end of the year.
Many people are willing to take these giant risks to save a few dollars, but in the end if you have a domestic under the table employee you could be on the hook for tens of thousands dollars in addition to exposing yourself to unnecessary risks by using an untrained worker.
Short term saving could turn out to be very large liability. Michael, LSW
Diane Masson
Regional Marketing Director at Freedom Management Co.
Top Contributor
Great discussion!
From Linked In – Alzheimer’s and Dementia Professionals
Kate Blake
Co Founder at The Edith Ellen Foundation
I believe it is right to question how this might work for both the person being the companion , and the person receiving their care! It could work well, but without such measures of completing a thorough risk assessment on both sides, and really establishing just how safe each are, in each others life, let alone in a home environment, it could just become a nightmare waiting to be played out! I don’t think that just hiring any person just because somebody knows somebody, or they seem ok, is a good recommendation alone. If you are going to enter into hiring an independent “companion”, and safeguard both parties, is almost essential to see this from a business contract perspective, with each having a number of responsibilities that needs to be thoroughly thought out and put in place, (especially around protection, commitment and best practices), before any steps are contemplated! But to do so, those who encourage such schemes, have a responsibility too, in producing written guide to aid people that wish to go down this down to one to one caring route.( As there should be, a helpful tool and training courses for all the unpaid carers already in situ, looking after their family in the community). I worry that we expect too much of those people whom we expect to take up the slack of diminishing nursing and care services, by allowing them to cope alone,( or as volunteers in this situation), without adequate advice and guidance. How do people really know that they are choosing the right person to look out for them, or their family member? Or conversely, that person taking on the burden of care, has the right match for their safety? So if I was looking to take on any independent companion to look after me, I would be looking for any easily found, useful short briefs that would highlight to me the main Q&A’s for parties entering into agreements around aspects of one to one at home care. Ones that consider such points as taking up references and previous histories of employment; legal liability, protection and insurance needed, to deal with any issues that might arise of safety and abuse (including financial), accidental injury,(for both parties, especially if any lifting and moving is required); suitable individual skills, education, knowledge, and training needed to be able to care; understand how to deliver safe personal care, particularly if facing complex health conditions, or challenging behaviour problems, (especially with Dementia sufferers). I am hoping that these do exist? If they don’t, why not? Because it does not make sense to me that year on year, the increasing number of cases of adult abuse directly relate to a perpetrator that is familiar to the person they are looking after, and that maybe, we are disregarding what could be a very important tool for preventing this happening; rather than just relying on hoping the majority of people that become ” “Companions” will not deliver any harm!
Susan Austin
Consultant, Workshop Presenter at Susan Austin
There are so many stories where the person being cared for has been abused, taken advantage of, which is the last thing anyone wants. It makes it difficult if the person is in early stages of dementia (hiring for themselves), or families do not take the time to investigate backgrounds of persons applying or research what is needed, for their loved ones, but are wanting the best care. Financial aspects become a factor in hiring, not a lot of applicants apply, word of mouth is still one of the best promoters and having the knowledge of different pathways or services available to them, remains a puzzle. There needs to be more education to raise awareness from utilizing the libraries with pamphlets of information, promoting resources in the communities, etc, to online information that is user friendly with clear messages. It is difficult to find specific information at the best of times but especially when under stress and immediate need.
From Linked iN – Link-age Marketing Senior Living
Steve Wittman
Director of Operations at Link-age
Diane makes some great points with regard to hiring caregivers under the table. The potential savings in costs is far out weighed by the increased risks associated with hiring people that have not been drug test and background checked. There is also potential liability for employment taxes and workers compensation. These are all good reasons to work with reputable home care providers!
Cheap is as cheap does. South Florida is different from most other states. Caregivers here from licensed companies make minimum of $10.00 an hour. When you hire privately you have to do your own screening, booking, filing with IRS, Soc. Sec. Workman’s comp. have no recourse when things go wrong, are liable to lose benefits if tax information goes awry– i.e. paying privately but not paying the add ons of an employer. At risk if cg. is injured in your home or on the job… and regarding continuity of care, what if the private cg. gets sick, moves, can’t show up, decides to take another job? You are left having to find another cg. or taking care of your parent yourself.
As Scott said, you probably wouldn’t let other service people work in your home without licenses and recourse. Why would you let someone care for your parent without recourse?
Having a retired nurse or empty nester do the care, that is very nice indeed, if they wish to do more beyond nursing care and are physically able to care for your parent.
lots to consider.
From Linked in – Executives in Long Term Care
Bruce Neufeld
Director at Boulevard ALP
Litigation Accident,,Being Ill,Replacement, Insurance
Wait one minute.You all talk about the caregiver whether licensed or illegitimate.About the elder employer.Whose talking about those licensed predetorial sharks who get into elder care to pounce and feed off of these unsuspecting adults who mind you get them from proverbial good sources and agencies.
Am a licensed Certified Nursing Assistant with certification in Alzheimer’s Care and Dementia care and other types of aging.
I’ve worked on private cases .I’ve worked for agencies who have relationships with these terrible case managers.Those who find these elderly clients whose family members are far away and can’t be there on the jump.They are so happy to have that elderly person say,”You’re hired to be my case manager”.
And unknowing to them they are about to be leeched off of, and bamboozled and lied to all with a cute smile.
From Linked In – Home Care and Healthcare Advocacy
Scott Greenberg
president at ComForcare Senior Services
I would argue that agencies fact pay caregivers what they’re worth all the time understanding that what caregivers do is invaluable. The market dictates rates for caregivers and for agencies and good owners know that their quality caregiving staff needs to be taken care of. As in all fields there are exceptions but please understand that we agency owners very much value the contributions of our staff
Brett Frankenberg
Program Director at RehabCare
Edith – I don’t think anyone on this thread doubts your integrity and motivation. I believe the collective assertion here is to promote practices that are the safest for Seniors because they are ripe for exploitation. I, for one, applaud your dedication and efforts.
Charles Kennedy
President at Charles Kennedy, P.C.
Both sides make valid points. Sometimes a family just doesn’t have the money to go through an agency. The sad fact is that the poor are the most likely to get scammed or create legal problems with issues that they had no idea existed. One big example is the failure to pay payroll taxes. We really need to find a better way to fund home health care. The money to do so exists, but the fortunate few do not recognize a duty to help those who need it.
Ginger Martin
Childbirth and breastfeeding educator at Associates in Family Medicine
I am a semi retired LPN, who has worked as a nurse in home health care and in clinical settings for the past 30 years. During this past year I have done private duty home health nursing for an elderly woman in our area. Anything medical that I do for her is under the direct order of her physician. I renew my license regularly, maintain nurses liability insurance and have registered my business, obtaining an LLC. I pay social security, federal and state income tax on a quarterly basis.I feel that in no way do I work “under the table.” I have enjoyed my private duty nursing and homecare business very much. Since I worked for many years in ob/gyn, my business expands to homecare in that area as well. I provide in-home services for childbirth education, lactation counseling and postpartum care. The medical community has been very supportive. Even though the majority of what I do is non medical, I definitely want to keep all bases covered.
I understand that an agency is excellent for most people, because of benefits, tax withholding, liability protection, etc. In my situation, however, I believe what I am doing is right for me and for the clients I serve.
Diane Masson
Regional Marketing Director at Freedom Management Co.
Top Contributor
Ginger, you sound wonderful and you are not my definition of under the table. You are a responsible small business woman. Way to go!
I am a good honest person that needs work and i am a good worker
If ya all think the above is challenging, just wait for Jan 1, 2015 and mandated caregiver OT implemeneted as a new fed law under the dept of labor, now it becomes a game changer and not for the betterment of our seniors, no matter who and or how they hire care! Peter C Leighton, Best Care, private duty in SFLO for 35 yrs
Hi, I have worked for an agency for about 6 or 7 years. a new client they assigned me to help is on medicaid, being cared for by a grown child, “Ms. B” in Ms. B’s fabulous home. the other day, the well-to-do grown child Ms. B asked me to work two hours a week “under the table” for her. Funny – during her request, she mentioned 4 times what’s in MY employee handbook concerning under-the-table work, which is a huge no no! The woman seems very self-centered, with no qualms whatsoever about jeopardizing my little job!
We caregivers do better to handle jobs and everything pertaining to the jobs Through The Office. It’s just better! Let the office stand up for you, back you up, be there for you.
Patti, Thanks for all you do to help seniors! Thank you for sharing your experience to help others.
Just to re-emphasize: a lot of our clients are very self-centered, especially Medicaid clients, who suddenly for the first time in their lives have a “butler.” don’t jeopardize your precious job to help a self-centered dishonest medicaid cheater who doesn’t have any respect for you nor the system!