You are not hiring one thing. You are hiring a person who works for someone, and that difference decides who gets the phone call when the aide does not show up.

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.

Two setups, two sets of duties

An agency hire puts the agency on the payroll, on the insurance, and on the schedule. The aide is the agency's employee, and you are its customer. An independent hire makes you the employer. You choose the person, set the hours, handle the pay and tax paperwork your state requires for household employers, and find a replacement yourself when they are sick. Neither setup is wrong. They are different jobs, and most burned-out daughters only learn which job they signed up for in the second month.

What to get from an agency before you sign

Ask for these in writing, not on the phone. First, a certificate of insurance covering workers' compensation and general liability, showing the carrier name and the coverage dates, sent to you directly by the agency. Second, their background check process: what it covers, how often it repeats, and whether it applies to substitutes. Third, the replacement promise: how long it takes for a substitute to arrive when the regular aide calls out, and what happens when no one is available. Fourth, the minimum shift length and the billing increment, because a short visit billed in fixed blocks costs more than the hours you actually used. Fifth, the cancellation notice required from you and from them. Sixth, who sets the schedule and who can say no to a change. Seventh, whether the written care plan lists the tasks, and which tasks the aide will not do. Last, the overtime and holiday rules.

What you take on if you hire directly

When the person works for you, you track the hours, run the payroll and tax filings your state requires, and answer the question of what happens if that person is hurt while working in your parent's home. Check your state's household employer rules, and ask your insurance agent whether your homeowner's or renter's policy covers a worker injured on the property. Those are questions for a professional, so put them to one rather than guessing. You also need a written backup plan. Ask the person who their substitute is, whether that substitute has been checked, and whether they have agreed to be called.

Run the sick-day test

Pick a Tuesday and ask each option the same question: 'My aide is out sick at seven in the morning. Who comes, how fast, and who pays if no one comes?' Write down the answer, the name of the person who gave it, and the time it took to reach them. An agency should give you a process and a phone line that someone answers. A direct hire should give you a named substitute who has already agreed. If either answer is 'we will try,' you have found the gap before it lands on you.

Put the two offers side by side

Compare the options on five lines: the hourly rate, the minimum shift and billing block, the replacement window, who holds the insurance and the background check, and what you personally do each week to keep the arrangement running. The lowest rate often hides the most of your own work. Medication reminders and picking up a prescription can be errands an aide handles, but the medicine itself, including sorting and giving it, stays with the family, the doctor, and the pharmacist. Whichever option you choose, the written agreement should say so.

You are allowed to pick the option that leaves you at least one day a week you do not have to cover. If you want a second set of eyes on the written list, Local Help for Caregivers in St. Louis has local starting points.