Getting a caregiver starts with figuring out what kind of help you actually need, then choosing whether to hire through an agency, a registry, or on your own. The process involves assessing daily care needs, understanding what insurance will and won’t cover, and knowing how to find and vet the right person. Here’s how to work through each step.
Figure Out What Level of Care You Need
Before you start looking for a caregiver, get specific about what tasks require help. Healthcare professionals use two categories to evaluate this: basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs). The distinction matters because it determines what type of caregiver you need and what insurance might pay for.
Basic ADLs are the physical essentials: bathing, dressing, grooming, eating, using the toilet, and moving from one spot to another (like getting from bed to the bathroom). If someone needs help with several of these, they typically need a hands-on caregiver for part or most of the day.
IADLs are more complex tasks that require planning and organization: managing money, paying bills, doing laundry, cooking, grocery shopping, scheduling appointments, and managing medications. Someone who handles their own bathing and dressing but can no longer keep up with bills, meals, or housekeeping may need a different kind of support, more focused on household management and companionship than physical care.
Walk through both lists honestly. Write down every task where you or your loved one struggles, how often help is needed, and at what times of day. This becomes your care plan, and it’s what you’ll share with agencies or potential hires so everyone is on the same page from the start.
Know the Different Types of Caregivers
The two main categories are home health aides and personal care aides, and the difference comes down to medical tasks. A home health aide works under the direction of a nurse or other medical professional and can check vital signs, help with prescribed exercises, give medications, change bandages, and in some cases operate medical equipment like ventilators. They keep records on the client’s condition and report changes to a supervising clinician.
A personal care aide, sometimes called a caregiver or personal attendant, handles nonmedical support: companionship, cooking, cleaning, driving, and helping with daily routines. Some personal care aides specialize in working with people who have developmental or intellectual disabilities, helping them build self-care skills like doing laundry or preparing meals.
Both types can assist with bathing, dressing, housekeeping, grocery shopping, meal preparation, and keeping someone socially connected. The key question is whether you need someone who can handle medical tasks. If so, you need a home health aide or a licensed nurse, not a personal care aide.
Understand What Insurance Covers
Medicare covers home health services, but only under specific conditions. You must need part-time or intermittent skilled care (like nursing or physical therapy), and you must be considered “homebound.” Homebound means you have trouble leaving your home without assistive devices or another person’s help, leaving isn’t recommended because of your condition, or getting out requires a major effort.
A healthcare provider must assess you face-to-face before certifying that you need home health services, a doctor or nurse practitioner must order the care, and a Medicare-certified agency must provide it.
What Medicare does not cover is equally important. It won’t pay for 24-hour care at home, meal delivery, housekeeping unrelated to your medical care plan, or custodial care like help with bathing and dressing when that’s the only care you need. If you primarily need someone to help with daily living tasks rather than skilled medical services, Medicare won’t foot the bill.
Medicaid coverage varies by state but is often more flexible for long-term personal care. Many states offer self-directed care programs that give participants control over who provides their services, including the authority to recruit, hire, train, and supervise their own caregivers. These programs grew out of the “Cash and Counseling” demonstration projects from the late 1990s and now operate in most states under Medicaid waiver authority. In some of these programs, you can even hire a family member as a paid caregiver. Contact your state Medicaid office to find out what’s available where you live.
Long-term care insurance, if you have it, typically covers personal care services. Check your policy for the specific benefit triggers, which usually require needing help with a certain number of ADLs.
Choose How to Hire
You have three main paths: a full-service home care agency, a caregiver registry, or hiring someone independently. Each comes with different tradeoffs in cost, control, and responsibility.
Home Care Agency
An agency employs the caregivers directly. That means the agency handles background checks, training, scheduling, payroll taxes, liability insurance, and workers’ compensation. If your caregiver calls in sick, the agency sends a replacement. If a caregiver is injured on the job, the agency’s insurance covers it. You pay a higher hourly rate (because the agency takes a cut), but you avoid the legal and administrative burden of being an employer. Agencies also provide supervision of caregivers by qualified staff, which adds a layer of accountability and protection against potential abuse.
Caregiver Registry
A registry connects you with independent caregivers but doesn’t employ them. You get a pool of vetted candidates to choose from, but once you hire someone, you become their employer. That means you’re responsible for payroll taxes, liability, workers’ compensation, and unemployment insurance. There’s no agency oversight of the care being provided.
Independent Hire
Hiring someone on your own, through word of mouth, online platforms, or community boards, gives you the most control and often the lowest cost. But you take on everything: finding candidates, running background checks, verifying credentials, handling taxes, and carrying liability. If the caregiver is injured in your home, you’re responsible for medical bills and potential disability payments.
Handle the Legal and Tax Side
If you hire a caregiver through a registry or independently, you are a household employer in the eyes of the IRS. In 2025, if you pay any one household employee $2,800 or more in cash wages during the year, you’re required to withhold and pay Social Security and Medicare taxes. You’ll file Schedule H with your tax return to report these.
Beyond federal taxes, most states require you to carry workers’ compensation insurance for household employees and pay into unemployment insurance. Failing to handle these obligations can result in penalties, and it also leaves your caregiver without protections they’re legally entitled to.
If you go through a full-service agency, the agency handles all of this as the employer of record.
Interview Candidates Thoroughly
Whether you’re choosing from an agency’s roster or screening someone you found independently, the interview should go beyond “tell me about yourself.” Focus on specific scenarios that test practical skills and judgment.
Ask questions like:
- Emergency response: “If my loved one had to be taken to the hospital for an emergency, what steps would you take?”
- Safety judgment: “What would you do if you found my loved one with an open bottle you suspect is poison?”
- Credentials: “Do you have CPR, first aid, or medication administration training?”
- Experience: “Tell me about any special training or experience you have in caregiving.”
- Practical logistics: “Do you have a valid driver’s license?” (if driving is part of the role)
Pay attention to how candidates describe past situations. Someone who talks about specific challenges they’ve navigated, like handling a fall or managing a client’s agitation, tells you more than someone who speaks only in generalities. If possible, arrange a trial shift so you can observe how the caregiver interacts with your loved one before committing.
Put Everything in a Written Agreement
A written contract protects both you and the caregiver. The U.S. Department of Labor provides a sample employment agreement for home care workers that covers the essentials.
Your agreement should specify the work schedule, including start and end times for each day. Decide who will track hours, you or the caregiver, and document that in the contract. If the caregiver will ever need to be on call, the agreement should state that on-call hours are compensated at the appropriate rate. Include regular meal and rest breaks, and note that short breaks of 20 minutes or less are generally paid time.
Build in a regular check-in, a set day and time each week when you and the caregiver sit down to discuss what’s going well, address any issues, and plan the week ahead. This prevents small frustrations from becoming big problems.
For termination, specify how much notice either side must give (one or two weeks is standard). Include severance terms if you choose to offer them, and list specific situations that would be grounds for immediate termination without notice. Having these terms written down before they’re needed removes ambiguity during what can be an emotional process.
Consider Paying a Family Member
If a family member is already providing care, there may be ways to compensate them. Medicaid’s self-directed services programs in many states allow participants to hire their own caregivers, and in some cases that includes family members like adult children or siblings. The participant gets “employer authority,” meaning they control who provides the services and how those services are delivered.
Eligibility and rules vary significantly by state. Some states exclude spouses or parents of minor children. Others require the family caregiver to pass a background check and complete training. Your state’s Medicaid office or Area Agency on Aging can walk you through what’s available and how to apply. Veterans may also have access to caregiver support programs through the VA that compensate family members.