Agency Versus Registry, and Why the Difference Matters

What's the Actual Difference?

A home care agency employs its caregivers directly — it recruits, trains, schedules, pays, and typically insures them, and bills the family for the service as a package. A registry is a different kind of business: it refers or matches an independent caregiver to a family for a fee, but generally does not employ that caregiver, which often leaves the family functioning as the employer even though the registry did the introducing.

That distinction is not a technicality. It determines who pays payroll taxes, who carries liability and workers' compensation insurance, and who is legally responsible if something goes wrong during a shift. Two services that look similar on a search results page, complete with similar-sounding language about screening and matching, can put very different obligations on the family that hires through them — and the difference usually only becomes visible once something has already gone wrong.

What a Home Care Agency Is, Legally and Functionally

An agency is a company: it hires caregivers as its own employees, trains and schedules them, and typically carries the general liability and workers' compensation insurance that comes with being an employer. Most states require agencies providing personal care to hold a state license, and agencies operating in the Medicare-certified home health space answer to additional federal rules, including aide competency evaluation and ongoing supervision by a registered nurse 1Ref 1Office of the Federal Register (Code of Federal Regulations) (2025).42 CFR 484.80 — Condition of participation: Home health aide services.The federal training, competency-evaluation, and RN-supervision requirements for aides employed by Medicare-certified home health agencies, contrasted with the lack of such standards for registries..

Because the agency is the legal employer, the family paying for the service is a customer, not an employer. The agency's bill is generally higher per hour than a private caregiver's wage, and that markup is, in large part, the price of the agency absorbing all of the employer-side functions rather than leaving them to the family.

What a Registry Is Instead

A registry operates more like a matchmaking or referral service: it maintains a roster of independent caregivers, screens some of them to varying degrees, and connects a family with one for a placement or membership fee. In most registry arrangements, the caregiver is not the registry's employee — they're either an independent contractor or, more often under the actual legal test, the hiring family's employee, even though the family found them through what feels like an agency-style platform.

The structure resembles what happens under a self-directed public program: Medicaid's self-directed, or participant-directed, service option similarly lets a beneficiary select and manage their own worker rather than receiving care through an agency-employed aide 2Ref 2Centers for Medicare & Medicaid Services (2025).Self-Directed Services.That Medicaid self-directed service delivery lets a beneficiary select, hire, and manage their own caregiver rather than receiving care through an agency-employed aide, structurally similar to a registry arrangement.. In both cases, an organization helps connect the family to a caregiver, but the deeper employment relationship, and the responsibilities that come with it, sits with the individual rather than the organization.

Registry screening also varies far more than agency screening does, since there's no consistent regulatory floor requiring a particular depth of background check, reference verification, or skills assessment before a caregiver is added to the roster. Some registries screen thoroughly; others do little beyond collecting an application, and a family usually can't tell which from the marketing alone.

Why "Who's the Employer" Is the Whole Ballgame

The practical stakes of this distinction come down to taxes, insurance, and liability. The IRS's household-employer guidance is built around exactly this question: whether someone paid to work in your home, including a caregiver found through a registry, counts as your employee and triggers federal employment-tax duties on the family's side 3Ref 3Internal Revenue Service (2026).About Publication 926, Household Employer's Tax Guide.That the guide exists to help a family determine whether a worker they pay, including a caregiver found through a registry, counts as a household employee triggering tax duties.. If a registry-sourced caregiver is legally the family's employee and is paid cash wages at or above the annual threshold, the family owes Social Security and Medicare taxes on those wages, the same as it would for a caregiver found through a newspaper ad or word of mouth 4Ref 4Social Security Administration (2026).Household Workers (SSA Publication No. 05-10021).That paying a household worker, such as a registry-sourced caregiver who is legally the family's employee, cash wages at or above the annual threshold requires reporting wages and paying Social Security and Medicare taxes..

None of that tax exposure applies to a caregiver employed by a true agency, because the agency, not the family, meets the legal test for employer in that case. The word "registry" doesn't change the underlying law — it just changes how the caregiver was found.

What Federal Rules Reach Certified Agencies but Not Registries

Agencies operating as Medicare-certified home health providers answer to federal Conditions of Participation that registries are not subject to at all. Beyond the aide training and RN-supervision standard, certified agencies must honor a specific federal patient-rights standard covering respectful treatment, freedom from abuse and neglect, informed consent, and a formal complaint process 5Ref 5Office of the Federal Register (Code of Federal Regulations) (2025).42 CFR 484.50 — Condition of participation: Patient rights.The enforceable federal patient-rights standards — respectful treatment, freedom from abuse/neglect, informed consent, complaint process — that apply to certified home health agencies but not to registries.. A registry, which is typically not itself a Medicare-certified provider, isn't bound by that same enforceable framework, because it isn't rendering care as an agency — it's introducing people.

This doesn't mean every non-medical home care agency meets these specific federal standards either, since most of them fall outside Medicare's home health rules too. But it does mean a registry sits a further step removed from any federal accountability structure than even a non-medical licensed agency does, which is worth knowing before assuming "registry" and "agency" carry the same baseline protections.

How to Tell Which One You're Dealing With, and Where Registries Fit

Ask directly: does the caregiver work for you, or for the company that found them? A true agency answers "us" — it pays the caregiver, withholds their taxes, and carries their insurance. A registry more often answers "you," even when its marketing describes screening and matching services that sound similar to an agency's.

Registries can still make sense for families who want more control over who they hire and are prepared to take on the employer role — the per-hour cost is often lower because the family, not an agency, is paying for it in reduced protection rather than reduced work. That tradeoff is a reasonable one to make deliberately, with a plan for taxes, insurance, and backup coverage already in place. It's a much worse one to discover after the fact, and informal caregiver-hiring arrangements found online carry their own scam risk worth watching for, including requests to send money or unusual pressure to skip meeting in person before hiring 6Ref 6Federal Trade Commission (2024).Is it a caregiving job or a scam?.Red flags common to caregiving-job scams — fake checks, no in-person interview, requests to send money — relevant to informal, registry- or listing-based hiring..