Is It Better to Hire an Independent Home Caregiver or Use an Agency?

Before hiring a caregiver for in-home help, you first must assess your own management abilities, according to Leslie Eckford, a nurse and geriatric clinical social worker who coauthored Aging with Care: Your Guide to Hiring and Managing Caregivers at Home with Amanda Lambert.^[01]

If you have a management background or experience collaborating with others, you may be well suited for managing private caregivers. If you don’t have experience managing others, it may make sense to work with an agency.

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There are pros and cons to using an agency to find a caregiver.

Benefits of hiring a caregiver through an agency

Agencies provide a wide range of services.

• Agencies typically perform background checks and verify caregivers’ certifications and experience in addition to taking care of payroll and scheduling.
• Reputable agencies typically require caregivers to attend periodic training on a variety of subjects and skills, some of which are regulated by the state.

“Private caregivers can explain their background and training, but there is often no way to verify the information,” says Lambert.^[01]

One of the biggest advantages of using an agency is that it can cover all shifts.

“If a private caregiver quits or doesn’t show up for a shift, you’re responsible for finding a replacement or covering the shift yourself,” Lambert says. “An agency is going to replace that person.”

Here’s another consideration: If an agency caregiver is accused of stealing or some other infraction, the agency typically has a process for communicating with authorities, suspending the caregiver during an investigation, and reporting the incident to your state’s department of human services.

“Hiring through an agency brings peace of mind, especially with regard to liability,” says Lambert.^[01]

Drawbacks of agency caregivers

You’ll typically pay more for agency caregivers than private caregivers. Agencies pay salaries for multiple employees, as well as workers’ compensation and liability insurance. Agencies factor those costs into the hourly rate. In 2021, the median hourly cost was $26 an hour for homemaker services and $27 an hour for home health aide services in the U.S.^[02]

There’s also no guarantee you’ll have the same caregiver every day. If you, your parent, or another senior loved one don’t like the person the agency sends, you can voice your concerns, but managers may not address them to your satisfaction. You’re not the one doing the firing or hiring, so you relinquish control.

Lambert recommends asking agencies these questions:

• How can I monitor what the caregiver does? Will they keep a daily or overnight notebook record, and can these notes be sent frequently? Is there an online family portal where notes can be viewed?
• How many of your caregivers are certified nursing assistants (CNAs)?
• What are your training requirements?
• Who is the main person to communicate with about problems? ^[01]

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Private caregivers for hire — sometimes called independent caregivers — may seem like the easier option, but it depends on how much responsibility you want and what you can handle.

Benefits of hiring independent caregivers

The main reason people hire private caregivers is lower cost, Lambert says.^[01] When someone hires through an agency, the hourly rate paid by the client is more than what the caregiver is paid per hour. Agencies have overhead costs such as insurance and benefits for the caregiver that also have to be paid for in addition to the caregiver’s salary. With a private caregiver, the client pays only the hourly wage of the caregiver, and this can generally keep average costs lower.^[03]

In addition to the cost, there are other reasons people hire private caregivers:

• You have more control over who takes care of your parent. “Many people want to select the person who will do personal care for their loved one,” Eckford says.
• You can communicate directly with a private caregiver rather than having to go through an agency manager.
• There’s more freedom in determining caregiver duties. Agencies are generally restricted by state laws regulating which tasks caregivers can perform.

Drawbacks of hiring a private home caregiver

You might save money with independent home care, but you’ll spend extra time on background checks, payroll, and taxes. If you choose to hire a private caregiver, they’ll likely be considered your household employee. Home care workers are almost never considered independent contractors.

“The worker is your employee if you can control not only what work is done, but how it is done,” according to IRS household employee guidelines.^[04]

For the home care worker to be considered self-employed, the following would have to be true:

• The worker provides their own tools.
• The worker offers their services to the general public as their own independent business.
• The worker controls how the work is done.^[04]

Things may be simpler for you with an agency caregiver. The home care worker is typically considered an employee of that agency, as the agency likely tells them what work to do and how to do it.

It’s best to consult with an attorney or financial expert in your state to learn more about the worker status of a potential independent caregiver.

Some people choose to purchase additional liability insurance coverage for injury or theft, depending on what they can afford and how much they trust the caregiver. You could even incur legal fees if a caregiver accuses a family member or another caregiver of assault or sexual harassment.

“If you have work experience with interviewing and hiring, this would be a natural progression for you,” Eckford says. “If not, but you want to hire the caregiver yourself, do your homework first.”

Before hiring privately, Eckford recommends asking yourself these questions:

• Am I good at supervising others, and do I enjoy managing people and tackling administrative tasks?
• Am I able to communicate clearly and regularly what I want and need?
• Do I have supervisory and management experience? ^[01]

The worst thing you can do is wait and make rushed decisions when a parent or senior loved one is discharged from the hospital, Lambert says. Know what kind of caregiving resources are out there before you need them. Lambert recommends exploring a few options, even beyond just in-home caregivers — and the sooner the better. That way, you aren’t making hasty decisions out of desperation or panic.

“Have three agencies in place. Tour assisted living communities,” Lambert says. “Be as prepared as you can and recognize that your parent is going to eventually need some help.^[01]”

If you decide that hiring a caregiver through an agency is right for your family, contact A Place for Mom’s Senior Living Advisors to learn about in-home caregiver resources and senior living options in your area.

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