# Problems & Risks

← Research overview

This sector pairs two unusually dangerous features: the buyers are vulnerable people (elderly, post-surgical, infants, chronically ill) and the service happens unsupervised, inside a private home. That combination amplifies every standard marketplace risk and adds life-and-death stakes.

The single most important strategic lesson: a platform that markets safety while pushing the actual vetting onto families will eventually face regulatory, legal, and reputational catastrophe.

## 2.1 Trust & safety failures #

Risk: Connecting strangers to vulnerable people without rigorous platform-owned vetting enables theft, abuse, fraud, and fatal harm — and the public blames the platform.

Real cases:

- Care.com / Wall Street Journal (2019): Over ~6 years, nine caregivers listed on Care.com who had police records were later accused of crimes while a child or elder was in their care — including theft, abuse, sexual assault, and murder. The site also carried hundreds of day-care listings falsely claiming state licensing. Standard membership performed only a "preliminary screening," not a real background check; stronger checks cost extra. (Daily Beast/WSJ, BackgroundChecks.com)
- Mass listing purge: Care.com pulled ~46,594 day-care listings (~45% of that database) after many were found to be false, nonexistent, or falsely claiming licensing. (Engadget)
- The "imposter nurse" (Shannon Womack, 2025): Allegedly posed as a nurse using 20+ aliases and 7 SSNs, stealing four real nurses' credentials, and worked at 9+ facilities by submitting forged documents through staffing agencies — even creating a fake LLC to self-deploy. Charged with 43 counts including endangering a care-dependent person and stealing medication from seniors. (Nurse.org, Washington Post) — the key cautionary tale for a nurse marketplace: even agencies that thought they were verifying were defeated by stolen-identity + forged documents.

Mitigations:

- Own the vetting; never delegate it to families. Make identity + criminal-record + license verification a platform-performed, non-optional gate before any nurse is bookable.
- Verify credentials at the authoritative source, not via uploaded PDFs (which are exactly what gets forged). In Iran: the Iranian Nursing Organization registry and the MoH پروانه صلاحیت حرفه‌ای (see verification).
- Bind every profile to the national ID + a liveness selfie to defeat the aliases/stolen-identity pattern.
- Re-verify periodically (license expiry, suspensions, new records).

## 2.2 Liability & legal exposure #

Risk: Three exposures stack — (a) worker misclassification (calling nurses "contractors" when the law treats them as employees), (b) vicarious liability / negligent hiring (sued when a caregiver harms a patient), and (c) insurance gaps. The "we're just a neutral tech platform" defense is eroding worldwide.

Real cases:

- $10M California judgment against TLC Home Care for misclassifying in-home workers as contractors (2023). (HRMorning)
- Federal courts repeatedly find in-home caregivers are employees, not contractors, under the "economic realities/control" test — the more you standardize and supervise care for quality, the more you look like an employer. (Ogletree Deakins)
- Home-care agencies are routinely held liable under respondeat superior and for negligent hiring/supervision. (Nursing Home Law Center)

Mitigations:

- Decide the model deliberately: either a true neutral marketplace (minimal control; family is the employer) or a full agency/employer model (payroll, supervision, insurance). The dangerous middle — heavy control for "quality" but contractor classification for cost — is exactly what triggers misclassification judgments.
- [unverified — confirm with local counsel] Iranian labor law (قانون کار) and social-security (تأمین اجتماعی) obligations attach to employment relationships; classify correctly before launch. (Note the documented labor-law gap for home-care nurses — see legal landscape §4.5 — cuts both ways: less mandated cost, but unresolved status.)
- Carry platform-level general + professional liability insurance, and require nurses to carry their own.
- Document every vetting step — it's both prevention and your legal defense against negligent-hiring claims.

## 2.3 Operational & quality-control problems #

Risk: Extreme caregiver churn, no-shows that strand a vulnerable patient, wide quality variance, near-impossible remote monitoring, and disintermediation (families + nurses pairing off-platform to dodge fees).

Real data:

- Caregiver turnover hit ~79% in 2024, with ~70% of new hires quitting within 100 days; each departure costs $2,600–$5,000 and clients often leave with the caregiver. (ShiftCare, AxisCare)
- Disintermediation is the predictable failure mode for recurring, relationship-based services — once trust forms, families and nurses transact privately. Punitive anti-leakage tactics tend to backfire. (Sharetribe)

Mitigations:

- Electronic Visit Verification (EVV): GPS/time-stamped clock-in/out with automated missed-visit alerts, so no-shows trigger an instant backup dispatch.
- Backup/coverage guarantee: a bench of available nurses and a promise to fill no-shows fast — a core reason to use you instead of hiring privately.
- Beat leakage with retained value, not lock-in: integrated scheduling/payments, the backup guarantee, insurance that only applies to on-platform bookings, and reviews/dispute protection that vanish if they go offline.
- Continuity-first matching: a primary nurse + named backup per patient; track continuity as a KPI.

## 2.4 Payment & fraud risks #

Risk: Off-platform payment (the financial side of leakage), fake reviews, identity fraud, credential forgery, and financial elder abuse.

Real data:

- Gig-marketplace fraud runs ~2× the rate elsewhere; one 2025 report cited a 21% YoY rise, >90% of it impersonation. (Security Boulevard)
- Financial elder abuse: a CFPB review found that where the victim knew the perpetrator, 1 in 9 was a non-family caregiver, average loss $57,800. (AARP)
- Care.com penalties: 2020 — $1M Marin County DA (falsely claimed checks searched the National Sex Offender Registry; improper auto-renewals); 2024 — $8.5M FTC (inflated available-job counts — more than half of postings came from users who couldn't actually hire — plus dark-pattern cancellation). (CNBC, PYMNTS)

Mitigations:

- Strong identity verification at onboarding (national-ID binding + liveness) for both nurses and paying families.
- Tie reviews to verified, completed, on-platform bookings.
- In-platform escrow/payment with dispute resolution — reduces fraud and is your strongest anti-leakage lever (buyer protection only if they pay through you).
- Protect clients' finances (advise families: secure cards, view-only monitoring, watch for sudden POA/will changes); consider bonding nurses against theft.
- Never advertise a guarantee or check you don't deliver, and make cancellation genuinely easy — every Care.com penalty traces to deceptive safety marketing or dark patterns.

## 2.5 Trust dynamics unique to caring for vulnerable people at home #

The service is delivered alone, unobserved, inside the home, to people who often cannot reliably report what happened (infants; dementia, post-anesthesia, cognitively impaired patients). Information asymmetry is extreme and a single incident can destroy a fragile brand.

Mitigations: compensate for unobservability with structured oversight — EVV, periodic supervisory tele-check-ins by a senior nurse, family-visible care logs, consented in-home cameras in common areas; a two-way feedback loop the patient isn't the sole source of (structured family check-ins, easy in-app concern flagging, monitoring for AARP "red flags"); rapid-response incident protocols with immediate suspension on credible complaints; and match qualification to acuity (route high-acuity post-surgical/ventilator cases only to verified RNs; reserve aide-level providers for companionship).

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