When it Comes to getting the right type of Home Care for your elderly loved one, there are many choices. At Alliance Senior Care we receive many questions from clients about finding the right type of care for their elderly loved ones. This article contains numerous question and answers and a Care Benefits Comparison Chart.

Families face so many questions about getting their elderly loved ones the right care. Here are just a few questions and answers we have heard from clients’ families:

Do I hire a Home Care Agency or a Private Caregiver? What is the difference between the Two?

I know that I need to get some help at home but how and who?

The first thing to understand are the differences between hiring an individual or a private caregiver versus and agency and determining the role that I want to take in your loved one’s care.

What is a Home Care Agency?

A Home Care Agency is a business that is hired to attract, screen, hire, train and manage a staff of caregivers for multiple clients.  They generally provide non-medical care to clients that wish to remain independent in their own homes, but oftentimes provide supportive services to clients located at assisted living and or nursing and rehabilitation facilities.

They are many differences amongst agencies, but for our purposes they are a full service agency, that will be contracted to handle the care needs of the individuals and ensure that staff is present during the scheduled times.  See our article on how to choose a Home Care Agency for questions to ask to ensure that you are hiring the right agency?

Home Care Agency’s have supportive staff in the office that is responsible for assessing the client’s needs, supervising staff, scheduling and supervision of the overall care of the client.


What is a Private Caregiver?

Private Caregiver is an individual that is hired to work as a caregiver.  The private caregiver is an independent contractor in your home.  This individual can have varying degrees of experience, training and availability.


What Kind of Costs are Involved with a Private Caregiver Directly?

True or false? Is it less expensive to hire privately than through an agency?

Most of you will say “privately” of course. Well, the old saying about “penny wise and pound foolish” applies very well here.

Did you know that when the caregiver is your own employee, you are responsible, by law, to pay various payroll taxes (including unemployment compensation, Medicare, and social security)?

Hiring a Caregiver Through a Private Agency

You might want to look for an agency that pays these taxes and others so that you do not have the expenses or headache of doing their payroll, buying private insurance, and filing tax forms.

Usually, you pay a flat per hour fee to such agency and they take care of not only the payroll, but also the tax-related issues and forms. There’s much more to costs than the out-of-pocket fees. Insurance, or lack of it, can cost one plenty… We’ll talk about insurance issues later.

What is the Process Like to Hire a Private Caregiver Directly?

There are costs associated with proper screening and hiring costs (such as ads and background checks). And if you’re weighing in-home care vs. a facility: did you know that it is usually less costly to hire in-home help, even full-time, than to pay for a facility?

Screening/References: if the person was recommended by someone you know, it’s still imperative that you check as many references as possible and request a background check (there’s a cost involved for doing this).

Questions for Screening Private Caregivers:

  • Is the caregiver new in the area?
  • Where has she lived before?
  • Why did she move?
  • Is she established in your area?
  • Was the caregiver drug screened?
  • Was the caregiver screened for communicable diseases such as TB?
  • If the caregiver will be doing errands, and in particular drive the elder, does the caregiver have a good driving record? Motor vehicles will issue such record (for a fee). Do not ask if the caregiver speaks English. Demand it! Instead ask if the caregiver has a valid Social Security # and if she is legal to work in the US. Illegal workers can be all kinds of headaches for you and there’s nothing to prevent them from suing, either.

Look for agencies that have already done their homework so you don’t have to.


What Kind of Training Should Professional Care Givers Have?

Many people assume that because someone has a certification (CNA, CHHA, etc.) that the person is qualified to assist an elderly person.

These certifications train someone to provide care to a sick or disabled person, be they old or young. It does not necessarily focus on the issues of caregiving for an elderly person.

When working with the elderly, the training should be focused on the elderly. Ask the agency how they hire and train the caregivers.

Does the Private Care Giver Help Create the Care Plan?

When hiring privately, the caregiver duties are usually verbally discussed between the caregiver and elder only. This can result in misunderstanding.

Ask the agency or the caregiver to put the plan of care in writing.

For example, specific needs are written down, such as:

  • listing of services
  • special diets
  • calendar of events
  • special instructions for personal and household issues.

Often times agencies make it a point to record the person’s medications, doctors and pharmacies, as well as emergency instructions to provide an up-to-date record for family, doctors, and anyone else caring for the person.

Having this information recorded not only avoids misunderstandings, but also helps the family and the substitute caregivers.


Quality of Care/Supervision: Whom is the caregiver reporting to?

In the case of privately hired help, as well as help from certain agencies, the caregiver is not supervised.

Certain agencies get a fee for finding and screening the caregiver, but once the caregiver is placed, they will wash their hands of any responsibility or anything that goes wrong.

Look for agencies who employ the caregivers directly, because they also supervise their staff and the agency is in control and responsible for the care services.


Reliability/Dependability: Does the caregiver have reliable transportation?

What happens if the caregiver does not show up because of car trouble, sickness, family matters, vacations, or other commitments?

As a private caregiver there would not be any care provided until there is a replacement found or family members step in.

In the case of working with an agency, you can ask the agency if they provide a backup, or replacement.


Guarantee and Continuity of Service: What happens if the elder doesn’t get along with the caregiver?Personality conflicts can and do arise from time to time. As the Elder’s family you may have to facilitate

Is there a guarantee of a replacement? If the caregiver is acceptable, is there continuity of service? Will the same person come on a set schedule, or will the agency send someone else each time or each week?

Injury Insurance: Is the caregiver covered by Worker’s Compensation Insurance? If not, then the elder or family member may be liable for caregiver’s job-related injuries. Homeowner’s insurance does not provide this type of coverage and shouldn’t be relied on. Automobile insurance policies do not insure household help. Privately hired caregivers sometimes sue the homeowner/client when they are injured, because they have nowhere to turn and have no insurance or no other means of making a living.

Liability Insurance: Does the caregiver have adequate insurance coverage? If not, and the caregiver gets in a car accident in the course of running errands for the elder, then the elder may be held liable for the damages caused to or by the caregiver.

Theft Insurance/Bonding: Is there adequate theft insurance? If not, then the elder should consider obtaining such coverage. In the unfortunate case of theft by a caregiver, adequate insurance will help recover the losses. Call your insurance company and ask if they cover theft by a domestic employee.

Do not be afraid to ask the agency or the individual caregiver about proof of insurance. Just saying one has insurance doesn’t make it so!

I guess by now you understand that there are huge differences between hiring privately or through an agency and hopefully you now know all the questions you need to ask.

If you do go the agency route, you should know there are different

Types of agencies: Most of the differences can be inferred by the way the agency deals with billing, or collects its fees.

  1. Some agencies collect an initial fee for providing a caregiver. Once the initial fee is collected, they’re done. You’re on your own after placement.
  2. Some agencies collect fees ongoing, the elder having to pay two checks, one to the caregiver and one to the agency. In this case, you’re on your own for payroll, taxes, forms, and supervision. They only guarantee a replacement if things don’t work out.
  3. Some agencies present one bill to the elder and take care of paying the caregivers and all the other hidden costs. These agencies supervise their employees, do their payroll, insure them, and work out any type of conflicts that arise.

Which type you choose is up to you and the criteria that suits you best, but don’t forget to ask all the other questions about insurance, supervision, reliability and quality of care and more importantly determine the role that you want to take.

Ask Yourself….

Are you ready to start a new business and become an employer?

If you answered No, you need to hire a Home Care Agency

If you answered Yes, then you can consider hiring a private caregiver


Who is going to step in and provide care when the private caregiver is sick, on vacation or unavailable?  Do you have family caregivers that can step in to help, oftentimes with little or no notice?

If you answered No, you need to hire a Home Care Agency.

If you answered Yes, then you can consider hiring a private caregiver.

What if the private caregiver isn’t caring for my parent the way I would like, what do I do then?

You can look to hire alternate caregivers, but you need to know who is going to fill in while you are looking and training.

What am I going to do if the caregiver gets hurt in my home? 

If you elected to hire a private caregiver, then maybe you purchased workers compensation insurance, otherwise open yourself and your loved one up to potential liability and legal action.

If you hire a home care agency, it will be covered under their workers compensation insurance and they will handle the injury and provide a replacement caregiver.

We hope that you have found this information useful.

At Alliance Senior Care, we believe that “an educated consumer is our best customer”.

If you feel that a Home Care Agency is the right choice for your loved one’s care, please call us at Alliance Senior Care.

Benefits Comparison Chart : Agency/Registry/Private Caregiver


  Full-Employment Agency Registry Private hire caregiver
Background checks Provides all background checks & criminal history investigation Varies. Most provide some form of background check & employment verification Must be done by family. Most families do not have access to criminal history information & must depend on caregiver to provide it. All reference checks must be done by family.
Training Provides on-going training for all caregivers. Varies. Most registries do not provide training. Many depend on experience of the caregiver and/or CNA certification. Varies. Most private caregivers focus on their work and less on their professional training. Some may have had CNA or HHA classes in the past.
On-site supervision Provides on-site supervision with periodic visits by qualified supervisor. Visits may be scheduled or unscheduled (surprise visits). None. None.
Payroll taxes Provides for all employer/employee tax withholding and reporting. None. Family is responsible for all payroll tax withholding & reporting. None. Family is responsible for all payroll tax withholding & reporting.
Substitution Assures smooth substitution should the caregiver be ill or should the family wish to change caregivers. None. None.
Insurance & Bonding All caregivers are fully insured & bonded. None. None.
Cost Most expensive.

Range: $20 – 25/hour

Hourly rate is usually that of the private caregiver plus a “finder’s fee” to be paid to the registry. Least expensive.

Range: $15 – 20hour


Alliance Senior Care’s In-Home services offer a wide range of services providing healthcare, daily living assistance, transportation to and from Doctor’s appointments and tailored care services for additional circumstances.

To learn more about how Home Care can help improve your loved ones’ quality of life, call Alliance Senior Care at 248-274-2170.  It’s not just Home Care, it is Integrated Care.

Home Care are an excellent resource for family caregivers and seniors alike.

Alliance Senior Care Home Care solutions offer a wide range of services providing healthcare, daily living assistance, transportation to and from Doctor’s appointments and tailored care services for additional circumstances.

If you or an aging loved-one are considering hiring a Caregiver in Bloomfield Hills, MI, please contact the caring staff at Alliance Senior Care today.
Call (248) 274-2170.