Home Care Agency vs. Caregiver Registry: Know the Difference Before You Hire

A licensed home care agency employs its caregivers: it handles payroll, taxes, insurance, training, supervision and backup coverage. A caregiver registry (sometimes called a referral service) matches families with caregivers but usually doesn’t employ them, which can leave the family responsible as the employer, including payroll taxes, overtime, workers’ compensation and finding a replacement when a caregiver is sick. Registries may cost less per hour, but families take on more risk and work.

Families comparing home care options often see similar-looking websites and assume every service works the same way. The key question is simple: who is the caregiver’s employer? The answer affects cost, liability, reliability and peace of mind. Understanding a home care agency vs. registry comes down to one question: who employs the caregiver.

This guide explains how registries and agencies differ, the risks families should understand, and questions to ask.

How do agencies and registries compare?

• Who employs the caregiver
  • Licensed home care agency: The agency
  • Caregiver registry: Often the family, or the caregiver is independent
• Payroll taxes
  • Licensed home care agency: Agency
  • Caregiver registry: Often the family
• Overtime and wage compliance
  • Licensed home care agency: Agency
  • Caregiver registry: Often the family
• Workers’ compensation
  • Licensed home care agency: Agency
  • Caregiver registry: Often the family’s responsibility
• Liability insurance and bonding
  • Licensed home care agency: Agency
  • Caregiver registry: Varies
• Background checks
  • Licensed home care agency: Required for registered aides
  • Caregiver registry: Varies
• Training and supervision
  • Licensed home care agency: Agency
  • Caregiver registry: Limited or none
• Backup if a caregiver is sick
  • Licensed home care agency: Agency sends a replacement
  • Caregiver registry: Family finds a replacement
• Hourly cost
  • Licensed home care agency: Higher
  • Caregiver registry: Often lower

Why does “who is the employer” matter?

If a registry places a caregiver who isn’t an employee of the registry, California may treat the family as the employer. That can mean responsibility for:

• Payroll taxes and wage reporting
• Minimum wage and overtime rules, which are complex for caregivers
• Workers’ compensation coverage if the caregiver is injured in the home
• Paid sick leave

An injury or wage claim can cost far more than any hourly savings. See private caregiver vs. agency in California.

What about quality and reliability?

Agencies supervise caregivers, provide training, check in on clients, and replace caregivers when needed. With a registry, families often handle problems themselves. For parents with dementia or complex needs, consistent supervision and backup coverage matter a great deal. See what families should know about caregivers for seniors.

When might a registry make sense?

• Families comfortable acting as an employer, with a payroll service and workers’ comp coverage
• Occasional or very short-term needs where backup isn’t critical
• Families who want to choose a caregiver independently and manage them directly

Even then, verify registration and background checks, and get advice on employer obligations.

What questions should you ask?

1. Is the caregiver your W-2 employee?
2. Who pays payroll taxes and workers’ compensation?
3. Are you a licensed California Home Care Organization?
4. Are caregivers registered on the Home Care Aide Registry?
5. Who supervises the caregiver?
6. What happens if the caregiver is sick or quits?
7. Are you insured and bonded?

See questions to ask before hiring an in-home caregiver.

How does Nona’s handle employment?

Nona’s is a licensed California Home Care Organization (#374700282). Our caregivers are our employees, registered with the state, background-checked, trained and supervised. We handle payroll, taxes, insurance and backup coverage, so families don’t carry employer risk. Care is $40 to $50 per hour depending on the level of care, with no minimums or deposits.

How do you protect your family if you use a registry?

Registries can work for some families, but they often shift responsibilities to you. Take steps to protect your parent and your family.

• Clarify who the employer is. If you are the employer, you may be responsible for payroll taxes, wage and hour rules, and workers’ compensation.
• Check insurance. Ask your insurance agent whether your homeowner’s policy covers injuries to a household worker, and whether you need workers’ compensation coverage.
• Verify credentials yourself. Check the caregiver’s Home Care Aide Registry status and background check.
• Plan for backup. Know who will cover if the caregiver is sick or quits.
• Put terms in writing. A written agreement should cover duties, hours, pay, and time off.

Talk with an attorney or tax professional if you are unsure about your responsibilities.

How do you switch from a registry to an agency?

Families often move from a registry to an agency when needs grow, backup coverage becomes a problem, or employer responsibilities feel overwhelming. Ask the agency how they handle transitions, how quickly they can start, and whether they can meet your parent before the first shift.

Plan an overlap if possible so your parent is not left without care. Home care agency vs registry decisions can change over time, and switching is often simpler than families expect.

What questions should you ask a registry before signing up?

Ask how caregivers are screened, who employs the caregiver, how payment and taxes work, what happens if the caregiver does not show up, and how complaints are handled. Ask what fees you pay and whether there are ongoing charges.

Clear answers help you understand exactly what you are taking on before care begins.

What happens if a registry caregiver gets hurt on the job?

Caregiving involves lifting, transfers, and other physical tasks that can lead to injuries. If a caregiver is injured while working in your parent’s home and the family is considered the employer, the family may be responsible for medical costs and lost wages unless proper insurance is in place.

Licensed agencies carry workers’ compensation for their employees, which is one of the reasons agency rates are higher. Before using a registry, talk with your insurance agent about coverage and understand who is responsible if an injury happens.

What does the real hourly cost look like?

When families compare a home care agency vs registry, the registry rate often looks lower at first glance. But the rate you see is not always the full cost. If the family is treated as the employer, extra costs can land on you.

Costs a household employer may need to cover include:

• Employer payroll taxes and, in some cases, unemployment insurance contributions
• Workers’ compensation insurance, which California generally requires for household employees
• Overtime pay for long shifts or live-in schedules, under California’s rules for domestic workers
• Paid sick leave
• Pay at or above the 2026 California minimum wage of $16.90 an hour, or a higher local minimum where it applies
• Time spent on payroll, record keeping, and finding replacements

A licensed agency builds these into one hourly rate. At Nona’s, hourly care runs $40 to $50 an hour, with overtime hours past 9 a day or 45 a week at $55 to $60. Before you choose, add up what a registry arrangement would really cost your family once taxes, insurance, and overtime are included.

How do you verify a California home care agency is licensed?

In California, agencies that employ caregivers and send them into clients’ homes for non-medical care must be licensed as Home Care Organizations by the state. Caregivers who work for them must be listed on the Home Care Aide Registry and pass a background check.

To check an agency:

• Ask for its Home Care Organization license number and look it up through the state’s Community Care Licensing search tools.
• Ask whether every caregiver is on the Home Care Aide Registry, and ask for the caregiver’s registry number before the first shift.
• Confirm caregivers are W-2 employees, not independent contractors.
• Ask for proof of workers’ compensation and liability coverage.

Nona’s Home Care is a licensed California Home Care Organization, License #374700282, serving San Diego County and Orange County. We’re glad to share this information with any family before care begins.

What about hiring a caregiver directly?

Some families skip both options and hire a private caregiver they found through a friend, a church, or an online listing. This is a third path, and it shares many of the same risks as a registry arrangement, often with even less support.

If you hire directly, you are almost always the employer. That means handling taxes, insurance, overtime, and backup coverage yourself. You also do your own background checks and reference calls, and you manage any disputes about hours, pay, or duties.

Direct hiring can work for a family that has the time and knowledge to be an employer, especially for a small number of predictable hours. For families who need reliable coverage, personal care, or care that may increase over time, the protections of a licensed agency usually matter more as needs grow.

What red flags should you watch for in any care contract?

Whether you are comparing a home care agency vs registry or two agencies, read the service agreement carefully before signing. Watch for terms that limit your flexibility or shift risk to your family.

• Large deposits or prepayment for weeks of care
• Weekly minimums that make you pay for hours you don’t need
• Long-term contracts or steep cancellation fees
• Vague language about who employs the caregiver
• No written backup plan for when a caregiver is sick or quits
• Fees for schedule changes on short notice

Ask for the agreement in writing and take time to review it. A good provider will answer questions directly and will not pressure you to sign the same day. Nona’s has no deposits, no weekly minimums, and no long-term contracts, and schedule changes need only 24 hours’ notice.

How do you decide which option fits your family?

The right choice depends on how much risk and responsibility your family can carry. A few honest questions can clarify the decision:

• Who will handle payroll, taxes, and insurance, and do they have the time?
• What happens on a day the caregiver calls in sick?
• Does your parent need help with bathing, toileting, or transfers, where training and supervision matter most?
• Will care hours likely grow over the next year?
• How would your family handle an on-the-job injury?

If most answers point to needing support, an agency is usually the safer choice. Families across San Diego and Orange County use Nona’s free in-home assessment to compare options with real numbers. Our caregivers are background-checked, dementia-trained where needed, and backed by backup caregivers, so care continues even when plans change.

What paperwork should you keep either way?

Whichever option you choose, keep a simple care file. It protects your family if questions come up later about hours, pay, or what happened on a given day.

• The signed service agreement or employment agreement
• Timesheets or visit records for every shift
• Invoices and proof of payment
• Caregiver names and registry numbers
• Notes on any incidents, falls, or changes in your parent’s condition

These records also help if you file a long-term care insurance claim or apply for benefits, since insurers and agencies often ask for proof of care received.

Frequently asked questions

What is a caregiver registry? A service that refers or matches caregivers to families, usually without employing them.

Is a registry cheaper than an agency? Often per hour. Registry and private caregivers usually charge $25 to $30 per hour versus $40 to $50 for a licensed agency depending on the level of care, but the family assumes all legal liability and insurance costs.

Am I the employer if I hire through a registry? You may be. Ask whether the caregiver is the registry’s W-2 employee, and get advice.

Who is liable if a caregiver is injured in my parent’s home? With an agency, the agency’s workers’ compensation typically covers it. Otherwise, the family may be responsible.

Are Nona’s caregivers employees? Yes. Nona’s employs, trains, insures and supervises its caregivers.

Home care agency vs. registry: key takeaways

In a home care agency vs. registry comparison, the key difference is employment. A licensed agency employs caregivers and handles payroll, taxes, insurance, training, and backup. What is a caregiver registry? A referral service that matches families with caregivers but usually leaves the family as the employer.

Registries vs. licensed agencies also differ in cost and risk. Private and registry caregivers usually charge $25 to $30 per hour, but the family assumes all legal liability and insurance costs, while licensed agencies charge $40 to $50 per hour depending on the level of care. The same logic applies to a nurse registry vs. home care agency. Always ask who employs the caregiver before you sign. See private caregiver vs. agency in California and 12 questions to ask before hiring an in-home caregiver.