Should You Use a Home Care Agency or Hire Privately?

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If you or someone close to you requires in-home health or personal care and you’ve figured out what type of care you need, the next step is deciding if you want go through a home care agency or hire an in-home care provider privately.

A home care agency is a business or organization—some are nonprofits or public—that employs home care workers to provide health and or personal care to individuals. (Home care agencies that are specifically certified as Medicare and Medicaid home health providers are called Home Health Agencies.)

If you go through an agency to find an in-home care provider, the agency screens the people they hire and is the official employer of those workers. That means that the agency is responsible for withholding taxes and providing benefits and provides supervision if there’s a problem with a particular worker or they get sick or need time off.  

Hiring an in-home care provider privately, on the other hand, can be less expensive, but it means that you’re the employer of that worker and you’re the one responsible for all of those financial and managerial responsibilities.  

There are pros and cons to going either route, explains Christina Irving, LCSW, Family Consultant at the Family Caregiver Alliance. Most important is for you to know what to expect in both scenarios, she says. “Home care is a very personal experience so finding the right individual is important, but families also need to understand their legal responsibilities and liabilities.”

You can browse in-home care agencies and providers using our service finder:

Here are a few other considerations to think about for both routes.

If you use a home care or home health agency…

“The ‘pro’ of an agency is that they’re the employer of the worker,” Irving says. They handle taxes, workers’ compensation, background checks and screening, and any issues that come up once the care provider starts. But agencies are typically more expensive because of all those overhead costs.

Pros of an agency

  • Agencies take care of taxes, screening, and other legal considerations. Note: Some agencies contract home care providers rather than those workers being employees, which means the tax and legal implications for you are different. Be sure to ask if the agency you use considers their workers employees and ask for proof of workers’ compensation insurance and unemployment insurance.
  • If the care provider needs time off or gets sick, the agency finds someone else to cover.
  • The agency manages conflicts. “If something’s not working out you can go back to the agency and they either work out that problem or find a replacement,” Irving says.
  • It may be easier to get long-term insurance coverage for home care if you use an agency.

Cons of an agency

  • Agencies are typically more expensive than private care providers (because you’re paying for the extra financial and legal services, as well as the agency’s overhead costs).
  • Agency care providers may be more limited in the types of services they can provide, depending on the type of plan or agreement you sign up for. Some workers, for example, may not be expected to do housekeeping or manage medications for the individual needing help. Or if you do need additional services, you may have to pay for them.
  • You may experience staff turnover at an agency.

If you hire home help privately…

There are a lot of extra responsibilities when it comes to hiring a home help privately, Irving says. But in some cases that extra effort can be worth it if it results in a much better care solution for the individual who needs help.

“You might be able to find somebody in your community who can speak the language of a loved one, where an agency may have more difficulty finding someone who can speak that language,” Irving explains.

In other cases the price difference between hiring privately and going through an agency where you pay for a lot of overhead costs makes getting home help possible.

Pros of hiring privately

  • Lower costs. Sometimes the cost can be between $10 and $15 less per hour if you hire privately versus go through an agency, Irving says (though rates vary widely based on where you live).
  • It may be easier to find a care provider to meet a specific language or cultural need if you hire privately.

Cons of hiring privately

  • You are responsible for screening the care provider(s) you hire and conducting background checks.
  • You will have to put in more time to take care of taxes and any responsibilities that are specific to your state, such as unemployment or disability insurance costs.
  • You are responsible for settling disputes that come up and finding a replacement or other coverage if the care provider  is sick or needs time off.

If you do hire a care provider privately, consider writing (or hiring an attorney to write) a contract between you and that worker to spell out details about the care provider’s rate, what the role entails, behavior expectations, grounds for termination, and other details you want agreed upon in writing.

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