You’re at a crossroads. Your mom isn’t safe to live at home alone anymore, or your dad has difficulty taking care of himself since your mom passed away. Now what? For many, the thought of family caregiving is a potential option. But it’s a big commitment. Caregiving can affect your own psychological and physical health, and the financial, emotional, and social impacts are countless. Fortunately, you have options. Home care services can be provided by a nonmedical home care agency, a Medicare-certified home health agency, or a privately hired caregiver. It’s important to understand the risks and benefits associated with hiring a private caregiver versus an agency.
Agencies
Agencies are licensed businesses that employ caregivers and send them to the home of your loved one to provide care. They can provide medical care (home health), nonmedical care (home care), or both. Agencies that provide both home health and home care are often called full-service home health agencies. Professionals, such as nurses or nursing assistants, provide medical care. Nonmedical care, also called personal care, consists of assistance with the activities of daily living, such as preparing meals, eating, and bathing, and can be provided by aides.
Independent Caregivers
Independent or private caregivers are employed directly by the family. There is no intermediary agency between the care recipient and the caregiver. Independent caregivers are also able to provide medical care (if trained to do so), but this is much less common. Rather, independent caregivers are more likely to provide personal care. If your family hires an independent caregiver, you must take on the responsibilities of being an employer or use a third-party payroll management service. However, by taking on this employer role, rather than going through an intermediary agency, your family can save 20 to 30 percent on home care costs.
Types of Care
Both agencies and independent caregivers can provide either home health or home care. However, if your loved one needs care from a physical therapist, occupational therapist, speech therapist or some other skilled care, you’ll find it is a much greater challenge to find an independent caregiver who is professionally trained and licensed. Because of the added difficulties associated with medical care (and the added liabilities), most families tend to use home health agencies for this purpose. On the other hand, an independent caregiver may be suited for providing companion care, serving as a friend to an isolated elderly person living alone. They could help your mom change light bulbs, go grocery shopping, or take her to a movie.
Quality of Care
The best agencies are up to date on trends in health and wellness in seniors and will constantly train their caregivers to provide the highest caliber care for their clients. Additionally, most agencies screen applicants and perform background checks, offer ongoing training, and handle all the paperwork, such as payroll, taxes, and legal matters. If your family works with an independent caregiver, you are responsible for all aspects of being an employer, including hiring and firing, background checks, taxes, insurance, and employee disputes. For example, if you hire a caregiver but are unhappy with the quality of care, you must go through the process of searching for, hiring, and training a new independent caregiver. If you work with an agency, you can simply request a different caregiver from the same home care agency. Additionally, if you hire a private caregiver and they are unavailable for any reason, your family will be responsible for finding an interim caregiver. Reputable agencies will have well-defined scheduling and backup procedures so that your loved one is never at risk for being left without care.
Training and Licensing
Licensing is a general term that can cover many different kinds of certifications. The rules for certification vary according to which type of care a caregiver is providing. They also vary from state to state. As a general rule, caregivers who help with the tasks of day-to-day living, such as cooking, companionship, and personal care, may not need to be licensed. Licensing or certification is required for those providing medical care, including:
- Home Health Aides: Home Health Aides who work for agencies that are funded by Medicare or Medicaid must meet minimum standards of training. These standards include 75 hours of training, plus 16 hours of supervised practical work, plus passing a competency evaluation or state certification program.
- Certified Nurse Assistants: In Massachusetts, Certified Nurse Assistants must sit for the state exam after completion of the 75-hour HHA course and get registered at the Nurse Aide Registry. State-certified CNAs can then work in any environment that includes skilled nursing
- Licensed Vocational Nurses: Licensed Vocational Nurses are trained to provide most levels of care in the home except for care requiring a registered nurse.
If you hire a caregiver through an agency, you can ask for information on any certifications a caregiver has received. In many states, the agency itself also must be licensed and/or accredited by the state in which it operates. If your home care will be paid for by Medicare, then you are required to use a Medicare-certified home health agency in order to qualify for payment coverage. If you are hiring a caregiver privately, you may need to verify this information yourself. Hiring a caregiver who has completed a certification course gives you the peace of mind of knowing that they have received a certain level of training and completed a testing process.
Bonded and Insured
Bonding is insurance offered by an agency so that if a caregiver is found stealing, the agency will compensate the client. Check with the agency to see if they provide bonding, as not all do. If you choose to work with an agency that does not provide bonding and an item is stolen and the caretaker is to blame, you have no recourse for compensation. Independent caregivers also can bond themselves, though this is not as common.
Home Care Agency vs. Independent Caregiver Comparison Chart
The chart below highlights some of the differences between hiring an agency versus a private caregiver.
| Pros | Cons | |
| Private Hire | You are “the boss.” | You are responsible for hiring/firing, payroll, taxes, insurance, and employee disputes. |
| You can be more selective about the caregiver. | Private hire caregivers are typically not bonded and insured. | |
| It is typically less expensive than going through an agency. | If the caregiver is sick, it is your responsibility to find alternate help. | |
| It may not be covered by long-term care insurance. | ||
| Home Care Agency | Screening, hiring/firing, payroll, taxes, and insurance are handled through the agency. | You might work with more than one caregiver if work hours are not consistent. |
| An agency will have professional liability insurance. | It is typically more expensive than a private hire. | |
| An agency hires caregivers with a variety of skills and matches you with someone who can provide the care or help that you need | ||
| An agency is better able to accommodate variable schedules that might be inconsistent or unpredictable at times. | ||
| If the caregiver is sick or goes on vacation, the agency will provide a substitute. | ||
| If the caregiver, is not the right fit, the agency can send an alternate choice. | ||
| It is often covered by long-term care insurance. |
For an in-depth look at the home health and home care options available, how to pay for home health and home care services, and what to look for when hiring home health and home care service, download our Guide to Home Health & Home Care Services.