Hiring In-Home Help in Central Ohio: Licensed Agency vs. Privately Hired Caregiver

Ohio licenses non-medical home care — a fact most families never learn until after they have already signed with someone. Here is what that changes about the agency-versus-private-hire decision.

By Ray Kessler, Certified Senior Advisor & Family Consultant · Published August 28, 2026

The Fork in the Road Most Families Hit First

Long before anybody tours an assisted living community, most central Ohio families try the obvious middle step: bring help into the house. A few hours a day, someone to handle bathing and meals and the drive to the cardiologist in Upper Arlington, and everyone gets to keep the arrangement everyone actually wants. And almost immediately the question becomes a fork. Do you go through an agency, at a rate that makes people wince, or do you hire the woman from church whose sister did this for years and who would come for a good deal less? Nearly every family we talk to has had some version of that conversation at a kitchen table in Westerville or Grove City or Lancaster. The honest answer is that both paths work for some families and neither is automatically the responsible choice — but the tradeoffs are not the ones most people assume going in, and in Ohio there is a wrinkle that changes the math.

Ohio Licenses Non-Medical Home Care — and Most Families Don't Know It

Here is the wrinkle. In a lot of states, "home care" that involves no nursing — bathing, dressing, meals, laundry, companionship, reminders to take medication — is essentially unregulated. Anyone can print business cards. Ohio is not one of those states. Under Chapter 3740 of the Ohio Revised Code, the Ohio Department of Health licenses home health providers in two distinct categories: Skilled Home Health Services and Non-Medical Home Health Services. The non-medical license is the one that covers home health aide and personal care services — hands-on help with activities of daily living, assistance with self-administered medications, and homemaker work like cleaning and laundry.

The application details tell you how seriously the state treats it. Each license carries a $250 non-refundable application fee. The primary owner of a non-medical agency must submit an actual fingerprint impression card to ODH — specifically a fingerprint card, not merely a criminal record check. And applicants whose business was not already providing direct care immediately prior to September 30, 2021 must post a surety bond: $20,000 for a non-medical license, $50,000 for a skilled one. Ohio also licenses "nonagency providers," meaning individuals delivering this care on their own rather than through a company, which is exactly where the privately hired caregiver conversation starts to get complicated. If you are hiring someone independently in central Ohio, it is a fair and reasonable question to ask whether they hold their own ODH license or need one for the arrangement you have in mind.

For families, the practical takeaway is simple: you can verify this. An agency either holds a current ODH license or it does not, and you are entitled to ask which license and what number before you sign anything.

What You Are Actually Buying From an Agency

The rate difference between agency and private hire is real, and it is worth understanding what sits inside it. A licensed agency is absorbing several things a family otherwise absorbs itself. It employs the caregiver, which means it handles payroll, tax withholding, and workers' compensation coverage — so if an aide hurts her back transferring your father out of a tub in Reynoldsburg, that is the agency's exposure, not your parent's homeowners policy. It carries liability insurance and typically bonds employees against theft. It runs background checks as a matter of routine. It supervises: most agencies send a nurse or care manager to the home periodically to reassess whether the care plan still matches the person. And it maintains a bench.

That last one is the item families consistently underweight, so it gets its own section.

The 6 A.M. Phone Call

Ask any family two months into a private-hire arrangement what went wrong, and a striking number will describe the same morning. The caregiver's car will not start, or her own child is sick, or she has quietly taken a better-paying job and is not coming back. It is 6 a.m., someone has to be at your mother's house in Hilliard by 7, and the entire arrangement rests on one person who is now unavailable. An adult daughter takes a personal day. Then another. Then the arrangement starts eating the very thing it was supposed to protect.

An agency's answer to that call is a substitute caregiver, sometimes an unfamiliar one, but a person who shows up. That is a meaningful portion of what the higher rate buys, and it is nearly impossible to replicate privately unless a family recruits and vets two or three caregivers instead of one. Families who succeed with private hire almost always do exactly that — they build their own bench in advance rather than discovering the need for one at 6 a.m. on a Tuesday.

The Real Cost of Private Hire, Once You Add It Up

The hourly savings are genuine. The total savings are usually smaller than the hourly number suggests, because a caregiver working set hours in your parent's home under your parent's direction is generally a household employee, not an independent contractor. That distinction is not a technicality a family gets to opt out of by handing over cash or issuing a 1099. It means the household becomes an employer, with the obligations that follow: withholding and paying Social Security and Medicare, federal and Ohio unemployment filings, and a workers' compensation question to run past the Ohio Bureau of Workers' Compensation, which sets a low earnings threshold above which household employers are expected to carry coverage. The federal wage thresholds that trigger these duties are set by the IRS and adjust annually, so check the current year's figures rather than relying on a number a friend remembers.

None of this makes private hire wrong. Plenty of central Ohio families do it well, and continuity of caregiver — the same trusted person, every day, for years — is a real and underrated benefit that agencies struggle to match. But the families for whom it goes smoothly tend to be the ones who treated it as employment from day one: a written agreement, a household payroll service, a background check they paid for themselves, a clear understanding of who covers a missed shift, and a conversation with an accountant before the first paycheck rather than the following April.

Paying for It in Central Ohio

Most in-home care in central Ohio starts as private pay, but it is worth knowing the other doors before you assume that is the only one. Long-term care insurance policies frequently cover home care, and some policies pay only when care comes from a licensed agency — one more reason the ODH license question matters. Veterans and surviving spouses may qualify for VA Aid and Attendance, which can be applied toward in-home help. County senior services levies across the region fund some in-home support directly, which is a separate track from Medicaid entirely. And Ohio's PASSPORT waiver includes a consumer-directed option that allows a participant to hire and supervise their own attendant, with a fiscal agent handling payroll and Medicaid billing — certain relatives can be hired that way, though spouses face real restrictions and the rules change often enough that they should be confirmed with the Central Ohio Area Agency on Aging rather than assumed.

How to Vet Either Option Before Anyone Starts

For an agency: ask which ODH license it holds and confirm it with the state rather than trusting a badge on a website. Ask whether it has had substantiated complaints — ODH runs an enforcement and complaints program for licensed home health providers. Ask what happens when a caregiver calls off, how many different aides a typical client sees in a month, whether a supervisor visits the home, what the minimum shift is, and whether rates change on weekends, holidays, or overnights. Get the rate structure in writing before the first shift, not after.

For a private hire: run a real background check yourself rather than relying on a reference from a friend of a friend, and ask whether the caregiver is licensed by ODH as a nonagency provider or believes they need to be. Put the arrangement in writing — hours, duties, rate, notice period, what happens when either side needs a day off. Set up payroll properly from the first check. And build the bench before you need it.

When In-Home Help Stops Being the Right Answer

In-home care scales beautifully up to a point and then stops. The point is usually not a specific number of hours — it is the moment a family realizes it is adding hours every few months rather than holding steady, or that nights have become the problem, or that the person needs someone within earshot rather than someone on a schedule. Around-the-clock coverage at home is expensive enough that it frequently exceeds what a residential setting costs, and the family is still absorbing the holidays and the gaps. That is not a failure of the plan; it is the plan doing its job right up until the need outgrew it. If you are watching that curve bend, it is worth pricing both paths side by side before the next increase forces the decision under pressure.

Where to Start This Week

Write down honestly what hours are actually needed and what tasks actually matter — not the ideal schedule, the real one. Call three licensed agencies serving your parent's county and ask each the no-show question and the turnover question; the answers will separate them faster than the rate sheet will. If private hire is on the table, price a household payroll service and a background check so you are comparing complete numbers rather than hourly rates. And if long-term care insurance exists, pull the policy out and read what it requires of a provider before you choose one, because that single clause can decide the question for you.

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