# Problems & Risks

[← Research overview](index.md)

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](https://www.thedailybeast.com/wsj-kids-assaulted-died-in-hands-of-carecom-caregivers/), [BackgroundChecks.com](https://www.backgroundchecks.com/blog/care-com-comes-under-fire-for-background-check-policies))
- **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](https://www.engadget.com/2019-03-31-care-com-pulls-47000-daycare-listings.html))
- **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](https://nurse.org/news/fake-nurse-arrested-shannon-womack-nursing-fraud/), [Washington Post](https://www.washingtonpost.com/nation/2025/07/23/pennsylvania-fake-nurse-shannon-womack/)) — *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](verification.md)).
- **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](https://www.hrmorning.com/news/worker-misclassification-tlc-home-care/))
- 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](https://ogletree.com/insights-resources/blog-posts/federal-court-finds-in-home-caregivers-were-employees-not-independent-contractors-under-economic-realities-control-test/))
- Home-care agencies are routinely held liable under *respondeat superior* and for **negligent hiring/supervision**. ([Nursing Home Law Center](https://www.nursinghomelawcenter.org/news/home-health-aide-lawsuit/))

**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](legal-landscape.md) — 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](https://shiftcare.com/us/blog/caregiver-retention-in-2026-what-the-data-tells-us-about-turnover), [AxisCare](https://axiscare.com/blog/understanding-the-90-day-turnover/))
- **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](https://www.sharetribe.com/academy/how-to-discourage-people-from-going-around-your-payment-system/))

**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](https://securityboulevard.com/2024/05/when-the-gig-is-fraud-building-trust-for-online-marketplaces-with-identity-verification/))
- **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](https://www.aarp.org/money/scams-fraud/financial-abuse-home-care-aide/))
- **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](https://www.cnbc.com/2024/08/26/carecom-reaches-8point5-million-us-ftc-settlement-over-job-listings-renewals-.html), [PYMNTS](https://www.pymnts.com/legal/2020/care-com-pays-1m-settlement-over-auto-renewal-background-check-allegations/))

**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).
