What Is Senior In-Home Care?
Senior in-home care is all about helping older adults live comfortably and safely at home while getting the support they need with daily tasks. Whether it’s help with bathing, dressing, meal prep, mobility, or companionship, in-home care allows seniors to stay independent while receiving personalized assistance tailored to their needs.
At CareWorks Health Services, we’re a local home care agency in Fountain Valley, CA, serving seniors throughout Orange County. Our trained caregivers provide non-medical support, ensuring seniors get the attention they deserve in the comfort of their own homes.
If you’re looking for the best private caregivers for seniors in Aliso Viejo, CA, or anywhere nearby, we carefully match each client with a qualified, compassionate caregiver who understands their unique needs. From companionship to specialized dementia care, we make sure your loved one is in good hands.
Home Care Services Explained
Non-medical home care services are really just about helping people with everyday tasks so they can stay comfortable and independent at home. It’s things like helping with bathing, getting dressed, meal prep, light housekeeping, or even just providing some companionship.
There’s no medical aspect to it—like wound care or medication management—but it’s perfect for someone who doesn’t need medical attention but could use a little extra help to recover from an illness, or an extra hand to help with their day-to-day routine.
Whether it’s a senior who wants to stay at home or someone recovering from surgery who needs support with chores or personal care, a licensed in-home care agency in Orange County, CA makes life so much easier. It’s also great for giving family caregivers a break, so everyone has peace of mind.
Home Care vs. Home Health
When it comes to getting care at home, it can be tricky to know the difference between home care and home health. Here’s a simple breakdown to help you decide what’s best for your loved one.
Home Health (Skilled Medical Care)
Regulated by state
Home Care (Non-Medical Assistance)
Some or no state regulations, depends on the state
Three Main Categories of Home Care Services
Non-Medical Home Care
- Focuses on daily living assistance, companionship, homemaking, such as:
- Bathing and dressing
- Meal preparation
- Light housekeeping
- Transportation
- Lifestyle support
- Personal care assistance
- Individuals with memory loss or dementia
- Ideal for seniors who need a helping hand but don’t require medical services.
Medical Home Care (Home Health Care)
- Provides skilled nursing care and therapies, such as:
- Wound care
- Physical or occupational therapy
- Medical social services
- Ideal for those recovering from surgery, injury, or managing chronic illnesses.
Specialized Home Care
- Hospice Care: Focuses on comfort and quality of life for individuals in the final stages of a terminal illness.
- Palliative Care: Provides relief from symptoms and stress of serious illnesses, aiming to improve the quality of life at any stage of the illness.
- Post-Hospitalization Recovery Support: Assistance with ADLs, mobility, home safety.
- Fall Prevention and Home Safety Monitoring: Clutter removal, safety checks, supervision.
- End-of-Life Comfort Care: Supportive care for individuals in hospice.
- Mobility Assistance: Help with walking, transferring, fall prevention.
- Hearing & Vision Support: Assisting clients with hearing aids, glasses, and daily tasks.
Comprehensive List of Home Care Service Types
Personal Care Assistance: Hands-on help with Activities of Daily Living (ADLs) like bathing, dressing, grooming, bathroom use, incontinence care, feeding, and transferring.
Homemaking Services: Help with household tasks such as light cleaning, meal preparation, laundry, and grocery shopping. These services help maintain a clean and safe living environment. This service is known as Instrumental Activities of Daily Living (IADLs).
Companionship Services: Focuses on social interaction, emotional support, and mental stimulation through conversation, activities, and outings, helping prevent loneliness, depression and isolation.
Skilled Nursing Care: Intermittent medical care provided by licensed registered nurses (RNs) or licensed practical nurses (LPNs) or licensed vocational nurses (LVNs). It can include medication management, wound care, IV therapy, and monitoring of chronic conditions like diabetes or heart disease.
Therapy Services: Physical Therapy: Improves mobility, strength, and balance. Occupational Therapy: Helps clients regain the skills needed for daily activities. Speech Therapy: Assists with communication, swallowing, and cognitive skills.
Medical Social Services: Counseling emotional support, and assistance navigating community resources for individuals dealing with health-related challenges by social workers.
Palliative Care: Focuses on relieving pain and symptoms for individuals facing serious illnesses, regardless of the stage of the disease.
Hospice Care: Offers compassionate end-of-life care for individuals with terminal illnesses, prioritizing comfort, dignity, and quality of life. Supplies provided are hospital bed, diapers, cleansing wipes, medication, and much more. Services they provide are nurse visits, home health aide bathing and clergy.
Respite Care: Often overlaps with companionship, homemaking, and personal care assistance, as it provides temporary relief for caregivers by ensuring their loved ones receive help with daily activities, social engagement, and household tasks while they take a break.
In-Home Support Services (IHSS): Offers assistance with daily tasks like meal preparation, personal care, and housekeeping. This program is funded by Medi-Cal (California) and helps low-income seniors and individuals with disabilities.
How Does Home Care Work?
The process starts when a family member or client contacts the agency to discuss their needs, including health conditions, personal care needs, homemaking tasks, and companionship goals. Whether they’re looking for personalized senior care at home in Mission Viejo, CA, or support in another Orange County city, we tailor our recommendations to fit each client’s unique situation. After gathering this information, the agency suggests the appropriate number of care hours needed to maintain the client’s quality of life. Once the family agrees and arranges payment, we carefully match the client with a qualified caregiver. Our agency takes care of all screening, background checks, and preparations, ensuring everything is in place before care officially begins in the comfort of the client’s home. Services start when the caregiver arrives, ready to provide compassionate, personalized support.
Check out our Questions to Ask When Interviewing Home Care Agencies to make an informed decision and find the right home care provider.
How do I know if my loved one needs home care services?
Determining if your loved one needs home care services can be challenging, but there are key signs to look out for. These include struggling with daily tasks like bathing, dressing, or meal preparation, experiencing recent health setbacks, showing signs of memory loss, or dealing with mobility issues that pose a safety risk. You may also notice changes in personal hygiene, an untidy home, or increased isolation and loneliness.
If you’re unsure, it can help to learn more about these indicators. Visit our guide on Warning Signs That Care Is Needed for a detailed list of red flags and expert advice on when to seek home care services.
What’s the Most In-Demand Home Care Service?
The most in-demand home care services are homemaking help and personal care assistance, as they help seniors with everyday tasks like housekeeping, meal preparation, bathing, and dressing—ensuring they can live safely and comfortably at home.
Why are these services so in-demand?
As seniors age, declining physical strength, mental sharpness, and mobility can make everyday tasks difficult. Simple activities like lifting, bending, or standing can become a struggle, while memory loss and slower decision-making may lead to confusion. Mobility issues increase the risk of falls, and chronic illnesses can sap energy. As a result, seniors may neglect basic hygiene, like bathing, or keeping their home clean, making personal care help and assistance with household chores essential for maintaining their health, safety, and comfort.
Home Care and Medicare
Does Medicare Pay for Home Care?
Medicare, the federal health insurance for people 65 and older, covers some home care, but there are limits. Here’s a clear breakdown to help you understand what Medicare covers—and what it doesn’t.
How Medicare Works
Medicare has four parts: A, B, C, and D. When it comes to home care, most people focus on Parts A and B.
- Part A covers hospital stays, skilled nursing, hospice and limited home health care.
- Part B covers outpatient care, doctor visits, medical supplies, preventative services, and some home health care services.
What Medicare Doesn’t Cover
Medicare does not cover non-medical care, like help with:
- Bathing, dressing, meal prep, and household chores (also called custodial care).
- 24-hour care, meal delivery, or housekeeping.
These services are typically paid out-of-pocket or through long-term care insurance, Medicaid, or veterans’ benefits. For more details, check out our guide on Payment Options for In-Home Care Services.
When Does Medicare Cover Home Care?
Medicare Part B coverage of in-home caregivers is minimal:
- A doctor or nurse creates a care plan after a hospital stay or skilled nursing facility (SNF) discharge.
- Coverage for caregivers is part-time and MUST work alongside skilled care providers (e.g. RNs, LVNs, physical therapists).
Medicare Coverage for Home Health Care After Hospitalization
Medicare can cover home health care after a hospital stay, but it depends on the details of your care plan:
- If a doctor recommends skilled services like nursing care or therapy, Medicare Part A may cover short-term home care.
- To qualify, care must start within 14 days of hospital or skilled nursing facility (SNF) discharge.
- After 100 days, coverage shifts to Medicare Part B and is limited to about 28 hours per week.
Care Limits
- Up to 28 hours per week of care.
- Care must begin within 14 days of discharge and typically lasts no more than 100 days.
In-Home Nursing Care Coverage
Medicare Part A covers in-home nursing care if you’ve spent at least three consecutive days in a hospital or SNF. To qualify:
- Home care must begin within 14 days of discharge.
- Coverage includes up to 100 days of home health services if eligibility criteria are met.
Non-Medical In-Home Care Isn’t Covered by Medicare
Medicare doesn’t cover non-medical care or help with Activities of Daily Living (ADLs). These services include:
- Bathing, dressing, meal prep, help with bathroom needs, mobility, and medication reminders.
Alternative Ways to Pay for Non-Medical In-Home Care
Since Medicare doesn’t cover non-medical care, here are some alternatives:
- Long-Term Care Insurance (LTC): Helps cover personal care ADLs and IADLs daily tasks. Assistance with usually 2 ADLs (activities of daily living), are required to use benefits. For more information on using LTC benefits, click here.
- Veterans’ Benefits: Programs like Aid and Attendance or Homemaker Home Health Aide Program benefits help veterans receive care.
- Private Pay: Use personal savings or out-of-pocket funds.
- Community Services: Local programs offering senior support. The Caregiver Resource Center in Orange County provides respite grants to caregiving agencies, so the caretaker can have respite.
Understanding what Medicare covers—and doesn’t cover—can help you make smart healthcare and financial decisions to ensure your loved one gets the right support.
Understanding Custodial Care
Custodial care is another term for non-medical home care or personal care assistance. This type of care helps people who struggle with daily tasks due to aging, illness, or disability. Custodial care focuses on essential day-to-day activities like:
- Personal Hygiene: Help with bathing, grooming, and getting dressed.
- Meal Preparation: Cooking and ensuring proper nutrition.
- Housekeeping: Light cleaning, laundry and other chores.
- Mobility Assistance: Support with moving safely around the home.
While custodial care is crucial for maintaining quality of life, Medicare doesn’t cover it because it’s not classified as medical care. Families often rely on Medicaid, long-term care insurance, or out-of-pocket payments to cover these services.
What Is Residential Care?
Residential care, sometimes called hourly care, long-term care or domiciliary care, involves shorter visits designed to meet specific needs. Like home care, domiciliary care is personalized to help individuals live comfortably and safely. Services include:
- Personal Care: Assistance with hygiene, dressing, and bathroom needs.
- Medication Management: Ensuring medications are taken correctly.
- Nutritional Support: Preparing meals to meet dietary needs.
- Household Maintenance: Keeping the home clean and organized.
- Emotional Support: Providing companionship and emotional care.
Residential care offers flexible, short-term assistance to help seniors stay independent and improve their quality of life.
Home Care and Family Caregivers
Caring for an aging parent is a big responsibility, and many adult children wonder if they can get paid for providing this care. While Medicare doesn’t typically pay family caregivers, there are other options available to help you get compensated for your time and effort.
Can I Get Paid to Care for My Parent?
Yes, depending on your situation and location, there are ways to receive payment for caregiving duties. Here are a few common options:
- Medicaid Programs: Some states have Medicaid-funded programs that allow family members to be paid for providing care.
- Veterans Benefits: The Aid and Attendance benefit and Homemaker Program helps veterans pay for personal care services, including care from family members.
- Long-Term Care Insurance: Certain policies cover in-home care provided by family caregivers.
- State Programs: Programs like California’s In-Home Supportive Services (IHSS) or New York’s Consumer Directed Personal Assistance Program (CDPAP) allow family members to receive payment.
Why Doesn’t Medicare Pay Family Caregivers?
Medicare focuses on medical care provided by licensed professionals like nurses or therapists. Since family caregiving is considered non-medical, it isn’t covered under standard Medicare plans. This leaves many families needing alternative sources of financial support.
Challenges of Family Caregiving
Family caregivers often face a lot of stress and pressure. Common challenges include:
- Emotional Stress: Feelings of guilt, anxiety, and burnout.
- Physical Strain: The physical demands of lifting, moving, or assisting a parent.
- Financial Burden: Reducing work hours or leaving jobs to provide care.
- Time Management: Balancing caregiving with other responsibilities.
Support Resources for Family Caregivers
It’s important for caregivers to take care of themselves too. Helpful resources include:
- Respite Care: Temporary relief that gives caregivers a break.
- Support Groups: Connect with others who understand your challenges.
- Counseling Services: Professional help managing stress.
- Educational Programs: Training and resources to make caregiving easier.
Understanding Home Health Services
Unlike home care, home health services focus on medical needs. These services help people recover from illnesses or injuries and are often covered by Medicare.
Examples of Home Health Services
- Skilled Nursing Care: Wound care, medication management, and health monitoring.
- Therapies: Physical, occupational, or speech therapy to aid recovery.
- Medical Social Services: Counseling and connecting patients to resources.
Home Health vs. Hospice Care
- Home Health Care: Focuses on recovery and managing chronic conditions with medical and therapeutic services.
- Hospice Care: Provides comfort and support for terminally ill patients, focusing on quality of life rather than curing illness.
Home Care vs. Personal Care
- Home Care: Includes both medical and non-medical services like therapy, personal care, and homemaking.
- Personal Care: Focuses specifically on daily activities like bathing and dressing.
Common Conditions Requiring Home Care
Many seniors who receive home care have chronic conditions that need ongoing support. These include:
- Heart Disease/CHF: Monitoring heart health and managing medications.
- Diabetes: Blood sugar checks, insulin management, and meal planning.
- Dementia: Supervision, medication reminders, and help with daily tasks.
- Arthritis: Pain management, physical therapy, and mobility assistance.
- COPD: Breathing therapy and medication management.
- ALS: Manage mobility challenges, assist with daily activities, and provide support as the condition progresses.
- Parkinson’s: Help with tremors, stretching for stiffness, and balance issues, ensuring safety and promoting independence.
- Vision Impairments: Seniors with vision impairments benefit from home care to assist with navigation, daily tasks, and maintaining a safe living environment.
- Physical Disabilities: Provides mobility assistance, personal care support, and help with household tasks to enhance independence.
What’s the Difference Between a Home Care Agency and a Registry?
When choosing non-medical elder care services for a loved one, you’ll often have two main options: a home care agency or a registry (also known as a referral service). Understanding the differences can help you make the right decision and ensure your loved one gets the care they need.
Home Care Agencies: Full-Service, Managed Care
Home care agencies are professional organizations that handle everything related to your loved one’s care. They hire, train, and supervise caregivers to ensure quality and safety. Agencies also manage the details like scheduling, payroll, and insurance, making the process hassle-free for families.
Benefits of Choosing a Home Care Agency
- Thorough Screening: In Orange County, CA, caregivers complete a LiveScan background check before they are approved for their Home Care Aide registry number (this is unrelated to the term home care registry). LiveScan checks for any convictions in both state level and federal level, for the life of the caregiver. Traditional background checks go back only seven years.
- Insurance Protection: Agencies carry liability insurance and workers’ compensation, protecting you from financial and legal risks.
- Supervision and Support: Caregivers are supervised to maintain quality standards, and any issues are addressed promptly. If your caregiver isn’t a match, the agency will have a roster they can find a better match for.
- Reliable Backup Care: If a caregiver can’t make a shift, the agency calls many caregivers to find a replacement. This process can take a few minutes to a few hours.
- Regulatory Compliance: Agencies have to be licensed, follow all state and federal rules for hiring, training, payroll, and insurance.
Registries: Flexibility With More Responsibility
Home care registries connect families with independent caregivers. While registries may offer more flexibility and lower costs, they put more responsibility on families for managing care. This includes hiring, supervising, and handling legal and financial obligations.
Risks of Using a Registry
- Limited Vetting: Registries may not perform thorough background checks, increasing the risk of hiring an unqualified caregiver.
- Employer Liability: Families are responsible for payroll taxes, workers’ compensation, and other employer-related duties.
- Inconsistent Care: Without agency oversight, care quality can vary, and finding backup caregivers may be difficult.
- Legal Complications: Managing employment laws and regulations can be complex and time-consuming for families.
What Is a Home Care Placement Agency?
A home care placement agency helps families find independent caregivers by connecting them with qualified professionals for in-home care. Unlike full-service home care agencies, placement agencies do not employ the caregivers—they simply match caregivers with families. This means families take on more responsibility, such as managing payroll, taxes, and supervision.
Placement agencies offer more flexibility and can be less expensive than full-service agencies, but they come with some risks and challenges, similar to using a registry.
Why a Home Care Agency Is the Better Choice
For most families, the reliable structure of a home care agency outweighs the potential cost savings of a registry. Agencies take care of the details so you can focus on your loved one.
Top Reasons to Choose a Home Care Agency
- Professional Management: The agency handles everything—hiring, training, supervision, and payroll—so you don’t have to.
- Quality Assurance: Caregivers are vetted and continuously supervised to ensure top-quality care.
- Legal and Financial Protection: Agencies provide insurance and take on liability, reducing your risk.
- Consistent Care: If a caregiver can’t make it, the agency ensures a replacement is ready to step in.
Comparison Table: Home Care Placement Agency vs. Full-Service Home Care Agency vs. Registry
| Feature | Full-Service Home Care Agency | Home Care Placement Agency | Registry (Referral Service) |
|---|---|---|---|
| Type of Caregiver | Agency-employed, fully vetted caregivers | Independent caregivers recommended by the agency | Independent caregivers recommended by the registry |
| Hiring Process | Handled entirely by the agency | Families select caregivers from the agency’s recommendations | Families select caregivers from the registry’s recommendations |
| Screening and Training | Extensive background checks, training, and supervision | Basic screening; families may need to verify qualifications | Limited or no screening; families verify qualifications |
| Liability and Insurance | Agency covers insurance and liability | Families responsible for insurance and liability | Families responsible for insurance and liability |
| Supervision of caregiver | Agency supervises caregivers and manages issues | Families manage and supervise caregivers | Families manage and supervise caregivers |
| Cost | Higher cost due to comprehensive services | Moderate cost; usually less than full-service agencies | Lower cost but with higher risks and responsibilities |
| Backup Care | Agency provides a replacement if the caregiver is unavailable | Families need to find backup care if the caregiver cancels | Families need to find backup care if the caregiver cancels |
| Legal Responsibilities | Agency handles taxes, payroll, and employment laws | Families handle taxes, payroll, and legal compliance | Families handle taxes, payroll, and legal compliance |
| Criminal Conviction Notification | Agency is notified and required to remove the caregiver | No notification; families may remain unaware | No notification; families may remain unaware |
| Best For | Families seeking a hassle-free, all-inclusive service | Families wanting cost savings with moderate support from an agency | Families prioritizing low cost and high flexibility, willing to take risks |
Key Takeaways
- Full-Service Home Care Agencies provide the most comprehensive support, handling everything from screening and hiring to supervision and backup care.
- Home Care Placement Agencies offer a middle-ground option, helping families find independent caregivers while leaving some responsibilities to the family.
- Registries offer the most flexibility and cost savings but come with greater risks and require families to manage all aspects of care.
Understanding these differences helps you choose the best care solution for your loved one’s needs and your family’s comfort level.
Hiring Private Caregivers: Risks and Liabilities
Understanding the Risks of Hiring a Caregiver Privately
Many families don’t realize the risks and responsibilities that come with privately hiring a caregiver. Whether you’re paying “under the table” or not, the reality is that anyone you pay to work in your home is considered your employee under the law—and that comes with legal obligations.
In California, a state known for being employee-friendly and litigious, the stakes are even higher. Caregivers you hire privately are entitled to the same rights as any other employee, including:
- State and federal minimum wage
- Overtime pay for hours worked beyond the standard workweek.
- Protection under harassment and discrimination laws.
Unfortunately, when relationships with caregivers sour, these legal protections are often brought up—sometimes legitimately, but often as leverage in disputes. Families may find themselves facing unexpected legal claims, even if they believe they’ve done everything correctly.
The Financial Risks You Could Face
Here’s where things can get tricky. If a caregiver gets injured on the job, becomes disabled, or files for unemployment, California law mandates that employers (in this case, the family) are responsible for:
- Workers’ compensation claims for injuries that occur while the caregiver is working.
- Disability benefits if the caregiver becomes unable to work due to injury or illness.
- Unemployment benefits if the caregiver is let go.
On top of that, families who fail to comply with these laws could also be on the hook for:
- Unpaid state income taxes the caregiver may not have reported.
- Potential penalties and interest for failing to follow employment laws.
All it takes is one work-related injury, unemployment claim, or disability filing—whether fraudulent or legitimate—to leave families tangled in a costly legal battle.
Also, state and federal taxing agencies often share information and cross-report to ensure compliance with tax laws. For example, if a caregiver reports income to the IRS but state taxes weren’t withheld, the state agency may be alerted and investigate. Similarly, if state unemployment claims are filed, it could trigger a review by federal agencies like the IRS to verify that proper payroll taxes were paid. This collaboration ensures that employers (families, or the client themselves) who hire privately are meeting all legal tax obligations, making it critical to handle employment taxes correctly to avoid penalties.
Why California Families Should Be Extra Careful
California’s legal system tends to favor employees in disputes, which means families who hire privately face significant risk. Even if you believe you’re being fair and transparent, the law still applies. For example, paying a caregiver “under the table” doesn’t shield you from liability. In fact, it often makes matters worse by leaving no official record of wages or employment terms, which can work against you if a claim arises.
How to Protect Yourself
The best way to avoid these risks is to work with a licensed home care agency. Agencies handle all the legal responsibilities, including:
- Payroll taxes and compliance with wage laws.
- Workers’ compensation and liability insurance.
- Thorough vetting and supervision of caregivers.
By hiring through an agency, you can focus on your loved one’s care without worrying about the legal and financial pitfalls of being an employer.
If you’re considering hiring a caregiver, we’d be happy to help you explore safer and more reliable options. Let us handle the details so you can have peace of mind.
How to Hire a Caregiver – Three Ways
Privately, Registry and Agency Employer Model
When Hiring a Caregiver, You Have Three Options
Choosing the right way to hire a caregiver can feel overwhelming, but understanding your options can help you make the best decision for your family.
- Hire Privately
You can find a caregiver through personal recommendations, online platforms, or newspaper ads. In this case, you’re the employer, which means you’re responsible for things like workers’ compensation (W/C), liability insurance, employment taxes, oversight, background checks, Home Care Aide Registry check, and unemployment claims. - Hire Through a Registry
A registry or referral agency connects you with independent caregivers. However, these caregivers aren’t employees of the agency—they’re legally employed by you. This means you’ll still handle many responsibilities, like taxes, insurance, and management, similar to hiring privately. You will want to get the caregiver’s Home Care Aide Registry number. Chances are, the caregiver never registered or let it lapse. - Hire Through an Employer-Model Agency
With this option, a California based home care agency takes full responsibility for the caregiver. They handle all the legal, financial, and administrative tasks, including payroll, workers’ compensation, liability insurance, taxes, background checks, Home Care Aide (HCA) registry verification, training, and caregiver management. This is a hands-off approach for families seeking peace of mind.
Each option has its pros and cons, and what works for one family may not work for another. The goal of this guide is to give you the knowledge you need to make an informed decision when the time comes to hire care for your loved one.
Comparison Table: Home Care Agency vs. Registry vs. Private Hire
| Category | Home Care Agency | Registry | Private Hire |
|---|---|---|---|
| Caregiver is Employee | Yes | No | You |
| Who Handles Payroll? | Agency | You | You |
| Taxes Paid | Agency | You | You |
| Workers’ Comp Included | Yes | No | No |
| Background Checks | Agency Handles | Limited/You Pay | You Handle/Pay |
| Replacement Care | Provided | No Backup | No Backup |
| Hourly Cost | Higher ($35-$45/hour) | Mid ($25-$35/hour) | Lower ($24-$28/hour + extras) |
| Legal Responsibilities | Agency Covers | You Are Responsible | You Are Responsible |
| Ease of Use | Hassle-Free | Moderate Effort | High Effort |
| Best For | Peace of Mind | Cost + Flexibility | Lowest Cost (risky) |
California Home Care Services Bureau and Home Care Aide Registry
The California Home Care Services Bureau regulates home care organizations and ensures they meet state standards for licensing, caregiver qualifications, and safety. The Home Care Aide Registry is a public database of caregivers who have been cleared to work in California.
When hiring a caregiver, confirm that they are registered with the Home Care Aide Registry, which requires passing a LiveScan background check to screen for criminal history and ensure they meet state safety requirements.
Additionally, you can verify the registration status of a Home Care Agency (HCA) with the California Home Care Bureau.
This process helps ensure that both caregivers and agencies are properly vetted, providing peace of mind for families.
This process adds an extra layer of protection, giving families peace of mind that their caregiver has been properly vetted.
Hourly Billing Breakdown for a Home Care Agency Employer in 2025
Average cost: $35-$43 an hour | Low risk and low effort for you
What the Client Pays
-
- Client Payment: $38.00/hour
- The hourly rate billed to the client for home care services.
- Client Payment: $38.00/hour
What the Caregiver Earns
-
- Caregiver Wage: $20.00/hour
- The direct hourly wage paid to the caregiver.
- Caregiver Wage: $20.00/hour
Payroll Taxes & Workers’ Compensation Costs
| Payroll Tax / Insurance | Cost Per Hour | Explanation |
|---|---|---|
| SDI (State Disability Insurance) | ~$0.20 | 1% of caregiver wages (California-specific). |
| SUTA (State Unemployment Tax) | ~$0.30 | 1.5% of caregiver wages. |
| FUTA (Federal Unemployment Tax) | ~$0.12 | 0.6% of caregiver wages. |
| FCR (FUTA Credit Reduction) | ~$0.24 | Additional 1.2% added in states like California with unpaid federal loans. |
| UI (Unemployment Insurance) | ~$0.60 | Around 3% of caregiver wages (California-specific). |
| ETT (Employee Training Tax) | ~$0.01 | California-specific tax for workforce training. |
| FICA (Social Security Tax) | ~$1.24 | 6.2% of caregiver wages for Social Security. |
| Medicare Tax | ~$0.29 | 1.45% of caregiver wages for Medicare. |
| Workers’ Compensation Insurance | ~$1.00 – $1.60 | Estimated 5%-8% of caregiver wages depending on industry and state. |
Total Payroll Taxes and& Workers’ Comp: $3.20–$4.00/hour
Other Costs to the Agency
| Category | Cost Per Hour | Explanation |
|---|---|---|
| Sick Pay | ~$0.70 | Caregiver earns 1 hour of sick pay for every 30 hours worked (CA max 40 hrs/year). |
| Recruiting Costs | ~$0.60 | Includes job ads, recruiter salaries, and caregiver coordination. |
| Training Costs | ~$0.50 | Covers caregiver training, certifications, and onboarding. |
| Administrative Overhead | $6.50 | Includes scheduling, payroll, supervision, and client coordination. |
Total Additional Costs: $8.30/hour
Total Agency Costs
| Description | Cost Per Hour |
|---|---|
| Caregiver Wage | $20.00 |
| Payroll Taxes and Workers’ Comp | $3.20 – $4.00 |
| Other Costs | $8.30 |
Total Agency Costs: $31.50 – $32.30/hour
What is the FUTA Credit Reduction (FCR)?
The FUTA Credit Reduction (FCR) is an extra tax that employers must pay if their state, like California, owes the federal government money for unemployment loans.
Normally, employers pay 0.6% of wages to the Federal Unemployment Tax Act (FUTA), but in states with unpaid loans, this credit gets reduced. For California, the FCR adds 1.2%, increasing the FUTA rate to 1.8% on the first $7,000 of wages annually.
While this might seem like a small amount, it adds up when managing multiple employees and is one of the many hidden costs agencies account for when hiring caregivers.
How the Employer Model Works
In the “Employer Model,” the company sending you the caregiver is fully responsible for them as their employee. That means they handle all the behind-the-scenes things—like withholding and paying taxes, unemployment insurance, and workers’ compensation. You don’t have to worry about taking on those costs or the risks that come with being an employer.
Basically, the company files a W4 form with the government, making it clear that they are the employer, not you. While this option might cost a little more than hiring privately or using a registry, it also comes with peace of mind. The company takes responsibility if something goes wrong, like a caregiver getting injured or filing for unemployment.
4 Things the Employer Model Protects You From
- Workers’ Compensation Claims: If a caregiver gets injured on the job, the company pays for medical bills and any disability payments—not you.
- Payroll Taxes: The company withholds and pays all necessary payroll taxes, so you don’t have to worry about tax compliance.
- Unemployment Claims: If the caregiver files for unemployment, the company handles the costs, and because taxes have already been paid, there’s no risk of back tax liability (unlike with private hires or registries).
- Lawsuits: The company is responsible for any legal claims related to discrimination or harassment, so you’re protected from that stress.
Why This Matters to You
When you hire a caregiver through an agency, you’re not just paying for their time—you’re paying for peace of mind. Most of the hourly rate goes toward your caregiver’s wages, taxes, insurance, and all the behind-the-scenes work the agency does to make your life easier.
Think about it: if you hired someone privately, you’d have to deal with payroll, workers’ comp, taxes, and making sure everything is legal. That’s a ton of responsibility (and stress!) on top of caring for your aging parent. An agency takes care of all that for you.
So, while the hourly rate might seem high, it’s covering so much more than just a caregiver showing up.
Cost Breakdown for a Domestic Referral Agency (Registry) in 2025
Average cost: $24-$28 an hour | High risk & medium effort for you
When hiring a caregiver through a domestic referral agency or registry, the costs work a bit differently than with an employer model. Here’s a breakdown of how the fees and wages typically play out:
- Caregiver Wages
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- Caregivers hired through a registry typically earn $24-$27 per hour, depending on experience, location, and the type of care provided (e.g., personal care, specialized dementia care, etc.).
- The client pays this amount directly to the caregiver.
- Registry Fees
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- The registry charges a fee of 10-25% of the total client invoice.
- This fee is billed to the caregiver, not the client. For example:
- If the caregiver is paid $25/hour, and the registry charges 15%, the caregiver effectively pays $3.75/hour to the agency.
- This means their take-home pay is reduced to $21.25/hour after fees.
- Client Costs
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- Clients typically pay a flat hourly rate to the caregiver and handle all related employer responsibilities.
- Let’s assume the caregiver earns $25/hour. The client’s responsibilities include:
- Taxes: Social Security, Medicare, unemployment, and state disability taxes (10-12% of the caregiver’s hourly wage).
- Workers’ Compensation Insurance: Approximately 4.7% of the caregiver’s hourly wage in California.
- Liability: Clients are legally responsible for any claims related to workplace injuries, harassment, or discrimination.
Example Cost Breakdown (Client Hiring a Caregiver at $25/hour)
| Cost Component | Amount |
|---|---|
| Caregiver Wage | $25.00 |
| Taxes (10-12%) | $2.50 – $3.00/hour |
| Workers’ Compensation (4.7%) | $1.18/hour |
Estimated Total Cost to Client: $28.68-$29.18/hour
Key Considerations for Clients
- Employer Responsibilities: Since the registry only refers independent caregivers, you (the client) are considered the employer. This means you’re responsible for taxes, payroll, workers’ comp, and any liability claims.
- Cost Savings vs. Risk: While the upfront costs may seem lower than with an employer-model agency, the added responsibilities and risks can make it more stressful for families.
The Registry Model: What You Need to Know
Let’s break it down: with the Registry Model, the company refers you to a caregiver who is classified as an independent contractor, not their employee. That means the registry isn’t responsible for things like taxes, unemployment insurance, or workers’ compensation—you are. They send you the caregiver and file a 1099 form with the government, which essentially shifts all the legal and financial responsibilities onto you.
While the registry model might seem more affordable than hiring through an employer-model agency, it carries risks that are similar to hiring someone privately. And let’s be honest—it can leave families exposed to some serious liabilities.
What Could Go Wrong?
- Tax and Unemployment Claims
If the registry isn’t withholding or paying taxes, you could end up on the hook. Agencies like the Employment Development Department (EDD) could contact you to pay back taxes, penalties, and even unemployment benefits for the caregiver. - Injury on the Job
If your caregiver gets hurt while working in your home, you could be responsible for their medical bills and disability payments, since workers’ comp isn’t provided through the registry. - Live-In Caregiver Risks
If you hire a live-in caregiver, and offer room and board as part of their pay, you’ve now made them your tenant, and this is extremely risky. If things don’t work out, you may face the additional challenge of evicting them from your home—which isn’t as simple as just letting them go. The California eviction process is lengthy and favors tenants, which have full rights to the use of their (yes, I meant their and not your) home.
Why It Matters
While the registry model might save you a few bucks upfront, the long-term risks can add up quickly. If you’re not careful, you could find yourself dealing with unexpected taxes, injury claims, or legal headaches.
Understanding these potential pitfalls is key to making an informed decision. If you’re unsure about the best option for your family, we’re here to help guide you through the process. Let’s make sure you’re protected while providing the best care for your loved one.
Cost Breakdown for Hiring a Caregiver Privately in 2025
Average cost: $25-$28 an hour | High risk and high effort
Hiring a caregiver privately might seem like a more affordable option upfront, but once you factor in all the hidden costs and responsibilities, the numbers add up quickly. Here’s a detailed breakdown of the costs involved in hiring a private caregiver with an hourly wage of $25–$28/hour:
- Caregiver Wages
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- Hourly Pay: $25–$28/hour depending on experience and the level of care required (e.g., personal care, specialized dementia care, etc.).
- Assuming 40 hours per week, you’re paying between $1,000 and $1,120 per week for wages alone.
- Payroll Taxes
When you hire privately, you’re considered the caregiver’s employer, which means you’re responsible for payroll taxes, including:
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- Social Security & Medicare Taxes (FICA): 7.65% wages.
- Federal Unemployment Tax (FUTA): 6% of the first $7,000 in wages.
- State Unemployment Tax (SUTA in California): Typically, 3-6% of wages.
- State Disability Insurance (SDI in California): Around 1% of wages.
For a $25/hour caregiver working 40 hours/week, payroll taxes add approximately $80–$100 per week.
- Workers’ Compensation Insurance
California law requires you to provide workers’ compensation insurance in case the caregiver is injured on the job.
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- Cost: Around 4.7% of the caregiver’s wages.
- For a $25/hour caregiver working 40 hours/week, workers’ comp costs about $47 per week.
- Payroll Service
Managing payroll alone can be overwhelming. That’s why many families hire a payroll service to handle taxes, wage calculations, and filings.
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- Cost: $50–$100/month or $12–$25 per week.
- Recruiting Costs
Finding the right caregiver takes time and money. Here’s what you might spend:
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- Job Ads: Posting on sites like Craigslist, Care.com, or Indeed costs $30–$200 per month, depending on the platform and visibility.
- Screening and Vetting: Conducting background checks, drug testing, and verifying references costs around $50–$100 per applicant.
- Time Investment: For every 10 applicants, only 2–3 may meet your requirements, and fewer might show up for interviews. The time spent reviewing resumes, scheduling interviews, and conducting screenings adds up quickly.
- Liability Insurance
You may want to carry personal liability insurance to protect yourself in case of lawsuits related to harassment, discrimination, or injury claims.
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- Cost: $300–$500/year or $6–$10 per week.
Example Weekly Cost Breakdown for Hiring Privately ($25/hour Caregiver)
| Cost Component | Weekly Amount |
|---|---|
| Caregiver Wages | $1,000 (40 hours x $25/hour) |
| Payroll Taxes (approximately 10%) | $100 |
| Workers’ Compensation Insurance | $47 |
| Payroll Service | $25 |
| Job Ads and Screening (estimated) | $20 (spread across weeks) |
| Liability Insurance | $10 |
| Total Weekly Cost | $1,202 |
Key Considerations
- Time & Effort: Beyond the financial costs, hiring privately requires significant time to recruit, vet, and manage a caregiver.
- Legal Risks: If you don’t handle taxes, insurance, or compliance properly, you could face penalties, lawsuits, or liability claims.
- Backup Care: If your caregiver quits or calls out, you’ll need to start the process all over again.
Hiring a Caregiver Privately: What You Need to Know
A lot of people find caregivers through friends, neighbors, or their community and decide to hire them privately. While this might seem like the cheapest and easiest option, it comes with some serious risks that families often don’t realize until something goes wrong. In fact, privately hired caregivers are where cases of fraud and abuse are most common.
What Could Go Wrong?
- Injury on the Job: If your caregiver gets injured while working in your home, you’ll be responsible for covering their medical bills and disability payments since there’s no workers’ compensation in place.
- Live-In Caregiver Issues: If you hire someone to live in your home, room and board is legally considered part of their pay. If you’re unhappy with their performance, firing them might also mean you’ll need to evict them, which can be a complicated legal process.
- Overtime Pay: If your caregiver works over a certain number of hours, you could be liable for overtime pay, which many families don’t account for.
How to Protect Yourself if You Hire Privately
If you decide to go the private hire route, here’s how to protect yourself and minimize risks:
- Background Check and References: Always perform a full background check and get at least three references from past employers or care recipients before hiring anyone.
- Set Up Payroll Properly:
- Talk to your accountant or a payroll service to ensure you’re paying all required taxes, including:
- Medicare and Social Security taxes (FICA).
- State and federal unemployment taxes.
- Talk to your accountant or a payroll service to ensure you’re paying all required taxes, including:
- Workers’ Compensation Insurance:
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- Reach out to your homeowner’s insurance provider and ask about adding a workers’ compensation rider to your policy. This protects you in case your caregiver files a claim for an on-the-job injury.
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Final Thoughts
Hiring a caregiver privately might seem like a good way to save money, but it can leave your family open to unexpected financial and legal headaches. Taking steps like running background checks and setting up proper payroll can help reduce those risks, but it’s important to fully understand the responsibilities you’re taking on as an employer.
If this feels overwhelming, you don’t like managing people, or you’d rather avoid the risks altogether, working with a professional caregiving agency might be a better choice. They handle all the complicated stuff—like taxes, insurance, labor laws, and management—so you can focus on what matters most: making sure your loved one gets the care they deserve, without the added stress.