In-Home Care: Licensed Agencies vs. The Gray Market

by Kim Keller

There are two ways to secure in-home care — through a licensed agency or through the “gray market,” a term which simply refers to in-home care without using an agency. The gray market has become popular because it’s less expensive.

But cost is obviously not the only factor to consider. Marki Flannery of Partners in Care, part of the Visiting Nurse Service of New York, gives this list of things to consider when hiring in-home care:

  • Will the home health aide be caring for someone with a diagnosed medical condition?
  • If my mom hates the person I hire, can I quickly find a replacement — or even a replacement for the replacement?
  • If this person calls in sick or plans a vacation, am I able to work from home to provide care?
  • Can I trust this person to do the food shopping for my dad and only buy what he needs and not extras?
  • I’m worried that my mom might fall and break her hip — again — and then need to be hospitalized; do I have an aide who is trained to prevent falls?
  • What is the chance that my situation becomes one of those awful newspaper stories of ‘elder abuse’ or financial fraud?
  • If my dad’s condition worsens and more medical attention is needed, can I get a registered nurse to come to the home? To talk directly to this doctor? To arrange a plan of care?
  • And, finally, do I need help understanding the health care system in this country and who pays for what?

This list is taken from a December 23, 2008 interview Flannery did with Jane Gross of The New York Times, which appeared in Gross’s blog, “The New Old Age.” This particular entry was entitled, “Home Health Aides: Why Hire From an Agency?

Getting help through the gray market can be successful. There are many dependable people out there looking for employment, and cutting out the agency reduces the cost of getting help. But Flannery’s list of concerns touches on the generally more reliable alternative of using a licensed agency. In addition to the state and federal regulations they must comply with, agencies also check their staffs’ credentials, provide training and supervision, provide coverage for absences, and are generally flexible if and when your needs change.

In our situation, we went from needing just a few hours a week, in order to give Mom a break, to full-time coverage when our dad really needed to be cared for 24/7. As his health worsened and our situation became more complex, we required a higher level of care, and the agency was able to accommodate us at every turn.

Of course, everyone’s situation is different, but we want to stress that we’ve heard from so many people who had great success hiring through the gray market. If you do choose the gray market route, and you have considered Flannery’s points above, then don’t forget to conduct your own reference and background checks. You’ll also need to pay the appropriate taxes for this person, as well as considering any potential insurance risks. Either way, here’s some more helpful information about “Where To Look For Help.


Kim Keller is the Co-Founder of In Care of Dad.  She lives and works in New York City.

Thank you Enrico Grande for the use of your photograph for this article.



18 Responses to “In-Home Care: Licensed Agencies vs. The Gray Market”

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