In-Home Care: Agency, Registry, or Independent?

You'll know when it's time to find in-home care. That moment can come suddenly or gradually, but at some point it sinks in that you're overwhelmed and it's no longer possible to handle all the responsibilities of helping your aging parents or other relatives without assistance.

To learn more about how in-home care works, what level of care you need, and what costs to expect, see our comprehensive overview to finding and hiring an in-home caregiver.

Unfortunately, though, this is not the only decision you'll have to make. You'll also have to decide how to find, hire, contract with, and pay a caregiver. In particular, it's important to know the difference between hiring independently and going through an agency or registry. Sometimes the word "agency" is used as an umbrella term to refer to all kinds of in-home care providers, but in-home care agencies and registries are different. And independent caregivers are another category altogether.

Agency In-Home Care Explained

In-home care agencies offer a selection of caregivers trained to provide a wide range of services. When you first speak to an intake coordinator for an in-home care agency, you'll be asked to describe the tasks you wish the caregiver to perform, the hours you'd like help, whether you need the caregiver to drive, and other details.

You'll also be asked to describe the level of care your loved one needs; typically a caregiver who provides personal care, which includes bathing and toileting, is paid a higher rate than a caregiver who provides help such as shopping, cooking, and companionship. Agencies can also provide overnight or live-in care, and some agencies offer on-call in-home caregivers to come to your home just when you need a break, which is known as respite care.

What an In-Home Care Agency Does

Payroll:
An in-home care agency is the employer of record. Agencies are responsible for hiring and paying the caregiver and for scheduling hours. You can expect an agency to provide more training, screening, and supervision of individual caregivers than with any other form of hiring.

Bonding and insurance:
Most agencies carry insurance that protects you from liability if the caregiver is injured in your home.

Background checks:
Agencies conduct thorough background checks on all workers, and you can ask to see the results on a caregiver before you hire.

Licensing:
Home-care agencies are state licensed and provide supervisory visits to enforce standards.

Taxes:
The agency is responsible for withholding social security, unemployment, and other taxes; keeping records; and providing the caregiver with tax information at the end of the year.

Determining duties:
In your initial consultation with an agency, you'll have a chance to explain exactly what duties you wish your caregiver to perform. You'll also be able to explain any personal characteristics that are important to your loved one. The agency will then present you with several possible caregivers and help you decide on a good fit.

Behavior issues and complaints:
The agency is responsible for handling any issues that come up regarding caregiver behavior and training. In other words, if you're unhappy with your caregiver, you don't have to speak with her directly, if that's uncomfortable for you. You can report the problem to a manager.

Back-up care:
Agencies can provide a substitute caregiver if your in-home caregiver is sick, injured, or goes on vacation.

What an In-Home Care Agency Doesn't Do

Nursing care:
Some in-home care agencies have aides trained to provide basic medical care (turning, wound cleaning), but many do not.

Time off/vacations:
If your loved one travels, visits other family members, goes on vacation, goes into the hospital, or otherwise requires that the caregiver take a break from employment, you may wish to offer your caregiver vacation pay if you don't want her to go to work for another family. Some agencies offer vacation pay, but most do not. You'll be responsible for making decisions about compensation.

Specific Issues When Hiring an In-Home Care Agency

Once you decide to work with an agency and sign a contract, you will usually not be allowed to switch to employing that caregiver directly. In some cases, you can directly hire a caregiver who has left an agency, but only after a specified amount of time has passed.

How to Choose an In-Home Care Agency

Selecting an agency is a process. You'll want to find one that offers caregivers who meet your needs and whose management style is a comfortable fit for you, as this is likely to be a long relationship. Some agencies are small and locally based; others are local branches of larger regional or national agencies.

The Caring.com In-Home Care Directory includes in-home care agencies from all corners of the U.S. -- this is where you can begin your search for agencies in your area. See what areas each serves and read comments and reviews from other families. Be sure to call at least a few different agencies, both large and small; the range of services provided may vary. To help you with your interviewing process, use our in-home care agency checklist.