Sheet 01 · Pick a lane
Agency vs independent caregiver: which is better for an elderly parent?
You typed it the way everyone types it: agency vs independent caregiver, which is better for an elderly parent. You are trying to hire a caregiver for your dad in St. Louis, and the internet wants to sell you a winner. This sheet does not. It puts the two lanes side by side with the same rows: who builds the schedule, who covers a no-show, who runs the background check, who is the employer for tax purposes, who you call at 2am, and who you call when it is not working. Neither lane is medical care. Neither lane gets a score.
What you are actually hiring
The National Institute on Aging lists the work as help with everyday activities, also called activities of daily living: bathing, dressing, grooming, using the toilet, eating, and moving around, plus household chores and, if you ask for it, a ride to the doctor. That is personal care and presence in the house. It is not a nurse visit. If the discharge planner ordered home health, that is a different product, on a different sheet.
Family Caregiver Alliance’s hiring fact sheet is the map for how to hire a caregiver for your dad once you know the tasks. FCA names two formal ways to find help: contact a home care agency, or hire an attendant privately. The rest of this page is those two lanes, in FCA’s own responsibilities, plus the Missouri fact that most sons do not hear on the first call.
The agency lane, in FCA’s words
Family Caregiver Alliance lists what an agency typically owns. Screening, hiring and firing, pay, and taxes are handled through the agency. If a worker is sick or goes on vacation, the agency provides a substitute. If the worker is not the right fit, the agency can send an alternate. The agency can help settle a dispute. FCA also lists the other side of that lane: you may see more than one attendant if hours are not consistent, you may see more staff turnover, and the agency may limit or charge more for certain tasks. This desk does not print a dollar. Rate questions go to the phone.
FCA’s shorter agency tip sheet adds the questions you still have to ask even in this lane: ask about caregiver background checks, inquire about caregiver training, ask whether the agency meets local certification requirements, evaluate the supervision process, ask to meet potential caregivers, and talk about a care plan. Requirements vary by state. In Missouri, “are you licensed?” is a real question with a real, public answer, below. Do not skip it because the person on the phone sounded organized.
The hire-it-yourself lane, in FCA’s words
The informal way, FCA says, is to hire privately. That means you find the person and you are responsible for hiring, firing, payroll taxes, and all aspects of being an employer. If the worker is sick, it is your responsibility to find alternate help. Pros FCA names: you choose the person, there can be more flexibility in tasks, and there is a greater opportunity to build a long-term relationship. Cons: you own the backup, the payroll, and the dispute. FCA says always check references and always do a background check. In Missouri that check has a name: the Family Care Safety Registry, on the next sheet.
Hiring a private caregiver instead of an agency is not a shortcut around paperwork. FCA says all U.S. employees must complete Form I-9, and that you will need a W-4 and an employer ID number if you are the employer. The IRS is the next stop, not a blog.
If I hire a private caregiver, am I the employer?
The IRS does not care what you called the person on the fridge sheet. Topic 756 says household workers are your employees if you can control not only the work they do, but also how they do it. Housekeepers, maids, babysitters, gardeners, and others who perform household work in or around your private residence as your employee are on that list. If you pay cash wages of $3,000 or more for 2026 to any one household employee, you generally must withhold Social Security and Medicare taxes. That is the IRS’s 2026 threshold, in the IRS’s words. It is not a payroll estimate, and it is not a care rate. The tax sheet walks the federal and Missouri pages. This sheet only tells you the lane carries that job.
Does Missouri license non-medical home care companies?
Missouri’s Department of Health and Senior Services describes three types of care in the home. Home health, the first type, requires a state home health license. Private duty and private pay, the third type, is the lane most families mean when they say “hire a caregiver.” DHSS says that type provides care in shifts, that no physician order is needed for aide personal care, respite, or companion care, and that no license is issued in Missouri for that type of company. Oversight for that type: DHSS prints “No government oversight.” Abuse and neglect still go to 800-392-0210. Fraud still goes to the Attorney General consumer hotline. Ask every company which of the three types they are. Write the answer. Do not treat “we are licensed” as a sentence you can skip checking against that page.
That fact is not a claim that one lane is safer. It is a claim about what the state does and does not issue. You still ask about screening. You still call references. You still write the agreement.
Agency lane
- Who builds the schedule: the company, with you.
- Who covers a no-show: you ask, and you write the backup name.
- Who runs the background check: you ask how, then you still call references.
- Who is the employer: the company, if the workers are their employees. FCA says to ask, because some agencies treat workers as contractors.
- Who you call at 2am: the office number they gave you. Call it once before you need it.
- Who you call when it is not working: the office, and you can ask for a different person.
Hire-it-yourself lane
- Who builds the schedule: you.
- Who covers a no-show: you.
- Who runs the background check: you, through the Family Care Safety Registry, plus references.
- Who is the employer: often you, if you control the work and how it is done.
- Who you call at 2am: you are the number.
- Who you call when it is not working: you, and then a lawyer if the agreement is a fight.
The stranger in the house
FCA says families often face a loved one who does not want a stranger in the house, and advises telling the person that you need help, and that accepting hired care is something they can do to help you, not a sign you are going to abandon them. That sentence is for either lane. It is not a reason to skip the check.
If you do not know where to start in this metro, NIA points at the Eldercare Locator for in-home help: eldercare.acl.gov or 800-677-1116. Aging Ahead covers St. Louis, St. Charles, Franklin, and Jefferson counties. The St. Louis Area Agency on Aging covers the city, (314) 612-5918. Those are directories. They do not pick a lane for you.
What to do tonight
- Write the tasks from NIA’s personal-care list that apply in this house.
- Pick a lane for the first call. You can change later.
- If the lane is a company, open the scorecard sheet and fill the blanks as you call.
- If the lane is a private hire, open the registry sheet and the tax sheet before you make an offer.
- Write the 2am number for that lane on the fridge, tonight, even if nobody starts until next week.
When to ask the care team or the doctor
Which tasks are skilled, whether home health belongs in the plan, and whether a parent is medically ready to be at home with only personal care are questions for the physician and, if they are in the hospital, the discharge planner. A non-medical caregiver does not make those calls. If someone on the phone blurs home health and home care into one sentence, stop and open the home health sheet before you book an hour.
Next sheets
Sources opened 10 September 2026. Full list on the sources page.