Finding a caregiver starts with two decisions: what level of care your loved one needs, and whether you want to hire through an agency or on your own. Each path has tradeoffs in cost, control, and convenience. Once you know what you’re looking for, the process of sourcing, vetting, and onboarding the right person becomes much more manageable.
Decide What Type of Caregiver You Need
Caregivers fall along a spectrum from companionship to hands-on medical support, and the title matters because it determines what they’re trained and allowed to do.
Personal care aides (sometimes called personal attendants) handle nonmedical tasks: bathing, dressing, cooking, cleaning, grocery shopping, driving to appointments, and general companionship. Some specialize in working with people who have developmental or intellectual disabilities, helping them build self-care skills like doing laundry or preparing meals.
Home health aides do everything a personal care aide does, plus basic health-related tasks under the direction of a nurse or doctor. That can include checking vital signs, giving medications, changing bandages, helping with prescribed exercises, and even operating medical equipment like ventilators with specialized training. They also keep records on a client’s condition and report changes to a supervising clinician. If your loved one has a chronic illness that requires monitoring, a home health aide is the better fit.
Certified nursing assistants (CNAs) have completed a state-approved training program and passed a competency exam. They can perform clinical tasks similar to home health aides and are common in facilities, though some work in private homes. For needs beyond what a CNA can handle, such as wound care, IV medications, or physical therapy, you’d be looking at skilled nursing or therapy visits rather than a caregiver.
Agency vs. Hiring Independently
This is the biggest fork in the road, and it comes down to how much you’re willing to manage yourself in exchange for lower costs.
Hiring Through an Agency
The national median rate for agency-based in-home care reached $33 per hour in 2025, with most families paying somewhere between $30 and $45 per hour depending on location. In high-cost areas like the San Francisco Bay Area, agencies charge $45 to $60 per hour. For that premium, the agency handles background checks, insurance, payroll, taxes, and compliance. If a caregiver calls in sick, the agency sends a replacement. The downside is less control: you may not always get the same person, agencies often require minimum weekly hours, and last-minute substitutions happen.
Hiring Independently
Independent caregivers typically charge $20 to $25 per hour, roughly 20 to 30% less than agency rates. You get to choose your caregiver, build a consistent one-on-one relationship, and set your own schedule without minimum hour requirements. But you take on the role of employer. That means conducting your own interviews and background checks, handling scheduling, and figuring out backup care when your caregiver is unavailable. It also means legal obligations: the IRS requires you to withhold Social Security and Medicare taxes (7.65% of wages) once you pay a household employee $3,000 or more in a calendar year. You’ll need to file a Schedule H with your tax return, issue a W-2 to the caregiver, and potentially pay federal unemployment tax if you paid more than $1,000 in wages during any quarter.
For families managing complex care needs or coordinating from a distance, an agency’s reliability often justifies the cost. For families who want consistency, live nearby, and are comfortable with paperwork, hiring independently can save thousands of dollars a year.
Where to Find Candidates
If you’re going the agency route, start by searching for licensed home care agencies in your area. Your state’s department of health or aging services typically maintains a directory of licensed providers. Ask each agency how they vet caregivers, whether they guarantee consistent staffing, and what their minimum hour requirements are.
For independent hires, online matching platforms are the most common starting point. Care.com is the largest marketplace, though some users find the subscription fees steep. Sittercity is known for thorough background checks. Most of these platforms let you browse caregiver profiles for free but require a paid subscription to unlock full profiles, messaging, or background check results. Look for platforms that verify certifications, offer integrated background checks, and show reviews from previous families.
Beyond websites, word of mouth remains one of the most reliable channels. Ask your loved one’s doctor, hospital discharge planner, or local Area Agency on Aging for referrals. Senior centers, faith communities, and caregiver support groups can also connect you with experienced aides. If your loved one is being discharged from a hospital or rehab facility, the social worker assigned to their case can often recommend agencies or individuals.
How to Vet a Caregiver
A thorough background check is non-negotiable, whether you hire through an agency or independently. At minimum, run a criminal history check at both the state and federal level. Many states maintain nurse aide registries that flag individuals who have been found guilty of abuse or neglect in care settings. You can check the federal Office of Inspector General’s exclusion list to see if a candidate has been barred from participating in Medicare or Medicaid programs. If the candidate has lived in multiple states within the past five years, run checks in each state of residence.
Agencies handle this screening automatically, but if you’re hiring independently, several online services offer comprehensive background checks for $30 to $75. Don’t skip this step because a candidate seems trustworthy in person.
Beyond the background check, verify certifications directly. Ask to see CPR and first aid cards. If the role involves any health-related tasks, confirm the candidate has completed a formal training program and, if your state requires it, holds current certification. Check references by calling previous employers and asking specific questions: Was the caregiver reliable? How did they handle emergencies? Would you hire them again?
Interview Questions That Reveal the Right Fit
The interview should test both practical skills and emotional temperament. Start with experience-based questions: What types of conditions have you cared for? Are you comfortable assisting with bathing, toileting, and other personal hygiene tasks? Can you cook to accommodate specific dietary needs? Do you have reliable transportation and a valid driver’s license? Are you able to lift or transfer someone who needs physical support?
Then move to behavioral and situational questions, which reveal far more about a caregiver’s character than their resume does. Ask them to describe a time they dealt with a frustrated or uncooperative client. Ask what they would do if a client refused to eat or take their medication. Ask how they manage their own stress and emotions after a difficult day. If your loved one has dementia, ask specifically about their experience with memory loss, sundowning, and redirecting agitated behavior.
Pay attention to how they talk about past clients. A caregiver who speaks with warmth and respect about the people they’ve cared for, even the difficult ones, is telling you something important. Someone who complains about former clients or their families is a red flag.
If possible, arrange a trial period of a few days or a week before committing. Watch how the caregiver interacts with your loved one. The best qualifications in the world don’t matter if the personal chemistry isn’t there.
Put It in Writing
Whether you hire through an agency or independently, a written agreement protects everyone. The U.S. Department of Labor publishes a sample employment agreement for home care workers that covers the key elements. Your agreement should spell out:
- Scope of work: List every task the caregiver is expected to perform, from personal care (bathing, dressing, toileting, medication assistance) to household support (cooking, cleaning, laundry, errands, transportation) to companionship activities. Being explicit prevents misunderstandings later.
- Schedule and pay: Include hours, days of the week, hourly rate, overtime policy, and how and when the caregiver will be paid.
- Emergency protocols: Define what the caregiver should do in a medical emergency and what happens when they can’t make it to work due to illness or severe weather.
- Termination terms: Specify a notice period (commonly one to two weeks) for either party, whether severance applies, and what grounds would justify immediate termination without notice.
For independent hires, the agreement should also clarify the tax arrangement. You are the employer, and the caregiver is your household employee, not an independent contractor. Misclassifying them can result in penalties from the IRS and your state tax authority.
Paying for Care
Medicare covers home health services, but only under specific conditions. Your loved one must be “homebound,” meaning they have trouble leaving home without help from another person or assistive device, or that leaving home requires a major effort due to illness or injury. A healthcare provider must order the care, assess the patient face-to-face, and a Medicare-certified agency must deliver it. Coverage is limited to part-time or intermittent skilled care, generally up to 8 hours per day and 28 hours per week of combined skilled nursing and home health aide services. Medicare does not pay for ongoing personal care or companionship if no skilled medical need exists.
Medicaid offers broader options through self-directed care programs available in most states. These programs give participants or their representatives the authority to recruit, hire, train, and supervise their own caregivers using Medicaid funds. You receive an individualized budget and manage it with support from a counselor or fiscal intermediary. States offer self-direction through several program types, including Home and Community-Based Services waivers and the Community First Choice option. Eligibility and available services vary by state, so contact your state Medicaid office or local Area Agency on Aging to find out what’s available.
Long-term care insurance, if your loved one purchased a policy before needing care, typically covers home care once the policyholder meets the benefit trigger, usually the inability to perform two or more activities of daily living. Veterans may qualify for home care benefits through the VA’s Aid and Attendance program. And for families paying out of pocket, the dependent care tax credit or a dependent care flexible spending account can offset some costs, though the annual limits are modest relative to the total expense of ongoing care.