What are the benefits/downsides of hiring a caregiver through an agency versus hiring independently?

As mentioned earlier, do your due diligence. The agency should be liscenced bonded, insured and do background checks and hire skilled caregivers. Always ask for references and then CALL THEM! Ensure there is good screening in place and a good interview process between you, your loved one, the Agency and the caregiver to ensure there is a good personality match. Make sure all responsibilities, care expectations, fees, vacation, hrs, expenses, etc are clearly outlined in writing. Understand insurance, liability, and emergency info. If you can, ask for weekly updates or written reports. Check in as often as you can while everyone gets aquainted. Remember to be patient and listen to both sides of the story when there is conflict during the adjustment period.

I like the idea of an agency because you have options and backup in case of emergency.

There is always risk, especially if you can't manage locally.

The most important indicator can be solid trusted references. By all means, see if you can visit with former clients or their family members.

i think hiring a caregiver through an agency is a better option because whenever you feel that the current caregiver is not doing well or you are not satisfied with him, you can always ask the agency to provide a new caregiver.

This is from Cindy Laverty recently posted:
Don't Hire a Caregiver Until You Read This!
You finally made the decision to hire a caregiver from an agency rather than the classified ads or Craigslist. You did this because you assumed that agencies screen, perform background checks, drug test caregivers, ensure citizenship and train their caregivers to perform the necessary tasks needed to be a caregiver, including receiving a certification in First Aid and CPR.

Well…think again! A new study (published in the Journal of American Geriatrics Society, July 13, 2012 issue), led by Dr. Lee Lindquist of Northwestern University Feinberg School of Medicine finds that nearly half of the agencies that send caregivers to help seniors in need do a poor job of screening, testing and training the caregivers they hire. The study reveals that many agencies recruit random strangers off Craigslist and place them in the homes of elders suffering from dementia, or long-term illness. The findings are disturbing to say the least.

According to Dr. Lindquist, a geriatrician, “Some of the paid caregivers are so unqualified it’s scary and really puts the senior at risk.”

Northwestern researchers posed as consumers and surveyed 180 agencies around the country. Their findings are pretty astounding:
• Only 55% of the agencies did a federal background check and many agencies didn’t check for any type of criminal record.
• Only 1/3 of the agencies did any type of drug testing. That means that paid caregivers who might have a drug problem have access to a senior’s medications.
• Only one in three agencies test their caregivers’ skills or do any kind of home visit to check on performance. (So much for CPR and First Aid competency)
• Two-thirds of the agencies advertise that their caregivers could assist with financial transactions, such as bill paying.
• And sadly, many agencies appeared to lie about their screening practices by making up assessments that do not even exist.
You might be wondering how this happens? Simply put: it’s because caregiving agencies are not regulated. The typical caregiver is a female immigrant earning $7.25 per hour on average and $5.44 per hour for live-in work. It’s a dreadful situation.

When you are interviewing a caregiving agency ask the following 10 questions. If they balk at any of your questions, move on!
1. How do you recruit caregivers, and what are your hiring requirements?
2. What types of screenings are performed on caregivers before you hire them? A federal or state criminal background check? Drug screening? Other? (Record the answers and research to make sure these screenings are authentic.)
3. Are caregivers certified in CPR or do they have any health-related training? (Ask for physical proof.)
4. Are the caregivers insured and bonded through your agency? (Ask for physical proof.)
5. What competencies are expected of the caregiver? (These could include lifting and transfers, homemaking skills and personal care skills such as bathing, dressing, toileting and training in behavioral management. This person is going to take care of your loved one. You must be on top of this process. )
6. How does the agency assess what the caregiver is capable of doing? (Make sure the agency is not just relying on the caregiver’s word that they have certain skills.)
7. What is the policy on providing a substitute caregiver if a regular caregiver cannot provide the contracted services?
8. If there is dissatisfaction with a particular caregiver, will a substitute be provided and may I interview this person in advance?
9. Does the agency provide a supervisor to evaluate the quality of home care on a regular basis? How frequently?
10. Does supervision occur over the telephone, through progress reports or in-person at the home of the older adult? (I always recommend that families make sure that the caregiver writes an hourly report and keeps track of all phone calls or door-to-door solicitors.)

This is a scary report, but the good news is that it has received a huge amount of media attention and now agencies are on notice. They will have to change their ways or go out of business. As a consumer you must be an absolute Empowered Advocate on behalf of your loved one.

sjrbeanie - any reputable agency will perform background checks and the aides will be their employees not 1099. Ask questions and to the agency would arrange for you to speak to current or past clients regarding their experience working with the company. The other thing to consider is, with a reputable agency, you will have the ability to say I want a different aide or if your aide is ill a replacement will be found to fill in. Good luck, there are some unscrupulous agencies out there but there are also great ones!

Thanks JessieBelle. My only concern is that I've heard some agencies don't do background checks.

I would only go through an agency, because they are licensed and insured. Plus, you don't have to withhold taxes, pay SS, or buy health insurance for them.