Hire Directly or Use an Agency? I spent thousands $ on In-Home Senior Care Aides

11 lessons I learned spending $147,683 on in-home elder-care aides. Should you use an agency or hire directly? (And I worked for an in-home senior care agency).


After working for a large, national senior-care agency, I thought: it must be cheaper for caregivers to hire directly. And I'm a smart woman, I can do it (cue inspirational music 🎶).

After hiring caregivers directly for our dad, I realized: Nope, it is NOT easier, NOR less expensive. However, there are some advantages: read on.

#1 - You can hire people "under the table." I did not do this, and I don't advise you do it either. I hired people and paid their state and federal taxes, because:

  • Senior care aides are employees and deserve the same protections as if they worked in your office.
  • There are *plenty* of examples of elder care aides telling the government "I want my social security, etc., benefits and here is the name of my employer." So don't pay "under the table" or via1099 - you run a high chance of getting in serious financial trouble.
  • Home care aides are often under-paid and denied paid time off or sick leave. I made sure every senior care aide who worked in our home received sick days and paid vacation time.

By the way, if you hire an in-home caregiver via a website such as Care - dot - com, this person is your household employee. According to the IRS,

If you pay cash wages of $2,400 or more for 2022 (this threshold can change from year to year) to any one household employee, you generally must withhold 6.2% of social security and 1.45% of Medicare taxes (for a total of 7.65%) from all cash wages you pay to that employee

Read it and weep on the IRS website

#2 - You have to pay for your own background checks. It's easy to do online and not too expensive.

When I write "easy" in this blog post I mean that it can be done by someone with moderate computer skills who is patient in following instructions. But these activities are still time consuming, require an organizational system, and one must monitor the ongoing activities and billing. If this is not you, it is not easy. Sure ain't fun!

#3 - Payroll is typically paid weekly for your care aide. I used Intuit/Quickbooks Payroll processing, which calculates the required tax witholdings and also makes it easy to pay those. You'll spend a few hours setting this up. More of your time.

#4 - Interviewing and hiring - I wrote and posted ads on Craiglist and Indeed, which is exactly where most agencies find their care workers. This is time consuming again. We did meet and hire some great caregivers.

#5 - Turnover - Our family hired a caregiver "Carlos," who was an excellent cook. He was wonderful with my father. After the first 2 weeks, he said he needed $10 more an hour. For 30 hours a week, that's another $1200 per month. I was disappointed - it was like bait and switch. I declined his offer.

#6 - Daily hours - clocking in and out. You think "this is your home," but you have an employee here, not a family member. Most of the care aides who worked in our home were wonderful. There was one who, we found out, was padding extra days into her time sheet. So, I had to let her go, the day before a major holiday. Not fun. More turnover.

#6b - The opposite of hiring is firing: Unless you are accustomed to running a business and firing people appropriately and legally, don't hire people directly. This is a messy topic, and agencies can switch out caregivers who are not a fit for your family.

#7 - Training - Caregivers hired through an agency have minimal training on caring for people with dementia, Alzheimer's or other specific challenges. Caveat Emptor - when agencies say their caregivers are "trained" it could mean they merely watched videos for a day. This is not hands-on training that you are getting when you hire a Registered Nurse.

Caregivers we hired directly were not be interested in the Care Academy training we provided to them. We offered incentives, but these never "took." The best we could do is hire an experienced caregiver.

#8 - Workplace compensation insurance -- Senior care aides deserve to be paid disability if they get hurt on the job, in your house. We paid over $1,000/yr for this insurance with BiBerk. Figure this into your hourly cost.

#9- Bonded -- It means nothing that the in-home care agency "bonds" the caregivers. This only protects the agency in case the careworkers are found - in a court of law - to have stolen from you or been criminally negligent. After your long legal battle, the "bond" provides the insurance money for the agency to pay you the judgement amount. So when agencies tell you their workers are "bonded" - don't think you are getting something; you're not.

#10 - Someone to call -- when you hire an in-home senior care agency, you have a 3rd person to call -- the owner or the case manager. This "client relations" person (who also doubles as a salesperson) is very interested in making sure you are satisfied, that your parent is well cared for, and the caregivers are treated fairly.

#11 - Backup - everyone gets sick, everyone's child gets sick, so sometimes your caregiver can't come. And yes, you may have to cancel a meeting or your plans for the day when that happens. But an agency will be able to have a fill-in caregiver help as soon as possible. That is hard to do on your own.

Many in-home care agencies for frail elders or disabled spouses or parents excellent service.

I did find that the caregivers I hired directly had more experience, and more skills, than the caregivers hired through the agency. If you want to pay more than the "going rate" for caregivers, you will find exceptional talent who can make your life at home much smoother, and be a positive and caring companion for your spouse, parent or loved one.

Either way, your loved one's live will be enriched by having an experienced caregiver work in your home.

You can't be a sole caregiver 24/7 without sacrificing a lot. If you have the financial means, hiring a caregiver is a life saver and sanity saver. It may also save your career and your marriage.

I have personally used each of the services mentioned above and links are provided for your convenience, I do not earn commission or payment of any kind from these links. - LL

Photo by Alex Boyd on Unsplash

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