Choosing the Right Home Care Provider

Home Care Options: Agency, Direct Hire and Registry

If you’ve decided that you or a loved one need help at home but aren’t sure if an agency is right for your needs, there are other ways to bring in a home care provider, including hiring them directly or choosing from a registry.  Below you’ll find a comparison of home care agencies, direct hires and registries so you can determine the best approach for your family’s needs.

There are benefits and drawbacks to all approaches – and every situation is different – so it’s important to look at your decision from a variety of perspectives. This overview of in-home care service options is designed to serve as general information and should not be taken as legal or tax advice.

Home Care Agency

This type of organization handles both the business and clinical aspects of hiring a caregiver, nurse, physical therapist or other in-home provider. The agency is responsible for background checks of care providers, payroll, taxes and other essential administrative functions. They ensure that caregivers and nurses maintain appropriate licensing requirements.

Some home care agencies provide staff ranging from companion care to complex skilled care. Those that provide comprehensive services are able to ensure that your loved one will receive the right type of care as their needs evolve. Agencies can often send a substitute provider if yours falls ill or is otherwise unable to come at their scheduled time. Caregivers can also collaborate with nurses and other team members to provide a more thorough care experience.

These comprehensive agencies typically provide training and guidance to the individuals they send to your home. Ongoing education should include skills and insights that help keep your loved one safe at home by decreasing the potential for falls, accidents or injuries. The quality of training and support varies by organization, so it’s important to choose an agency with a strong reputation for superior care, nursing oversight and a commitment to the families they serve.

Direct Hire

Some families have success with hiring a relative, neighbor or friend to provide care at home. Perhaps they’ve had good luck hiring a caregiver or nurse they know in their community or have found them online or by referral. This arrangement may be agreed-upon informally with a few conversations or it may take on a more business-like approach with a contract and written set of expectations for the in-home care.

Even though the hourly cost may be less, you’ll be responsible for any legal paperwork, payroll tax and other employer requirements. You should also ask an attorney about any potential liability and consider a liability insurance policy in case the caregiver gets hurt on your property or while providing support such as transportation.

Caregiver Registry

This approach builds upon the direct hire concept, but you have access to a larger pool of candidates. Sometimes called a private duty registry, independent contractor agency or referral agency, this type of company collects the names of caregivers, nurses, physical therapists and other individuals that provide home care services.

After identifying your needs, they'll share a list of possible providers that you interview and may choose to hire directly. In most cases, the registry agency doesn’t complete background checks or provide training – of course, this can vary. The agency typically charges a finder’s fee and then all aspects of the relationship with the caregiver or nurse are your full responsibility.

Comparison of Home Care Agency, Direct Hire and Registry

Now that we’ve reviewed the various options, let’s look at a summary of the key aspects of three different sources for in-home caregivers and nurses.

Home Care Agency:

• Cost: Moderate
• Responsible for background check, payroll, benefits, taxes, etc.: Agency
• Provides training, supervision, making sure care provider is properly licensed and certified: Agency
• Available personnel for back-up coverage: Agency handles this for you
• Range of service offerings: Agency may have providers along the entire continuum of home care (varies by location)*
• Schedule flexibility: Can usually support variety of short- or long-term needs
• Covered by long-term care (LTC) insurance: Usually

Direct Hire:

• Cost: Lower
• Responsible for background check, payroll, benefits, taxes, etc.: You
• Provides training, supervision, making sure care provider is properly licensed and certified: You
• Available personnel for back-up coverage: If you arrange for it
• Range of service offerings: Limited
• Schedule flexibility: Varies
• Covered by long-term care (LTC) insurance: No

Registry:

• Cost: Relatively Low
• Responsible for background check, payroll, benefits, taxes, etc.: Usually you
• Provides training, supervision, making sure care provider is properly licensed and certified: Depends, but generally you
• Available personnel for back-up coverage: Could possibly call another provider
• Range of service offerings: Variety of providers, but not part of a collaborative team
• Schedule flexibility: Varies
• Covered by long-term care (LTC) insurance: Possibly

These lists represent the common characteristics of the three options described above and is not a definitive guide to the types of services offered by various categories of providers. Source: Family Caregiver Alliance, caregiver.org