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Hiring in-home help
Sooner or later, most aging-in-place plans mean bringing a paid helper into the house. There are three ways to do it, and they differ less in the caregiver you get than in who is legally the employer — which decides who handles taxes, insurance, backup, and what happens if someone gets hurt.
First, know which kind of care you're buying
Skilled home health (nurses and therapists, doctor-ordered, short-term) is a Medicare benefit with its own rules — covered on the crisis-side page and in What does Medicare actually pay for?. This page is about non-medical home care — bathing, dressing, meals, errands, companionship, supervision — which families almost always pay for privately (or through a Medicaid waiver, VA benefits, or long-term-care insurance). The national median cost was $35/hour in the 2025 CareScout/Genworth Cost of Care Survey (carescout.com) — about $80,000 a year at 44 hours a week, which is why most families use fewer hours and combine them with adult day programs and family time.
The three ways to hire
- Full-service agency. The agency employs the caregiver: it screens, insures, bonds, pays payroll taxes, carries workers' comp, supervises, and sends a substitute when someone is sick. You pay the most per hour for that safety net, and you may have less choice of which caregiver comes.
- Registry / matching service. The registry introduces you to pre-screened candidates for less per hour — but in most arrangements you become the employer, with the tax, insurance, and backup responsibilities that follow. Read the agreement's fine print on exactly this question.
- Hiring on your own. Cheapest per hour and the most control — and every employer duty is yours: verifying work authorization, background checks, payroll. In 2026, paying a household employee $3,000 or more in a year triggers Social Security/Medicare withholding (the "nanny tax," IRS Publication 926), and some states require workers' compensation coverage for household employees. Paying cash under the table risks IRS penalties and leaves the caregiver without Social Security credit — and you without any liability protection.
AARP's hiring guide walks through each model (aarp.org).
Questions and red flags
Our printable hiring in-home care checklist has the full list. The short version — ask any agency: Are caregivers your W-2 employees, screened and covered by workers' comp? Who supervises them? What happens on a missed shift? What's the hourly rate, the minimum, and what costs extra? Can a Medicaid waiver, VA benefit, or LTC insurance pay for any of this?
Red flags reported consistently by consumer guides: large upfront cash demands; fees that won't go in writing; "our caregivers are independent contractors, we're not responsible"; no backup coverage; pressure to sign a long contract today.
Where the public record stops — and who to ask
What would in-home help cost for your person, and could a program pay part of it? That answer depends on your state and your situation, and it belongs to the people who decide it — not to us. Here is who has it, and exactly what to ask so you arrive prepared instead of lost.
Who to ask: your Area Agency on Aging (free options counseling, 1-800-677-1116); your state Medicaid office about HCBS waiver hours; a VSO about VA home-care programs
What to ask them:
- What do local agencies charge per hour here, and what's the realistic minimum?
- Does our state's Medicaid waiver pay for in-home personal care, and is there a waitlist?
- For a veteran: what VA in-home care programs (homemaker/home health aide, Veteran-Directed Care) exist locally?
- Are there caregiver-support or respite funds that could cover a few hours a week?
You now know more than most people who walk into that office. That is the whole point of this page.
Who helps you locally — free, and on your side. You do not have to figure this out alone. Your Area Agency on Aging gives free options counseling; reach any of them through the federal Eldercare Locator at 1-800-677-1116 or eldercare.acl.gov (Administration for Community Living). More on the four people who help — and what each one does — on Who helps me locally.
Quick answers
How much does in-home elder care cost per hour?
The national median for a non-medical in-home caregiver was $35/hour in the 2025 CareScout (Genworth) Cost of Care Survey — roughly $80,000 a year at 44 hours per week. Rates vary widely by state and by how you hire (agency, registry, or independent).
What is the 'nanny tax' for a home caregiver?
If a household directly employs a caregiver (not through an agency) and pays them $3,000 or more in cash wages in 2026, the household must withhold and pay Social Security and Medicare taxes under IRS household-employer rules (Publication 926). Federal unemployment tax can apply at $1,000 in a quarter. Agencies handle these obligations themselves; with registries it depends on the agreement.
Is it better to hire a caregiver through an agency or privately?
It is a trade-off, not a right answer: agencies cost more per hour but act as the legal employer — screening, insurance, workers' comp, payroll taxes, supervision, and substitutes are theirs. Private hiring costs less and gives more control, but the family takes on every employer duty and liability. Registries fall in between; the agreement's fine print says who the employer is.