What is the short answer?
Hire directly when the care is light, predictable and a missed visit would be inconvenient rather than dangerous. Use an agency when the care is daily, hands-on, medically involved, or when nobody in the family can drop everything to cover a gap at 7am.
Cost follows that split. Published comparisons put agency rates 20–30% higher than hiring an independent caregiver — roughly $33–$40 an hour versus $25–$30. You are not paying more for a better caregiver; you are paying for the operation standing behind them.
What do you get for the agency premium?
- Cover. The single biggest one. When your caregiver is ill or on holiday, arranging a replacement is their job, not yours.
- Screening you could not run yourself. Background checks, reference and credential verification, done as a matter of course.
- Employment handled. The agency is the employer: payroll, withholding, insurance and workers' compensation are theirs.
- Somebody accountable. A supervisor to escalate to, and a written record of what was agreed and what happened.
- Continuity as needs change. More hours, a second caregiver or clinical input can be added without you starting the search again.
What do you get for hiring directly?
- A lower rate, because there is no agency margin in it.
- You choose the person. Not a rota, not whoever was free — the individual you met and liked.
- Continuity of face. The same person every visit matters enormously in dementia care, and agencies cannot always promise it.
- Flexibility. Arrangements can be changed in a conversation rather than through a service agreement.
- More of your money reaches the caregiver, which is not nothing for retention.
Where does hiring directly usually go wrong?
Almost always in one of three places. The first is cover: one person is the entire care plan, and the plan collapses the morning they cannot come. The second is employment status — families treat a regular caregiver as casual help and discover the household employment rules afterwards. The third is screening: a cheap online report is mistaken for a background check.
None of these are reasons not to hire directly. They are the three things to have an answer for before you start.
Can you combine the two?
Frequently the best answer. Many families hire directly for companionship, household help and driving — where the risk of a missed visit is low — and bring in an agency for personal care or clinical needs, where cover and accountability matter most. There is no rule that says one household uses one model.
How do you decide?
Ask one question: if this visit did not happen tomorrow morning, what would actually go wrong? If the answer is "it would be a nuisance", hire directly and save the margin. If the answer is "somebody would not be washed, or would miss medication, or would not be safe", buy the cover.
What next?
To hire directly, search caregivers near you — free, no card, and you agree the rate with the caregiver. If you run an agency and want the software to deliver that accountability properly, see The Care Royal for agencies.
Cost comparisons are 2026 figures published by home-care industry sources. Rates vary substantially by state and by the care required.