You need help. You cannot keep caring by yourself. Do you hire someone from an agency or find someone yourself?

Agency Pros

1. The agency, not you, deals with payroll, taxes, benefits, and workmen’s compensation.
2. The agency conducts relevant background checks and interviews.
3. The agency handles staffing schedules, including replacements for call-ins.
4. The agency should be licensed (if required in your state), insured, and bonded. Bonding is a process where money is held by an independent entity, not the company. If the employee steals or breaks something, you can file a claim with the third party instead of dealing with agency.

Agency Cons

1. The agency decides who to send…and that individual may not always be a good fit for your home or your loved one.
2. The individual may no-show…and the agency may not be able to send a replacement immediately.
3. The agency may use multiple people to care for your family member with dementia, which means you have to repeat the “home orientation” to several paid caregivers.
4. EXPENSE! Agencies may charge $25+ per hour, even though the sitter is receiving minimal wage.

Self-Hire Pros

1. Cost…maybe. Paying a person directly is initially cheaper. But, you can get yourself in trouble with the IRS. If you pay your sitter/caregiver $2000 or more each year, he or she is considered an employee. The “employee” classification comes with an entire set of issues that is beyond the scope of this blog–like payroll taxes, social security contributions, insurance. Click here for more information.
2. Direct control over who comes into your house.
3. Flexibility around schedules and are not bound by agency restrictions (such as a 4 hour minimum block).
4. Consistent caregivers, especially if you have 1 primary person with a second person back-up or relief sitter.

Self-Hire Cons

1. Potential liability…if that individual steals or breaks something valuable, or gets hurt in your home, you bear the cost…or your homeowner’s insurance does, if the issue is a covered event.
2. Becoming an employer, if you pay the person $2000 or more each year.
3. Effort and other costs. Even if you use a website like care.com, you still have to check references and interview the individual. These websites are not free, and if you choose to conduct a background check, you have to pay for that, too.
4. Minimal or no back-up. If you depend on one person and that person has an emergency, or cannot work anymore, you have no sitter until you find one. Again.

Can I Be Paid to Care for My Family Member?

Possibly! I recommend the website “Paying for Senior Care.” The site has a page where you can type in your information and find out if you qualify for any programs.

How Do I Locate an Agency?

1. Figure out what you need. Are you looking for someone to bathe and dress the person? Or are you looking for someone who would act more like a companion? Some agencies only provide sitters/companions. Other agencies are full home health agencies that employ RNs, physical therapists, speech therapists, and home health aides.
2. You can find home agencies in your area on the Medicare web site. You can also see how these agencies have been ranked using the Medicare star system.
3. Search the internet using “in home dementia care.” I’m a Google fan, and I like how reviews will pop up next to the names. Be careful of ads–those reviews may be fake.
4. Go the Better Business Bureau website. You can type in “elder care” and search. The page gives you options to select sitter services, home health care, and other services. You can see which businesses have had complaints or not.
5. Ask friends and family who have used paid caregivers. Sometimes, you will rapidly find out which agency you should NOT use.

What Questions Should I Ask?

1. Cost, including any discounts. Some agencies will lower the hourly price if you use them for a specific number of hours or commit to a specific duration of time. Also, are there higher costs for weekends, shifts, holidays?
2. Training. Nearly every agency claims to specialize in dementia services. How many hours? What is the content of the training? Is there training once the person is hired? If so, how often? Yearly?
3. Behaviors. How do the employees handle challenging behaviors, like care refusals?
4. No-show or call-in policy. What does the agency do when your caregiver does not arrive? Is there a guarantee that a replacement will be found within a certain time frame?
5. Licenses, insurance, and bonding. What happens if an employee steals money or items? What happens if the employee damages something?
6. Change of caregiver. If you do not think the caregiver is the right fit for your loved one, or if you question the caregiver’s competence, can you request another person? What is the process?
7. Caregiver consistency. Will the same person be assigned to my loved one? If not, will the agency limit the number of people so that only 2-3 people rotate through each week?

Categories: Caregiving

Dr. Rita Jablonski

Rita Jablonski, PhD, CRNP, FAAN, FGSA is a nurse practitioner, researcher, tenured professor, and former family caregiver. Her research and practice involve all aspects of dementia management; she is best known for non-drug strategies to address dementia-related behaviors.