You can hire a caregiver directly, or you can buy help through an agency. Both are real options. The difference is who becomes the employer. Hiring direct moves the payroll duties onto your household. Buying through an agency keeps them on the agency's side of the table. Decide that first, before you compare anything else.
Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.
What the agency carries
An agency usually handles the paperwork for the worker, including withholding, required insurance, timekeeping, and the process of finding a replacement when someone is sick or leaves. Its rate reflects the worker's pay plus the cost of running that system. You are paying for the system, not just the hours.
What you take on when you hire direct
You will set the pay yourself, and you will need to register as an employer with the state and federal agencies that handle payroll taxes and worker protections. You will need to keep time records, decide how sick days and holidays work, and arrange insurance that covers an in-home worker. You will also need a backup plan of your own when the worker cannot come. These duties are not hard in principle, but they are continuous.
Check the payroll line before you decide
Whatever route you take, look at the public pay tables for your county before you set an offer or read an agency's rate. A rate that looks high may still be reasonable once you see what sits underneath it. A rate that looks low may be asking a worker to take less than the local market. The county payroll tables give you the local reference point.
Questions to ask yourself
Do you have time to keep payroll records every week? Do you have a backup person you trust for the days your regular worker is away? Would you be comfortable ending the arrangement yourself if it stopped working? If the answer to most of these is no, buying through an agency is probably the better fit, even with a higher rate.
Check the rules with the right people
Employer obligations change, and they differ by situation. Before you hire direct, confirm the current requirements with the state labor agency, the federal tax agency, and an accountant or payroll provider. This guide describes the decision. It does not replace their advice.