How to Hire Private-duty caregivers: An Employer's Guide

A private-duty caregiver is the hire that delivers your service: one caregiver matched to one private-pay client, in an assignment that can run long, consistent blocks of hours. The tasks themselves are the everyday caregiver mix: companionship and conversation, meal preparation, light housekeeping, errands and transportation, and hands-on help with bathing, dressing and moving safely. What makes the role distinct for you is the assignment pattern, not the task list.

Medicare does not pay for 24-hour-a-day home care, homemaker services unrelated to the care plan, or custodial personal care when that is the only care a person needs — so non-medical home care is generally paid privately, through Medicaid, VA benefits or long-term care insurance. Your clients are buying dedicated coverage: the same face every day, for hours Medicare does not fund.

That makes reliability the product. A call-off on a long assignment does not reshuffle one visit — it leaves a client's entire day uncovered at once, and your office spends the morning re-building a schedule instead of selling one. Every step below — qualifications, screening, pay, the offer — points at the same question: will this person show up on time, for the full assignment, week after week, and use good judgment in someone's home?

Both placement models hire for this role, and the difference matters before you post anything. A full-service agency employs the caregiver and directs the work; a registry refers caregivers to households that direct their own care. The IRS reads the employer relationship from who controls what work is done and how — and that answer decides whether payroll, Social Security and Medicare taxes and workers'-compensation checks sit on your books or the household's. The home care registry vs employer agency model guide compares the two in detail.

The worker's side of this arrangement — how caregivers find private clients, what they charge, and how they handle contracts — lives in the private-duty caregiver career guide. This page stays on your side of the hire.

Write the qualification list from the assignment, not from the job title. "Private-duty caregiver" can mean a companionship-only case, a hands-on personal care case, or a case that needs certified-aide scope — and the rule that applies follows what the assignment includes, who the employer is, and what your state requires of your service line.

For non-medical private-pay assignments, the training and competency expectations come from your state's rules for the agencies it regulates. Those rules are written state by state and they change, so confirm the current requirements with the state agency that oversees home care where you operate before anything goes into a posting. The state-by-state pattern — what a regulated state writes into orientation, initial training, competency checks and annual education — is walked through in the caregiver hiring guide.

For assignments that need certified-aide scope, verify the credential itself rather than accepting a resume line. A Medicare-certified home health agency may use only qualified home health aides. The federal rule lists four routes: a training and competency evaluation program, a competency evaluation program, a state-approved nurse aide program while listed in good standing on the nurse aide registry, or a qualifying state licensure program. Where the route is a training program, classroom and supervised practical training must total at least 75 hours, with at least 16 hours of classroom training before at least 16 hours of supervised practical training. When a candidate holds a credential from another state, verify it at the source — the registry or agency that lists it — and check whatever your own state requires before the first shift.

If you run a registry, the employer question splits the picture again. When an agency provides the worker and controls what work is done and how, the worker is not the household's employee. When the household employs and directs the worker instead, IRS Publication 926 puts household-employer duties on the family. Those duties include Social Security and Medicare taxes once the family pays $3,000 or more in cash wages to one household employee in 2026. Publication 926 also tells household employers to check whether state law requires workers' compensation coverage. Your referral agreement still sets what you place, so screen, orient and reference-check every caregiver you refer.

Rules change, and they are state-specific. Confirm the qualification, training, verification and employer requirements that apply to your assignments with the state agency that oversees home care in your state before you write them into a posting or an offer.

The occupation you are hiring from is large, and the replacement math never pauses. BLS Employment Projections project home health and personal care aide employment to grow 18.1% from 2025 to 2035 — from 4,677,100 jobs to a projected 5,524,400 — with 760,500 openings projected each year.

PHI, a direct care research and policy organization, separately projects an estimated 9.7 million total job openings in direct care from 2024 to 2034, once occupational transfers and labor-force exits are counted alongside new jobs. The two series differ — BLS projects 2025 to 2035, PHI's estimate covers 2024 to 2034 — but they point the same direction: constant replacement hiring is part of running this business, so the pipeline runs even when the roster looks full.

Work the channels you control first: previous applicants and rehires already in your file, employee referrals with a structured reward, and your own postings. Add a training pipeline for certified scope — partnerships with CNA schools put your openings in front of new graduates, and the CNA school pipeline guide covers how the partnerships and paid-training arrangements work. Staffing agencies can cover short-term gaps while your own pipeline catches up.

The channel-level detail — which boards earn their budget, how to word the ad, how to structure referral rewards — belongs to the recruitment strategy guide. Before you publish anything, browse the private-duty caregiver jobs board to see the postings your ad will compete against and what candidates in your market are being offered.

Run every candidate through the same fixed sequence: application review, phone screen, interview, reference calls, then the background screening your state and your payer contracts require. A fixed sequence treats candidates consistently, and it leaves you a record of how every hire was made.

Two pieces of federal paperwork govern the sequence. Before you order a consumer report on an applicant — a criminal background check or a motor vehicle record — the Fair Credit Reporting Act requires a clear written disclosure in a stand-alone document and the applicant's written authorization. And a covered employer can require a medical examination only after a job offer and before duties begin, and only if every entering employee in the job category is required to take one.

Health screening comes next. CDC guidance recommends TB screening of health care personnel upon hire, and does not recommend routine annual testing unless there is known exposure or ongoing transmission. That is a recommendation for health care personnel: whether non-medical home care aides must have TB tests is set by state licensing rules, so confirm what your state requires.

Then there is exclusion screening. Federal law does not require providers to check the OIG's List of Excluded Individuals/Entities, but OIG recommends screening before hiring and periodically. The exposure is real for an agency that bills federal programs: no Medicare, Medicaid or other federal health care program payment may be made for any item or service furnished by an excluded individual.

When the assignment needs certified-aide scope, verify the credential at its source before the first shift: an active listing on the state nurse aide registry, checked the way your state's verification rules direct. What to run, in what order, and with which written disclosures is the territory of the background checks guide, and the nurse aide registry check guide covers registry verification step by step.

BLS publishes no "private-duty caregiver" occupation, so there is no wage line with your role's name on it. The closest published group is home health and personal care aides (SOC 31-1120), which BLS reports combined — benchmark against it, and label it as the broader group when the number goes into a budget conversation.

In the May 2025 Occupational Employment and Wage Statistics, the group earned a national median of $17.21 an hour — $35,800 a year — with a 10th-to-90th percentile hourly range of $13.00 to $21.65, in payroll employment of 4,305,810.

The industry row moves the median. Aides in home health care services (NAICS 621600) had a median of $17.42 an hour. In services for the elderly and persons with disabilities (NAICS 624120) — the row where most non-medical home care agencies are classified, though individual agencies may be coded under home health care services — the median was $16.73 an hour, with 2,274,140 employed. These are May 2025 medians: benchmarks to set a range against, not offers to copy. Live postings in your market show what competing agencies are offering.

Then budget the wage-hour rules, because long private-duty assignments are where they bite hardest. Since January 1, 2015, third-party employers such as home care agencies cannot claim the FLSA companionship-services exemption. Your agency owes at least the federal minimum wage — $7.25 an hour, though state or local minimum wages may be higher — for all hours worked. It also owes overtime at time-and-a-half over 40 hours in a workweek. Third-party employers are barred from the live-in overtime exemption too, even when the worker is jointly employed by the household; only the household itself may claim these exemptions.

The exemption's own definition explains the boundary: companionship services means fellowship and protection, and care counts toward it only if it does not exceed 20 percent of the total hours worked per person and per workweek. An agency cannot claim that exemption for its assignments at all, so every hour you assign — companionship or hands-on care — is paid; the 20 percent test matters only when a household is the one claiming the exemption.

Two more rules attach to long assignments. Travel between clients during the workday is compensable hours worked, and the third-party employer owes it. On duty of 24 hours or more, employer and employee may agree to exclude a bona fide regularly scheduled sleeping period of not more than 8 hours when adequate sleeping facilities are provided. Interrupted sleep must be paid while it lasts. And if the caregiver cannot get reasonable periods of sleep totaling at least five hours, the entire night must be paid. The companionship exemption and overtime guide and the live-in and 24-hour pay compliance guide work through both in detail.

Interview against the assignment, not a generic script. The questions that matter in private duty are about judgment across long, unsupervised stretches. Ask what the candidate does when a client refuses a task, when they call the office instead of handling something alone, and how they would report a change they noticed during a visit. Listen for answers that stay inside the role and report up the chain.

Keep interview and application questions about the job and the candidate's work history — EEOC guidance says pre-employment information requests should be limited to what is essential for determining whether a person is qualified for the job. Give every candidate the same working skills check, mirroring the tasks the assignment actually includes, so you compare like against like.

Call references yourself rather than delegating all of them. A short conversation with a former supervisor tells you more about call-offs, boundaries and punctuality than a written file: ask whether the person showed up on schedule, how they handled a refused task, and whether they would rehire them.

Put the offer in writing with the concrete terms of the job. Name the schedule and the hours the assignment covers, the hourly rate, and how travel time between clients is paid. Add the overtime terms that follow from the rules in the pay section above, mileage and transportation expectations, the training you provide and when it happens, and the client types the role covers. If you use hiring or retention bonuses, build in one federal rule: bonuses promised at hiring, or announced to keep employees working steadily, are not discretionary — they must be included in the regular rate used to compute overtime.

Onboarding starts before the first solo shift. Sequence the first weeks around whatever your state requires of your service line, then layer your own program on top. That program covers documentation, the clock-in routine your scheduling system uses, and your escalation path for changes in a client's condition. Pair every new caregiver with an experienced one for shadow shifts on the assignments they will actually cover. The caregiver onboarding guide walks those first weeks.

Keep the training calendar running after week one, at whatever cadence your state requires of your service line, and document every hour so your training files match the rules your agency operates under.

Retention is where the hiring math pays out. PHI, a direct care research and policy organization, attributes direct care workers' median annual earnings of just under $26,000 to low wages and part-time hours — annual earnings that include part-time schedules, which is why the figure sits below the BLS annual median of $35,800 above. The levers it points at are hours and wages, and both are yours to set: consistent assignments, full hours for caregivers who want them, and a range set against your live market. Judge your own retention from your own records — separations, exit reasons, how long new hires stay — then fix what your records name. The caregiver retention guide is the playbook.

Registry operators keep the same work in a different shape: retention means keeping strong caregivers in your referral pool, which is the same wages-and-hours lever applied through the placements you offer. The scheduling, overtime and wage-hour topics around this hire sit in the employer hiring guide.

Employer information, not licensing, legal, medical, benefits or tax advice. Training, screening, registry and pay rules come from the state agencies and federal bodies named above — confirm the current requirements with the state agency that oversees home care in your state, the DOL, the IRS, or your attorney or CPA before you hire.