Hiring a caregiver: Should you work with an agency or find your own?
Even though my father was in an assisted living facility, it was clear he needed more support. His dementia had advanced enough that he needed daily help with basic tasks but not enough that he would have been happy in a locked memory care facility. I had to hire more help if I wanted him to stay in the apartment he had called home for the last three years. But where to start to find quality help? And what could I afford?
Choosing the right caregiver for your aging parent or relative is an important decision and the good news/bad news is that you have plenty of options when hiring someone. The good news is you can work with an agency to source someone to support your family member or you can search and hire someone independently. The bad news is that the choices can be overwhelming.
To take the stress and guesswork out of choosing, here are the key considerations when deciding to work with a caregiving agency or to hire help on your own.
Working with an agency
Based on his personal experiences in seeking a home health aide to support his mother, Zack Demopoulos, a former human resources executive from Randolph, New Jersey, decided to open his own home care company. He shared these benefits of working with an agency:
Supervision: When you work with an agency, you attain resources beyond the in-home caregiver. There’s someone vetting the caregivers and reviewing the quality of care delivered, and there’s usually a registered nurse on staff who supervises the aides and assesses the care recipient’s care plan.
Administrative assistance: It also means there’s a staffer to manage the administrative side of the relationship, such as scheduling, workers’ compensation, billing and scheduling.
Choices: Many agencies offer a meet-and-greet with a prospective caregiver, followed by a trial period to ensure there’s a fit between your aging parent and the person you’re hiring to assist them.
Regulations: Most agencies must comply with federal consumer affairs regulations that protect the consumer.
Training: Quality care agencies provide training for their employees, so you can have peace of mind that the agency will be able to assist you as different care situations arise. And they can usually offer extra resources and support when needed. Agencies will often create care plans that are individualized to the care recipient.
Backup care: Perhaps one of the most helpful aspects of working with an agency is that when an aide calls out for an emergency or doesn’t show up to work, the agency will send a replacement.
Vivian Geary, of Orlando, Florida, who cared for her mother in her home with the support of paid caregivers, echoes the benefit of having backup.
“There are always replacements if a caregiver calls out or does not show,” she says. “Many times, the agency will match the skills needed for the job when sending the replacement.”
That said, Geary says not all replacements are equal.
“There are times when you will have more of a presence than a replacement,” she says.
To ensure consistent levels of care when you do use fill-in help, she suggests creating a document outlining your parent’s daily routine. This document, she says, “gives anyone providing care the general rules so that they can be effective help for you, and so that you have a measuring stick for gauging a good worker from one who may not be so good.”
Demopoulos points out that cost can be a consideration when working with an agency, as it can be significantly higher than hiring an independent aide. But he says, “Keep in mind many expenses are not covered in private that the agency is handling — like employment taxes and workers’ compensation.”
Going the independent route
Geary found that hiring independently provided many benefits she needed.
“My mom suffered a stroke that resulted in the left side of her body being paralyzed,” she says. “She was also diabetic with a weak swallow. So, I found that no agency aide could help me with some of the everyday activities that I needed to have performed in my absence.”
That’s because agencies would not allow their employees to crush pills — something Geary’s mother needed to swallow her medication.
“So, I found it more beneficial to hire home health aides independent of an agency,” she says. “We had a renewed sense of relief in my household after making the change to independently hired home health aides.”
Based on her experiences with her mother Geary shared these benefits of going the independent route:
Flexibility: A home health provider hired independently often can assist with a wider range of tasks than one hired through an agency. Many aides working with agencies are prohibited from doing anything considered invasive, like taking a patient’s blood sugar or assisting with medication management or administration.
Choices: While hiring independently may require more time and legwork, it can allow you more choices, in whom you hire and what skills they possess.
Scheduling: While the risk of not having backup exists when you take the independent route, you are able to work with the caregiver to create a mutually beneficial schedule. When you work with an agency you are restricted to the hours they provide coverage.
Cost: Often you can negotiate more affordable options for care when you choose to hire independently because you don’t have to cover the overhead costs of agencies.
Whether you work with an agency or hire independently, the most important factor to consider is that you find a fit that puts you and your parent or family member at ease.