Frequently Asked Questions


What is a Home Care Agency?

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

Benefits of Working with a Home Care Agency

Considerations in Working with a Home Care Agency

  • Trained and licensed staff are available.

  • Cost is typically higher due to agency administrative overhead.

  • Back-up people are available in case the usual home care worker is absent.

  • Higher costs may mean using fewer hours of care overall.

  • The agency furnishes 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.

  • The agency is responsible for the worker's salary and benefits.

  • You may not be able to choose the individual, only the type of worker (e.g., Home Health Aide)

  • The agency is responsible for each employee’s Worker's Compensation insurance, Social Security, state and federal taxes, professional liability and bonding.

  • The agency is responsible for development and ongoing supervision of the client’s care plan by a registered nurse.

  • The agency assumes full liability for all care and scheduling.

  • The agency supervises and trains the worker. If you don't like the person assigned to you, the agency will provide another.

  • With an agency, it’s generally easier to find help on short notice.

Who Are Independent Home Care Providers?

Independent home care providers are people you hire directly to provide home care services. Some are listed in registries; others are located through advertising or word-of-mouth. Hiring someone independent of a home care agency maximizes your choice and control. Training, skills 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. However, there are also many drawbacks to hiring an independent home care provider, especially if you don’t want to spend time with the numerous administrative and legal responsibilities of an employer.

Benefits of Hiring an Independent Home Care Provider

Considerations When Hiring an Independent Home Care Provider:

  • You choose who to hire according to your best judgment.

  • You will incur additional work and time to locate and interview applicants and check references.

  • You direct the provider's care and their related tasks to meet your or a loved one's needs.

  • There’s no guarantee the provider you select will have nursing credentials or clinical training as a Certified Nursing Assistant or Home Health Aide.

  • The cost to hire an independent provider is typically lower than an agency.

  • You are responsible for the provider’s payroll, including filing 1099’s with the IRS, and paying any benefits.

  • More hours can be purchased for fewer dollars.

  • Background checks on the worker are up to you.

  • You may choose to expand care time and defer some costs by offering room and board as partial payment for live-in care.

  • There is no back-up should your independent provider be unable to work.

  • Liability for care is not covered by an agency. You are personally liable for an independent provider’s work, including negligent or criminal acts.

  • As the employer, you are responsible for your independent home care provider’s pay and benefits. It is advisable to consult with a tax specialist regarding employer and employee withholding. Alternatively, check out the IRS household employers tax guide.

  • You and your family are responsible for developing a care plan, and for ensuring the worker is adequately trained.

  • You and your family are responsible for scheduling and supervising the home care worker.

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 and 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? Do 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.