Hiring a Private Caregiver, Step by Step

What are you actually taking on when you hire privately?

You are becoming an employer. A private caregiver is your household employee, not a vendor — which means the vetting, the payroll, the tax filings, the supervision, and the scramble when nobody shows up all land on you. The lower hourly rate is the reason families do it. It is also the price of a service bundle you are now assembling yourself.

It helps to see what the agency model puts underneath a caregiver. When an aide works for a Medicare-certified home health agency, federal rules require the aide to complete training and pass a competency evaluation covering specific skills, and require a registered nurse to supervise the aide's work 1Ref 1Office of the Federal Register (Code of Federal Regulations) (2025).42 CFR 484.80 — Condition of participation: Home health aide services.That aides employed by Medicare-certified home health agencies must complete training and pass a competency evaluation and work under registered-nurse supervision — the federal structure a privately hired caregiver sits outside of.. A privately hired caregiver sits outside that structure entirely — no federal training floor, no competency exam, no nurse checking the work.

That is not an argument against hiring privately. Some of the best caregivers in the country work directly for families, precisely because they got tired of being rotated through six houses a week. It is an argument for building the missing pieces deliberately, since nobody else is going to.

Five jobs transfer to you the moment you hire someone yourself:

• Vetting — references, background, and a judgment call nobody can make for you.
• Payroll and tax — wages, withholding, filings, deadlines.
• Insurance — what happens if she hurts her back lifting your father.
• Supervision — noticing that care has drifted, and saying so out loud.
• Backup — a second person for the morning the first one cannot come.

If the agency vs private caregiver question is still open, it is worth closing before you start interviewing. The direct hire caregiver pros and cons are mostly about which of those five jobs you are willing to hold — not about how good the person you find turns out to be.

What should the job description say?

A job description that produces good candidates says four things plainly: the specific tasks, the hours, the pay, and the parts of the job that people quit over. Vague postings — "companion for elderly mother, light duties" — attract candidates who will be surprised on day three and gone by week three. The most valuable hour in this whole process is the one spent writing this down before anything is posted.

The exercise that works is walking a single ordinary Tuesday hour by hour, writing what a stranger would actually have to do. Not "help with the morning routine" but: arrives at 7:30, he is usually still in bed, needs a hand from the bed to the wheelchair, showers three days a week and refuses on the others, takes his pills with breakfast — which he has already forgotten he took.

Three categories tend to blur together, and separating them changes who applies:

• Personal care — bathing, dressing, toileting, transfers, feeding. Hands on a body.
• Homemaking — laundry, meals, dishes, groceries, the floors. Hands on a house.
• Companionship — being there, conversation, a card game, supervision so nobody goes out the back door at 2am.

Most real jobs are a mix. The mix matters legally as well as practically, because the wage rules further down turn partly on it.

Then the details that decide whether someone stays. Stairs. Whether a transfer needs two people. Dogs. Smoking. Incontinence care, named plainly. Dementia behaviors, named plainly — the sundowning, the same question forty times, the accusation that someone stole the remote. Driving: whose car, whose insurance. Whether weekends are part of this.

The hard parts belong in the posting. A candidate who reads "assistance with toileting, and a two-person transfer from bed to chair" and applies anyway already knows what the job is. A posting that hides the difficult parts does not avoid them. It moves the discovery to week two, when your parent has already gotten attached.

Where do people find private caregivers, and where are the scams?

The routes that work are personal ones: an aide who cared for someone in your parent's building, a hospital discharge planner's off-the-record suggestion, a neighbor, a church network, a nurse who knows who is looking for hours. Online marketplaces and classified boards work too, and they are also where the scams live. Every route ends in the same place — a person in your parent's kitchen, being interviewed.

The Federal Trade Commission publishes guidance on caregiving-job scams, and the pattern it describes runs in both directions 2Ref 2Federal Trade Commission (2024).Is it a caregiving job or a scam?.The red flags of caregiving-job scams encountered when hiring or job-seeking informally: no in-person interview, overpayment checks with a request to wire back the difference, and requests to send money before any work has happened.. Someone answering your ad may be running it; someone answering a caregiver's job search may be running it on her. The markers are the same either way: an arrangement that never includes an in-person interview, a check that arrives for more than the agreed amount with a request to wire back the difference, a request to send money before anyone has worked a single shift 2Ref 2Federal Trade Commission (2024).Is it a caregiving job or a scam?.The red flags of caregiving-job scams encountered when hiring or job-seeking informally: no in-person interview, overpayment checks with a request to wire back the difference, and requests to send money before any work has happened..

Money moving before anyone has met in person is the clearest sign that this is not a hire.

The gray market is not only scammers, and it is worth being honest about that. The pull toward a handshake and cash — someone's cousin, wonderful with older people, available Monday — is strong, and it is not a scam. It is an arrangement with no floor under it. It works until the day it doesn't: the injury, the accusation, the notice from the state. That day is the reason the rest of this page exists.

Whatever the route, the shortlist should be short. Three candidates you have actually spoken to beats thirty résumés, and a phone call before anyone visits removes most of the list for free.

How do you screen someone who will be alone with your parent?

Screening is four things, done in order: an interview in your parent's home with your parent present, reference calls to the families she actually worked for, a background check you pay for and read yourself, and household safeguards that hold no matter who you hire. The fourth one matters most, because the first three are all judgment, and judgment is the thing that fails.

The interview happens in the house. Not a coffee shop. You are watching two things a résumé cannot show: how she speaks to your parent, and whether your parent's face changes when she does. Direct some questions to your parent and see whether she lets him answer. Ask the specific ones — what she did the last time a client refused a shower, the last time someone fell, the last time she was accused of something she did not do. Generic questions produce generic answers.

References are two phone calls about one question. Call the family, not a name written down as "supervisor" with no institution attached to it. Then ask the only question people answer honestly: would you hire her again? The pause before the answer is usually the answer.

The background check is yours to run and yours to read. Run it with her written consent; what a check may cover and how it may be used is set by rules that vary by state. A clean check guarantees nothing — it is one input among four. Read the report rather than a summary of it.

The safeguards are the part that survives being wrong about a person. The Consumer Financial Protection Bureau publishes resources specifically on protecting older adults from fraud and financial exploitation, including exploitation by people in positions of trust 3Ref 3Consumer Financial Protection Bureau (2025).Protecting Older Adults from Fraud and Financial Exploitation.That federal consumer-protection resources exist on preventing fraud and financial exploitation of older adults, including exploitation by people in positions of trust — the basis for household financial safeguards around in-home caregivers.. That framing is uncomfortable and useful: this job runs unsupervised, for hours, in a house that contains a checkbook.

• One card for household spending, with a low limit, reconciled every month by someone who is not the caregiver.
• Statements read by a family member monthly. Not filed. Read.
• Nothing added to an account, and no change to a will, a deed, or a power of attorney while a caregiver is employed. Families who cross that line almost always have a good reason at the time.
• Jewelry, cash, and prescription medication somewhere other than a bedside drawer.

None of that is an accusation. It says the household is legible — and a legible household protects the caregiver too, because the person who is not stealing is the one most exposed when something goes missing and nobody can account for it. If something does go missing, your caregiver theft recourse turns heavily on whether you hired privately or through an agency, which is worth understanding before you need it.

Is a paid trial shift worth it?

A paid trial is the step families skip and the one that pays for itself. Two or three full shifts at the agreed rate, with someone from the family in the house for part of each, will tell you more than any interview. You are watching for three things: whether your parent relaxes, whether she finds work without being handed a list, and whether her account of the shift matches what happened.

Paid, at the full rate, is not a detail. An unpaid audition starts the relationship with a small theft, and it distorts what you are trying to see: someone working for free performs, and someone working for wages does the job.

What the trial actually surfaces:

• Initiative. A good caregiver finds the third thing to do. The list you wrote covers the first two.
• Pace. Whether your father gets rushed through a shower because there is a bus to catch.
• Documentation. A short end-of-shift note — what he ate, what he refused, how he slept, anything different. If it is thin on day one it will be nonexistent by month two, and that note is your only window into the hours you are not there.
• Your parent. This is the whole thing. He may be furious that anyone is in the house at all, and that is not the caregiver's fault. Watch whether the fury has a particular person attached to it or not.

A trial that goes badly is a cheap outcome. It is also the least painful version of ending a private hire — a conversation about a trial not working out is nothing like a termination six months in, after your parent has come to depend on her. The trial exists partly so you have fewer of those.

What do you owe once you say yes?

Once someone works in your home, on your schedule, doing tasks you define, the law generally treats her as your household employee rather than an independent contractor. Three obligations follow: minimum wage and, in most private-hire arrangements, overtime; Social Security and Medicare taxes once cash wages cross an annual threshold; and a return filed alongside your own taxes at the end of the year.

Wages and overtime. The Department of Labor's guidance on home care work sets out when these workers are entitled to the federal minimum wage and overtime, and how two narrow exemptions — one for companionship services, one for live-in domestic workers — apply 4Ref 4U.S. Department of Labor, Wage and Hour Division (2016).Fact Sheet #25: Home Health Care and the Companionship Services Exemption Under the FLSA.When home care workers are entitled to the federal minimum wage and overtime, and how the companionship and live-in exemptions apply based on the duties actually performed.. They are narrower than families assume, and they turn on what the worker actually does across a shift rather than the job title in the ad 4Ref 4U.S. Department of Labor, Wage and Hour Division (2016).Fact Sheet #25: Home Health Care and the Companionship Services Exemption Under the FLSA.When home care workers are entitled to the federal minimum wage and overtime, and how the companionship and live-in exemptions apply based on the duties actually performed.. A "companion" who spends most of the shift on bathing, dressing, and transfers is doing personal care, whatever the posting said.

Taxes. The IRS household employer's guide is the instruction manual for the rest. Social Security and Medicare taxes apply to cash wages at or above an annual threshold, federal unemployment tax carries its own, and household employers report the whole thing on Schedule H, filed with their Form 1040 5Ref 5Internal Revenue Service (2026).Publication 926, Household Employer's Tax Guide (for use in 2026).The household employer's federal tax obligations for a privately hired caregiver: Social Security and Medicare taxes on cash wages at or above an annual threshold, federal unemployment tax, and Schedule H filed with Form 1040.. The dollar figures move every year, which is why they are not printed here. The current ones live on the IRS page, and that is the only version worth trusting.

The employer's share of payroll tax, plus any overtime premium, sits on top of the wage you agreed. The private caregiver hourly rate is not the cost of the caregiver.

There is nothing exotic about any of this. The caregiver taxes agency vs private comparison is the same money collected by a different party: an agency withholds and files as part of what its rate covers, and a family hiring directly does it themselves or pays a payroll service to. The money was always there. Hiring privately makes it visible.

The full responsibilities of hiring privately run past tax, into workers' compensation and into whether a homeowner's policy reaches an employee injured in the house. Both are questions for an insurer and a state labor office, and both are far cheaper to ask before the first shift than after a fall.

Will anything else pay for a caregiver you hired yourself?

Usually nothing does, and the one real exception is worth checking before you hire rather than after. Long-term care insurance can pay for care at home, but many policies require the care to come from a licensed agency or a licensed provider — which a person you hired yourself is not. Reading that clause first is the difference between a reimbursed year and an unreimbursed one.

The National Association of Insurance Commissioners' consumer guidance describes both constraints in the same breath: long-term care policies can pay for home care, but they often require that the care come from a licensed agency or provider, and benefits are typically triggered by needing help with a set number of activities of daily living, or by cognitive impairment 6Ref 6National Association of Insurance Commissioners (2025).Long-Term Care Insurance.That long-term care insurance can pay for home care but often requires care from a licensed agency or provider, and that benefits are typically triggered by needing help with a set number of activities of daily living or by cognitive impairment..

Activities of daily living are the basic self-care tasks a policy measures — bathing, dressing, toileting, transferring, continence, eating. Most policies name a specific number of them a person must need help with before a dollar is paid, and cognitive impairment can trigger benefits on its own 6Ref 6National Association of Insurance Commissioners (2025).Long-Term Care Insurance.That long-term care insurance can pay for home care but often requires care from a licensed agency or provider, and that benefits are typically triggered by needing help with a set number of activities of daily living or by cognitive impairment.. A parent who needs supervision and company but can still dress and bathe himself may sit well short of the trigger, however obvious the need looks from the kitchen.

Two questions to the carrier, in writing, before anyone is hired:

• Does this policy pay benefits for a caregiver the family employs directly, or only for a licensed agency?
• What documentation does it want — timesheets, a plan of care, a physician's certification — and starting from when?

Some policies pay a cash benefit the family can spend as it likes. Some pay nothing outside a licensed agency. That second answer, arriving in month four with four months of receipts already spent, is an expensive way to learn a clause.

Absent an insurer, a private hire is money out of your parent's pocket every month, and the arithmetic that decides how long it survives is worth doing on paper before it starts: hours per week, times the rate, plus the employer's share, times fifty-two. A better number to have before than after.