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Our BlogSYNERGY HomeCare
of North East Chicago

Agency vs Direct Hiring Caregivers – What to Know

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Can home care be expensive? Yes. If you aren’t one of the lucky ones to have a Long-Term Care insurance policy, or to have had a very lucrative career, you may be trying to weigh the value and cost of home care.


We all know that people are healthier and happy at home; it’s been documented repeatedly. So, in cases where aging in place is the preferred choice and can be done safely, what are the care options for your loved one?

There are so many possibilities today, that it can be quite confusing to the individual who has been tasked with researching and making the best choice. While there is some complexity to home care options, there is also the unknown of the future health condition of your loved one. To make this exercise more beneficial, let’s remove the uncertainty of the future health condition with the assumption that maximizing the time at home for your loved one is an agreed approach.

There are two distinct options to provide care at home and we will review both. Both options can be supplemented with the support of family and friends. The level of caregiver support can be great if family availability is minimal or great if family is remote or busy with responsibilities. The goal will always be to provide the best care for your loved one at the best value.

Direct Hire Caregiver

Congratulations! You are now an employer. If you have ever owned a company, worked in Human Resources or had experience with the intricacy of hiring and managing an employee, you may be comfortable with this role. It includes hiring appropriately, being compliant with the Department of Labor, insuring your employee, safeguarding with redundancy plans, and keeping the caregiver motivated. Is a national background check, past work history, skill or certifications important to you? If so, more work to do.

So, you have done a fine job with hiring and managing and your loved one has been enjoying the care, then….your caregiver hurts his or her back during a transfer assist, or twists an ankle helping mom into the car, did you purchase worker’s comp insurance? Yes, nice work, now you only need to find a new caregiver and fast. No, get ready to pay for all medical costs for the caregiver incident.

So, your caregiver is approached by a lawyer asking if they have been getting paid time and a half for any hours above 40 in a week. Your caregiver responds that they haven’t been tracking but know they work more than 40 hours in a week. The Federal Government requires every hour be tracked and any time over 40 hours be paid at time and a half. We can hope the caregiver doesn’t want to cause trouble but then the lawyer starts telling them the dollars they could be getting if they litigate and well….I think you can guess the ending of this scenario.

Beyond the logistics of day to day management with caregivers being late, sick, needing respite or the relationship souring, it can be quite a challenge to hire directly. So why do so many people try this method? Cost and cost alone. You aren’t paying an agency for redundancy, insurance, background checks, training, systems that track clock-ins, benefits and many other items that are required to ensure the most value for the care your loved one receives. And the reality is, not everyone is in a financial position to secure the best care, tough choices sometimes need to made but it is important to know all the challenges and potential risks of hiring directly.

Agency Care

Utilizing an agency removes many headaches and reduces liability concerns. You will want to ensure the agency is licensed by the state and that you are comfortable with the management team. If the management team is good, the care provided through the company will undoubtedly be a great experience. Not all agencies operate the same way, so you will want to ask about each of the areas listed. Most will offer the following benefits:

  1. Caregivers will be employees not contracted workers
  2. Caregivers will be insured with worker’s compensation insurance and have other benefits
  3. Caregivers will have training required by state, and even more with a quality company
  4. Caregivers will have experience, typically a minimum of 2 years
  5. Company interviews clients and caregivers to get a good match, and will allow you to request a new caregiver in the event of a mismatch
  6. Company will have a tracking system that will automatically notify if late or absent, many have GPS
  7. Company will have a large bench of qualified caregivers to ensure backup care is covered in the event a primary caregiver is sick or needs time off
  8. Company handles all HR management issues for caregivers

By allowing the agency to handle the employer role, you remove many challenges that can affect your loved one’s care. You also eliminate the risk of legal and medical issues from a caregiver. Remember, the agency is now the employer and assumes all liability for HR, pay, insurance and care coverage allowing you to sleep better at night and to focus your attention on quality time with your loved one.

More recently, certain legal entities have been targeting caregiver employers, both agencies and direct hirers. They know that many direct hirers are not complying with the Department of Labor and the Federal laws surrounding compensation. It is an easy target, they know direct hirers typically do not keep agreements or time records which then lead to he-said/she-said scenarios, and the rulings almost always benefit the employee.  

Both options will allow for a great relationship between a caregiver and your loved one but if the relationship sours and you are the employer it can sometimes become messy. Everyone knows that you don’t drive without insurance, or own a home without insurance, why would someone choose to hire a caregiver directly and assume all the responsibility of an employer and the liability of legal and medical issues? The reality is, care through an agency costs more, but there is a reason for it. You buy the comfort of knowing you won’t be sued, you won’t have a big medical bill become your responsibility, and you won’t have the headaches of managing an employee. In the long run, you could argue that an agency is cheaper if you were to manage the caregiver and provide all the benefits and training but most who choose hiring direct do not.

Always remember your primary goal, to ensure you have the best of care for your loved one. Here at SYNERGY HomeCare of Chicago, one of the top agencies providing live-in home care in Chicago, we help you accomplish your goal. Visit our website or call us at 877-432-2692 to find out how we can help!