Matching the tier to the task is the single largest saving available in home care, and the single most common mistake. Tier one is the registered nurse: medication administration, injections, wound dressing, catheter and stoma care, post-operative monitoring, tube feeding. Tier two is the assistant nurse or licensed caregiver: bathing, dressing, toileting, transfers, feeding assistance, basic vital signs, companionship with clinical awareness. Tier three is a non-clinical aide or companion, appropriate only where there is no medical task at all.
Under-buying is the mirror-image error, and it is more dangerous than expensive. Wound dressing, injections and any medication given by the carer rather than taken by the patient legally require a licensed nurse. If a cheap quote quietly assigns clinical tasks to a caregiver, the saving is an infection or a medication error waiting to happen.