Differences in Care Options

I don't understand the difference between hiring a caregiver independently, hiring through a placement agency, and hiring an agency to provide an agency-employed worker. Help!

There are three ways to hire a home care aide:

  1. Use a Home Services Agency
    Also called a home care agency, these agencies are the most common. Agency employees provide the service to the older adult, and the agency is paid directly by the client. In Illinois, all home care agencies are required to be licensed as Home Services Agencies by the Illinois Department of Public Health.
  2. Use a Home Services Placement Agency
    Placement agencies are agencies that match a home care aide and a client for private employment. Clients employ and supervise the aide directly. In Illinois, all placement agencies are required to be licensed as Home Services Placement Agencies by the Illinois Department of Public Health.
  3. Hire someone on your own
    When hiring someone on your own, you may want to consider SASI’s Caregiver Screening service.

If more medical care is needed, a Home Nursing or Home Health Agency may be more appropriate for your needs. Check our Home Care Aide FAQs section for more information on these types of agencies.


Home Services Agencies

What do I need to know about Home Services Agencies?

  • Home Services Agencies are the employer of the home care aide.
  • The agency supervises, pays, and takes responsibility for the worker. It handles Social Security and Medicare withholdings. Most have bonded employees, but you should ask specifically if the aides are bonded.
  • Agencies develop a job description with you, and are required to do in-person supervision every 90 days.
  • Ask about worker consistency and experience. Different agencies have different philosophies, experience requirements, training requirements, and may send different aides for different days of the week.
  • Ask how much the home care aide earns. Is this a living wage in your area?
  • Home Services Agencies are private pay or covered by long term care insurance. All long term care insurance policies are different; see some questions to ask.

Home Services Placement Agencies

What do I need to know about Home Services Placement Agencies?

  • Home Services Placement Agencies are not the employer of the home care aide.
  • You supervise, pay, and take responsibility for the aide.
  • Agencies may develop the initial job description with you, but you and the aide will discuss job description and wages as time goes on. This gives you more flexibility as your needs change.
  • Make sure the agency you work with interviews the aides prior to working with them (ask about their application process). The agency should demand experience and references; complete criminal background checks in compliance with the Health Care Workers Background Check Act; and can assure you the aides are authorized to work in the US and that you and the aide share a common language.
  • Home Services Placement Agencies may be “licensed and bonded,” but cannot bond their workers. If an agency claims to be “Licensed and Bonded,” ask it to specify 1) what license it has (should be IDPH Home Services Placement Agency or Home Nursing Placement Agency license) and 2) how it bonds its aides if they are not employees of the agency.
  • Some placement agencies will not accept requests for short hour jobs.
  • If you hire through a placement agency, speak to your homeowner’s insurance agent regarding what policy changes need to be made before having an employee in your home.


Hiring A Home Care Aide Independently

What do I need to know about hiring someone independently?

Hiring someone a friend or family member has recommended is often the way home care aides are hired. Many aides go years without working through an agency, just working via word of mouth referrals. What should you know to prepare to hire someone independently?

  • You supervise, pay, and take responsibility for the aide.
  • The job description is determined between you and the aide, as is the pay rate. Be sure to have a good sense of your needs prior to beginning the interview process—you want to be determining your needs, not listening to a list of what the aide will and will not do.
  • Occasionally home service aides will carry independent liability insurance—but usually they do not. Speak to your homeowner’s insurance agent to find out what coverage you need to have an employee in your home.
  • Be ready to discuss whether the aide will be an independent contractor or your employee. You need to know what paperwork will be required at tax time for both you and the aide.
  • Decide if you are comfortable working with someone who is not background checked or screened, or who may not be authorized to work in this country. Only you and your loved ones can make this decision—no agency can determine your comfort with these issues.
  • Get more references, and speak to them. Just because your neighbor used one person doesn’t mean he or she is right for you! Get a good sense of the aide’s work history.

SASI screens home care aides for your peace of mind—learn more.

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