According to the 
U.S. Congressional Budget Office, one third of seniors aged 65 and over need some assistance with the activities associated with daily living. Facing the need for such assistance is often greeted with resistance and disappointment by the senior herself, and concern and worry on the part of her family members.
Before an aging senior needs assistance with tasks such as dressing and personal hygiene, shopping and preparing meals, loved ones may observe incidence of forgetting doctors appointments, birthdays and routine responsibilities, distracted driving, and a general slowing down of logical or sequential information processing. These patterns are not cause for alarm (unless dangerous as with driving), but they do suggest increased consideration as safety and health issues become more acute
This transition seems mountainous to most. The gap in time from observing these first needs, and taking action, can sometimes take years.
As family members, we often hear what our own peers are experiencing in terms of care for their senior family members. Before we’re willing to entertain such concepts as Independent Living, Assisted Living or nursing care we may recognize the need for senior home care of one kind or another.
Aging adults can often function well in their private home with full or part time support services and this is often the first step in exploring services that help seniors continue living full and productive lives at home.
Senior caregivers, also referred to as companions or home health aides, are in increasing demand to meet the needs of our aging baby boomers. Senior caregivers can provide necessary support services to seniors with functional or mobility limitations, and mild cognitive impairment; this allows seniors to continue to live independently.
When a family needs the services of a senior caregiver, they are typically faced with the complex choices in engaging a home health or senior care giver. There are an increasing number of senior home care agencies that provide fully screened and insured care providers for a fee. There is also the option of privately hiring a senior home care giver and negotiating background checks, salary, taxes and work agreements independently without the added fees.
The senior home care agency handles all payroll, tax and insurance matters. The agency charges the family a flat hourly fee that is approximately double the rate a caregiver is paid, with the markup covering all employer taxes, insurance, recruiting, training and administrative expenses.
There are pros and cons to privately hiring senior caregivers, and times when outsourcing this staffing responsibility to an agency is the right choice.
Senior home care agencies represent the right choice when the aging adult must have scheduled care where gaps in that care might cause risk to the aging adult and logistical challenges to caring friends and family. If there are no reliable adult family members or friends who can step in when a caregiver is sick or needs to schedule time off, the senior home care agency almost always has a similarly qualified replacement available.
A family that privately hires a caregiver typically goes this route because they want to have greater control over the caregiver selected, more freedom to determine the scope of the caregiver’s job responsibilities, and lower expenses associated with care.
Privately employed caregivers typically earn 20% more than they would working for the agency, and the family typically spends 20% less than they would with the agency after accounting for employer payroll taxes, insurance and administrative expenses. Higher wages often results in lower caregiver turnover, especially important to seniors in light of the highly personal nature of the services provided. Care gaps caused by senior caregiver illness, vacations or simply turnover are an important consideration. Many families will fill these transition times with temporary workers, often provided by a senior care agency.
Recruiting, interviewing, reference-checking and payroll taxes are areas that are unfamiliar to most families. Since it is illegal to hire and pay these private care givers without paying taxes, many families rely on turnkey payroll tax services to be able to hire privately without extensive bookkeeping and administrative complexities.
Other Resources:
Companionship Care: Minimum Wage and Overtime by State
Overtime Rules for Senior Caregivers
Payroll for Privately Employed Senior Caregivers
FAQ: Privately Employed Senior Caregivers