How to Hire a Caregiver: A Complete Guide for Families

Step 1: Work Out What Help Is Actually Needed

Families often start by searching for a caregiver before they can describe the job. Doing this step first saves money, prevents mismatched hires, and gives you a job description you can actually recruit against.

Start by reviewing the person’s activities of daily living (ADLs) and instrumental activities of daily living (IADLs) to identify where support is actually needed.

Once you have your list, work out when help is needed. Mornings are the most common pressure point because bathing, dressing, and breakfast cluster together. Evenings and nights matter if there is a fall risk or if your loved one has dementia and experiences sundowning.

Step 2: Choose the Right Level of Care

For a clearer comparison of aide roles, see HHA vs PCA vs CNA. Before finalizing the job description, review the full guide to caregiver duties and responsibilities.

Step 3: Agency, Private Hire, or Registry

This is the single biggest decision in the process, and the right answer depends on your budget, your capacity to manage an employee, and how much risk you want to carry.

Registries, referral services, staffing platforms, and full-service home care agencies operate differently, and the term “registry” is used loosely. Some are matching platforms, others verify credentials without referring anyone. Families can also review the National Caregiver Registry when they want a way to verify caregiver credentials and certification status.

The IRS also notes that a worker supplied through an agency may be the family’s employee rather than the agency’s, depending on who controls the work.

Step 4: How Much It Costs

According to the CareScout Cost of Care Survey 2025 data, the national median rate for non-medical caregiver services is around $35 per hour, up from $34 in 2024, a 3 percent increase. At 44 hours per week that works out to roughly $80,080 per year. State medians vary widely, from roughly the mid-$20s per hour in the least expensive states to the mid-$40s in the most expensive.

What raises the cost: overnight and weekend hours, dementia or complex care needs, short shifts, live-in and 24-hour arrangements, and high cost-of-living areas. Skilled nursing at home costs considerably more than caregiving.

Step 5: How to Pay for Care

Private Pay

Out of pocket, from income, savings, or the sale of assets. This funds the majority of non-medical home care in the United States.

Medicare

Medicare does not cover long-term companion care or custodial personal care when that is the only care needed.

• Aide services can be covered alongside skilled care. Medicare may cover part-time or intermittent home health aide services when the person qualifies for the home health benefit and is also receiving qualifying skilled nursing or therapy.
• There is no fixed time limit. Coverage may continue as long as eligibility requirements remain satisfied, recertified in 60-day periods.
• Improvement is not required. Under the Jimmo v. Sebelius settlement, Medicare covers skilled care needed to maintain a person’s condition or to prevent or slow decline.

Eligibility generally requires the person to be homebound, to need intermittent skilled nursing or therapy, to be under a plan of care, and for the care to be certified and ordered by a qualifying healthcare provider. Medicare recognizes nurse practitioners and other authorized providers in addition to physicians.

Medicaid

Medicaid is the primary payer for long-term services and supports in the United States. Some Medicaid self-directed services, state plan options, and waiver programs allow eligible participants to hire certain family members. Availability, eligibility, permitted relatives, pay rates, waiting lists, and spouse rules vary by state and program. Families exploring this route can also read ACA’s guide on how to get paid to be a caregiver for parents.

VA Benefits

Eligible Veterans may have several different options that work differently from one another. Aid and Attendance can add a monthly amount to an eligible VA pension; it is a pension increase rather than a caregiver service or insurance plan. Veteran Directed Care and other VA home and community based programs may provide access to specific services directly. Eligibility and local availability differ. The Department of Veterans Affairs also provides VA caregiver support resources for eligible Veterans and their families.

Long-Term Care Insurance

If a policy exists, check the benefit trigger, the daily benefit, the elimination period, the eligible provider types, and whether an approved plan of care is required before care starts.

Your local Area Agency on Aging can explain what is available in your state. The federal Eldercare Locator (1-800-677-1116) will connect you to it.

Step 6: Where to Find Caregivers

• Licensed home care agencies in your area
• Referrals from people who know the field: discharge planners, social workers, geriatric care managers, hospice teams, and your loved one’s physician
• Your Area Agency on Aging, which often maintains lists of local providers
• Word of mouth from neighbors, faith communities, and support groups
• Online caregiver marketplaces, remembering that most platforms do not employ or supervise the caregiver

Step 7: How to Screen and Verify a Caregiver

1. Run a criminal background check, and follow the law when you do

If you hire through an agency, ask what their check covers and how recently it was run. If you hire privately and use a third-party screening company, federal law applies.

Fair Credit Reporting Act requirements

If you use a third-party screening company, follow the Fair Credit Reporting Act. Provide a standalone written disclosure, obtain written authorization, and follow the required pre-adverse and adverse action procedures before rejecting a candidate based on the report. That means giving the candidate a copy of the report and the Summary of Rights before you decide, then a formal adverse action notice afterward. State and local laws, including “ban the box” and criminal record restrictions, may impose additional limits.

2. Verify driving records if the role involves transport

Confirm a valid license and appropriate insurance, and decide whose vehicle will be used.

3. Check references properly

Ask for at least two recent care-related references and actually call them. Useful questions: How long did they work for you? What were they responsible for? Were they reliable and on time? How did they handle a difficult day? Would you hire them again?

4. Verify any certification they claim

A caregiver who says they are certified should be able to tell you which organization issued it, so you can confirm the person’s status directly with that organization rather than accepting a printed certificate.

A certificate documents completion of the issuing organization’s course. It does not by itself prove hands-on competency, replace a state-required credential, or guarantee safe performance. Verify separately whether the training is state-approved or employer-recognized for the role, and check work history, references, background screening, practical competency, and any required state registry listing such as a state nurse aide registry.

5. Confirm training that matches the need

If your loved one has dementia, ask specifically what dementia training they have and how they handle agitation or wandering. ACA’s dementia caregiver's playbook can help families understand the care situations a candidate should be prepared to manage.

6. Ask about CPR and first aid

Many families require this. Ask when the certification was issued and when it expires.

Step 8: Interview Questions to Ask

Ask scenario questions rather than yes or no questions. You learn far more from how someone thinks than from whether they say yes.

Include your loved one in the interview wherever possible. Their comfort, consent, communication style, and sense of safety are important factors in whether the arrangement will work.

Red Flags to Watch For

• Refuses or resists a background check
• Cannot provide checkable references, or references do not answer
• Vague about which organization issued their certification, or unwilling to let you verify it
• Gaps in work history they will not explain
• Asks to be paid only in cash, or discourages any written agreement
• Pushes to be classified as a contractor to avoid paperwork
• Arrives late to the interview or is unprofessional in early communication
• Talks about previous clients by name or shares their private details
• Discourages you from visiting unannounced
• Pressures the family for loans, gifts, account access, advance payments outside the agreement, or involvement in the client’s finances
• Offers to help with legal documents or banking, or asks about the will
• Your loved one is uneasy around them, even without a clear reason

Clear early questions about pay, overtime, mileage, holidays, and duties are normal professional behavior, not a warning sign. The concern is pressure for money or access outside the agreed arrangement.

Step 9: Run a Paid Trial Shift

Before committing, arrange a paid trial of a few hours with you or another family member present, then ideally a second shift where you step out for part of the time.

What to watch for: Does the caregiver speak to your loved one rather than about them? Do they explain what they are doing before they do it? Do they encourage independence or take over? Are they observant, noticing details in the home and about the person? Does your loved one seem relaxed?

Step 10: The Legal, Tax, and Employment Side

This is where families most often get into trouble, usually without meaning to.

Employee, Not Contractor

A privately hired caregiver is almost always your household employee, not an independent contractor. The IRS applies a control test: if the family decides what work is done and how it is performed, the worker is generally a household employee. Classifying a caregiver as a 1099 contractor to simplify paperwork is misclassification and carries real financial and legal exposure.

Federal Tax Obligations

For federal household-employer rules, review the IRS Publication 926, Household Employer's Tax Guide. The IRS also publishes guidance on family caregivers and self-employment tax.

• Social Security and Medicare (FICA). If you pay any single household employee $3,000 or more in cash wages during 2026, you must withhold and pay Social Security and Medicare taxes on those wages.
• Federal unemployment (FUTA). If you pay total cash wages of $1,000 or more to all household employees combined in any calendar quarter of the current or preceding year, FUTA applies to the first $7,000 of cash wages per employee for the year.
• Federal income tax withholding. This is not normally required for household employees. You withhold only if the employee asks and you agree, in which case they complete a Form W-4.
• Family member exceptions. Special federal rules apply when the employee is your spouse, your child under 21, your parent, or a worker under age 18.
• Reporting. Get an EIN from the IRS, which is free. Issue a Form W-2, not a 1099, and file Schedule H with your own tax return.

Separate state unemployment tax, workers’ compensation, paid leave, and local payroll rules may apply at different thresholds. Contact your state unemployment tax agency.

Form I-9

Complete Form I-9 for a household employee to verify identity and authorization to work in the United States, and retain it as required. Do not ask for specific documents. The employee chooses which acceptable documents to present from the Form I-9 lists.

Insurance

Look into workers’ compensation. Requirements vary by state, and homeowner’s insurance often does not cover an employee injured in your home. Check with your insurer before the first shift.

Wage and Hour Rules

Home care workers generally have federal minimum wage and overtime protections under the Fair Labor Standards Act, with narrow exemptions. Most covered workers receive overtime after 40 hours in a workweek.

Live-In and 24-Hour Care: Read This Carefully

A narrow federal overtime exemption may apply to a qualifying live-in domestic service worker employed directly by the individual, family, or household. That worker must still receive at least minimum wage. A third-party employer such as a home care agency currently cannot claim that exemption, so an agency-employed live-in worker must receive both minimum wage and overtime.

A live-in worker and the employer may agree to exclude sleep time, meal time, and genuine off-duty periods from paid hours. However, the worker must be paid for all hours actually worked, so interrupted sleep or duties performed during a supposed off-duty period become paid working time. Keep accurate records.

Many families use a household payroll service to handle all of this, which typically costs far less than the penalties for getting it wrong. If you hire through an agency and the agency is the employer of record, the agency handles these obligations. Confirm that in writing.

Step 11: Write a Care Agreement

Nearly every dispute between families and caregivers traces back to something that was never written down. Put it on paper before the first full shift, whether the caregiver is a stranger or a relative.

• The specific duties, listed task by task, and anything explicitly excluded
• Schedule: days, hours, start and finish times, and how changes are requested
• Pay rate, pay frequency, overtime, and how hours are recorded
• Holiday, sick leave, and time-off expectations
• Transportation: whose vehicle, mileage, insurance
• House rules: visitors, phone use, smoking, meals, use of the family’s food
• Confidentiality and social media, with no posting about the client
• How and when the caregiver reports updates, and who they contact
• Emergency procedures and contacts
• What happens if the caregiver cannot work a shift
• Notice period for either side to end the arrangement
• A review date to revisit the arrangement as needs change

For arrangements involving payment to a family member, a properly drafted agreement can document that payments were compensation for care rather than gifts. It does not by itself guarantee Medicaid eligibility. Consult an elder law attorney before transferring significant money to a family caregiver.

Setting the Caregiver Up to Succeed

• Write a simple one-page care plan: routines, preferences, what your loved one can still do independently, food likes and dislikes, mobility notes, and what a good day looks like.
• For safer medication management, provide a medication list with times, and be clear that reminders are the caregiver’s role while clinical decisions are not.
• Post emergency information where it is visible: contacts, doctors, allergies, diagnoses, and any advance directive.
• Do a home walkthrough: where supplies are kept, how equipment works, alarm codes, and any quirks of the house.
• Agree a communication rhythm. A short daily note and a weekly check-in call works well for most families.
• Introduce gradually where possible, with shorter shifts at first, especially for someone with dementia.
• Give feedback early and specifically. Small corrections in week one prevent resentment in month three.

When It Is Not Working

Sometimes a hire does not fit, and that is not a failure. Watch for repeated lateness or no-shows, tasks quietly not being done, your loved one becoming withdrawn or anxious around the caregiver, resistance to family oversight, or unexplained missing money or belongings.

Address concerns directly and early, in writing where it matters. If the issue is serious, end the arrangement. If you suspect abuse, neglect, or financial exploitation, contact Adult Protective Services through the Eldercare Locator (1-800-677-1116), or call 911 if someone is in immediate danger. Anyone can make a report, and many states allow anonymous reports.

Hiring a Family Member as the Paid Caregiver

Many families conclude that the right caregiver is already in the family. This can work well, and in some states it can be funded through Medicaid self-directed care or VA programs, subject to program rules on which relatives are permitted.

Two things make it far more likely to succeed. First, a written care agreement, exactly as you would with an outside hire, which prevents resentment between siblings and documents that payments were compensation rather than gifts. Second, relevant training such as caregiver certification. Training may improve a caregiver’s knowledge of safe transfers, infection control, and emergency response, although a certificate alone does not prove hands-on competency or guarantee safe performance.

Also plan for relief. Caregiver burnout is a real risk because care responsibilities may continue beyond scheduled working hours and overlap with family obligations. Building in respite from the start, rather than after a crisis, is what keeps the arrangement sustainable.