Most of us want to stay at home as long as possible. In fact, only 4.3% of people over 65 are in nursing homes, and only 18% of people 85 and older are in nursing homes (1). Most seniors who require long term care at home have family caregivers, but caregiving can take its toll on the family caregiver — physically, financially, socially, and emotionally, especially if you are caring for someone with Alzheimer’s disease, dementia, or memory loss. At some point, you may need to arrange for paid in home help to not only care for your family member, but to preserve your physical and mental health so you can continue to provide care for your family member.


What is in-home help?

In-home help is different than home health care. Home health care is ordered by a physician and is provided by licensed professionals. Home health care services include a wide range of medical services, including medication assistance, nursing services, and physical therapy.

In-home help is non-medical help and may include companionship, housekeeping, cooking and many other household activities and chores.

You can arrange for in home help through an agency or hire your own worker.

What are the pro’s and con’s of hiring in-home help through an agency?

There are many reasons why you may want to work through an agency:

  • The agency will screen, hire and fire, and pay the worker
  • The agency will pay the taxes and the unemployment and workers compensation insurance and will also handle all the paperwork required (i.e. immigration papers, Social Security, etc.)
  • If the worker is sick, a substitute can be sent
  • The agency may be able to provide individuals with a variety of skills to meet varying needs (e.g., nursing care, transportation, etc.)
  • Services from an agency may be partially covered by Medi-Cal or private insurance

There are also reasons why you may not want to work through an agency:

  • Often several workers are used which can be confusing or distressing for the person receiving care
  • You may have less individual choice in workers
  • Working with an agency is usually more expensive than privately hiring someone

What are the pro’s and con’s of hiring in home help on my own?

You may want to hire your own worker because:

  • You and your family member can develop a family relationship
  • Paying for a in-home worker privately is usually less expensive
  • You will get exactly the person that you want

Some people decide not to hire a person privately because:

  • If the home care worker is sick, no substitute is readily available
  • If you are not happy with something the in-home worker is doing, you must confront the person directly, rather than go through the person’s supervisor
  • You must handle all the details of hiring and firing, training the person, paying wages and taxes, and filing all the appropriate paperwork

What can I expect the in-home worker to do?

Whether you hire someone through an agency or privately, it is a good idea to develop a job description or a list of duties and expectations. Will the in-home worker provide companionship and supervision, assistance with bathing, dressing and feeding, housekeeping, driving and/or grocery shopping? Will the in-home worker be provided with meals and a place to sleep? What about personal telephone calls or visitors? Is smoking acceptable? What are the wages? What about vacations and holidays? What are the days and hours of work? It is good to get all of this in writing and signed by both parties so there are no misunderstandings.

Where do I find in-home help?

If you decide to hire an in home worker privately, the best way to find someone is through a personal recommendation from a relative or friend. You may also want to advertise through your church, temple, local community center, or local college.

There are private and community agencies that may maintain lists of people who are available to be in-home workers, or you may want to post a “Help Wanted” advertisement in the newspaper.

What are my legal responsibilities if I hire an in-home worker?

As an employer of a “household employee,” there are several legal considerations. First, you should verify that your home insurance covers household employees in case of an accident.

You will be responsible for:

  • Withholding Social Security taxes, Medicare taxes and/or federal unemployment tax and filing them with the Internal Revenue Service annually or quarterly. Social Security taxes are owed by both you and the in home worker. For information on paying federal taxes for household employees, call (800) TAX-FORM and ask for Publication 926 or view it on the web at
  • Filing a W-2 form and giving a copy to the in home worker. You will need to file a W-3 form if you have more than one in home worker.
  • Registering with the California Employment Department if you pay the in home worker more than $750 in one quarter.
  • File quarterly state withholding tax and paying unemployment taxes for the in home worker.
  • Paying for state disability taxes for the in home worker if the worker is paid more than $999 in one quarter.

The penalties for not paying taxes on household employees include paying the back taxes and paying interest and penalty fines.

As an employer, you are required to have the in home worker fill out an Employment Eligibility Verification form I-9. You should keep a copy of this form on file. This form verifies that the person is legally entitled to work in the United States. The form can be downloaded online at or ordered by calling (800) TAX-FORM.

Where can I get more information?

Family Caregiver Alliance

180 Montgomery Street, Suite 1100

San Francisco, CA 94104

(415) 434-3388

(800) 445-8106


E-mail: [email protected]

Employment Development Department, State of California

800 Capitol Mall, MIC 83

Sacramento, CA 95814


(1) Federal Interagency Forum on Aging-Related Statistics,