Two arrangements can put the same person in Dad's kitchen on the same Tuesday. In one, you hire an individual yourself, usually called a direct hire. In the other, a company employs the worker and bills you. The care can look identical on day one. The difference shows up in payroll, scheduling, and who answers the phone when the worker does not show.

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.

Aid and Attendance is paid to the veteran, not to the caregiver or the agency, so the money trail runs from Dad's account to whoever you hire.[1] That makes it important to know, before any shift starts, who the legal employer is.

What a direct hire makes you responsible for

With a direct hire, the family is the employer. In practice that usually means you set the schedule, agree on pay, keep time records, and decide how taxes and workers' compensation coverage will be handled. Some families use a payroll service. Others file the forms themselves. Ask a tax preparer or your state labor office which rules apply in your situation, since they depend on where Dad lives and how the person is paid.

What an agency takes off your desk

An agency is the employer of its staff. Its invoice carries the hourly rate, and the agency normally handles scheduling, payroll, and finding a replacement when a worker calls out. Do not rely on the sales call for insurance. Ask for the written statement of which liability and workers' compensation policies cover its workers, and check that the policy is named for the work being done in Dad's home.

Questions to put to each option

Ask a direct hire: who covers the shift when they are sick, who keeps the time log, and what you will do if Dad's needs grow beyond what you can supervise. Ask an agency: whose name is on the invoice, what the minimum shift length is, how fast a replacement arrives, and whether you can hire one of its workers directly later and what that costs. Write the answers down before the first shift.

Where the choice usually lands

Families who want one steady person and can carry the employer tasks often choose a direct hire. Families who want one phone number and a backup plan often choose an agency. Neither is the wrong answer. The fair comparison is the administrative hours you can keep up with each week, not the hourly figure on a single quote.

If you want help sorting the St. Louis options, including offices that explain the choice without selling a plan, see the Local Help page. For how this desk checks its claims, see Sources.

Footnote

[1] VA.gov, Aid and Attendance and Housebound benefits.