There are advantages and disadvantages to using a private-duty nursing agency for hiring help in the home. The most obvious advantage is the agency pays the salary, taxes, Social Security, and worker's compensation. The agency usually provides background checks and health screenings and bonds the employee. However, don't assume this to be the case — ask, and get it in writing.

Most agencies have policies against customers hiring employees away from their agency, but some will work with you in a manner similar to how a temp agency works. They screen the applicants and you can try them out for a set period of time, then hire them permanently and pay the agency a fee for this service.

The employees are usually trained in CPR and how to handle an emergency. They have a supervisor to contact for help and advice. That supervisor can act as a buffer to mediate issues for you as well.

As discussed earlier in this chapter, there are rules and regulations licensed nursing agencies have to abide by. These are set by the federal, state, and local government to protect the public. Government agencies oversee the continued compliance with the rules and can intervene on your behalf if a legitimate complaint is filed.

These rules dictate the level of care provided by unlicensed caregivers as well as licensed nurses. Again, these rules are meant to protect the public. In hiring an agency to provide care, you will need to discuss all tasks you might expect the employee to perform. Unlicensed caregivers cannot perform any hands-on care, including grooming, dressing, bathing, and feeding. They can only provide care such as meal preparation, light housekeeping and laundry, and companionship to ensure if your parent falls or needs further assistance someone can call for help. They may or may not be allowed to transport your parent in a car or on a bus or other public transportation. Shopping and errands may not be something they can provide either, so be sure to ask.

Certified nurses aides can provide hands-on care but cannot dispense medications or perform medical tasks. Transporting patients is an issue that varies from state to state and even agency to agency, depending upon liability-insurance issues.

Hiring someone privately can eliminate some of these restrictions but can create other headaches for which you need to have a backup plan. The most obvious is if the person is ill or doesn't show up. You have to be the employer and withhold and pay taxes, Social Security, and provide a worker's compensation plan in case this person gets hurt on the job. You have to carefully check references.

If you have a community college or university in your vicinity that offers nursing programs or other health-care education, you may have an opportunity to find a pool of students willing to provide quality part-time care, but you still need to check them out carefully. Word-of-mouth advertising through a social network such as coworkers, church, school, and other personal contacts should be used first, as you'll have personal references to rely on. Local and throwaway newspapers can be your best bet, as opposed to the more expensive metropolitan publications potential employees cannot afford. Don't take short cuts: Screen your applicants carefully, and if you find a gem, reward and praise them.