What are the different types of home care?

When you browse the produce section in the grocery store, the prices are clearly marked. Most of us comparison shop, depending on what we need, what we want, and our budget. For example, when shopping for apples, there many choices – organic vs. conventional, red delicious vs. golden delicious, we can even choose the size of apples and how many we want.


When you are thinking about home care for yourself or a loved one, you also have choices. There are three different models of home care. Unlike shopping for apples, the stakes are considerably higher when choosing home care. Price is often a major component, but there are many other variables. With all three models providing similar care, it can seem like you are comparing apples to apples. This can make it confusing to figure out the right fit for you. The following provides an overview to help understand your options.

Let’s start with the basics:

In general, home care provides assistance with life’s daily tasks, such as bathing, dressing, medication reminders, light housekeeping, meal preparation, and companionship. However, the difference in home care models is significant. Understanding the variations will likely influence your decision.

Home Care – Three different models of delivering care

1. Home care agencies: Home care agencies employ their staff. An agency provides an integrated team to oversee and manage the care of each client. The team includes a certified nursing assistant, registered nurse, and oftentimes a social worker. Each client has a plan of care devised by a registered nurse and reviewed regularly, with client input. Because home care agencies employ and supervise their personnel, they assume liability for all care. They also handle employee taxes, background checks, and provide employee benefits and staff training. Services are usually available 24 hours a day, 7 days a week. Lifematters is a home care agency, and every Lifematters caregiver is an employee.

2. Staffing registries: Staffing registries match providers (certified nursing assistants, and/or licensed nurses) with clients and collect an ongoing staffing fee. In most cases, home care registries are not licensed or regulated by the state and serve as staffing agencies. When you hire a caregiver through a registry, it is much the same as hiring him/her yourself – the person works for you, and you pay directly. As an employer, you may also have to pay payroll taxes, Social Security, unemployment insurance, and worker’s compensation if the caregiver is injured on the job. Further, the care provided is not overseen by a registered nurse and training is not provided by the staffing registry.

3. Independent providers: Independent providers are certified nursing assistants, homemakers, companions or nurses who are privately employed by the individual receiving care, or his/her family. The individual or family must recruit, hire, and supervise these providers. The individual or family pays directly, and may also be responsible for payroll taxes, Social Security, unemployment insurance, and worker’s compensation if the caregiver is injured on the job. The care provided is not overseen by a registered nurse and training is not provided. Because most independent providers are not licensed and bonded, clients are not covered for property damage, loss or theft caused by the caregiver.

Types of Home Care – hours and costs

• Hourly: Caregivers come for a set amount of hours based on the client’s needs and wants. In the DC metro area, the minimum is usually 4 hours and the average cost ranges between $22.00 and $28.00 per hour, plus mileage reimbursement. A caregiver hired for an overnight shift must remain awake and alert.

• Live-in: A caregiver lives with his/her client. Caregivers need their own room to sleep and must have the ability to take breaks. The caregiver is allowed to sleep 6 to 8 hours overnight. The average cost for live-in care in the DC metro area ranges between $250.00 – $325.00 per day, plus room and board.

Next week: How Do I Pay for Home Care?