Choosing a non-medical home-care agency

When a parent needs help at home — with bathing, dressing, meals, medication reminders, and company — a non-medical home-care agency sends a caregiver to provide it. But not all “home care” is the same, and the choice between a licensed agency, a registry, and an independent caregiver has real consequences for safety, cost, and who’s responsible when something goes wrong. Here’s how to choose well.

First, know what kind of care you need

Two very different things share the name “home care.” Non-medical home care (also called personal care or custodial care) is help with daily living — hands-on but not medical — and it’s usually paid for privately. Medicare home health is skilled care: intermittent nursing, physical or occupational therapy ordered by a doctor for a homebound patient recovering from an illness or surgery. Medicare covers home health for eligible patients but does not pay for ongoing personal care or companionship. If you need long-term help with daily tasks, you’re looking at non-medical home care and paying for it another way. You can look up Medicare-rated home-health and hospice agencies and browse non-medical personal-care agencies by state on this site.

The three models: agency, registry, independent

• Licensed agency (full-service). The agency employs the caregivers. It screens and trains them, handles payroll, taxes, and workers’ comp, carries liability insurance and bonding, supervises the care, and — critically — sends a backup when your caregiver is sick. It costs the most per hour, and it buys you the least risk.
• Registry (referral service). A registry matches you with an independent caregiver but doesn’t employ them. It’s cheaper, but you typically become the employer — responsible for taxes, and often without agency supervision, insurance, or guaranteed backup coverage.
• Hiring privately. Finding a caregiver yourself is cheapest of all and can work well with someone trusted, but you take on everything: background checks, taxes (the “nanny tax”), liability if they’re hurt in the home, and no coverage when they can’t show up.

There’s no universally right answer — but understand which model you’re buying, because the cheap hourly rate on a registry can hide costs and risks a licensed agency absorbs.

What to ask a home-care agency

• Are you licensed by the state (where required), bonded, and insured? Do you carry workers’ comp on caregivers?
• How do you screen caregivers — background checks, references, credentials — and how are they trained and supervised?
• Who writes the care plan, and how is it updated as needs change? Can we meet the caregiver first?
• What happens when our caregiver is sick or quits — is backup guaranteed, and will we get the same caregiver consistently?
• Is there a minimum shift (many require 3–4 hours)? What’s the cancellation policy? Is a supervisor reachable after hours?

Red flags

Walk away from an agency that can’t show a state license where one is required, won’t explain its screening or supervision, has no plan for backup coverage, pressures you to sign quickly, is vague about total cost or bills for unexplained “fees,” or discourages you from meeting the caregiver first. A pattern of no-shows early on rarely improves.

What it costs and who pays

Non-medical home care runs about $35 an hour nationally, so a few hours a day is affordable while round-the-clock care gets expensive fast — the point where a community can cost less and do more. Payment usually starts with private funds, then: a long-term-care insurance policy if one was bought years earlier; a Medicaid home-and-community-based waiver for those who qualify (some let you hire a family member); and VA benefits for eligible veterans.

Vet before you sign

Check any state licensing record, ask for and actually call references, start with a short trial before committing to many hours, and stay involved — an engaged family is the best guarantee of good care. If home care is your entry point to caregiving, our caring for a parent at home guide covers building the rest of the plan around it.

This guide is general information, not medical, legal, or financial advice. Rules vary by state and change over time. For personalized, unbiased help, your Area Agency on Aging and your state’s Long-Term Care Ombudsman are free.