Live-in care - help and advice

ChocolateBrownie

Registered User
Nov 21, 2018
67
0
I cannot find a thread on this specific subject, so would be interested to know the experience of others who have used live-in care as I am looking into this for my father.

What works best?
Pitfalls to avoid?
Agency v employ direct?
 

Jessbow

Registered User
Mar 1, 2013
5,678
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Midlands
If you want 24/7 cover, you'll need more than one person.
Dont forget, if you employ, you have tax , NI, Holidays and pension to cover,
What happens if you employ and carer is sick? Agency would cover it.
 

Bod

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Aug 30, 2013
1,958
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Also using an agency, if the Carer and caree don't get on then it is easier to change the Carer.

Bod
 

Sirena

Registered User
Feb 27, 2018
2,324
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I had carers for my mother for 6 hours a day, using an agency. As others have said, if someone is sick or goes on holiday, someonelse covers. The care director of the agency was also very proactive in getting my mother other help she needed (e.g. from OT, the council, or CPN). My mother has now moved to a care home as she needs supervision 24/7 and live-in care was too expensive when added to her rent, bills, food etc.

My grandparents had live-in carer for the last six months of their lives (my grandfather was 98 and chair-bound, my gran had dementia). From what I remember, the carers did six days on, six days off, so they effectively had two main carers. One carer was lovely, the other ... not. I am sure the unlovely one could have been changed, but I was not in charge of their care so didn't get that option. It worked well for them and was cost effective because they just had one carer between the two of them, rather than paying for two care home places.
 
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love.dad.but..

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Jan 16, 2014
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Kent
Dad was in moderate stage and a night time pacer when I tried 2 different agencies for 24 hr live in care...unfortunately neither worked out for dad or me mainly because:

Although the agencies promise carers to be experienced in dementia care I did not find this to be the case.
I was still having to cover 2 hours daily care so the carer could have a break time during the day.
As dad was up and about during the night nore than 2 disturbances for the carer...and not necessarily dad needing help just making a noise that would wake the carer...required a second carer so the live in carer could sleep...all perhaps understandable but in practice very restrictive and expensive taking the cost far beyond his eventual NH placement especially when considering that all household bills and food for carer has to be added to the cost.

The overwhelming and serious problem however was the totally unsuitable 2nd carer sent who I felt left vulnerable dad at risk and resulted in an immediate removal of the carer..written complaint to the agency owner and CQC as I was so concerned this carer would be sent to someone else. Live in care should work well in some circumstances with an experienced carer but sadly it didn't for us.
 

sinkhole

Registered User
Jan 28, 2015
273
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I am just about to start live-in care for my mum. I am using an expensive, but by the looks of it, very good agency which I found through a care specialist.

I couldn't see how a private carer could possibly provide the level and breadth of care necessary for a dementia sufferer. The agency has their own nurses and will be able to cover any carer sickness etc. without me having to worry. I am determined to ensure the two carers we get are suitable for my mum, even if that means a delay of a few weeks before we start.

At the moment I have carers from another agency coming in twice a day for 6 hours each but that's been very challenging and has demonstrated many of the problems one can expect when inexperienced or just plain lazy carers are employed by an agency overstretching it's capabilities. This agency had a 'good' rating across the board from the CQC, as well.

So my main advice is take time up front to find the right agency and the right carers so the care will be consistent and the right level for your needs. Make sure you know the notice period of whoever you choose just in case it all goes bad and you have to replace them. Don't be afraid to reject carers you don't think will be suitable or who don't get on with your father. A live in carer is going to be a companion as much as anything, so they have to be able to communicate and like each other.

Good luck.
 

ChocolateBrownie

Registered User
Nov 21, 2018
67
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Thank you - that is all useful.

I just want to try to let Dad have as much time at home for as long as possible - so keen to explore all options.
 

sinkhole

Registered User
Jan 28, 2015
273
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One other recommendation I would give to anyone having carers coming into the house (especially for the first time) is to think about installing cameras to monitor what's going on.

This can be useful on several levels. Apart from anything, once a 'stranger' starts visiting, it's possible they will be accused of all sorts of things by the PWD and having a record of what's happening in the house can help with that.

I also found one carer falsifying her time sheet and leaving up to 2 hours early on some days without telling anyone. Needless to say, she was replaced very swiftly.
 

MTM

Registered User
Jun 2, 2018
40
0
My parents both have dementia now, but Mum's only became obvious recently, Dad has been declining since 2004. Mum looked after him until 2015 until her own health broke down. They have a care team who come in, officially, to look after my dad, although they do help Mum too from time to time. The team comprises four local ladies who come in on an hourly rate, and two live-in ladies.

To do it comfortably, I think a lot of it is about connections.

If you are well connected and well established in your local community I think employing your own carers can work really well. The ones Mum and Dad use are all self employed so we simply pay them and they take care of their own holiday pay, etc. That said one is a mother and daughter team and when the husband/dad died suddenly I gave them time off and paid them their usual rate. But usually it's OK. There is now a team of four 'local' carers and they work with two live in carers who come in turn and turn about. For the live-in carers, we started with a care agency but then we discovered the contact details of a lady Mum and Dad already knew who'd looked after Mum's aunt so we stopped the agency and went with her, instead.

We went through a host of different ladies, with the lady who'd cared for Mum's aunt, until another finally popped up who my parents got on with.

Now we have a live in care team of two and the day care ladies also do some nights and do relief care during the day.

My parents live 140 miles away and I drive down every Wednesday and have lunch with them. We have a filing box and the carers put notes, queries, letters that need sorted etc in there for me to pick up. We also have a watsapp group which is brilliant for keeping in touch.

You need to trust your carers. Mum and Dad's carers deal with a lot of the admin or I would do nothing else. They also get cash out for Mum to spend and look after her bank card. She's not really up to doing her own finances anymore but if I activate LPA over her side of the account she will have no access to cash, a checkbook or any way to pay for anything outside electronic transfer or direct debit and worse, neither will I because even as the person with Power of Attorney, neither my brother, nor I are allowed a card or chequebook, either. I have been added to my parents bank account for ebanking and I pay the entire team by BACS.

Where we fall down is finding anyone to help with the nights on weekends, when the live-ins struggle doing two nights in a row - Dad doesn't sleep much, if at all and he is very difficult these days - he can be shouty, intransigent, a bit violent and he has very limited mobility. Think Father Jack out of Father Ted with slippers and a zimmer.

So yes it can be done but, caveats to take away:

I'd recommend using an agency for live in: the first one was lovely, although we only needed them a week. We also had another bunch when I was looking for help for the current team at weekends. They came recommended by a local lady who used them.

Neither agency could do bits. Live-in usually works by self employed carers on contract doing two week stints at four or five clients in rotation. That's why it's usually the whole package or none - I found this out when I was consulting Helping Hands about relief nights/care at the weekends.

A day of live-in is more competitively priced than a day at hourly rates. Sometimes, even if you start live-in care a bit before you're ready, you will find it's not much more expensive than having carers in at an hourly rate. Plus you get to know the carers well and they get to know you before the hard stuff starts.

Bolted on top of the live-in, you can use yourself or local carers to cover breaks. They'll need 2hrs minimum a day possibly more if the loved one being cared for is active at night.

Some care agencies will count the number of times the person wakes up each night and if it's more than a certain number will charge hourly rates rather than a flat night rate. That said, when they start work, there is often some flexibility with that.

It helps, going local, if you, or the person you are seeking care for, are well connected and active in their local community you will have more of a feel for who to employ. One agency we used briefly was run by someone who's father lived near my folks and had picked up Dad when he'd had a fall in the garden. It all helps. That said ...

Seek recommendations from people you know who are, or have been, in the same boat. This will help you to find some quality carers. For live-in, local doesn't matter so much if they are people friends or family have used and got on well with. Some knowledge of each other will help you to get to know and trust them, which has been a godsend for me as these people have to be trusted to get cash out of the bank for Mum, help her get shopping, attend her and Dad's medical appointments with her because someone has to remember what's been said in there, etc.

Make sure they are all self-employed so you are not paying NI etc.

Make sure someone on the team can cook and drive.

They should all have public liability insurance themselves, it's not your job to do that, but it's worth making sure they have before you employ them.

Think hard about what it entails. Could you tell someone who you like, and think is competent, but who just isn't getting on quite well enough with the person being cared for, that it isn't working out and you are terminating their employment?

It's a LOT of admin and I mean a LOT. You are running the house and sometimes the social lives of the loved ones in need of care as well as your own. Plus you are paying the care team, ordering supplies, etc.

If you get the right care team, they are amazing. The people who look after Mum and Dad love them as much as my brother and I do. They are incredibly loyal and protective, even now when Dad is not always very pleasant to be around. Mum and Dad want to stay in their own home and I am trying to fix that for them, for as long as is possible. I can thoroughly recommend it but I would say that you need to get the right people and being able to find people we trusted recommended by friends whose judgement we trusted implicitly helped a huge amount. The right team, if you can find them, will be amazing. But yes, it takes application and some trial and error to find the right ones!

I hope this is handy,

Best of luck

MTM
 
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jugglingmum

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Jan 5, 2014
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Chester
Make sure they are all self-employed so you are not paying NI etc.

This is a fairly risky strategy, certainly for the live ins, under tax law they are employees, the rules are significantly tightened from 1 April 2020, but my interpretation under current rules is that the live ins are employees. If HMRC come across this and determine they are employees you will need to pay the NI and be landed with a penalty - minimum of 20% but actually it can carry a prison sentence as from a legal perspective this is actually fraud.

The dailies may well be classified as employees under the current rules as well, it does depend on what your expectations of them are, the relevance of other work they are doing no longer applies (this did used to apply) and now it is possible that someone who works for you for just one week could be deemed an employee.

Given the way HMRC crack down on these things (they have gone for self employed in various industries over the past few years) I suspect that they are likely to examine the care industry in due course.
 

MTM

Registered User
Jun 2, 2018
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Lorks! Thanks for the heads up. I should have known. I've had the care in place since 2016, at which point my brother and I checked it out carefully and were advised that it was fine, my bad for not checking it's changed regularly enough! Gah I do hate the way the HRMC keeps moving the goal posts and leaving the onus on us mere mortals to know this stuff.

Thank you so much. I'd looked into some of it in my own respect, because I'm an author so I'm self employed, myself, but numb nuts here never even clocked about the care team. God knows what we'll do, but at least I know what I'm facing. I have a couple of tame tax advisor friends who I will consult.

Cheers

MTM
 
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jugglingmum

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Jan 5, 2014
7,085
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Chester
The big hit is from 1 April 2020, but you do need to be aware of both tax and employment law.

The uber and other gig economy cases are the ones affecting employment law, also minimum wage challenges are being made by some that are classified as self employed, HMRC have been tasked with enforcing minimum wage regs.

Ultimately HMRC are making sure that the right amount of tax and NI is paid by everyone, mine is taken out of my wage packet every month.

There are specialist payroll bureaus that deal with the care industry I understand that might be worth a look at.

I had a cleaner who came weekly and was self employed, however she did vary which day she came and the hours she worked to suit her, which I thought was enough to satisfy the rules. But if the hours are fixed and set by you that can start causing a problem. I don't think legislation has substantially changed since 2016, but there have always been a lot of very lax practices in this area, and a lot of urban myths/pub chatter as to what is acceptable. We certainly come across smaller more old fashioned small accountancy practices advising this is acceptable when it hasn't been for a long time.
 

Katrine

Registered User
Jan 20, 2011
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England
If you have done due diligence that your carers are registered with HMRC as self-employed then you're OK, at least for now. With new live-in carers I would ask for the carer's Unique Tax Reference Number, and confirmation from the carer in writing that they are registered with HMRC as self-employed. If you're using the same group of regular carers ask for their HMRC letter re self-assessment, and repeat this every year.

Live-in carers from agencies have multiple clients. They go from placement to placement, and although they may have regular clients the individual booking periods are usually between 1-4 weeks maximum. It would be totally impractical for them to have each client as a separate employer, with all the administrative delay involved. Therefore they work as genuinely self-employed people and most use an accountant to keep track of their earnings records.

However, people who are working for you as possibly their only paid job ARE employees. The onus has shifted so that carers have to prove a genuine reason to be self-employed (multiple and regular new clients), otherwise HMRC will insist that they are not.
 

jugglingmum

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Jan 5, 2014
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Chester
I have a query re live in care (which SIL is proposing for MIL, aged 92 who likely is in early stages of dementia, but OH and SIL are in denial)

MIL has a house with in theory 4 bedrooms, but only one reception room, where MIL spends her time.

So it should be quite easy to sort out a bedroom. The room set up as a spare bedroom has a very old bed and mattress (I refuse to sleep on it, and sleep on the floor on a roll mat) so I think that a more modern med and certainly new mattress would be needed.

OH and SIL think that perhaps they should sort one of the other rooms out to create an en suite and maybe also a small kettle microwave area - I'm not sure this is necessary.

They also think that as MIL flannel washes, there is no need to sort out any shower that functions in the main bathroom, whereas I think a live in carer might expect suitable showering facilities to be available for MIL.

The house has no TV aerial, satellite dish, or broadband, and again, what would be expected in this respect.

The heating in the bedrooms is minimal with a storage heater in each I think. MIL provides us with a very old fashioned bed warmer (a light bulb in a cage) which is a clear fire hazard. I think she may use one herself as well.

In OH's opinion, MIL is still living in the 1950's - and always has throughout his life (this was his father's influence to some extent).

Basically what is the minimum requirement for the sleeping and living arrangements for the live in carer I think is my question.
 

jugglingmum

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Jan 5, 2014
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Chester
multiple and regular new clients

My understanding is that HMRC do not consider the position re other work as a decisive factor anymore, not sure they ever did, however it was propagated by some of the larger players and to some extent falls under the category urban myth - many of the arguments used in this respect have repeatedly failed in decisions handed down by tribunal. It is how the person is engaged to work for you that counts.

Confirmation from the person that they complete a tax return doesn't actually interest HMRC, it might mean they are paying their own tax, but still the obligations of NI and pension are being avoided. It does mitigate the tax that would be collected in an enquiry as if you can prove the individual has paid the tax HMRC can only collect the NI and levy penalties on the NI. They will go back up to 6 years if they do look into it.

As I've stated, on my understanding of current HMRC practice, I find it hard to see how a live in carer is self employed. If they work for an agency they are likely to be employed, as some agencies (not in the care field) have been hammered in court for these sort of practices.

I don't think the admin involved is any form of argument to support the fact that they are self employed. Many people to have multiple employments, eg I have a friend with 6 employments as she works a few hours for each one each week (again not in the care industry).

There is a big difference between common practice and the legislation as it has stood for a while.
 

MTM

Registered User
Jun 2, 2018
40
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If you have done due diligence that your carers are registered with HMRC as self-employed then you're OK, at least for now. With new live-in carers I would ask for the carer's Unique Tax Reference Number, and confirmation from the carer in writing that they are registered with HMRC as self-employed. If you're using the same group of regular carers ask for their HMRC letter re self-assessment, and repeat this every year.

Ah right, that's useful to know. We did collect the UTR numbers and got letters of confirmation at the start but haven't done so every year. I must get onto that.

Live-in carers from agencies have multiple clients. They go from placement to placement, and although they may have regular clients the individual booking periods are usually between 1-4 weeks maximum. It would be totally impractical for them to have each client as a separate employer, with all the administrative delay involved. Therefore they work as genuinely self-employed people and most use an accountant to keep track of their earnings records.

The live-in carers are part of a group who work together so they do work in exactly the way you outline there, the only difference being that it's only two of the original six who come to us and their clients pay them directly rather than going through an umbrella agency. Likewise the day care team work for other clients as well as us but work as a group in a similar way. I've left the entire team to arrange among themselves who comes when. I know at least three of them have enough other clients to justify a book keeper and an accountant, because they have mentioned it, but I must make a note to check the status of the others.

However, people who are working for you as possibly their only paid job ARE employees. The onus has shifted so that carers have to prove a genuine reason to be self-employed (multiple and regular new clients), otherwise HMRC will insist that they are not.

Yikes! One is just starting out and does four hours a week with us so I will have to check whether or not she has other clients. I don't want to have to NI contributions on her wages if I can avoid it because it will be a lot of phaffage for about £10!

Lots to think about, thanks.
 

MTM

Registered User
Jun 2, 2018
40
0
The big hit is from 1 April 2020, but you do need to be aware of both tax and employment law.

The uber and other gig economy cases are the ones affecting employment law, also minimum wage challenges are being made by some that are classified as self employed, HMRC have been tasked with enforcing minimum wage regs.

Ultimately HMRC are making sure that the right amount of tax and NI is paid by everyone, mine is taken out of my wage packet every month.

There are specialist payroll bureaus that deal with the care industry I understand that might be worth a look at.

I had a cleaner who came weekly and was self employed, however she did vary which day she came and the hours she worked to suit her, which I thought was enough to satisfy the rules. But if the hours are fixed and set by you that can start causing a problem. I don't think legislation has substantially changed since 2016, but there have always been a lot of very lax practices in this area, and a lot of urban myths/pub chatter as to what is acceptable. We certainly come across smaller more old fashioned small accountancy practices advising this is acceptable when it hasn't been for a long time.

Thanks, I did get the letters and UTR numbers etc. Our carers work out times with one another and I leave them to it on that score, luckily, they all earn more than minimum wage, I think, although I'll need to check flat rates. Is there a minimum 'daily' wage, I don't know yet. I will come back and post here when I do.
 

MTM

Registered User
Jun 2, 2018
40
0
It is how the person is engaged to work for you that counts.

So basically, they only can only be engaged as an actual employee, as I understand this, whether or not they are self-employed.

Confirmation from the person that they complete a tax return doesn't actually interest HMRC, it might mean they are paying their own tax, but still the obligations of NI and pension are being avoided. It does mitigate the tax that would be collected in an enquiry as if you can prove the individual has paid the tax HMRC can only collect the NI and levy penalties on the NI. They will go back up to 6 years if they do look into it.

As I've stated, on my understanding of current HMRC practice, I find it hard to see how a live in carer is self employed. If they work for an agency they are likely to be employed, as some agencies (not in the care field) have been hammered in court for these sort of practices.

So if you're reading it correctly, it looks like that means the live-in carers at my Mum and Dad's, will have to be employed, separately, by each of the six people they work for (including me) and same for the day carers. The idea being that if you are self employed in this kind of game, the state is now looking at you as someone who has several part-time jobs as opposed to someone working their own income.

How lovely! I have discalculia and find managing my parents' finances difficult enough. I can't wait for this! It's just a question of whether I have the hours in the day to do it all. There isn't really the spare cash to pay anyone to do it for me. Mwahahahargh! I can see that sorting out the care scheme is going to be truly joyous.

Presumably HRMC look at someone's accounts more than their tax returns. Most of us pay voluntary contributions which are fixed according to what we earn. I'm guessing carers will all have to set themselves up as limited companies and pay themselves a wage if they intend to continue freelance in the same manner they do now.

That said, as I understand it, if you are self employed and your turnover is over a certain amount, I think it's around 80,000 a year, you have to submit your accounts to HRMC with your tax return. I seem to remember there was a bit of an outcry about this from some quarters as HRMC will also only accept accounts submitted electronically and only from a handful of programmes, SAGE is one, there are others but all are several hundred pounds. Presumably anyone working for me in this bracket - so builders or people who routinely buy a lot of materials and the like, are going to be OK.

Blimey. Interesting times.
 

sinkhole

Registered User
Jan 28, 2015
273
0
I have a query re live in care (which SIL is proposing for MIL, aged 92 who likely is in early stages of dementia, but OH and SIL are in denial)

MIL has a house with in theory 4 bedrooms, but only one reception room, where MIL spends her time.

So it should be quite easy to sort out a bedroom. The room set up as a spare bedroom has a very old bed and mattress (I refuse to sleep on it, and sleep on the floor on a roll mat) so I think that a more modern med and certainly new mattress would be needed.

OH and SIL think that perhaps they should sort one of the other rooms out to create an en suite and maybe also a small kettle microwave area - I'm not sure this is necessary.

They also think that as MIL flannel washes, there is no need to sort out any shower that functions in the main bathroom, whereas I think a live in carer might expect suitable showering facilities to be available for MIL.

The house has no TV aerial, satellite dish, or broadband, and again, what would be expected in this respect.

The heating in the bedrooms is minimal with a storage heater in each I think. MIL provides us with a very old fashioned bed warmer (a light bulb in a cage) which is a clear fire hazard. I think she may use one herself as well.

In OH's opinion, MIL is still living in the 1950's - and always has throughout his life (this was his father's influence to some extent).

Basically what is the minimum requirement for the sleeping and living arrangements for the live in carer I think is my question.

I've had the assessment done by the new agency we're using (who are very thorough) . In addition, I paid for their OT to come in yesterday and carry out an assessment as I've found the OTs provided by the LA to be somewhat lacking in knowledge and common sense.

I had the same reservations regarding the bathroom facilities, as my mum's house only has one working bathroom with a high bath and power shower at one end of it. They have been fine about that. I was prepared to put another bathroom or shower room in for the carers, but they have said it's not necessary.

So in my mum's house, the carers will have their own room upstairs and there is a separate toilet they can use, but that's basically all they need. All other areas will be shared with my mum. They will be preparing the meals and eating with her (if she wants).

The agency have said a TV and broadband is expected, which is fair enough. Also, a way to monitor my mum during the night. This could be a simple baby monitor but I will have a camera they can use to keep an eye on here. We will probably put a bed pressure pad in to alert if she gets out of bed during the night.

Storage heaters can be OK, if rather inefficient. You could supplement them with oil-filled electric radiators, which are safe and easily controlled if you don;t want to consider installing central heating.

From what you've said, it sounds like you will need to invest in a new bed for the bedroom and get broadband installed. Depending on the speed you can get, TV could all come from the broadband connection, but it shouldn't cost much to have a TV aerial put up for Freeview.

Agencies should usually do an assessment for free (as they want your business) so maybe you could enquire with one or two and see if they will pop round and give you their opinion.
 

jugglingmum

Registered User
Jan 5, 2014
7,085
0
Chester
The live-in carers are part of a group who work together so they do work in exactly the way you outline there, the only difference being that it's only two of the original six who come to us and their clients pay them directly rather than going through an umbrella agency. Likewise the day care team work for other clients as well as us but work as a group in a similar way. I've left the entire team to arrange among themselves who comes when. I know at least three of them have enough other clients to justify a book keeper and an accountant, because they have mentioned it, but I must make a note to check the status of the others.


If the day care team choose who comes when I think you gain some comfort, certainly the substitution rule is satisfied, but the tests are based on direction by the employer as to what is done. For live in care I would be more cautious as whilst they rotate, one team is there for a whole week. At the moment I haven't read anything about HMRC cracking down in this area for the care industry, and based on previous practice there is a good chance they would give an opportunity to disclose first(ie an amnesty) which reduces the penalty level, they had a disclosure period for the building trade (the majority of subcontractors have become employees, and this is creating one week employments for some).
 

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