Hiring Help


To help a family member remain safely at home, a caregiver may need additional help. This help may come from family and friends, an individual you employ, or an agency.



Types of In-Home Care

It is important to understand the difference between the types of in-home care. There are three basic categories, but they may overlap.

  • companion services - friendly visiting; reading
  • chore services - house cleaning; bill paying; personal care
  • home health services - medically oriented services

Companion and chore services may be provided by an agency or by an individual that you hire.

Home health services are medically oriented to help a person recover from an illness or injury or to assist a person with a chronic medical condition(s). This type of home care offers skilled health care prescribed by a physician. Allowable services include: skilled nursing care; physical, occupational, and/or speech therapy; medical social services and nutrition. Due to the nature of the assistance of home health services, the people providing the service(s) are often licensed practical nurses, therapists, or trained home health aides. Most work for home health agencies, hospitals, or public health departments that are licensed by the state. Medicare may pay for home health care services provided through a certified home health care agency.




Using an Agency

The Yellow Pages of the phone book will provide you with a number of agencies offering a wide range of services from friendly visiting to more health care related tasks. The workers are employees of the agency and you pay the agency. Your fee to them includes their hourly rate and overhead for the agency, including profit. The employees should be insured and bonded. The agency should be licensed (if state law requires it).

As the need for in-home services has grown, so has the number of agencies providing service. To distinguish themselves from the crowd, many home care providers seek accreditation. Accreditation is a process that evaluates an agency based on predetermined criteria to signify that they have met national standards for quality care. Some agencies that provide this service are:


Be sure to ask about accreditation. Contact the organization providing accreditation and ask what criteria were used to evaluate the agency. Usually, they verify that the agency has workman's compensation, liability insurance, that the employees are bonded, etc. Frequently, agencies that would go through the accreditation process also conduct employee background checks and some test for tuberculosis. Find out what steps an agency has taken to ensure the proper care and safety of your family member in need.

Think about what type of assistance your family member needs and how you will pay for the service. This will impact which agency you choose.

Ask these questions:

  • How long has the agency been in business?
  • Are they licensed (if required by state law)?
  • Are the employees bonded?
  • Have criminal background checks been conducted?
    (Note: a criminal background check may be negative in one state but the person may have a record in another state.)
  • Are employees screened for communicable diseases?
  • Is the agency Medicare approved?
  • Does the agency have accreditation? If so, what does that mean?
  • Does the agency offer a sliding scale fee based on ability to pay?
  • What are the payment expectations?
  • Get a copy of the contract for service and read it carefully.
  • Does the agency specialize in any one type of service?
  • How are sick days and vacation days of employees handled?
  • What type of training are employees required to have?
  • How is supervision of employees handled?
  • How does the agency select the employee to help you?
  • Does the contract specify tasks to be done, frequency, and time frame for completion?
  • Is there a written plan of care and, if so, how often is it reviewed and updated?
  • What hours and days is service available?
  • How is confidentiality ensured?
  • How are complaints or problems handled?
  • Are references available for individual employees?

The Administration on Aging provides information on the types of help a caregiver might call upon, from family and friends to home care workers. They also provide information on ensuring security when an in-home worker is hired and how to identify and prevent elder abuse.


The National Association on Home Care offers information on:

  • what home care is
  • who provides the care
  • what type of services may be provided
  • who pays for the services
  • billing practices
  • finding an agency
  • selecting an agency
  • what to do if you have a problem
  • patient rights
  • accrediting agencies

Home Health Compare

Medicare offers a service called Home Health Compare. The service offers detailed information about Medicare-certified home health agencies. Searches can be done by zip code, county, state, or agency name. Note: Medicare does help with the cost of Home Health services.

Home Health Compare

The information in Home Health Compare should be used as a starting point for your selection of a home health agency. You have no way of knowing when the data was submitted.




Hiring an Individual Directly

Some families prefer to hire a helper directly. This can be a good choice if proper planning and investigation is done.

Consider these things:

  • You will be legally responsible for paying social security, taxes, etc.
  • What will be your liability if the person gets hurt while on the job?
  • Is the person bonded?
  • Ask to see licenses, certificates, etc.
  • Ask for references and then be sure to check them out.
  • Does the person relate well to your family member during the interview?
  • Does your family member like the person and feel comfortable with him or her?
  • How will the person be paid?
  • Is the person physically able to do the care needed?
  • Does the person have any special skills?
  • Are there tasks the person is not willing to do?
  • Would you feel confident that this person could handle an emergency?
  • How will vacation and sick leave be handled? Will you pay for vacation days?
  • What happens if the person is late?
  • Is the person being hired as a contractor (versus employee)? If so, check with your accountantt about your legal responsibilities related to the IRS.
  • How will you supervise this person?

It would be prudent to do a background check. Be aware that if you do a background check in one state and find no problems, that is no guarantee that the person does not have a record in another state.

Be sure to have a written contract that identifies expected tasks to be performed and remedies for non-performance.


Consider what you will do if this person cannot show up or is due some vacation time. Think about interviewing a backup worker or interviewing an agency to use for this purpose.

Check with your Area Agency on Aging about the possibility of using institutional respite for emergencies. Have a backup plan in place.

Check with your insurance agent and accountant to make sure that you have covered all your legal responsibilities. Be aware that there are payroll preparation agencies that will issue your employee a check with withholdings, for a fee.


Additional information:
Some of these sources of information provide sample ads and contracts and identify what you are legally responsible to provide such as taxes.


Remember, the Older American's Act also offers states the opportunity to provide in-home services on a voluntary contribution basis. Your Area Agency on Aging will know what is available in your area.




NCNC Nurse Aide I and Health Care Personnel Registry

North Carolina has an online Nurse Aide I and Health Care Personnel Registry. The database provides pre-employment verification of an applicant's credentials. All individuals listed on the North Carolina Nurse Aide I Registry have completed at least a 75-hour state-approved nurse aide training (or comparable) program and a state-approved competency evaluation or a state-approved competency evaluation program. The service can be reached by phone at 919-715-0562.

They provide the following registries:

  • Nurse Aide I
  • Medication Aide
  • Geriatric Aide
  • Health Care Personnel
Health Care Worker





Paying for In-Home Care

Calculating Payments
Part of your consideration in arranging for in-home care for your family member will be the cost of the care. There are various ways to finance care which may be used individually or in conjunction with other sources.




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