Families looking for help at home usually find two kinds of offers. A licensed home care agency sends a caregiver it employs. An independent caregiver, often found through a friend, a church, or an online listing, works for the family directly. Beyond the hourly price, the two differ in who employs the caregiver and who handles the problems that come with employing someone.
This guide is for families in Georgia deciding between the two.
Who employs the caregiver
When an agency employs the caregivers it sends, the agency is the employer, so ask whether it does. An employing agency hires, screens, trains, schedules, supervises, and pays the caregiver, and handles payroll taxes.
When a family hires a caregiver directly, the family may become the employer. The IRS treats many in-home caregivers as household employees. For 2026, a family that pays one household employee $3,000 or more in cash wages generally must withhold and pay Social Security and Medicare taxes, according to the IRS. The threshold changes from year to year, and there can be federal unemployment tax and state obligations as well. A tax professional can tell you what applies to your situation.
Licensing
In Georgia, businesses that provide or arrange private home care services are licensed by the state under the rules for private home care providers, Ga. Comp. R. & Regs. ch. 111-8-65. Those rules cover subjects such as service plans, client rights, and complaints. When a family hires a caregiver directly, no agency supervises the work, so the family does. Ask any agency for its license number and confirm it with the Georgia Department of Community Health.
| Question | Ask an agency | Ask yourself if hiring directly |
|---|---|---|
| Who covers an absence? | How do you staff a sick day or vacation? | Who will we call, and are they ready? |
| Who checks the work? | Who supervises caregivers, and how often? | Who in the family will check, and how? |
| Who handles taxes and insurance? | Are caregivers your employees? | Have we spoken with a tax professional and our insurer? |
Paying a family member
Some families pay a relative to provide care. The same household-employer questions can apply, and payments to family can affect later eligibility for some benefit programs, including Medicaid. Talk with an elder law attorney before you start.
A first step this week
Write down the hours each week that need coverage and the tasks in those hours. Then ask an agency the questions in the middle column of the table, and answer the right column as a family.
To see how OPA defines coverage and coordinates the start, see how care starts at OPA.
Rules and thresholds change, and the tax and licensing statements here can change. Confirm the current requirements before you act. Confirm them with the IRS, the Georgia Department of Community Health, or a qualified tax or legal professional before you act on them. This is general information, not legal or tax advice.
For a reliable next step, use Georgia’s health care facility regulation information for the official details, then use how care starts when your family needs to organize support at home.
For a related decision, IRS household employee information can help frame the question, and this site’s medication-planning guide offers a practical next step.
Families can also compare the next handoff with OPA’s Care Coordination Grid.
Compare the practical safeguards, not only the hourly rate
Before deciding, ask what happens when the regular caregiver is sick, late, or no longer a good fit. Ask who checks references, handles payroll and insurance questions, supervises the work, and keeps the family informed. The answers can matter more to the household than a small difference in the initial rate.
Also ask what information a new caregiver would receive about routines, preferences, mobility, and communication. A plan that depends on one person remembering every detail becomes fragile quickly. Families should keep a short current summary of what helps the day go smoothly, regardless of which arrangement they choose.
Choose the arrangement your family can manage
Some families are comfortable taking on the responsibilities of direct employment. Others value an agency's scheduling, supervision, and backup structure. The useful choice is the one that fits the family's time, confidence, and need for dependable coverage, not the one that sounds simplest in a single conversation.
