Hiring a caregiver to come into your home to care for a loved one can be a very scary prospect. The thought of leaving a vulnerable senior or disabled adult alone with a stranger can add extra stress to an already difficult situation. Selecting a person or agency to provide these services takes research and time. There are really two ways to bring in home health care services, hire a person you find on your own, or work with a professional agency.

Professional Home Health Care service providers can basically be broken down into two different models, the registry model (Registry) and the employee based model (Agency). Both types can offer the services of home health aides (HHA's) certified nurses aides (CNA's), nurses (RN's, LPN's), companions and other services such as physical therapy (PT) and occupational therapy (OT) The question for many consumers, what is the difference and which type is right for them.

Nurses registries have been around since the civil war. In this model, an agency does all of the background work, such as interviews, criminal background checks, reference checks and any other checks they feel necessary. Once a candidate has been approved, the registry will refer them to the person in need. The caregiver is considered an independent contractor by the agency and not supervised directly by the agency. This is also called the consumer directed model as the consumer is the person in charge.

With the employee based model, the agency does a similar type of screening; however, instead of referring the caregiver to the consumer, the agency employs them.

Each model has its' pros and cons.

Pros of the registry model include

* Cost of the service is generally lower than agency model.
* Caregivers usually earn more, which tend to attract a higher quality of caregiver.
* Consumer is in total control. They decide what gets done, when it gets done and how it gets done. They decide if the caregiver stays on the job or needs to be replaced.


Cons of the registry model include:

* Person is not supervised by agency nurse.
* Caregiver is not covered by WC insurance.
* Family may be the employer and need to take out payroll taxes.


Pros of the agency model include:

* Caregivers are covered by workers comp and bonded by the agency.
* Caregivers are supervised by agency nurse.
* Agency is always the employer and deducts all appropriate taxes.


Cons of the agency model include:

* Cost tends to be higher.
* Caregivers do not earn as much as those on the registry side.
* Agency has control over when and where caregiver performs their duty. Agency can pull a caregiver if they need that person for a different case.


You will find supporters for both sides. It is up to you to decide which type of business is right for you. There are several professional resources which can also be helpful when doing your research.

To locate home health care services and read reviews about each business, go to

To learn more about nurses registries, go to

To learn more about employee based agencies, go to