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FirstLight client Paula M., with caregiver Cynthia

Should I hire a Home Care Agency or a Private Caregiver?

Families have been grappling with this decision for many years. Should I hire a private caregiver or engage with a local Home Care agency to provide care to your loved ones? There are pros and cons to both. There are some exceptional agencies all over Westchester and Putnam Counties. Likewise, we regularly speak with families about the fantastic private caregivers that they had the privilege of working with. This article will discuss the facts that you should consider as you make your decision.

What is a Home Care Agency

A Home Care agency is generally a local business whose sole focus is providing care to adults or children in the community. Here in Westchester, they’re are agencies that provide skilled medical care, non-medical care, or both. Some are Medicare certified, some accept Medicaid, and others are private pay only.

To provide services, they should be fully Certified (Medicare) or Licensed by the State of NY (Licenced Home Care Services Agency). There are strict New York State regulations that agencies must follow to remain compliant. Agencies that follow these licensing requirements operate at a very high level in terms of compliance and quality and offer a very high level of patient satisfaction. In this article, we will discuss Licenced Home Care Services Agencies (LHCSA) vs. private caregivers who generally provide the same level of care.

What is Private Care

Private caregivers can be hired directly by the family or the individual needing care. The family is fully responsible for ensuring the caregiver they hired has the appropriate skill set, experience, and background to do the job. This is certainly within the scope of ability for many families. Private caregivers can appear to be less expensive initially, but there are many other factors to consider which we will discuss below.

What should you consider when deciding to hire a caregiver?

Suddenly, you are faced with the realization that you need to provide additional support to your loved one. It’s an overwhelming decision, that normally sneaks up on you. You visit for the holidays and see a deterioration in Mom’s abilities, or Dad was hospitalized due to a medical emergency. You are now faced with many tough and emotional decisions. Our goal with this article is to present some facts to help you answer one question: Should you engage with a reputable Home Care Agency, or hire a private caregiver?

Caregiver Training and Supervision

Agencies are required to provide a minimum of 12 hours of continuing education to all Home Health Aides. Training includes topics such as patient rights, infection control, safety in the home, confidentiality, understanding elder abuse, memory care, fall prevention, and personal care tasks. Reputable agencies will provide additional training on important topics such as advanced dementia care, Hospice care, bedbound patients, and more. You should be comfortable asking the agency for details about their training programs.

All agency caregivers are required to have frequent onsite supervision (at no cost to the family) by a Registered Nurse. This augments their training and provides a high level of support to both the caregiver and the family. Caregivers are required to demonstrate skills such as bathing, toileting assistance, ambulation assistance, etc, to the Registered Nurse who will ensure that they are performing the tasks correctly and safely. Caregivers welcome this and feel more confident in their ability to provide exceptional care.

While some private caregivers may have had a level of formal training, many do not. They generally learn on the job and follow the family’s lead. This can initially appear sufficient, however as the care needs progress, it may place your loved ones at risk. Further to this, there is no professional supervision or support available to a private caregiver. As care needs increase, you as the family member are responsible for ensuring the caregiver is capable of safely meeting the care needs.

Background Checks Immigration Status and Drug testing

Finding a caregiver you can trust implicitly in your home should be top of mind. More often than not, they will be alone in your or your loved one’s home, caring for your elderly family member. A Licensed Agency is required to run extensive criminal background checks on all caregivers. In addition, The NY State Department of Health will notify the Licensed Agency if there are any future incidents they should be aware of, while that employee is employed.

If the caregiver is a driver, a reputable agency will run annual Motor Vehicle Checks to ensure that they remain compliant with the agency’s policies. In addition to background compliance, Home Care agencies verify the Immigration status of all potential employees.

Caregiving is a physically, mentally, and emotionally demanding job. Whether you are a professional caregiver or a non-paid family caregiver, the toll it takes on your own well-being can be significant. Caregivers often develop health problems of their own. This leads to more instances of substance abuse, as 26% more caregivers than non-caregivers report having a substance abuse problem in the past year. For the 100 million family caregivers in the USA, the results are similar. Almost half of all family caregivers take more medication than they did before assuming a caregiving role. About 10% of family caregivers are thought to be substance abusers.

All Licenced Home Care Agencies are required to drug test their employees to ensure they meet the agency’s policies. In addition, with routine supervision and support, Home Care Agency caregivers will be more engaged in their job, and feel less stressed and isolated. If you are hiring a private caregiver, this is something that you should think about. Are you comfortable doing the appropriate background testing and drug screening? Do you feel you can support your private caregiver sufficiently, where they will be comfortable and engaged in providing care, especially if as the care needs progress?

Insurance and Benefits

All reliable Agencies will carry multiple insurance policies. These are to protect the Agency, its employees, and its clients. At a minimum, an agency should carry General and Professional Liability Insurance, Non-Owned Auto Insurance, Criminal Insurance, Cyber insurance, Sexual Abuse coverage, Employee Practices Liability Insurance, and Worker’s Compensation. In addition In NY State employers are required to carry NY State Unemployment Insurance, NY State Disability Insurance, offer Paid Family Leave and sick time.

In hiring a private caregiver you need to evaluate how best to manage your risk when having someone in the home doing physical work.

Providing Advanced Care

Caregivers can generally perform many of the same tasks whether it be a caregiver through an agency or a private caregiver. Home Health Aides who are working with a Home Care Agency are guided by a specific plan of care that is created by a Registered Nurse. They follow a strict set of guidelines defined by the NY State Department of Health.

If there is a need for a more advanced level the Home Care Agency Registered Nurse can visit the client, free of charge, and adjust the plan of care. In addition, the Registered Nurse will ensure that the Caregivers have the skillset and are comfortable doing these tasks. If there is a need for medical/skilled care, the Registered Nurse will easily identify this. Some Home Care Agencies will have the capacity to handle Skilled/Medical, and others will refer it out to an appropriate Medicare Agency.

With a private caregiver, there are generally no restrictions on the level of care that they can provide. The Caregiver takes direction from the family members or uses their intuition. This allows for more flexibility in the level of care they can provide, however, you as the employer should be comfortable that they are sufficiently trained and capable of performing those advanced tasks, or medical/skilled tasks.

Caregiver Time Off

Caregivers have lives outside of work just like you and I. They have children and families and will have situations where they become ill, or a child is sick, or they cannot come to work for other reasons. A good local Home Care Agency starts preparing for this the day they onboard you as a client. They will have backup care available and ready to cover any shifts that open due to call-outs. More importantly, the Care Coordinator should be discussing this as a matter of protocol from day one. All caregivers will need time off work at some point and this applies to both private and Agency caregivers.

When you consider hiring a private caregiver, you should think about putting a plan in place to ensure you have coverage when this happens. Are you able to stay home from work? If you are living out of state, do you have a neighbor or friend who can jump in when needed? Trying to find someone to help out at 8 am, when you are least prepared brings its own set of challenges.

Financial Responsibility

Ultimately, this is the area that drives most decisions. When comparing the base hourly rate between using a Home Care Agency Vs. hiring a private caregiver, the private caregiver can initially appear to be more affordable. That being said, there is much more to consider in terms of the true costs per hour that the employer is responsible for.

When using a Licensed Home Care Agency, the caregivers are all W2 employees. This means that the Home Care Agency withholds all required taxes from the employees, and remits them to the relevant state and federal agencies. In addition, the Home Care Agency remits all employer taxes. Along with this, the Home Care Agency will pay for all required sick time, Overtime, Travel time, Spread of shift time, Unemployment Insurance, Workers’ Compensation, and Disability Insurance and coordinate the NY State Paid Family leave benefits. As a private employer, you are legally responsible for covering these additional tax and insurance burdens. Feel free to review this IRS publication for further information.

When you take all of this into consideration, along with the cost of your time if you are a working professional, you will get a much clearer comparison in terms of the true cost of hiring a private caregiver Vs. using an agency.

Long-Term Care Insurance

A final item to consider is whether your loved one may have a Long Term Care Insurance policy. Many of these policies require that you work with a Home Care Agency that is Licensed in the state where you receive services. Some, require that the caregivers be certified, and others have limited requirements. Most licensed Agencies will work directly with all Long Term Care (LTC) Insurance companies to manage all aspects of your claims and reimbursements for covered services. The more reputable Agencies will bill them directly and accept the assignment of benefits so that the Agency is paid directly, and you and your loved one are not out of pocket, waiting on a reimbursement.

If you have a policy and are considering hiring a private caregiver, be sure to call the Insurance company in advance and confirm that they will reimburse you when you have a private caregiver.


Licensed Home Care Agencies and private caregivers can provide a life-changing experience for you and your loved ones, but there is much to consider. They both provide a clear path to helping your elderly family members age in place and live their golden years in the comfort of their own homes As the person responsible for making the decision, you should weigh the pros and cons discussed here and make the best decision you can for your family.

Using a Licensed Home Care Agency can offer the wonderful advantage of professionals being responsible for all the items discussed here. Home Care agencies will have a professional team dedicated to care, planning, and oversight. There will be a qualified staff ensuring the caregivers in your home are experienced, well-trained, safe, legal, and supported. You will have access to dedicated client support professionals who are available to you for any questions, changes to the care schedule, or just a sounding board to support you as you are navigating this emotional time in your life.

About FirstLight Home Care

FirstLight Home Care is a NY State Licensed Home Agency, serving Westchester and Putnam Counties since 2012. We have offices in Mount Kisco and Bronxville, NY. We are dedicated to providing exceptional Home Care services to individuals and families in our local community. As a local business, our goal is to serve our community with compassion, integrity, and professionalism. We understand that navigating the world of home care can be overwhelming, which is why we strive to make the process as seamless and stress-free as possible for our clients.

Our office team includes a Director of Patient Services (RN) and a dedicated Client Care Coordinator, who are available at any time to help answer your questions. Our Care Coordinator offers free In-Home consultations for new clients and makes ongoing home visits to ensure our quality of care goals are being met as well as fostering a long-term relationship with the client. We treat all of our clients as we would our aging family members and we prioritize building strong relationships with our clients and their families, taking the time to understand their unique needs and preferences.

In addition to our comprehensive home care services, we also offer resources and support to help individuals and families navigate the complexities of aging, illness, and disability. From informational articles to personalized care plans, we are here to empower our clients to live their best lives every day. Whether you need companionship, personal care, dementia care, or disability care, FirstLight Home Care is here to help. Contact us today to learn more about our services and how we can support you and your loved ones on the journey to better health and well-being.

You can request more information about FirstLight Home Care directly by clicking HERE. Alternatively, call us at 914-215-1915.

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