The temptation to hire a private caregiver is tremendous. Why? Two main reasons. Number one, the cost to you as the consumer will be less and the caregiver will make more. Number two, control. The ability and flexibility to make decisions about caregivers and scheduling yourself may seem appealing. Many families make decisions “on the fly” during a crisis. This can lead to hiring someone that may be recommended, but you haven’t had enough time to thoroughly vet.

As a Geriatric Care Manager, I am often asked about whether to hire a private caregiver or go through an agency. The question is so prevalent that a colleague and I wrote a book about the subject titled, Aging with Care: Your Guide to Hiring and Managing Caregivers at Home. Our story is personal and professional and takes us both on a journey of the pros and cons of hiring a private caregiver (without going through a home care agency). Now I’d like to take you through some of those pros and cons so you can make an informed decision about the type of care you'd like for yourself or a loved one.

What Are The Risks of Hiring a Private Caregiver?

Let’s take a closer look at what is involved in hiring a caregiver. Hiring private caregivers can be a full-time job and knowing the risks and responsibilities of hiring a caregiver will help protect you.

1. Background checks. When hiring privately, you will need to do the checks yourself. It can be tempting to skip this step. Don’t.
2. Payroll taxes, minimum wage and overtime. How will your caregivers be paid? If you are handling payroll, then you will need to consider what taxes need to be withheld. This includes social security. You may decide to hire caregivers as independent contractors. This means that they have the responsibility to report income. But it is your responsibility to know what the minimum hourly wage is and overtime pay. Bottom line: know the current tax laws on hiring workers.
3. Liability insurance. What do you do in the case of fraud, theft, abuse or exploitation? Talk to your insurance agent about additional protection in the event of illegal actions or accusations. There are real risks to seniors and/or their caregivers that can include the following types of abuse or neglect:
   • Physical
   • Sexual
   • Emotional
   • Medical
   • Financial
4. Work experience and responsibilities. Checking references is critical to making decisions about whether to hire a caregiver. Verifying the experience of caregivers is also your responsibility. States each have their own rules about what a caregiver can and can’t do. For example, some states allow a caregiver to dispense medications while others do not. This is just one example of the myriad of tasks that can or can’t be performed according to state regulations.
5. Scheduling and plan of care. Many people underestimate the time and stress of managing privately hired caregivers. How do caregivers know what their responsibilities are? How do you give feedback to your caregiver? That call in the middle of the night from a caregiver who is calling in sick the next day comes to you. How do you replace a caregiver who is essential to the care of your spouse or family member? Are you or another family member prepared to cover that shift if there is no backup? Consider these possible scenarios:
   • A caregiver does not show up for a shift.
   • A caregiver quits without notice.
   • A caregiver requests a schedule change.
   • A caregiver complains about tasks.

What Are The Benefits of Using a Home Care Agency?

Using a good home care agency helps mitigate a lot of the difficulties mentioned above, providing peace of mind on several fronts.

1. An agency will perform background checks and references on employees prior to hiring. Some agencies also require drug testing.
2. Payroll, taxes, and overtime pay are handled by the agency. Agencies comply with state and federal regulations with regard to employment practices.
3. A home care company will do all scheduling and will replace a caregiver in the event of a missed shift. That middle of the night call will not come to you. It is the agency’s responsibility to replace caregivers and to make any necessary schedule changes. You can also let them know if you need to update your care plan or give feedback to your caregiver.
4. Accusations of abuse, exploitation or neglect are handled by the agency. Complaints can come from the client being served or the caregiver themselves. It can take some time and effort to sort out the truth but a good agency will take complaints seriously.

If you make the decision to hire a private caregiver, tread carefully and be fully prepared for what is involved. Plan ahead, if possible, for caregiving needs before a crisis occurs. Making decisions under duress can lead to poor judgment, so be flexible and willing to adapt as the journey continues!