Should I use an agency or hire someone directly?

It depends on what you can take on. An agency pre-screens and trains workers, handles payroll and liability, and can send a replacement quickly — for more money. Hiring directly (through a registry or referral) usually costs less and gives you more say in who you hire, but you become the employer: you are responsible for the background check, payroll taxes, and liability coverage yourself.

What if I already suspect something is wrong with a current aide?

This page is about vetting before you hire, not a response protocol. If you suspect neglect, financial exploitation, or abuse, contact your state Adult Protective Services rather than relying on general guidance, and if there is immediate danger, call 911. Rules and reporting channels vary by state.

How Do I Find and Vet an In-Home Aide I Can Trust?

Q: How do I find and vet an in-home aide I can trust?

Search through one of three channels: a home care agency, a private-duty registry, or personal referrals from your Area Agency on Aging. Whichever channel you use, vet the same way: confirm a background check was done, check at least three references (two from previous employers if possible), verify any certifications, and put tasks, schedule, and pay in writing before the first day.

The short answer: search through one of three channels — a home care agency, a private-duty registry, or personal referrals through your Area Agency on Aging — then vet every candidate the same way: confirm a background check happened, check at least three references, verify certifications or relevant experience, and put duties, schedule, and pay in writing before day one.

Family Caregiver Alliance frames hiring home help as a real workflow, not an informal favor: define the tasks and schedule you need before you start interviewing, then check references, background screening, and certifications or dementia experience where relevant.¹ Which search channel you use changes who does that screening — an agency, or you.

Where to search

Home care agencies — local companies that recruit, background-check, train, and schedule aides for hands-on, nonmedical support (bathing, dressing, meals, mobility, medication reminders). They handle payroll and supervision.²
Private-duty registries — staffing services that refer independent workers matching what you're looking for; you tell them the need, they connect you with candidates, and the employment relationship is between you and the aide.³
Personal referrals — recommendations from friends, neighbors, your place of worship, or a community group who have used someone directly.
Your Area Agency on Aging — call Eldercare Locator (1-800-677-1116) or search eldercare.acl.gov to find your local agency, which can point you toward vetted local options and, in some areas, maintain its own registry of certified home care workers.⁴

Note the difference between "home health," which typically requires a doctor referral and provides short-term skilled medical services like physical or occupational therapy, and "in-home care" or "home care," which is ongoing, nonmedical help with daily living. Most families searching for an aide to help day-to-day mean the second one.²

Agency vs. direct hire: what changes

Using an agency generally means workers are pre-screened with a background check already completed, the agency can send a backup if your aide is out, and the agency carries liability if someone is injured on the job — for a higher hourly cost and less say in exactly who is assigned to you.³

Hiring directly (through a registry, referral, or on your own) usually costs less per hour and gives you more control over fit and schedule, but you take on the agency's usual jobs yourself: running the background check, verifying credentials, handling payroll and tax withholding as an employer, and arranging liability or workers' compensation coverage.³

Vetting steps for every candidate

Whichever channel you use:

Write down the specific tasks, schedule, and any relevant experience you need (dementia care, mobility transfers, medication reminders) before interviewing.¹
Interview candidates together with the person receiving care whenever possible.
Check at least three references, two of which should be previous employers.
See a photo ID, and verify a driver's license (including checking the record with the DMV) if the person will be driving.
Verify any required certifications or training, and ask directly about experience with the specific condition involved.
Confirm whether a criminal background check was done — if you're hiring through an agency, ask what the check consisted of; if hiring directly, run one yourself or through a screening service.
Put the agreed duties, schedule, and pay in writing.

If you hire directly: extra responsibilities

If you're the employer of record, plan on payroll tax withholding, an employer identification number, and — in some states — required workers' compensation coverage, since caregivers generally must be treated as W-2 employees rather than independent contractors. Confirm your state's specific rules and consider a payroll service built for household employers if the paperwork feels like too much on top of caregiving.⁵

Checking a licensed home health agency

If the need involves skilled, doctor-ordered home health services rather than nonmedical daily support, use Medicare's Care Compare tool to find Medicare-certified home health agencies in your area and compare their quality-of-care and patient-survey star ratings before choosing one.⁶

Red flags to walk away from

The Center of Excellence on Elder Abuse & Neglect's published warning-sign list flags a caregiver who isolates the person from visitors or phone calls, is verbally aggressive, demeaning, or controlling, is overly concerned about the person's money, or fails to provide basic hygiene, food, medical aids, or a safe living environment as red flags worth treating seriously during and after hiring.⁷ If you see any of these, stop using that aide and follow up with your state's Adult Protective Services rather than continuing the arrangement.

What to check before you sign anything

What exactly is included in the hourly rate or fee, and what costs extra
Who is liable if the aide is injured, or if something is damaged or goes missing
What happens if the aide is sick, quits, or doesn't work out
How to end the arrangement, and any notice required
Whether a written care plan or schedule is included

Common mistakes

Skipping references or background checks because a referral came from someone trusted — a good referral doesn't replace verification.
Assuming "agency" always means fully vetted; ask specifically what the agency's background check covers.
Treating a private hire as an independent contractor for tax purposes without checking your state's employment rules first.

Sources to verify

Family Caregiver Alliance. "Hiring In-Home Help." https://www.caregiver.org/resource/hiring-home-help/ ↩ ↩²
AARP. "Who to Hire if You Need Caregiving Help." https://www.aarp.org/caregiving/financial-legal/who-to-hire-caregiving-support/ ↩ ↩²
AARP. "Hiring an In-Home Caregiver." https://www.aarp.org/caregiving/home-care/hiring-caregiver/ ↩ ↩² ↩³
Administration for Community Living. "Eldercare Locator." https://eldercare.acl.gov/Public/Index.aspx ↩
CaringInfo. "How to Employ In-Home Caregivers … Legally." https://www.caringinfo.org/planning/in-home-care/how-to-employ-in-home-caregivers-legally/ ↩
Medicare.gov. "Care Compare — Home Health." https://www.medicare.gov/care-compare/ ↩
Center of Excellence on Elder Abuse & Neglect, University of California, Irvine. "Red Flags of Abuse." https://www.centeronelderabuse.org/red-flags-of-elder-abuse.asp ↩

← Back to Words