How to choose in-home care: questions to ask before you hire
This guide is general educational information, not medical, legal, or financial advice. Talk with your own attorney, financial advisor, or care professional about your situation. Elder Living Guide provides education and referrals; we are not a care provider, facility, agency, or medical practice.
Short answer: First decide which kind of help you need: non-medical home care (personal care, meals, companionship), which Medicare generally doesn't pay for when it's the only care needed, or Medicare home health, which is part-time skilled care a doctor or other provider orders (Medicare: home health services). Then decide how you'll hire, through an agency that employs the caregiver or on your own, because that changes who handles supervision, backup and payroll taxes. Ask every provider the same questions, write the answers in one scorecard, and compare monthly totals and written terms, not just hourly rates.
This page helps you run that comparison. It doesn't recommend any provider, and coverage and licensing rules vary, so check the official pages linked here for your own situation.
Home care or home health? Know which one you're shopping for
Families often use "home care" for everything. Medicare draws a sharp line, and it decides what you'll pay.
| Non-medical home care | Medicare home health | |
|---|---|---|
| Typical help | Bathing, dressing, meals, light housekeeping, errands, company and supervision | Part-time or intermittent skilled nursing, physical, occupational or speech therapy, medical social services, and home health aide care only while the person is also getting skilled nursing or therapy |
| Who starts it | Your family, usually by calling an agency or hiring someone | A doctor or other provider must see the person in person, confirm the need and order the care |
| Who provides it | A home care agency, a worker found through a registry, or a worker you hire | A Medicare-certified home health agency |
| Medicare pays? | Generally no, when personal care is the only care needed | Yes for covered services if the person is eligible, including being homebound. Covered home health services cost nothing; after the Part B deductible, the person pays 20% of the Medicare-approved amount for covered medical equipment |
Medicare says it doesn't pay for 24-hour-a-day care at home, home meal delivery, homemaker services unrelated to the care plan, or custodial or personal care such as bathing, dressing or using the bathroom when that is the only care needed. In most cases, "part-time or intermittent" means skilled nursing and home health aide services up to 8 hours a day combined, for a maximum of 28 hours a week, and more frequent care (less than 8 hours a day and up to 35 hours a week) may be possible for a short time if the provider decides it's necessary (Medicare: home health services). Before services start, the home health agency should tell you what Medicare will pay and give you a notice called an Advance Beneficiary Notice before providing anything Medicare won't cover (same page).
Many families end up with both: a few weeks of Medicare home health after a hospital stay, plus private-pay home care for the hours in between. If you aren't sure home care is the right setting at all, our guide to the main types of senior care compares it with adult day programs and assisted living.
Agency, registry, or hiring on your own
There are three common ways to bring in a non-medical caregiver. The real difference is who controls the work, because that decides who is the employer.
- Home care agency (agency employs the caregiver). The IRS says that if an agency provides the worker and controls what work is done and how it's done, the worker isn't your employee (IRS Publication 926). Ask the agency to confirm in writing that caregivers are its employees and that it handles their pay and taxes.
- Registry or referral list. Some services only introduce caregivers. If you then direct the work, the IRS says it doesn't matter that you found the worker through an agency or from a list an agency provided; the worker can still be your employee (IRS Publication 926). Ask plainly: "Who employs this caregiver, and who handles payroll taxes?"
- Hiring directly. A worker is your household employee if you can control not only what work is done but how it's done; the IRS lists caretakers, health aides and private nurses among household workers (IRS Publication 926).
If you hire directly, federal tax rules can apply. For 2026, if you pay one household employee cash wages of $3,000 or more, you generally must withhold 7.65% for Social Security and Medicare from those wages (or pay the employee's share from your own funds) and pay a matching 7.65% yourself, and that threshold can change each year (IRS Tax Topic 756). If you pay household employees $1,000 or more in cash wages in any calendar quarter, federal unemployment tax can apply too, and these taxes are generally reported on Schedule H with your return (IRS Publication 926). Publication 926 also covers Form I-9 work-eligibility checks and says to contact your state unemployment tax agency about state unemployment tax. There are exceptions, for example for wages paid to your spouse or your parent in most cases, so read the publication or ask a tax professional before you start paying anyone.
None of this makes one route right. An agency usually costs more per hour but takes on screening, backup and payroll. Hiring directly can cost less per hour but makes your family responsible for those jobs. Put both on the same scorecard and decide with your eyes open.
Start with the job, not the logo
Before you call anyone, write down the tasks that would actually help: meal preparation, medication reminders (as allowed), bathing help, transportation, light housekeeping, overnight presence, or simply reliable company. Note the days and times that matter most, and what "good" would look like in two weeks.
Include your loved one's preferences. Help that ignores dignity or routine often fails even if the schedule looks perfect on paper. If you're still deciding whether a parent needs help, start with signs a parent may need help at home and how to bring it up. Hiring help at home is one stage in our senior care planning guide.
Schedule, consistency and backup coverage
- Which days and hours can you reliably staff, and what is the minimum shift?
- Who comes if the regular caregiver is sick or on vacation, and how fast?
- How much notice do you need for schedule changes?
- Can the same person usually return, or will faces rotate often?
- What happens on holidays or in severe weather?
Consistency matters for trust. Backup coverage matters for family sanity. Write the answers down so siblings hear the same story later. If you hire directly, backup is your job, so name a second caregiver or family member before the first shift.
Screening, training, supervision and scope
- How are caregivers screened before hire, and what does that screening include?
- What training do they get, and who supervises them? How often does a supervisor check in?
- What licenses or registrations does the agency hold in your state, and where can you check them? Rules for home care agencies vary by state, so verify with your state's licensing agency rather than taking a brochure's word for it.
- What can caregivers not do, especially around medications, transfers, wound care and driving?
- How do families get updates: a written log, a check-in call, a shared note?
- What should a caregiver tell the family right away, and what stays private, such as topics not to discuss in front of visitors?
If a task needs licensed clinical care, don't assume a companion-care schedule covers it. When medical needs are changing, involve the person's clinician; that is also the route to Medicare home health if the person qualifies.
Pricing without surprise math
- Is pricing hourly, by shift, or packaged? Is there a minimum number of hours per visit or per week?
- Are there higher rates for nights, weekends or holidays?
- What fees apply for cancellation, travel, deposits or the first assessment?
- What is included, and what is billed as an add-on?
- Does the agency accept long-term care insurance or any public program, and who files the paperwork?
Get every quote in writing and turn it into a monthly total for the same schedule. Medicare doesn't pay for most long-term care; Medicaid may cover some long-term care if the person meets their state's eligibility rules, and some people use private long-term care insurance (Medicare: long-term care). Our guide to how families pay for senior care covers those routes, and the private-pay care budget worksheet helps you see what you can sustain. If a policy is involved, use our long-term care insurance questions before you assume it pays for home care.
Compare providers on one scorecard
Charm and glossy brochures are hard to compare. The same columns for every option are not. Our blank in-home care scorecard (CSV) opens in Excel, Google Sheets or Numbers and has a column for up to three options. It covers:
- Who employs the caregiver and who handles payroll taxes
- Weekday, weekend and holiday rates, minimums, and the monthly total for your schedule
- Backup plan, caregiver matching and how often faces change
- Screening, training, supervision and state license or registration you checked
- Cancellation, deposit and contract-length terms, all in writing
- Trial period, how your loved one felt after a meet-and-greet, and open questions
A two-week relief block is a different contract from ongoing daily hours, so label each quote. If short breaks are what you need, see respite or ongoing care: how to tell the difference.
Where to find options near you
- Your local Area Agency on Aging. These are agencies designated by each state to serve older adults in a city, county or region, and they coordinate services such as home-delivered meals and homemaker assistance (ACL: Area Agencies on Aging). Find yours through the federal Eldercare Locator.
- Medicare-certified home health agencies. If a provider orders home health, they should give you a list of agencies that serve your area and tell you if their organization has a financial interest in any of them (Medicare: home health services). You can also look agencies up on Medicare Care Compare.
- Your state's licensing agency for non-medical home care agencies, to confirm a license or registration before you sign.
Fit, respect and a trial period
Ask whether a meet-and-greet and a short first schedule are possible before any long contract. Notice whether the conversation centers your loved one's preferences or only the family's logistics. A good fit usually shows up as patience, clear language and willingness to adjust small routines. If caregiver strain is already part of the story, read caregiver burnout signs too.
Red flags worth pausing on
- Pressure to sign the same day, or before a meet-and-greet
- Rates, fees or cancellation terms that won't go in writing
- No clear answer to "who employs this caregiver?"
- No backup plan when a caregiver calls out
- Promises that Medicare or any program will "cover everything"
- Medical promises or clinical tasks offered in a non-clinical sales call
- Dismissing your loved one's preferences as unimportant
A made-up example
This is an invented example to show how the scorecard works, not a real family or real prices. A daughter needs weekday help for her father from 9 to 1. Agency A quotes a lower hourly rate but a 4-hour minimum and a higher holiday rate; Agency B quotes more per hour with no holiday surcharge and a named backup caregiver. A neighbor offers to work directly. On the scorecard she writes the same 20 hours a week for each, adds holiday weeks, and notes that the direct hire would make her family the employer, responsible for backup and possibly payroll taxes. The lowest hourly rate isn't the lowest monthly total, and only one option has a written backup plan. She books a meet-and-greet with that one before signing anything.
Next steps without rushing
Compare two or three options with the same questions. Involve your loved one where you can. Keep detailed medical and financial information for private, necessary conversations. When you want help sorting home care from community options, see how Elder Living Guide helps or contact us.
How this page is made
Carter Hockinson wrote and reviews this guide. The Medicare coverage details come from Medicare.gov's home health services and long-term care pages, the employer rules from IRS Publication 926 and Tax Topic 756, and the Area Agency on Aging description from the Administration for Community Living. Those pages were checked on October 7, 2026, and re-checked on October 10 and October 13, 2026. The scorecard, the question lists and the made-up example are our own organizing suggestions. We don't list phone numbers, prices or program limits beyond what those official pages state, because they vary by place and change. If an official page changes, we update this guide. If anything here looks out of date, follow the official page, not this one.
Keep reading: Talking to a parent about getting help at home · Respite care: a practical reset for family caregivers · How to build a private-pay senior care budget
Elder Living Guide provides education and referrals. We are not a care provider or medical practice.