The decision to bring a caregiver into your parent's home is significant. You're entrusting a stranger with your parent's safety, comfort, and daily wellbeing. The right caregiver becomes like family; the wrong one creates stress, safety concerns, and endless turnover.
Whether your parent needs a few hours of companionship each week or around-the-clock care, the hiring process follows the same fundamental steps: understanding what you need, finding qualified candidates, thorough screening, and ongoing management. This guide covers all of it.
Step 1: Assess Your Parent's Care Needs
Before you start looking for caregivers, get clarity on exactly what help your parent needs. This determines what type of caregiver to hire, how many hours you need, and what you should pay.
Types of Care Needs
Companionship and Supervision
Your parent can handle personal care but needs:
- Someone to keep them company and prevent isolation
- Light housekeeping and meal preparation
- Transportation to appointments and errands
- Medication reminders (not administration)
- Supervision for safety
Personal Care Assistance (ADLs)
Your parent needs hands-on help with Activities of Daily Living:
- Bathing, showering, grooming
- Dressing and undressing
- Toileting and incontinence care
- Transferring (bed to chair, etc.)
- Walking and mobility assistance
- Feeding assistance
Skilled Medical Care
Your parent has medical needs requiring trained professionals:
- Wound care and dressing changes
- Medication administration (injections, IV)
- Vital signs monitoring
- Catheter or ostomy care
- Physical therapy exercises
- Complex health condition management
Determining Hours Needed
Consider when your parent most needs help:
- Morning routine: Getting out of bed, bathing, dressing, breakfast
- Midday: Lunch, medications, companionship, activities
- Evening: Dinner preparation, evening routine, bedtime assistance
- Overnight: For those who wander, need repositioning, or have nighttime medical needs
Start with More Than You Think
It's easier to reduce hours than to suddenly need more. If you're unsure between 4 hours and 6 hours daily, start with 6. This gives the caregiver time to build a relationship with your parent and complete tasks without rushing. You can always scale back once you see how things work.
Step 2: Understand Caregiver Types
Different caregivers have different training, certifications, and capabilities. Match the caregiver type to your parent's needs.
Companion Caregivers
What they do: Companionship, conversation, light housekeeping, meal prep, transportation, supervision, medication reminders.
What they don't do: Hands-on personal care (bathing, toileting), medical tasks.
Training required: No formal certification required.
Typical cost: $18-25/hour.
Best for: Parents who are mostly independent but shouldn't be alone.
Home Health Aides (HHAs)
What they do: Everything companions do PLUS personal care assistance (bathing, dressing, toileting, grooming, feeding, transferring).
What they don't do: Medical tasks like wound care, medication administration, injections.
Training required: 75+ hours of state-approved training, competency evaluation.
Typical cost: $22-30/hour.
Best for: Parents who need help with daily personal care.
Certified Nursing Assistants (CNAs)
What they do: Similar to HHAs, often with more formal training. May include basic vital signs monitoring.
Training required: State-approved CNA program, certification exam, ongoing education.
Typical cost: $22-32/hour.
Best for: Parents who need reliable personal care with some health monitoring.
Licensed Practical Nurses (LPNs)
What they do: All personal care PLUS medication administration, wound care, catheter care, vital signs, health monitoring, care coordination.
Training required: 1-year nursing program, state licensure.
Typical cost: $35-55/hour.
Best for: Parents with medical needs requiring professional nursing skills.
Registered Nurses (RNs)
What they do: Complex medical care, care plan development, care coordination, supervision of other caregivers, emergency response.
Training required: Nursing degree, state licensure.
Typical cost: $50-100+/hour.
Best for: Complex medical situations, post-hospitalization care, hospice care.
Step 3: Agency vs. Private Hire
One of the biggest decisions is whether to hire through an agency or find a caregiver privately. Each approach has significant trade-offs.
Home Care Agencies
Pros:
- Caregivers are pre-screened with background checks
- Agency handles payroll, taxes, insurance
- Backup caregivers available if yours is sick
- Supervision and quality monitoring
- Easier to request a different caregiver if needed
- Less administrative burden on you
- Workers' compensation coverage through agency
Cons:
- 20-30% higher cost than private hire
- Less control over who comes to your parent's home
- May see different caregivers frequently
- Agency policies may limit what caregivers can do
- Caregivers earn less of what you pay
Typical agency costs: $25-40/hour for non-medical, $50-100+ for skilled nursing.
Private/Direct Hire
Pros:
- Lower cost (caregiver gets more of what you pay)
- Complete control over who you hire
- Consistent caregiver relationship
- More flexibility in duties and schedule
- Direct relationship builds trust
Cons:
- You must conduct background checks yourself
- You're the employer: taxes, insurance, paperwork
- No backup if caregiver is sick or quits
- No supervision or quality oversight
- Potential liability if caregiver is injured
- More time and effort to manage
Typical private hire costs: $18-30/hour for non-medical care.
Liability Warning
If you hire privately and your caregiver is injured in your parent's home, you could be liable. Consider purchasing workers' compensation insurance or umbrella liability coverage. Some families use a household employer service that handles insurance and compliance for a monthly fee.
Where to Find Caregivers
Home Care Agencies:
- Search online for "home care agencies near me"
- Ask your parent's doctor for recommendations
- Contact your local Area Agency on Aging
- Check hospital discharge planners' recommendations
Private Caregivers:
- Care.com: Large database of caregivers, background check options
- Indeed, Craigslist: Post job listings (requires more screening)
- Local nursing schools: Students or recent graduates
- Church bulletins: Community members seeking work
- Word of mouth: Friends, support groups, neighbors
- Senior centers: May have caregiver referral lists
Step 4: Screen Candidates Thoroughly
This is where many families cut corners—and regret it later. Thorough screening protects your parent and gives you confidence in your hire.
Background Checks
Essential checks:
- Criminal background check: State and national databases. Look for violent offenses, theft, fraud, drug charges. Cost: $30-75.
- Sex offender registry: National Sex Offender Public Website is free.
- Identity verification: Confirm they are who they claim to be.
- Employment verification: Confirm previous caregiving positions.
Additional checks to consider:
- Driving record: If transportation is involved.
- Credit check: If they'll handle money (requires candidate permission).
- Professional license verification: For CNAs, LPNs, RNs—verify through state board.
- Drug screening: Especially for live-in or medical caregivers.
Background check services:
- Care.com (included with premium membership)
- GoodHire
- Checkr
- Sterling Volunteers
Reference Checks
Always call references. Don't just check that they exist—have real conversations.
Questions to ask references:
- How long did [caregiver] work for you?
- What were their primary responsibilities?
- How did they handle difficult situations or emergencies?
- Were they reliable and punctual?
- How did your [parent/loved one] respond to them?
- Why did they stop working for you?
- Would you hire them again?
- Is there anything I should know before hiring them?
Red Flags to Watch For
Be wary of candidates who: can't provide verifiable references, have gaps in employment they won't explain, speak negatively about previous employers, seem uncomfortable with background checks, or give inconsistent answers. Trust your instincts—if something feels off, keep looking.
Step 5: Conduct Effective Interviews
The interview is your chance to assess not just qualifications but personality, communication style, and fit with your parent.
Interview Questions
Experience and Skills:
- Tell me about your caregiving experience. What conditions have you worked with?
- Have you cared for someone with [parent's specific condition]?
- What training or certifications do you have?
- Are you comfortable with bathing/toileting/transferring assistance?
- Can you safely lift or transfer someone who weighs [parent's weight]?
- What meal preparation experience do you have?
Scenarios and Problem-Solving:
- How would you handle a medical emergency?
- What would you do if my parent refused to take medication?
- How would you respond if my parent became agitated or upset?
- What would you do if you noticed signs of a fall or injury?
- How do you handle boredom or resistance to activities?
- Describe a difficult caregiving situation and how you handled it.
Reliability and Logistics:
- What schedule are you available?
- How do you handle your own sick days or emergencies?
- Do you have reliable transportation?
- Are you comfortable with our location/commute?
- What is your expected hourly rate?
- Why did you leave your last caregiving position?
Personal Fit:
- Why did you become a caregiver?
- What do you find most rewarding about this work?
- What do you find most challenging?
- How do you handle stress?
- Are you comfortable following detailed care instructions?
- How do you maintain boundaries while being compassionate?
Including Your Parent
If your parent is cognitively able, include them in the interview process:
- Have the caregiver meet your parent during the interview
- Observe how they interact—is there natural rapport?
- Ask your parent's opinion afterward
- Consider a paid trial shift before committing
Trial Period
Always start with a trial period before committing long-term:
- 2-4 weeks is typical for a trial
- Be present during early shifts to observe
- Check in frequently with your parent
- Provide feedback and see how caregiver responds
- Make clear that either party can end the arrangement during trial
Step 6: Understand Costs and Payment
Caregiver costs vary significantly by location, care type, and whether you use an agency. Budget carefully to ensure sustainable care.
Typical Hourly Rates (2024)
| Caregiver Type | Private Hire | Agency |
|---|---|---|
| Companion/Sitter | $15-22/hour | $22-30/hour |
| Home Health Aide | $18-28/hour | $25-35/hour |
| Certified Nursing Assistant | $20-30/hour | $28-38/hour |
| Licensed Practical Nurse | $30-45/hour | $40-60/hour |
| Registered Nurse | $45-75/hour | $60-100+/hour |
Monthly Cost Examples
- Part-time companion (20 hrs/week): $1,600-2,400/month
- Daily personal care (4 hrs/day): $2,400-4,200/month
- Full-time care (8 hrs/day, 5 days): $4,000-7,000/month
- 24-hour care (live-in or shifts): $10,000-18,000/month
Live-In Caregiver Considerations
Live-in caregivers cost less per hour but have different requirements:
- Typically paid a daily rate ($200-350/day) rather than hourly
- Must have private sleeping quarters
- Need scheduled time off and sleep periods
- Labor laws vary by state—some require minimum hourly pay for all hours present
- May need a second caregiver for nights off
Step 7: Handle Employment and Legal Requirements
If you hire privately, you become an employer with legal obligations. Don't skip this step—the IRS takes household employment seriously.
When You're an Employer
If you pay a caregiver $2,700 or more per year (2024 threshold), you're a household employer. This means:
Tax obligations:
- Obtain an Employer Identification Number (EIN) from IRS
- Withhold Social Security and Medicare taxes (7.65% each from employer and employee)
- Pay federal and state unemployment taxes
- Provide W-2 form at year end
- File Schedule H with your personal tax return
Employment verification:
- Complete I-9 form to verify work eligibility
- Keep I-9 on file for 3 years after hire or 1 year after termination
Insurance considerations:
- Workers' compensation may be required (varies by state)
- Liability insurance protects you if caregiver is injured or causes damage
Don't Pay Under the Table
Paying caregivers cash without taxes might seem simpler, but it's illegal and risky. If discovered, you'll owe back taxes, penalties, and interest. Your parent could lose eligibility for certain benefits. And if the caregiver is injured, you have no protection. Use a payroll service if managing taxes yourself seems overwhelming.
Payroll Services
Household payroll services handle all the paperwork for $50-100/month:
- HomePay (Care.com): Popular, comprehensive service
- SurePayroll: Affordable option for household employers
- GTM Payroll: Specializes in household employment
- Paychex: Large payroll company with household option
Caregiver Agreement
Create a written agreement covering:
- Job duties and responsibilities (be specific)
- Work schedule and hours
- Pay rate and payment schedule
- Overtime policy (over 40 hours/week typically)
- Paid time off and holidays
- Notice required for termination (2 weeks typical)
- Confidentiality expectations
- House rules (smoking, visitors, phone use, etc.)
- Emergency procedures and contacts
- Mileage reimbursement policy if applicable
Step 8: Manage the Caregiver Relationship
Hiring is just the beginning. Ongoing management ensures quality care continues and problems are caught early.
Initial Onboarding
First day essentials:
- Tour of the home and where things are located
- Introduction to your parent and their routine
- Review of care plan and specific instructions
- Emergency contacts and procedures
- House rules and expectations
- Keys, alarm codes, and access information
- Documentation system (care logs, communication book)
Create a care binder with:
- Parent's medical history and conditions
- Current medications with schedule
- Physician contact information
- Insurance cards and information
- Daily routine and preferences
- Food preferences and restrictions
- Emergency procedures
- Family contact numbers
Ongoing Communication
- Daily logs: Caregiver documents activities, meals, medications, observations
- Regular check-ins: Weekly calls or texts to discuss how things are going
- Periodic in-person meetings: Monthly or quarterly to review care plan
- Open door policy: Encourage caregiver to bring up concerns
- Feedback both ways: Provide appreciation and constructive feedback
Quality Monitoring
- Drop in unexpectedly occasionally (but not excessively)
- Ask your parent how things are going (if cognitively able)
- Watch for changes in parent's mood, hygiene, or health
- Review care logs for consistency and thoroughness
- Check that medications are being given correctly
- Monitor for signs of neglect or mistreatment
Handling Problems
Minor issues:
- Address promptly with direct, specific feedback
- Document the conversation
- Give caregiver opportunity to improve
- Follow up to ensure improvement
Serious concerns:
- If you suspect abuse or neglect, remove caregiver immediately
- Report suspected abuse to Adult Protective Services
- Document everything with dates and specifics
- If using an agency, report immediately to agency
When to terminate:
- Abuse, theft, or serious safety violations: Immediate termination
- Pattern of unreliability despite warnings
- Inability or unwillingness to follow care instructions
- Poor chemistry with your parent that isn't improving
- Violation of agreed-upon terms
Paying for Care: Funding Sources
Home care is expensive. Understanding funding options helps families afford the care their parents need.
Private Pay
Most home care is paid out of pocket from:
- Parent's savings and retirement funds
- Sale of assets (home, investments)
- Family contributions
- Reverse mortgage proceeds
Long-Term Care Insurance
If your parent has LTC insurance, it may cover home care:
- Review policy for home care benefits
- Check elimination period (usually 30-90 days before benefits start)
- Understand daily/monthly benefit limits
- Know what triggers benefits (ADL limitations, cognitive impairment)
- File claims promptly with required documentation
Medicare
Medicare provides very limited home care coverage:
- Only covers skilled care (nursing, therapy) that is part-time and medically necessary
- Must be homebound
- Must be ordered by physician
- Does NOT cover custodial care (help with bathing, dressing, meals)
Medicaid
Medicaid may cover home care for those who qualify financially:
- Income and asset limits vary by state
- Home and Community-Based Waiver programs may cover personal care
- Often waitlists for waiver programs
- Contact your state Medicaid office for eligibility
Veterans Benefits
- Aid & Attendance: Monthly benefit for veterans/surviving spouses needing assistance with ADLs
- Veteran-Directed Care: Allows veterans to hire and manage their own caregivers
- Homemaker/Home Health Aide program: VA-provided home care services
- Contact VA or a veterans service organization for eligibility
Other Resources
- State programs: Many states have programs for low-income seniors
- Area Agency on Aging: Can identify local resources
- Disease-specific organizations: May offer respite or care assistance
- Community organizations: Churches, civic groups, volunteer networks
Frequently Asked Questions
Home caregiver costs vary by location and care level. Companion care typically costs $18-25/hour, personal care aides $22-30/hour, and skilled nursing $50-100+/hour. Agency caregivers cost 20-30% more than private hires. Monthly costs range from $2,000-4,000 for part-time care to $10,000-15,000+ for full-time care.
Agencies are better if you want vetted caregivers, backup coverage when someone is sick, and no employment paperwork. Private hire costs less (20-30% savings) but requires you to conduct background checks, handle taxes and insurance, and find backup care yourself.
Key questions include: What experience do you have with conditions like my parent's? How would you handle an emergency? Are you comfortable with bathing/toileting assistance? What would you do if my parent refuses care? Can you lift or transfer someone? Why did you leave your last position?
Essential background checks include: criminal background check (state and federal), sex offender registry, driving record if transportation involved, reference verification from previous employers, and professional license verification for certified caregivers.
Types include: Companion caregivers (companionship, light housekeeping), Home Health Aides (bathing, dressing, toileting assistance), Certified Nursing Assistants (similar to HHAs with certification), Licensed Practical Nurses (medication administration, wound care), and Registered Nurses (complex medical care).
If you pay a caregiver $2,600+ per year, they're your household employee. You must: obtain an EIN, verify work eligibility (I-9 form), withhold Social Security/Medicare taxes, pay unemployment taxes, provide a W-2 annually, and file Schedule H with your taxes. Using a payroll service ($50-100/month) simplifies compliance.
Look for good chemistry and communication with your parent, relevant experience with similar conditions, patience and compassion during the interview, reliable references, proper certifications if required, and willingness to follow your care preferences. Always do a trial period of 2-4 weeks.
A caregiver agreement should include: job duties and responsibilities, work schedule and hours, pay rate and payment schedule, overtime policy, time off and holiday policies, termination notice requirements, confidentiality expectations, house rules, and emergency procedures.
Finding the Right Fit
Hiring a home caregiver is one of the most important decisions you'll make for your aging parent. Take the time to do it right. Thorough screening prevents problems, clear communication sets expectations, and ongoing management ensures quality care continues.
Remember that finding the perfect caregiver may take time. You might go through several candidates before finding the right match. That's normal. The relationship between your parent and their caregiver is deeply personal, and chemistry matters as much as qualifications.
Don't wait for a crisis to start looking. The best time to hire is before care is urgently needed, when you have time to screen carefully and your parent can adjust gradually to having help. Start the process early, even if you only need a few hours of companion care at first.
Most importantly, trust your instincts. You know your parent best. If something doesn't feel right about a caregiver, keep looking. The right person is out there—someone who will treat your parent with the dignity, respect, and compassion they deserve.