Individual caregivers vs. agency? Pros/cons/experiences?

livingintx: As the potential employer of the in home caregiver, you are going to have to treat the carer as your employee and follow suit with withholding taxes and other things. As others have stated, it may not be worth it to go that route.

The biggest mistake with in house caregivers is that you have to deduct taxes, shell out overtime, make sure they’re provided a lunch break of at least one half hour per day, buy an insurance policy to cover their workers comp. Otherwise, all this can come back to bite the employer far more than the employee.

Could it be possible that your Mom needs Memory Care help rather than Assisted Living? Just wondering because in Memory Care, many of the residents have anti-social behavior, so the nurses are trained to deal with it (yes, MC costs more.)

Just prior to COVID and for 2 years, we used an agency for my Mom. During the day, 5 days a week, my Mom went to adult day care. She was/is a fall risk, hence we were at the lowest possible level of care for the agency. At adult care, she was at the highest level of care. In the morning, I would take my Mom to the adult day care where they would provide breakfast and lunch and snacks. I would pick up my Mom at 5:30 pm, cook dinner, help her bathe and at 10 pm, the caregiver would start and leave at 7 am.

I started to sleep overnight at my Mom's just because of the transit time to/from my Mom's. My Mom is a sleep walker so she is up all night (remember she is a fall risk) Most caregivers expect their patients to stay in their bed at night. My Mom was up a lot, as the longest she would sleep at any one time was 1.5 hours therefore the caregiver was getting up and down throughout the night. My Mom had a weekly housekeeper and I did her laundry.

My Mom was hard to deal with. First, being an educated female with a Master's degree, she didn't really respect anyone who wasn't either going to school or didn't have any long term plans other than being a caregiver. She always asked where they lived and if they replied with an area that was considered not an elite area, she was even harder to deal with (snob). She would tell the caregiver to get something from another part of the condo and while the caregiver was off doing that, attempt to get up and use the toilet (she fell a few times and blamed it on the caregiver not being there.) She forbid anyone to eat in the condo as she was worried about bugs. She had a sensitive nose so she could tell if they cooked something and would complain that it stunk up the condo. They couldn't even drink water from a thermos in her bedroom. She didn't want them to use her bathroom, not even the sink. She would ask details of where they lived, and if it didn't match her map of the area, would brand them as a liar. Add to that her racist comments. I was told that her care folder with the agency was over an inch thick.

Starting about 4 months into the caregiving, we noticed that if a caregiver called in sick (at that point due to exposure to COVID), the agency could not find a replacement therefore I was on duty overnight.

When the rules for COVID relaxed, we noticed that it became even harder for the agency to find people for my Mom. They either did not want to come or we asked to put them on the "do not assign" list. For instance, one of the people who made the list was someone who would routinely get in bed with my Mom with her shoes on, and be sound asleep while my mother was awake. Then there were the people who just ignored my Mom and went to another room even though my Mom was moving around. My Mom was a bully when she didn't get her way.

By the time I moved her to a Memory Care unit, she needed assistance bathing and was occasionally incontinent (and hiding it). The person who was with her the longest, was going to request a different person and my mother started arguing with all the caregivers over everything.

I was tired of dealing with the agency not providing caregivers. I was tired of my Mom's constant complaints about the caregivers and the daytime senior care. Most of her complaints were because of her memory of events.

I placed her in Memory Care. I did the math. If we rented out her condo, the monthly out-of-pocket cost would be less than the financial cost of the caregiving. Then there is the mental cost that I went through.

As my niece said: the best part about the Memory Care is that when my Mom becomes uncooperative, there is someone else to take over. That was not true when she lived in her own dwelling.

I had thought a home health person might be happier with his/her work and do a better job if working privately and making more money per hour. One friend of mine does private care home health and would have it no other way. Another friend used to work for an reputable agency and touts the advantages of working for an agency: work is steadier, thete are always jobs waiting if a current job ends and some of their earnings are put into an IRA Account.

An agency will allegedly have vetted the employee and will take care of paper work and taxes. For private pay, the client needs to file that paper work, withhold taxes, etc

I'm still not sure which way o go myself.

Private caregivers are by far the best. They will be far better paid by you and have better working conditions, provided you explain the symptoms your mother has and how best to handle her anxiety, impulsiveness and self destructive behavior. I have found that people who do not have a lot of education or credentials are often the very best caregivers. Personality is more important than skills that caregivers will learn to do better as they get more experience with the person they are caring for. Your loyalty to them and appreciation for what they do for you will also create the kind of conditions for relationships that feel more like family extenders than employee/employer characteristics. Loyalty means being considerate of their personal needs, buying them small presents, remembering the names of their significant others, asking about their family members and remembering birthdays, planning time off and helping them when personal issues and problems arise. Give them raises without them having to ask and bonuses for exceptional work. Retaining a caring person to help with your mother is less abut perfection and more about acknowledging your dependency on the caregiver to make both of your lives work well. Overlook small errors and always buy the caregiver her favorite foods to eat while she is there.

I've spoken with agencies but they are more expensive and the caregiver doesn't make as much.

My 95 yo mother lives with me and I have 3 amazing private caregivers.

I feel like each of them has become a friend of sorts. They are all punctual, dependable and trustworthy. Two of them are PT Assistants, so they really try to get my mother moving as much as possible.

For the past 2 years, I've had two caregivers helping me but couldn't take on more time because of other obligations. And because I'm so burned out, I wanted to find a third caregiver and after carefully searching online for several months and by word of mouth, I finally found someone in June who has also been a blessing.

They always tell me ahead of time when they can't come, so I can prepare and/or another one may be able to sub that day.

I'm not the type of person who can handle having people I don't know constantly coming in and out of my home - especially when I'm not here. Even having the regular caregivers in here sometimes gets on my nerves because it steals my sense of privacy and sanctuary, but that's the nature of the beast if I'm ever going to be able to leave my home.

You can always try both... use an agency for certain days or shifts and hire privately for the rest then you can transition to the one you prefer later or keep the mixture. Hopefully in time you will find just the right caregivers to become your primary and backups for each shift. Be aware, any caregiver that you meet through an agency can not be hired privately without paying a hefty fee. I also have found using two agencies to have more than one option in place in case you have a major issue with the first agency, the transition would be easier than starting from scratch. A friend did this for her mom and said it helped as a backup plan when someone went on vacation or called in sick. As everyone else has suggested, be sure you are doing everything legally to avoid having to deal with tax issues or legal penalties later. If you hire your own, check with your insurance company as you may need a separate policy to be sure you are covered for potential liability. You don't want an accident to happen with your mother or the caregiver then find out her health insurance nor home owners will pay because it was a business arrangement. Agencies are insured for just these issues.

Talk to an elder law attorney about what is required in a care agreement with someone you hire privately. Mom becomes the employer, withholds taxes, medicare, unemployment, social security, etc. I wonder how much going private, if you do it legally, it really saves.

livingintx, my Dad needed 3 shifts of caregivers because he was a major fall risk and had a bit of memory loss. He used an Agency and had excellent results. Yes, they were expensive as there were overhead costs for the Agency. The Agency took care of the payroll taxes, they vetted whomever came to work for them, they were licensed, bonded, and insured. And the caregivers were all up-to-date on their vaccines. The 3rd shift caregiver was required to be awake through-out her whole shift.

As I had mentioned the cost was expensive, here in my area it was costing Dad around $20,000 per month. Dad decided to sell him house and used the equity to live in senior living. He even brought along his favorite morning caregiver which gave him a routine.

Senior living was costing him $5k-$7 per month [eventually he needed to move into Memory Care]. What I liked was the senior facility had around the clock nurse available. The monthly rent included housekeeping and linen service, 3 meals in the private restaurant style dining room, and the cost of his alert pendent.

Dad was shy, so he wouldn't go on his own to social gatherings unless his caregiver would prompt him to attend. He loved the music from his generation. And he really liked being around people from his age group.

It's not easy to get a win-win situation on the first, second or third try. Keep looking for a good match that you Mom would like having in her home.

Not sure an apartment plus hired caregivers every day/ night is significantly cheaper than AL. Not to mention you are committing to helping EVERY SINGLE day too. Plus since she's confused for whatever reason she may actually need Memory Care. Maybe do the math first. Just be sure you're not jumping from frying pan into the fire.

"My mother is an undiagnosed borderliner. I was her 'identified patient', aka the black sheep. I got the brunt of the physical and mental abuse."

"I would not put my life on hold. (I can say that because I have and I regret every minute I have.) I would do as much from afar as I could, like arranging care or letting them know about other options like care cottages, adult day care, etc."

And now you're planning to rent her an apartment, take care of her "a few hours a day" and get caregivers for the rest? Who's paying for this? (I hope YOU aren't.)

When caregivers don't show up, YOU will be the one to fill in.

How did you come to be responsible for her, as the black sheep who bore the brunt of her physical and mental abuse?

The best 2 caregivers I hired were recent graduates of the CNA program at the local Community College. They were waiting for the Nursing program to start and I told them both when the program began I would work with them with their schedules.
Hiring privately has it's positives as well as negatives.
You do have to make sure that you are properly taking out taxes and following a proper schedule as far as hours are concerned.
Depending on where you live if you hire through an agency if giving medications are required an agency may require you to hire a Nurse to administer medications.
Hire privately and you can instruct your caregiver to administer medications.
Hire through an agency and if your caregiver calls you at 8 am and says they are sick you contact the agency and hopefully they can get a replacement soon. (hopefully before you have to leave if you have plans for the day.)
Hire privately and your caregiver calls you at 8 am and says they are sick...you roll up your sleeves and get to work.
I could go on and on but you get the idea. There is no Perfect.
do get background checks done if you are hiring privately
There are drawbacks to background checks. It will only show if a person has been convicted of a crime. If this person has managed to slip through the cracks ....
Get a safe to keep any valuables in. Give no one the combination.
Keep all important papers locked up and any papers that have personal information should be locked up.
I suggest that all mail either be directed to your address, a post office box or if the condo has a locked mail box, you keep the key.
I also suggest that you place cameras in the condo. If your caregivers will be living there you can not place a camera in areas where they would expect privacy, their bedroom and their bathroom if they have a private bath. (no cameras in bathrooms anyway.)
check with your State and find out if Audio recording is a 2 party consent or just 1. Video recording is legal without consent.
I am sure others will give you more ideas.