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Care at home: agencies and private caregivers

Choose, hire, and manage reliable nonmedical help at home.

Reviewed August 22, 2026

Home care can help with bathing, dressing, meals, mobility, supervision, errands, and companionship. It is not the same as Medicare-certified home health, which provides time-limited skilled clinical care.

Your next 3 actions

  1. List the exact shifts and tasks needed. Include hands-on transfers, dementia supervision, driving, pets, stairs, and overnight needs.
  2. Get two agency proposals and, if considering a private hire, price the employer duties. Compare the same weekly schedule and cancellation assumptions.
  3. Run a paid trial shift with a written care plan. Observe communication, safe transfers, punctuality, and respect for the older adult’s choices.

Agency or private hire?

  • Licensed home care agency: The agency recruits, screens, schedules, supervises, and usually handles payroll and replacement coverage. It costs more than the worker’s wage because it includes those services. Ask what happens when the regular caregiver is absent.
  • Private caregiver: You may have more control and continuity. The household may become the employer and may need to handle screening, payroll taxes, workers’ compensation, overtime, records, and backup coverage. Do not assume calling someone an “independent contractor” makes it so.
  • Family or friend: Familiar and sometimes flexible, but boundaries, respite, payment, and decision authority should still be written down.

Questions to ask

  • Is the agency licensed by Washington? Who supervises the care plan?
  • What screening, references, training, and competency checks are completed?
  • Is the caregiver an employee? Who handles taxes, insurance, injuries, and overtime?
  • Can the caregiver perform every listed task safely? What tasks are prohibited?
  • Who covers a late arrival, illness, holiday, or abrupt resignation?
  • How are schedule changes, complaints, and suspected theft handled?
  • What are the minimum shift, cancellation, mileage, holiday, and rate-increase rules?
  • May the client change caregivers without losing service?

Warning signs

Stop if anyone asks to use the older adult’s debit card or PIN without safeguards, borrow money, receive gifts, become a beneficiary, or keep financial activity secret. Also act on missed medications, unsafe transfers, unexplained injuries, isolation from family, chronic lateness, or falsified time records. For immediate danger call 911; report suspected vulnerable-adult abuse or exploitation to APS.

Common failures

  • Buying hours before defining tasks. The wrong skill level leaves the highest-risk needs uncovered.
  • No backup plan. Keep a second contact and a same-day plan for essential care.
  • Treating companionship as skilled care. Home care aides do not replace nursing, therapy, or medical assessment.
  • Paying off the books. This can create tax, wage, insurance, and liability problems.
  • No privacy limits. Lock up sensitive papers, medications, checkbooks, and account credentials; share only what care requires.

Costs and payment basics

Home care is commonly billed hourly, often with minimum shifts and higher holiday or overnight terms. Private hiring adds employer costs and administration beyond wages. Medicare generally does not cover ongoing nonmedical personal care by itself. Long-term care insurance, VA benefits, or Medicaid programs may help if eligibility and policy rules are met. Ask what is authorized before assuming reimbursement.

King County help

Sources

Reviewed 2026-08-23.