Agency vs Registry vs Private Hire: Which Home Care Option Is Right for Your Family?

Three Paths to Home Care#

When you need care for a loved one, you have three main options:

1. Home Care Agency — A company employs caregivers and manages everything
2. Caregiver Registry — A matching service that connects you with independent caregivers
3. Private Hire — You find and employ a caregiver directly

Each has distinct advantages, costs, and risks. Here's how to choose.

Quick Comparison#

Factor	Agency	Registry	Private Hire
Hourly Cost	$25-40	$18-28	$15-25
You Handle Payroll	No	Sometimes	Yes
Background Checks	Agency does	Registry does	You do
Backup Caregiver	Yes	Limited	No
Insurance/Bonding	Included	Varies	You provide
Scheduling	Agency manages	You manage	You manage
Quality Oversight	Agency supervises	Minimal	None
Tax Compliance	Agency handles	You may handle	You handle

Option 1: Home Care Agency#

How It Works#

You hire a company, not an individual. The agency:

• Employs the caregivers (W-2 employees)
• Handles all payroll, taxes, and insurance
• Provides supervision and quality oversight
• Supplies backup caregivers when your regular caregiver is unavailable
• Manages scheduling and care coordination

Typical Costs#

Service Level	Hourly Rate	What's Included
Companion/homemaker	$25-30/hr	Light housekeeping, companionship, meal prep
Personal care	$28-35/hr	Bathing, dressing, toileting, transfers
Skilled nursing	$35-50/hr	Medication management, wound care
Live-in	$250-400/day	24-hour presence (with sleep time)

Pros#

Peace of mind:

• Vetted, trained caregivers
• Licensed and bonded
• Supervision and accountability
• Backup coverage guaranteed

No employer headaches:

• No payroll taxes to file
• No workers' comp to purchase
• No liability insurance needed
• No employment law compliance

Professional support:

• Care plans developed
• Regular check-ins
• Issue resolution
• Coordination with healthcare providers

Cons#

Higher cost:

• 40-50% of what you pay goes to overhead
• Caregiver gets $15-20/hr; you pay $30/hr

Less control:

• Can't always choose your specific caregiver
• Agency policies may be rigid
• Minimum hour requirements common (4-hour minimums typical)

Turnover:

• Agency caregivers may change frequently
• Building relationship takes time

Best For#

• Families who want hands-off management
• Complex care needs requiring supervision
• Those who value backup coverage
• People uncomfortable being an employer

Option 2: Caregiver Registry#

How It Works#

A registry is a matchmaking service. They:

• Maintain a database of pre-screened caregivers
• Help you find matches based on your needs
• Facilitate introductions
• May provide ongoing support

The caregiver is not the registry's employee—they're either an independent contractor or become your employee.

Typical Costs#

Fee Type	Amount
Membership/placement fee	$50-500 one-time
Monthly subscription	$0-100/month
Caregiver hourly rate	$18-28/hr (you pay directly)

Pros#

Lower cost:

• Cut out agency overhead
• Pay closer to what caregiver actually earns
• Often 20-30% cheaper than agencies

More choice:

• Browse caregiver profiles
• Interview multiple candidates
• Select based on personality fit

Flexibility:

• No minimum hours typically
• Direct communication with caregiver
• Customize schedule as needed

Cons#

Employer responsibilities (sometimes):

• May need to handle payroll
• Workers' comp requirements vary by state
• Tax obligations unclear for many families

Less backup:

• If caregiver calls out, you scramble
• Registry may help find replacement, but no guarantee

Variable quality:

• Screening depth varies by registry
• Limited ongoing supervision
• Issues are between you and caregiver

Best For#

• Cost-conscious families
• Those who want to select specific caregivers
• Flexible scheduling needs
• Families comfortable with some management

Option 3: Private Hire#

How It Works#

You find, hire, and employ a caregiver directly. This means:

• You're the legal employer
• You handle payroll, taxes, and insurance
• You manage the relationship directly
• No middleman

Typical Costs#

Cost	Amount
Caregiver wage	$15-25/hr
Employer payroll taxes	+7.65% (Social Security/Medicare)
Workers' compensation	$200-800/year
Background check	$50-150 one-time
Total effective cost	$18-30/hr

Pros#

Lowest cost:

• Caregiver gets more; you pay less
• No agency/registry markup
• Control over wage and raises

Maximum relationship:

• Direct hiring means direct loyalty
• Caregiver works for you, not a company
• Stronger long-term bonds

Total flexibility:

• Set your own schedule
• Create your own policies
• No minimums or restrictions

Cons#

You're an employer:

• Payroll taxes required (not optional)
• Need workers' compensation in most states
• Employment law compliance (breaks, overtime, etc.)
• Potential liability exposure

No backup:

• Caregiver sick? You're on your own
• Vacations require finding coverage
• No one to call for emergencies

Finding is hard:

• Where do you even look?
• How do you verify credentials?
• Reference checking is on you

Risk:

• No bonding or liability insurance (unless you buy it)
• If caregiver is injured, you're liable
• Theft or damage—limited recourse

Best For#

• Very long-term, stable care relationships
• Families with HR/payroll experience
• Live-in situations where cost matters most
• Those with a known, trusted caregiver already

The Tax Reality Check#

Many families privately hire caregivers and pay "under the table." This is illegal and risky:

If You Pay Cash Without Withholding:#

1. IRS penalties for not withholding/paying employment taxes
2. No workers' comp means you're personally liable for injuries
3. Caregiver has no protections (unemployment, Social Security credits)
4. You can't claim tax credits (Dependent Care FSA, etc.)

The "Household Employer" Threshold#

If you pay a household employee more than $2,700/year (2026 threshold), you must:

• Withhold and pay Social Security/Medicare taxes
• Pay federal unemployment tax (FUTA)
• File Schedule H with your tax return
• Provide W-2 to caregiver by January 31

Making It Easier#

Payroll services that handle household employers:

• HomePay (by Care.com)
• SurePayroll
• Paychex
• GTM Payroll

Cost: $50-150/month. Worth every penny for compliance and peace of mind.

Decision Framework#

Choose an Agency If:#

• You want hands-off management
• Backup coverage is critical
• Care needs are complex
• Budget allows $28-40/hr
• You want someone else handling liability

Choose a Registry If:#

• You want to choose your caregiver
• Cost is a significant factor
• You're comfortable with light management
• Backup isn't critical (family can step in)
• You prefer a direct relationship

Choose Private Hire If:#

• You already know a trusted caregiver
• Cost is the primary driver
• You have HR/payroll capability
• It's a long-term, stable situation
• You're comfortable being an employer

Hybrid Approaches#

Many families combine models:

Agency + Private Backup#

Use an agency for regular scheduled care, but have a trusted neighbor or family friend as backup for emergencies.

Registry to Find, Then Hire Directly#

Use a registry's screening and matching service, then hire the caregiver directly once you've built a relationship.

Start with Agency, Transition to Private#

Begin with an agency to establish routines and identify great caregivers, then potentially hire a favorite caregiver directly (check your contract for non-compete clauses).

Questions to Ask#

When Evaluating an Agency:#

1. How do you screen and train caregivers?
2. What's your caregiver turnover rate?
3. How do you handle backup when my caregiver is unavailable?
4. What's included in your hourly rate?
5. Do you have minimum hour requirements?
6. How do you supervise care quality?

When Evaluating a Registry:#

1. What background checks do you perform?
2. Who is the employer—me or you?
3. What happens if there's a problem with a caregiver?
4. Do you help with backup caregivers?
5. What ongoing support do you provide?

When Hiring Privately:#

1. Can you provide references I can actually contact?
2. Will you consent to a background check?
3. What certifications/training do you have?
4. How do you want to be paid? (Hint: legal answer is "on the books")
5. What would you do in [specific emergency scenario]?

The Bottom Line#

There's no universally "best" option—only what's best for your situation:

• Agency = Maximum protection, maximum cost
• Registry = Middle ground on cost and control
• Private = Lowest cost, most responsibility

Whatever you choose, do it legally and with clear expectations. The relationship between your family and your caregiver is too important to build on a shaky foundation.

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CareCade helps Washington families find verified home care agencies with transparent quality metrics. Search agencies in your area or compare providers side-by-side.