Finding a Private Caregiver for Your Loved One: Consider Your Three Options Carefully

By Marc Spector, President & CEO of Best Care

An August 2013 study published by the AARP Public Policy Institute concluded that the supply of family caregivers is unlikely to keep pace with future demand in America. The study found that the number of potential adult family caregivers for each American over the age of 80 is expected to plunge from seven potential caregivers in 2010 to just four potential caregivers by 2030 and then down to as few as three potential caregivers by 2050.

This looming “caregiver crisis” is largely the result of fundamental changes in the age and makeup of the families in our country. Two out of every five American adults are caring for an older loved one who is aging in place, a number that continues to increase each year as the demographics shift toward an aging population. Moreover, the number of elderly Americans suffering from Alzheimer’s disease has continued to rise in recent years, compounding this need for full-time care of elderly loved ones.

Finding a Private Caregiver

For families that are faced with the painful challenge of finding in-home care for an aging parent or other family member, the options for locating those caregivers can be confusing and difficult to navigate. The first term a family needs to embrace is the notion of “private duty care”; this is the kind of care that consumers need to seek out for elderly loved ones who are unable to get around or take care of themselves without some assistance.

The concept of private duty care has been around for many years and basically refers to in-home care that is paid for directly by the consumer or their long-term care insurance policy — not Medicare or commercial health insurance. This care can either be provided by a home care agency, an individual caregiver whom a consumer finds online or through some other informal means, or a third option that combines the best of both models: a professional referral from a private duty caregiver registry.



Option One

The first option of finding home care through an agency – a company that hires caregivers – provides a good mechanism for obtaining quality caregivers whose credentials have been verified. However, this is often the most expensive model due to the increased overhead of an employee-based business structure.

For example, an agency must pay half the cost of Medicare and Social Security taxes for their caregiver employees (i.e., FICA taxes), which makes the cost of hiring a caregiver from an agency that much more expensive; the same thing is true with respect to workers’ compensation insurance and unemployment taxes. In addition, new labor laws passed at both the federal level and in some states now require home care agencies to pay their employee caregivers overtime, raising the wages that must be paid by agencies and further increasing the rate they must therefore charge families for caregivers. Moreover, obtaining private duty care from an agency is about to become even more costly due to requirements from the Affordable Care Act (“ObamaCare”), which has imposed a number of new financial burdens on employers to provide health insurance benefits for their employees.

Option Two

The second option of hiring an “underground” caregiver by consulting Craigslist or some other online directory is often the least expensive avenue for obtaining in-home care. However, this approach is fraught with a wide range of risks since there are no consumer protections, professional credentialing requirements or background checks on the caregivers. For example, it is much more difficult to verify how much prior hands-on work experience a candidate has as a caregiver, or if they have any nursing certifications or training certificates. It’s also very difficult for a family to independently confirm the caregiver is eligible to work in the U.S., whether they have any sort of criminal history or professional disciplinary citations in their background, or even if they have had proper medical checks to make sure they are not carrying any communicable diseases. These are all serious and important risks that a family is taking when they choose to hire a caregiver “underground” through some private arrangement.

The Third Option: A Caregiver Registry

The third option — and the original model for home care — combines the best of both worlds. A caregiver registry is a company that refers self-employed caregivers to consumers on a private basis, for care needed anywhere from a few hours at a time up to 24 hours a day. The registry provides administrative support to the consumer and access to caregivers that have been pre-screened prior to entering the client’s home.

There are three things that most families want when they set out to find a private in-home caregiver for their elderly loved one: a caregiver who is trustworthy; to be protected in case something goes wrong in the home; and to be protected in case someone is dishonest. Registries address all three of these concerns because of clear guidelines that are established and promoted by its trade association, as well as governed by the Florida Agency of Healthcare Administration (who oversees and licenses Florida Nurse Registries). As a Florida licensed Nurse Registry, Best Care conducts background checks, verify credentials and checks the professional references of caregivers it refers to consumers. This ensures that only the very best, qualified caregivers are referred to a family in order to meet their unique needs.

At the same time, since the caregivers are self-employed, a caregiver registry can save families anywhere from 10 to 30 percent on their in-home care expenses. This is because registries take significant costs out of the business that are created by the agency model – ranging from additional tax obligations to increased employee benefit expenses – and returns those cost savings to families in the way of reduced caregiver rates.

The end result of the registry model is to provide the consumer with safe access to a private duty caregiver at a more affordable cost.


In the end, the delivery of care is similar between an agency and a registry. The primary factors for a consumer deciding on how to obtain in-home care for an elderly loved one comes down to price and the quality of the caregiver. Caregivers who are referred to consumers by Best Care carry their own liability insurance to cover the rare occurrence of an accident in the home.

A caregiver registry not only allows caregivers the opportunity to earn more wages than they would working for an agency, it also affords families to obtain the same high-quality care for their loved ones and – in many instances – at a more affordable price.

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