Home care agency or private caregiver? A Delaware family's comparison
Short answer
A private caregiver works for you, so you become the employer. In Delaware that can mean payroll taxes, insurance, and finding a backup when they're sick. An agency handles those things for you, and its hourly rate covers them. Hiring privately can work for a few hours a week with someone you know well. For daily care, or care through Delaware Medicaid, most families use an agency.
Last updated · Reviewed by Reliable Aid care team
Maybe a friend knows a caregiver who works privately, or you've seen ads online. It's a fair question: why pay an agency when you could hire someone directly? Here's what really changes, so you can choose with your eyes open.
What's the real difference between an agency and a private caregiver?
With an agency, the caregiver works for the agency. The agency hires, screens, pays, insures, and schedules them, and it sends someone else when they can't come. With a private caregiver, they work for you. You handle all of that yourself, including the paperwork the IRS expects from employers.
| Home care agency | Private caregiver | |
|---|---|---|
| Who is the employer | The agency | You |
| Payroll taxes | The agency withholds and pays them | You may owe them as a household employer |
| Insurance | The agency carries it | You arrange it, or go without |
| Background check | The agency runs it before the first visit | You arrange it, if you do one |
| Sick days and vacations | The agency sends a backup | You find someone, or you fill in |
| Delaware Medicaid | Can pay approved agencies | Only through a self-directed option the plan approves |
| Price | One hourly rate that covers all of the above | A lower hourly rate, plus your own costs |
Who handles taxes if you hire a caregiver privately?
If you hire a caregiver yourself and control how and when they work, the IRS usually treats you as a household employer. Once you pay them more than a yearly amount the IRS sets, you owe Social Security and Medicare taxes on their wages. You may also owe federal unemployment tax.
The IRS explains the rules in Publication 926. Many families don't know this until tax time. An agency caregiver is the agency's employee, so the agency handles their payroll taxes, not you.
What happens when a private caregiver gets sick?
When a private caregiver is sick, has a family emergency, or quits, nobody comes unless you find someone. For a parent who needs help getting out of bed or eating, even one missed day matters. That's often why families switch from private help to an agency.
At an agency, a missed shift is the agency's job to cover. At Reliable Aid, if your caregiver can't make it, we send a backup.
Can Delaware Medicaid pay a private caregiver?
Delaware Medicaid long-term care, called DSHP Plus, pays for personal care at home through approved providers. A caregiver you find and pay on your own isn't one of them. Some people on DSHP Plus can direct their own care and hire their own attendant instead. That's a separate process the Medicaid plan has to approve, and the person or a representative takes on the paperwork.
If you'd like a family member to be the paid caregiver, there is a path. When your loved one qualifies, an agency like Reliable Aid can hire that relative as an employee. See how paid family caregiving works, or start with Medicaid home care in Delaware.
When can hiring privately work?
Hiring privately can work well when:
- You need a few hours a week, not daily care
- The caregiver is someone you already know and trust
- You're comfortable handling payroll, taxes, and insurance
- Someone in the family can step in on short notice
It's harder when care is daily, when your parent needs hands-on help with bathing or moving, or when nobody lives close enough to cover a missed shift.
What to ask either way
Whether you hire privately or call an agency, ask:
- Who is the employer, and who pays the payroll taxes?
- Has the caregiver had a background check? Who ran it?
- What happens if the caregiver can't come?
- Is there insurance if someone gets hurt or something is damaged?
- What tasks will the caregiver do, and what won't they do?
- How do you pay, and is there a contract or notice period?
How Reliable Aid works
Our caregivers are W-2 employees of Reliable Aid. Every caregiver is screened before the first visit. We're insured and bonded, and if your caregiver can't make it, we send a backup. We work with private-pay families and with all three Delaware Medicaid plans.
We help with personal care, companionship, meals, and more in homes across New Castle, Kent, and Sussex counties. Call (302) 689-3240 to talk it through. You can also visit our Dover office.
Questions
Is a private caregiver cheaper than an agency?
The hourly rate often is. But when you hire privately, you also pay the employer's share of taxes, any insurance, and the cost of covering days they can't come. Compare the total, not just the hourly number.
Can I hire a friend or neighbor privately?
Yes. Many families do for a few hours a week. You're still their employer, so the tax and insurance questions in this guide still apply.
Can my mom's Medicaid pay a caregiver I hire on my own?
Not if you pay them on your own. Delaware Medicaid long-term care pays approved providers, or a self-directed attendant the plan approves. If you want a relative to be the paid caregiver, an agency like Reliable Aid can hire them.
Does Reliable Aid charge a fee to talk it through?
No. The first conversation is free. Call (302) 689-3240.