Integrated Wisdom

The Hired Caregiver Dilemma  

Working your way toward finding a solution.

by Amanda Lambert and Leslie Eckford


Amanda Lambert

As two geriatric professionals and caretakers of our own aging parents, we are staunch advocates of the concept and practice of “aging in place.” Aging in place means living at home as one ages, rather than moving to a residential environment, such as assisted living or nursing home.

Our stance is not based solely on our opinion. In survey after survey by AARP over multiple years, the majority of older American adults indicate that they are adamant that they want to stay in their present home. However, choosing to stay in one’s home with assistive care is usually a challenge to put into practice and may not be the perfect solution for everyone. Is it the right decision for you or your family member?

First Steps

Hiring care in the home can be complicated. Even the initial decision of who and how to hire can be divisive. Even we differ in our opinions and experience of arranging care, and we share our views in our book “Aging with Care: Your Guide to Hiring and Managing Caregivers at Home.”  Amanda relies on licensed agencies to serve her clients, while Leslie tends to favor reliable and recommended people from the community. There is no “correct” way to approach this for families who are faced with this decision. Some may choose to combine both agency staff and a privately hired caregiver to make the schedule work for their family’s unique situation. Overall, you will be better equipped to make a reasonable selection by being informed about the consequences of each. This can make the journey less stressful.

Leslie Eckford

We encourage you to find a way to discuss the possibility of home care with your elder family members long before it is needed. It is so much harder to find your way when under duress. Imagine a situation in which, in spite of feeling unprepared, you must go headlong into the process of hiring caregivers. You may be pressured by medical circumstances or crisis. Consider a daughter who makes a sudden discovery about how poorly an elder family member is doing at home. Others may be acting on the observations and well-meaning advice from friends, neighbors or landlords who report signs of decline. Making major, life changing decisions with a clock ticking (“We’ve got to decide where dad is going before he is discharged from the hospital this weekend!”) can increase the risk of making choices that you may later regret.

Agency or Private Hire?

There are pros and cons to whether you decide to go with an agency or hire someone yourself. For example, hiring through an agency can bring some degree of peace of mind since they take care of many unavoidable details such as payroll and liability insurance. An agency can find a last-minute replacement of a caregiver if they don’t show up for a shift or if there is a compatibility issue.  However, all of those responsibilities come with a price. Hiring through an agency will be more expensive. Moreover, you may be surprised after hiring an agency to provide care for your family member that they cannot actually do some of the tasks that are most needed. For example, your father may have arthritis and can no longer give his own insulin injection. You expected the hired caregiver to do that for him, but you are told that it is against your state’s laws for her to do so. An agency must adhere to state regulations with regard to allowable caregiver tasks. Not to mention, how do you decide which agency is best? There can be scores of available agencies depending on the community in which you live. And, finally, you may have the idea that hiring an agency absolves you of all responsibility and reduces your involvement and stress. This is not necessarily true. Even the best agencies need some degree of oversight.​

Handling all of this yourself can be tempting. Leslie decided to do that in the beginning of her family’s “care at home” saga when a friend recommended a really great caregiver. Even though she lives across the country from her parents, it seemed like a good idea at the time. The family loved the caregiver and she seemed very responsible and caring. Over time, however, big problems arose, including theft and exploitation. What started as a great solution, ended as a disaster.​

You may think that this could be avoided if you live close by to your elder family. Certainly, it can be easier to oversee care when you can just pop in from across town and check on how things are going. Consistent oversight from any distance is key. Making unannounced visits gives you a chance to see first hand how your elder looks, talk with them about how they feel, and evaluate the home environment.

​Hiring someone outside an agency can be successful but has its own advantages and disadvantages. Many people want and like to be in control of the hands on, day to day management of this delicate and complicated situation. The cost is likely to be much lower as well. The downside? It takes a lot of time and energy to do this right. You and only you are responsible for finding a replacement for a sick caregiver, figuring out payroll, background checks and assuming liability insurance. Payroll can be contracted out, and hiring a geriatric care manager can assist with many of these management tasks, but both add to the cost.

There are online companies that connect family employers with potential caregivers. A variety of options are available to assist you in finding a caregiver, provide online tools for payroll and background checks such as at Care.com. Some online companies combine the convenience of an internet search and agency oversight. These companies, such as Honor.com, are the employer of the caregivers, provide convenient online communication with caregivers and instant customer feedback. Check for availability in your region.

​Take the time to think through this process. Be flexible in your decision-making. The health and daily needs of a person aging at home can change suddenly. Realize that as things change with your elder, so will your approach.


Amanda Lambert and Leslie Eckford are the co-authors of “Aging with Care: Your Guide to Hiring and Managing Caregivers at Home” (Rowman and Littlefield, November 2017).

See more posts on MindfulAging.com and the MindfulAging facebook page.

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