Finding home care for an elderly family member starts with two things: understanding what level of help they actually need, and knowing the difference between your hiring options. The process can feel overwhelming, but it breaks down into a clear sequence of steps, from assessing daily needs to vetting caregivers and figuring out how to pay for it.
Assess What Level of Care Is Needed
Before you contact a single agency, spend a few days observing your family member’s daily routine. Healthcare professionals use two categories to gauge how much help someone needs: basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Understanding where your loved one struggles tells you exactly what type of caregiver to look for.
Basic ADLs are the physical essentials: bathing, dressing, using the toilet, eating, getting in and out of bed, and maintaining continence. If your family member needs hands-on help with several of these, they likely need a personal care aide or home health aide rather than a simple companion.
IADLs are the tasks that keep a household running: managing finances, grocery shopping, preparing meals, doing laundry, handling medications, making phone calls, and arranging transportation. Someone who can still bathe and dress independently but forgets to take medications or can no longer manage the stove safely may do well with companion-level care or light personal assistance. Write down every task your family member struggles with. This list becomes the foundation for every conversation you’ll have with agencies or potential caregivers.
Three Types of Home Care Services
Home care falls into three broad tiers, and many families find their loved one needs a combination.
- Companion care is for someone who is mostly independent but shouldn’t be alone for long stretches. A companion provides comfort, supervision, and light household help like cooking or tidying up.
- Personal care involves hands-on assistance with daily physical needs: bathing, dressing, walking, and getting in and out of bed. Some personal care aides have specialized training that allows them to handle more advanced tasks under a nurse’s supervision.
- Skilled nursing care is medical care delivered at home by a registered nurse. This includes wound care, IV therapy, administering medications, pain management, and monitoring overall health. A physician must establish a plan of care, and a nurse carries it out on a set schedule.
If your family member only needs help with housekeeping and errands, you’re shopping for companion care. If they need someone to help them shower and manage medications, personal care is the right fit. If they’re recovering from surgery or managing a complex medical condition, skilled nursing enters the picture.
Agency vs. Hiring Independently
You have two main paths: hire through a licensed home care agency, or find a caregiver on your own through word of mouth, online platforms, or caregiver matching websites. Each comes with real tradeoffs.
An agency handles background checks, verifies credentials, manages payroll and taxes, and often bonds its caregivers. If your regular aide calls in sick, the agency sends a replacement. The downside is cost. Agencies typically take up to 50% of the hourly fee as overhead, and you have less control over which specific person shows up. Still, for families who don’t want to become an employer, an agency removes significant administrative and legal burden.
Hiring independently gives you more control over who provides care and usually costs less per hour, since you’re paying the caregiver directly. But you become the employer. That means you’re responsible for running background checks, drafting a contract, handling payroll, and withholding and reporting taxes. If you find someone through a caregiver matching website, the platform may run the background check for you, but payroll and taxes remain your responsibility. If you find someone through a personal recommendation, every screening step falls on you.
What Home Care Costs
The national median pay for home health and personal care aides is $16.78 per hour, according to 2024 data from the Bureau of Labor Statistics. The lowest-paid 10% earn under $25,600 a year, while the highest-paid 10% make more than $44,190. These figures reflect what caregivers earn, not what families pay. If you hire through an agency, expect to pay significantly more per hour because the agency’s cut covers insurance, training, administrative costs, and profit.
Costs also vary by region and by the complexity of care. Companion care in a rural area will run less than skilled nursing visits in a major city. When you’re comparing agencies, ask for an all-in hourly rate and find out whether there are minimums per visit, overtime charges, or holiday surcharges.
How to Pay for Home Care
Medicare covers home health care only under specific conditions. Your family member must be homebound, meaning they need assistive devices, special transportation, or another person’s help to leave the house, and leaving home requires considerable and taxing effort. They must also be under a physician’s care and need skilled nursing on an intermittent basis (fewer than seven days a week or less than eight hours a day, generally for periods of 21 days or less) or need physical therapy, speech therapy, or ongoing occupational therapy. Medicare does not pay for companion care or around-the-clock personal care aides.
Medicaid offers broader coverage through Home and Community-Based Services (HCBS) waivers, which vary by state. To qualify, an individual must demonstrate a need for care at a level that would otherwise require placement in a nursing facility. States can also adjust income and resource rules so that people who wouldn’t normally qualify for Medicaid in the community can receive waiver services. Some states further target eligibility by age or diagnosis. Contact your state Medicaid office or your local Area Agency on Aging to find out what waivers are available where you live.
Long-term care insurance, veterans’ benefits (particularly the Aid and Attendance program), and private pay round out the most common funding sources. Many families combine two or more of these.
Where to Start Your Search
Your local Area Agency on Aging (AAA) is the single best starting point for unbiased referrals. AAAs exist in every part of the country and connect older adults with home care providers, meal programs, transportation, and other community services. Find yours by visiting the Eldercare Locator website or calling 1-800-677-1116.
From there, gather names of at least three agencies or independent caregivers. Ask your family member’s physician for recommendations as well, especially if skilled nursing will be involved. Hospital discharge planners are another valuable resource if your loved one is transitioning home after a hospital stay.
Vetting Caregivers and Agencies
Whether you go with an agency or hire directly, thorough screening protects your family member. For agencies, the National Institute on Aging recommends asking three key questions upfront: How do you train your care providers? Will it be the same provider each time? And are you available for emergencies around the clock?
Beyond those basics, ask about supervision. Find out how often a nurse or care manager checks in on aides, and what the protocol is when a caregiver can’t make a scheduled visit. Ask whether caregivers are bonded and insured through the agency.
If you’re hiring independently, run a criminal background check through your state’s highway patrol or equivalent agency. Many states maintain an Employee Disqualification List (sometimes called a registry) of individuals prohibited from working with the elderly or disabled due to substantiated findings of abuse, neglect, or exploitation. Your state’s Department of Health and Senior Services typically maintains this list. Check it before making a hire. Some states also allow you to search adult abuse and neglect databases separately.
Setting Up a Care Agreement
A written agreement protects everyone involved. Whether you’re working with an agency or an independent caregiver, the agreement should cover the specific services to be provided, the schedule, and compensation. Conduct a salary survey of agencies in your area to make sure the rate you’re offering (or being charged) is reasonable for your region.
Include provisions for time off. Respite days, vacation, and sick leave matter in any employment arrangement, and a caregiver who burns out will not provide good care. Spell out how absences will be handled and who provides backup coverage.
Keep a daily log of care provided and any payments made. This documentation serves multiple purposes: it helps you track your family member’s condition over time, supports insurance or Medicaid claims, and creates a clear record if any disputes arise. Even a simple notebook entry listing the date, tasks completed, and hours worked is far better than nothing.
Monitoring Care Over Time
Finding the right caregiver isn’t a one-time decision. Your family member’s needs will change, sometimes gradually and sometimes after a fall, illness, or hospitalization. Revisit your original needs assessment every few months. Someone who started with companion care may eventually need personal care or skilled nursing, and catching that shift early prevents gaps in support.
Drop by unannounced occasionally if you don’t live in the home. Talk to your family member privately about how things are going. Watch for red flags like unexplained bruises, changes in mood or hygiene, missing belongings, or a caregiver who discourages family visits. Trust your instincts, and remember that switching caregivers or agencies, while disruptive, is always an option if the current arrangement isn’t working.