Agency vs Independent providers

Determining what type of home care worker to hire depends on your needs, preferences, and financial resources.  It is important to assess your needs and your loved level of care.  Once this has been established, you will want to consider whether to hire someone from a home care agency or independently by private contract.  This decision will have implications in terms of training, cost, type of individual you employ and other factors.  Use this information to weigh the pros and cons of each option to see what is best for you.  Determining what type of home care worker to hire depends on your needs, preferences, and financial resources.  It is important to assess your needs and your loved one’s level of care.

Home care services cover a wide range of health and social services for individuals recovering from surgery or an injury, those with disabilities and chronic conditions, or people with terminal illnesses. Services can range considerably in scope and often can be tailored to meet your needs. Keep in mind that Medicare does not cover 24-hour home care, personal care, homemaker or chore services (or any services not “medically-necessary” but considered to be “custodial care”). If you are considering home health care, use this guide to help you decide which option is best for you.

Home Care Agency
According to the National Association for Home Care, there are over 20,000 home care agencies in the U.S. that provide care to about eight million people. Home care agencies offer consumers convenience. Agencies differ though; some are more medically oriented, while others provide exclusively non-medical care. Nearly half are Medicare certified.

Pros

Cons 

Trained and licensed staff generally are available. Cost is typically higher due to agency administrative overhead.
Back-up” people available in case the usual home care worker is absent. Higher costs may mean using fewer hours of care overall.
Able to furnish references or other assurances of the worker’s competence. There may be less flexibility in the type of tasks each category of home care worker is permitted to do.
Responsible for the worker’s HR benefits. You may not be able to choose the individual, only the worker type.
Responsible for Worker’s Compensation Insurance, Social Security, State and Federal Taxes, Professional Liability and Bonding.
Supervises and trains the worker. If you don’t like the person, the agency will handle dismissal.
Development and ongoing supervision of care plan by a registered nurse.
Assumes full liability for all care and scheduling.
Generally easier to find help on short notice.

Independent Provider
Independent providers are people you hire individually to provide home care services. Some are listed in attendant registries at local community-based programs; others are located through advertising or word-of-mouth. Hiring someone independently maximizes consumer choice and control. Training, skill and fees for independent providers vary greatly. You may wish to contact a local council on aging to ask about average rates in your community.

Pros

Cons 

Choose who to hire according to your best judgment (even friends, neighbors or relatives). Additional work and time to locate and interview applicants and check references.
Consumer control to direct the care and related tasks to meet your own needs (e.g., no restrictions for driving or other duties mutually agreed upon). No guarantee of a nursing credential or clinical training.
Cost is typically lower than an agency. Background checks are up to you.
More hours can be purchased for fewer dollars Usually no back-up should your independent provider be unable to work.
Expand care and defer some costs by offering room and board as partial payment for live in care. Liability for care is not covered by an agency.
Additional responsibilities as the employer (e.g., paperwork for social security, taxes, employee benefits). It is advisable to consult with a tax specialist regarding employer and employee withholdings. Alternatively, check out the IRS household employers tax guide.
Care plan and worker training responsibility of family.
Family responsibility for scheduling and coverage.

Making Your Choice
Whether you choose the agency path or the independent provider route, you can increase your confidence by asking about your home care worker’s prior experience, training, credentials and by checking references.  When hiring someone independently, you can also conduct a personal background check by getting written authorization from a prospective employee for criminal background, medical records, driving record, and credit.  For a fee, some private companies will conduct a background check for you.

Think through your care-giving situation.  Is it more important to get the “biggest bang for your buck,” or do you value convenience — perhaps paperwork and employer responsibilities seem daunting?  Assessing your preferences will help you choose the right home care worker to make life easier for your loved one and provide you, the caregiver, with both practical support and peace of mind.