Home health care aides cost. Any advice?

There are penalties for tax evasion.

CaringDaughter7, in either case, if one hires privately you become the "employer" and the caregiver the "employee". When it comes to paying the employee, it is decided between you and the employee how to work this.

It is highly important to have an employment agreement. If the person being cared needs to go onto Medicaid [different from Medicare], you have proof that monies paid to a caregiver were not gifts.

Payroll taxes can be mind boggling, thus there are companies out there that will do payroll taxes. You pay the company, the company pays the employee. There is a fee for this service.

In either case, if you are the employer, you need to have workmans comp insurance or something similar in case the employee gets hurt on the job.

When my Dad needed caregivers, I went to an Agency. Yes, it was more expensive, but the Agency was the "employer" thus they did the payroll taxes, they were licensed, bonded and insured. Plus they had workman comp insurance on their "employees" in case one would get hurt on the job. I also liked the fact that if the assigned caregiver was unable to make his/her shift, the Agency found another employee to fill in.

It is always good to have an accounting of how much is spent when caring for someone.
As their assets dwindle there may have to be an application for Medicaid and there is going to have to be proof how and where their assets went.
If you are paying me "under the table" for caring for "Aunt Betty" legally I have to pay taxes on the money you pay me. So at the end of the year you send me a form that tells me I have to pay taxes on all that you have paid me. Most people will not have that kind of money. (Think about what would happen if your employer did not withhold taxes and sent you a form at the end of the year and you had to pay everything that was withheld.)
Yes there are a LOT of caregivers that work without having taxes paid on the money made.
Also what happens if the person you hire is injured.
Is your homeowners insurance going to cover an employee? Will this person be able to work again?
Technically, Legally, Morally you should pay your caregiver properly.
At least this way there is a paper trail if they try to sue you for any thing. Keep a log of hours so there is no breach of Labor Laws, keeping good records also keep you out of hot water with the IRS and later if you have to document cost of care.

The IRS would be very interested in these people.

Most caregivers who get paid in cash do not intend to report it to the IRS as income. They pocket all of it. If their "employer" gives them a 1099, this would be a problem for the caregiver if they don't report it at their end. Besides, if you pay them in cash, there is no "proof" you actually paid them unless you gave them a receipt and they signed it and kept a copy for themselves. With no receipt or proof, you will have an "interesting" time explaining the outlay of these funds to Medicaid.

In my state (MN) a caregiver is never considered a contract employee, therefore they are a full employee and tax withholding needs to be done by the employer, quarterly reporting, W2s at year end, etc. They come under labor laws for overtime. The state decides who is a contract employee, not you.

The people who work for cash may be getting a "benefit" up front but they are robbing themselves of their future SS and Medicare benefits at a time when they will surely need it, since none of their income will go into these programs on their behalf.

Caregiving agencies do all of that for their clients, as well as providing subs and doing background checks. They are also ultimately responsible if anything goes wrong (liability), like theft or injury. If a cash caregiver gets injured in your home you can be sued and you'd have no protections. Or, if your caregiver injures your LO...

I've been an employer for 38 years, so I've had experience in this area. It differs by state but you should look at the labor and caregiver laws where your LO resides for definitive guidance.

Well, there are tax rules, and if you pay more than I think it is only 100 or 200 a year in wages you have to provide W2 forms I think at the end of the year to that person. What they do with those is a whole other question. Many people pay "under the table" which is of course a risk. I would discuss this with a CPA or tax advice line, or with the IRS itself if you can wait the two hours by phone. Once you get them they are very kind.
Insurance is another matter. Whether someone trips over your sidewalk root, lawn sprinkler or your terrier nips the postal person, you could be looking at a law suit. That is to say anyone hired in your home who injures themselves (even in lifting and such for a patient) may sue you. So a call to your insurance person to ask about your coverage is a good idea. Those working for agencies may be covered by workman's comp and for taxes. Ask.
A good insurance umbrella coverage is a good idea and cheap in the long run. When you are sued you may WIN and the case may be clear, but you will have to defend in court. That means an attorney. You will be so thankful for a good umbrella policy.
So this means calls to the people in the know. Forums are great for "This is what I did!" and "That worked for ME", but when it comes to good legal, medical, financial advice you should contact those who know.
I sure wish you the best.

A friend of the family reported all the checks he paid every year to his caregivers and then gave them 1099s. One made over $30,000 and was begging me not to do the same thing "to" her after he died. (I was the executor of his trust and had to keep the records.) I did the same thing because, one, it was the legal thing to do in the event of an estate audit down the road and, two, I would not want to change his way of handling things because it was, after all, HIS estate. She told me later that she ended up owing so much money to the IRS. I know it can be hard on them, but it's how you're supposed to do things.

I live in NYC and cash paid caregivers are VERY common here. They often prefer it, especially if they are not legal citizens. I know a couple of families that have excellent caregivers who were nurses in their home countries and are are working as caregivers here while winding their way the through the immigration process. When they work at an agency, the agency pays them less than what they can make being paid directly from the client. If you think that at some point your LO will need to be on Medicaid, then you can prove the money wasn’t a gift by giving your caregiver a 1099 at the end of the year. They become independent contractors and they pay taxes on their earnings. Many people will do a 1/2 and 1/2 situation to cut down on the taxes they have to pay. Pay them 1/2 in cash out of their own funds and find a way to be reimbursed by their loved one, and 1/2 in a check out of the LO account that are then given a 1099 for. The caregivers make more money and because if this are often very reliable.

I am not advocating for anything here, just giving you an example of how some families do it to make ends meet.

If you pay for the caregivers not through an agency you are required to pay taxes. Federal, social, and medicare taxes. Please check with your tax person for details.

CaringDaughter7: Perhaps you should pose your question to a certified public accountant.