Many sources provide home care workers

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Home care providers can come from a variety of sources — whether agencies, direct hire, or through online services. Here are descriptions of the differences between various types of home care agencies.

Home health agencies

The term home health agency often indicates that a home care provider is Medicare-certified. A Medicare-certified agency has met federal minimum requirements for patient care and management, and therefore can provide Medicare and Medicaid home health services. Individuals requiring skilled home care services usually receive their care from a home health agency.

Due to regulatory requirements, services provided by these agencies are highly supervised and controlled. Some agencies deliver a variety of home care services through physicians, nurses, therapists, social workers, homemakers and home care aides (HCAs), as well as durable medical equipment and supply dealers and volunteers.

Other home health agencies limit their services to nursing and one or two other specialties. Home health agencies recruit and supervise their personnel; as a result, they assume liability for all care.

The home health agency provides a number of advantages. The agency will create and implement a comprehensive care plan and coordinate this with you and the physician. They will also manage the administrative details, such as payroll, (including state, federal, unemployment, Social Security, disability taxes, workers’ compensation, and paperwork, like the I-9 employment eligibility form), screening and supervisory oversight.

Another advantage of hiring through an agency is that they can provide you with a variety of caregivers for back-up coverage so that, in most instances, you will not be without care should one caregiver be unavailable.

A commonly cited disadvantage is the cost. The home care agency is usually more expensive than hiring a person privately.

Some home health agencies may have a side to their agency that is private pay or non-Medicare certified. This side of the agency provides services to those individuals that no longer require skilled care, but continue to have ongoing personal, custodial care needs. The private pay side of a home health agency may have higher rates than an agency that is strictly a private pay home care agency.

To find a home health agency that is right for you, ask for referrals from friends. Check for quality of services and possible infractions. You can check with the Chamber of Commerce and Better Business Bureau, which will have a record of any specific complaint lodged against an agency.

Home care and non-medical/companion private pay agencies

A private pay home care agency is generally an agency that provides home care services that are not reimbursable under Medicare. This type of agency provides what is termed “custodial care,” or care that can be given by a non-medical care provider.

The services offered may range from companion care to assistance with personal care functions such as bathing and dressing. They may offer non-skilled therapy and nursing services.

The care is paid for privately by the client, or in some instances, by private insurance such as long-term care insurance. It is not always mandatory to have a physician’s order for care.

Some states, including Maryland, require these agencies to be licensed and meet minimum standards established by the state. Most home care agencies recruit, train and supervise their personnel, and thus are responsible for the care rendered.


Registries serve as employment agencies for home care nurses and aides by matching these providers with clients and collecting finder’s fees. These organizations usually are not licensed or regulated by government.

Registries are not required to screen or background-check the caregivers, but some do undertake these tasks routinely. In addition, although not legally required to, some registries offer procedures for patients to file complaints.

Clients select and supervise the work of a registry-referred provider. They also pay the provider directly and must comply with all applicable state and federal labor, health, and safety laws and regulations, including payroll tax and Social Security withholding requirements.

Independent providers

Independent providers are nurses, therapists, aides, homemakers and companions who are privately employed by individuals who need such services.

Aides, homemakers, chore workers and companions are not required to be licensed or to meet government standards except in cases where they receive state funding. In this arrangement, the responsibility for recruiting, hiring and supervising the provider rests completely with the client.

Excerpted from “Receiving Care at Home” and “Since You Care” by the MetLife Mature Market Institute and the website of the National Association for Home Care and Hospice. For more information, see or call (202) 547-7424.