Private Duty Caregivers

May 14, 2020 | Aging Services Risk Management


Private duty caregivers (PDC) are persons who assist a resident in performing some of the activities of daily living, but who are not necessarily employed by the facility in which the resident resides. The distinction between PDCs and facility employees is that PDCs work pursuant to an arrangement with the resident, rather than an arrangement with the facility. These persons may be licensed nurses or certified nursing assistants, or they may be unlicensed or noncertified. They may work in independent living facilities, assisted-living facilities, or skilled nursing facilities. Their duties may range from assisting with or administering medications, to assisting with feeding, bathing, toileting, or mobility. While residents generally have the right to enter into a relationship with anyone they choose to provide these services, facilities need to manage this process to ensure that the resident's dignity and rights are respected, and also that the PDC does not present a safety threat to the resident, other residents, the facility, or the facility's staff or visitors.

Four basic types of arrangements are typically made with PDCs, although other arrangements are possible. The resident or family may contract with an agency to provide a PDC; the resident or family may contract directly with an individual or individuals to work as a PDC; the facility may arrange for the services of a PDC, in which case the resident pays a fee over and above the standard rate; and family members, friends, or other persons who are not compensated may act as informal PDCs. General considerations apply to all of these types of PDCs, but other considerations may be specific for each type.

PDCs are not casual visitors to the facility—they may be on the premises for an extended period of time and have specific duties with respect to the care of the facility's residents. Consequently, their work should be managed, at least to some extent, by the facility. This may be a balancing act, because if the facility tries to exert too much control, it may find itself responsible for persons over whom it really does not have control. Consequently, management should be undertaken with a light touch and focus on what is required of the PDC to function in this environment.

A resident's right to employ or use the services of a PDC is largely guaranteed by the Fair Housing Act (FHA), which provides protection from discrimination against residents of certain facilities on the basis of race or color, religion, sex, national origin, familial status, or disability. If the resident has a recognized disability and engages a PDC as an accommodation to manage his or her disability, this activity may be protected under the FHA, as long as the use of the PDC is reasonable. While the term "private duty caregiver" also applies to in-home health...

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