All Home Care Is Not The Same

There are Differences in the types of Home Care

Home Care provide a wide range services and assistance that allows individuals to remain in their own homes. There are three  business structures of providers who offer in-home care: employment based agencies, registries, and independents .  Each is substantially different in how they staff and charge for services as well as who assumes the role of employer and the associated responsibilities of the employer.

Employment Based Agencies

The first option is an employment based agency which may be a corporation. The greatest benefit to hiring a caregiver from an organization that employs its caregivers is the oversight provided and convenience for everyone involved. Once you have met with the company and made the decision to work with the company, the “back office” details are not your responsibility. Tender Loving Family Care, Inc. is an Employment Based Agency

Tender Loving Family Care, Inc.

Is a NY State Corporation and a Department of Health Licensed Home Care Service Agency. We employ our caregivers providing oversight and convenience for everyone involved. Once you have met with us and make the decision to work with us, the “back office” details are not your responsibility. The biggest distinctions with our organizations are:

  • We employ the caregiver and clients are not burdened with the laws and requirements associated with being an employer
  • Employees have undergone rigorous background checks, interview process, and reference validation
  • Caregivers are covered by Workers’ Compensation, general liability, and bonding insurance
  • Caregivers are trained prior to being placed in a client’s home and there is ongoing training to ensure caregivers are educated and prepared to deliver quality care
  • A large roster of caregivers are available and prepared to “step in’ in the event the regular caregiver is unavailable
  • Ongoing oversight and involvement from the coordination team


The second option is a Registry. Registries build and manage databases of caregivers, but do not actually employ the caregivers. The caregivers often act as 1099-contract labor, but the employment arrangements can vary. If you opt to hire a caregiver from a registry, you should know who assumes the role of employer and who is responsible for employment tax withholdings and the appropriate insurance coverage?  Generally, they do not provide training, nor do they ensure a level of caregiving proficiency prior to placing the caregiver. Registries act as a “match maker” and provide viable caregiver personnel options for consumers to consider.

If you choose a registry to provide an in-home caregiver, make sure you understand:

  • Who employs the caregiver
  • Who is responsible for employment tax withholdings
  • What kind of background checks have been run on the caregiver and the outcome of the checks
  • Any and all insurance coverage that may apply to the caregiver in the home
  • The type of training the caregiver may have received and certifications the caregiver may have secured
  • How the caregiver is paid
  • The type of caregiver oversight


Then there is Independent as the name suggests; an individual who is not part of an organizational structure. An independent may be someone you know personally or from the community, or it may be someone who advertises in-home services in the classified section of the newspaper. No matter the source of the independent caregiver, there are implications surrounding hiring an independent that should be considered before securing the relationship.

A “plus” in hiring an independent is the hourly rate. Generally, you pay the caregiver less than what you will pay a registry or an employment based agency. However, a lower hourly rate does not always translate into the most cost efficient solution. If you secure an independent to provide in-home care, you are now the employer. That means you are responsible for all employment taxes and deductions for your employee, the caregiver. You also become responsible for securing the appropriate insurance coverage such as Workers’ Compensation in case the caregiver is injured while providing care in the home and general liability insurance in the event the caregiver causes property damage. Most homeowners’ policies do not cover the expenses associated with an injury or damages sustained while a caregiver is in your employ. Beyond the finances, is there a backup caregiver in the event the primary caregiver is ill or unable to care for the individual? Is the individual trained or does he/she have access to training, to accommodate the changing care needs of a client?  A lower rate does not always translate to a more cost efficient, or highest quality, care solution.