Home Care Agency, Independent Caregiver, or Structured Family Caregiving: Understanding Your Options

When someone you love needs more help at home, deciding what kind of care to arrange can feel overwhelming. You may be wondering whether to call a home care agency, hire a caregiver directly, or continue care with help from a family member or friend.

There is no one-size-fits-all answer. The right fit depends on the support your loved one needs, who they feel comfortable with, what your family can realistically manage, which services are available nearby, and whether your loved one qualifies for a public program.

This guide walks through three options: working with a home care agency, hiring an independent caregiver, and exploring Structured Family Caregiving (SFC). Each offers a different mix of choice, responsibility, continuity, and support. Understanding those differences can help your family decide what feels both safe and sustainable.

What Is a Home Care Agency?

A home care agency generally provides non-medical support at home, such as help with bathing, dressing, meals, transportation, household tasks, and companionship. This is different from home health care, which is clinical care ordered by a health care provider and delivered by licensed professionals—such as nurses or physical, occupational, or speech therapists—often for a defined period after an illness, injury, or hospitalization. Some organizations offer both services, but families should ask exactly what type of care is being provided and how it is paid for.

When you work with an agency, it takes care of:

• Hiring and background checks: the agency finds, screens, and matches caregivers to your loved one
• Training and oversight: caregivers are trained and supervised by the agency
• Payroll and taxes: the agency is the employer, so it handles paychecks and tax paperwork
• Backup coverage: if the regular caregiver is sick or on vacation, the agency sends someone else
• Insurance and liability: the agency carries liability and workers’ compensation coverage, which lowers your family’s risk if something goes wrong on the job

Home care agencies can reduce the administrative burden on families by managing staffing and employment responsibilities. They may be a practical fit when a family needs scheduled help from paid caregivers, does not have a relative or friend who can provide care, or wants the agency to coordinate backup coverage. If your loved one needs clinical services, ask whether the organization provides home health care or can coordinate with a separate home health provider.

Before choosing an agency, ask how caregivers are matched, what happens when someone is unavailable, which services are included, and what the family will pay. Your loved one may meet more than one caregiver over time, so it can also help to ask how the agency supports consistency and communication.

What Is an Independent (Private) Caregiver?

Hiring an independent caregiver means the family hires someone directly rather than through an agency. This can provide more choice and flexibility, but the family generally takes on the role of employer: finding, screening, hiring, training, supervising, and paying the caregiver. The hourly rate may be lower than an agency’s, but families should consider the full financial and administrative responsibility—not price alone.

It’s worth looking closely at the workload that comes with it:

• Training and supervision: someone close to your loved one needs to be comfortable teaching the caregiver their routines and needs, and checking in to make sure it’s a good fit.
• Backup care: if the caregiver is out sick or on vacation, finding coverage is up to your family.
• Insurance: check with your insurance provider to confirm what’s covered if the caregiver is injured in the home.
• Payroll and taxes: a private caregiver is considered a household employee, so payments and tax forms are your responsibility. Talk with your tax professional to understand the process.

Hiring directly may work well when your family wants more say in who provides care and can manage the responsibilities that come with it. Before moving forward, talk through supervision, backup care, insurance, payroll, and taxes so everyone understands their role. An independent caregiver arrangement is different from Structured Family Caregiving (SFC), which has its own eligibility rules and program-based support.

What is Structured Family Caregiving (SFC)?

For some families, SFC may be another option to explore. It is designed for eligible people who need significant support and live with a qualifying family member or friend who provides their care.

Structured Family Caregiving is a Medicaid-funded service available in some states. It may allow a qualifying family member or friend to receive payment for providing live-in care while also receiving guidance from a professional care team.

Support can include a care plan, caregiving education, regular check-ins, and help navigating day-to-day needs. The exact services and payment structure depend on the state, program, and provider. SFC does not replace skilled home health care when clinical services are needed, but the two may be part of a broader care plan when program rules allow. Learn more about how Structured Family Caregiving works.

Eligibility varies, but common factors may include:

• Be eligible for Medicaid
• Need an institutional level of care, like a nursing home or transitional care program
• Live in a home shared with their caregiver (their own home or the caregiver’s)
• Have a family member or friend who could serve as their official caregiver

Because requirements differ by state and program, a screening is the best way to understand whether SFC may be available to your family. Careforth can help you review the options in your area. To check your eligibility, please call 866-797-2333 or fill out this form.

Comparing Your Care Options

Consideration	Home Care Agency	Independent Caregiver	Structured Family Caregiving
Caregiver relationship	A caregiver is assigned or matched through an agency	The family selects and hires a caregiver directly	An eligible family member or friend provides live-in care
Training and ongoing support	The agency trains and supervises its caregivers	The family arranges training and supervision	The program provides coaching, training, and care planning
Hiring, payroll, and paperwork	Generally handled by the agency	Generally handled by the family, subject to applicable rules	Payment and program requirements are administered through the SFC provider
Backup coverage	May be available through the agency; confirm its policy	The family creates a backup plan	Varies by program and provider; ask what respite or backup support is available
Availability and eligibility	Depends on local staffing, services, and payment options	Depends on finding a caregiver who matches the family’s needs and budget	Depends on Medicaid, state rules, care needs, living arrangement, and caregiver eligibility
May be a fit when	The family wants an organization to coordinate scheduled non-medical care	The family wants to hire directly and can manage employer responsibilities	An eligible person wants to receive live-in care from a qualifying family member or friend

Questions to Ask Before Deciding

You do not have to make every decision at once. Start with the questions below, and revisit them as your loved one’s needs change.

1. What specific tasks does my loved one need help with?
  Caregivers can help with many different things, so start by sorting your loved one’s needs.

☐ Medical care to remain at home → Home health or another clinical service. Ask a health care provider what services are needed and whether an order or referral is required. Non-medical home care, independent caregiving, or SFC may still help with daily activities, depending on the situation.

☐ Loneliness and few social activities → Companion care. Consider the person’s preferences, the family’s ability to manage hiring and oversight, and whether an agency, independent caregiver, or trusted family caregiver is the best fit.

☐ Forgetting hygiene routines, missing medications, or needing transportation → Personal care. Consider how complex and frequent the needs are, whether clinical services are also required, and whether SFC eligibility should be explored.

2. How many hours a day does my loved one need a caregiver?

☐ Around the clock (24/7)

☐ Waking hours (for example, 6am–8pm)

☐ Business hours (for example, 8am–5pm)

☐ Limited hours (for example, 8–10am and 3–5pm)

Think about both the number of hours and the kind of help needed. An agency may be useful for scheduled shifts and backup staffing. A direct hire may offer consistency and flexibility when the family can manage the arrangement. If a family member or friend already provides live-in care, it may also be worth checking SFC eligibility.

3. If we don’t use an agency, who in our circle can handle these pieces?

☐ Background check and hiring: ______________

☐ Training and supervision: ______________

☐ Insurance needs: ______________

☐ Payroll and tax forms: ______________

☐ Backup caregiver coverage: ______________

If your family does not have the time or capacity to manage these tasks, an agency may be helpful. If you want to hire directly, decide who will take responsibility for each item before care begins. If an eligible family member or friend provides live-in care, ask an SFC provider which responsibilities and supports are included in the program.

4. Is SFC a possibility?

☐ Is my loved one eligible for Medicaid?

☐ Do they qualify for institutional-level care, such as a nursing home or transitional care program?

☐ Do they already live with a family member or friend who could be their caregiver? Or are they willing to?

☐ Is there a family member or friend who could be their official caregiver?

If you answered yes to all four, check your loved one’s eligibility or contact Careforth to learn more.

Frequently Asked Questions

Ready to see whether SFC could work for your family? Check eligibility or talk with Careforth today.