Choosing home care for a loved one is a crucial step, often filled with emotions and questions. It's a bit like choosing a co-pilot for an important journey: trust, competence, and compatibility are essential. One of the first major decisions you will have to make is structural: should you opt for direct employment, where you become the employer of the caregiver, or go through a service provider, who takes care of everything?
These two paths lead to the same destination—the well-being of your parent—but the landscapes and responsibilities of the journey are radically different. With us, we support families and professionals facing these choices every day. Our experience has shown us that there is no one-size-fits-all solution, but there is a solution suited to each situation, each family, each need.
In this article, we will thoroughly explain to you, with clarity and without jargon, the pros and cons of each model. Our goal is not to tell you what to choose, but to give you all the tools you need to make the most informed and serene decision possible for you and your loved one.
Before weighing the pros and cons, it is fundamental to understand what each option concretely implies. These are two philosophies of home care, with very distinct legal, administrative, and human implications.
The direct employment model: you are the employer
In the context of direct employment, also known as "caregiver agreement," the relationship is simple and bilateral: you, or your loved one, are the employer, and the caregiver is your employee. This configuration gives you a central role and total responsibility.
Specifically, this means you have to manage the entire process from A to Z. You are responsible for recruitment (posting ads, conducting interviews, checking references), drafting the employment contract in accordance with the collective agreement of individual employer employees, and all related administrative formalities. Every month, you must prepare a pay slip, declare the hours worked, and pay social contributions to the URSSAF (via the CESU service, Universal Service Employment Cheque, which greatly simplifies the process but does not eliminate your obligations). You must also manage paid leave, absences due to illness, and, if necessary, the end-of-contract process (dismissal, mutual agreement termination), which can be complex and delicate.
Choosing direct employment is somewhat like becoming the manager of a micro-enterprise dedicated to your loved one's well-being. It requires time, organization, and some comfort with administrative tasks.
The service provider model: delegated simplicity
The service provider mode is radically different. Here, you are not an employer, but a client. You sign a service contract with a specialized structure (an association or a home service company). This structure is the employer of the caregiver who will work at home.
The service provider manages absolutely everything. It recruits, trains, and supervises its staff. It manages schedules, employment contracts, salaries, social contributions, and insurance. In the case of the regular caregiver's absence (illness, holidays), it is the organization's responsibility to find a replacement to ensure service continuity, an absolutely crucial point for families' peace of mind. Your sole responsibility is to pay the monthly invoice sent by the organization, which corresponds to the hours of service provided.
If a problem or disagreement arises with the caregiver, the organization plays a mediating role. It is your sole point of contact, a safety net that frees you from all administrative and legal complexities. You buy a turnkey service, a peace of mind.
The Advantages and Disadvantages of Direct Employment
Now that the basics are set, let's take a closer look at what the status of an individual employer can bring to you, with its benefits and constraints.
The advantages: total control and a privileged relationship
The main benefit of direct employment lies in control and personalization. You choose, after a recruitment process that you manage yourself, the person who will share your loved one's daily life. This highly personal choice often allows you to find the rare gem, someone whose personality and skills perfectly match your expectations.
The relationship that develops is often more direct and stronger. There is no intermediary. This closeness can foster great stability. If the relationship is good, the same person will intervene in the long term, which is particularly reassuring for an elderly person, especially if they suffer from cognitive disorders that make them sensitive to change.
Finally, the financial aspect is often a significant argument. The hourly cost in direct employment is generally lower than that of a service provider. You pay the net salary of your employee and the social contributions without the margin that the service provider applies to cover its own structural costs (management, supervision, recruitment, etc.).
The disadvantages: a heavy administrative burden and significant responsibilities
The downside of total control is total responsibility. Administrative management can quickly become a real burden for a family already very solicited by the situation of their loved one. Declarations, vacation calculations, legal monitoring to stay in compliance with labor law... All this requires time and energy that we do not always have.
The greatest source of stress remains the management of the unexpected. What do you do if your caregiver falls ill on a Monday morning at 7 am? Or if they take three weeks of vacation in August? It is up to you, and you alone, to find an emergency replacement. This lack of service continuity can be extremely destabilizing for the assisted person and distressing for the family.
Finally, as an employer, you are subject to all legal obligations. A conflict with your employee can lead to complex situations, even litigation before the labor courts. The end of the contract, whatever the reason, must comply with strict legal standards, with compensation to be paid. This legal dimension is often underestimated from the start and can prove to be tricky.
The Advantages and Disadvantages of the Service Provider Mode
Going through an organization seems to be the easy way. But does this simplicity have a cost, and does it imply compromises?
The advantages: peace of mind and security
The number one argument of the service provider mode is undoubtedly serenity. You delegate all the constraints. The organization is your only contact and the guarantor of the quality and continuity of the service. It is an immense weight lifted off your shoulders. You no longer have to worry about schedules, replacements, pay slips, or potential conflicts.
Safety is another major advantage. Serious organizations have rigorous recruitment processes: verification of diplomas, experiences, criminal record. Their caregivers are supervised professionals, often continuously trained and insured. The organization has civil liability in case of a problem (a broken object, an error in care...). This professional framework is particularly reassuring, especially when the required help is complex (personal hygiene care, transfers, management of severe pathologies like Alzheimer's).
Moreover, the organization can provide real expertise. It will know how to accurately assess your loved one's needs and propose the most suitable caregiver for the situation, mobilizing specialized profiles if necessary.
The disadvantages: higher cost and less direct control
Peace of mind comes at a price. The hourly rate in the service provider mode is logically higher than in direct employment. This difference covers the salaries of supervisors, management costs, recruitment and training costs, and the organization's margin. It is important to request detailed quotes to understand what the rate includes.
The other major disadvantage is the loss of control over the choice of the caregiver. It is the organization that selects the person who will come to your loved one's home. Although you can express preferences and request a change of caregiver if it does not work out, you are not at the heart of the initial recruitment process.
Finally, the risk of "turnover" can be higher in some organizations. Seeing several different faces can be very disturbing for an elderly person, who needs stable landmarks and trusting relationships to feel safe. It is therefore crucial to inquire about the organization's personnel management policy before committing.
How to Choose? Essential Criteria to Evaluate
The choice between these two models is a personal decision. There is no right or wrong answer, only the one that suits you best. To help you see more clearly, here is a list of questions to ask yourself:
- Your time and energy: Do you have the time, desire, and skills to manage the administration and recruitment? Be honest with yourself about the mental load you are willing to take on.
- The nature of the needs: Is the help occasional and simple (a few hours of cleaning or companionship) or is it daily, complex help, involving care and constant supervision? The more complex the situation, the more the secure framework of a service provider is recommended.
- The importance of continuity: Is it more important for you that it is ALWAYS the same person, even if there is no solution in case of absence? Or is it crucial that there is ALWAYS someone, even if it's not the same person?
- Your budget: Calculate the total cost over a year, including paid leave and any end-of-contract compensation for direct employment. Compare it to the service provider's quote. Sometimes, the difference is smaller than it initially appears, especially if you value the time and peace of mind gained.
- Your attitude towards risk: Are you comfortable with the legal responsibility of an employer? Or do you prefer the security of a service contract where responsibilities are borne by a third party?
Beyond Status Choice: The Importance of Training and Tools
Whether you choose direct employment or the service provider mode, status is not everything. The real key to success lies in the quality of human support. A caregiver, even the most devoted, needs to be trained and equipped, especially when dealing with complex conditions like Alzheimer's disease. This is where our mission makes perfect sense.
The importance of training for complex conditions
Supporting a person with Alzheimer's disease is not improvised. You need to know how to communicate when words fail, how to manage behavioral disorders with kindness, how to stimulate memory without putting the person at a disadvantage. It's a skill that goes far beyond mere physical aid.
That's why we've developed a training session dedicated to stimulation and creating a bond with the elderly. This training is intended for both professionals in service provider structures and direct employment caregivers and even families. We share concrete techniques for building a connection, soothing anxieties, and offering suitable activities that bring meaning and joy to everyday life. A well-trained caregiver means better support for your loved one and a more serene family.
Facilitating communication and stimulation on a daily basis
The relationship between the caregiver and the cared-for is woven into the little things of everyday life. But when verbal communication becomes difficult, you need to find other ways to maintain the bond. It is with this conviction that we designed our tools.
Our memory game program on a tablet, EDITH, is much more than just a pastime. It's an excuse for exchange, a support for sharing a pleasant moment. The caregiver can sit with your loved one and play a quiz about songs from the past, a proverb recognition game... These activities, designed to be stimulating but never frustrating, create smiles, revive memories, and strengthen the bond of trust. They turn a simple presence into a true moment of sharing.
Similarly, we have noticed that one of the greatest frustrations for people with cognitive disorders is not being able to express a simple need: "I'm thirsty," "I'm cold," "I have pain here." To meet this fundamental need, we have created MON DICO. It's a very simple application, with large clear images, which allows the person to point out what they feel or need. For the caregiver, it's a precious tool, a real translator of intentions that avoids misunderstandings and frustrations on both sides.
In conclusion, the choice between direct employment and the service provider mode is an important decision that entirely depends on your personal context. Take the time to weigh each aspect. But never forget that behind the status, there is the human. Whatever path you choose, ensure that the person who will accompany your loved one is not only competent but also trained and equipped with the right tools to turn their intervention into a rich and calming relationship. It is the most beautiful guarantee you can offer your parent for their well-being at home.
In the discussion about the advantages and disadvantages of direct employment of a caregiver versus a provider, it is also relevant to consider the financial aspects related to home care. An interesting article on this subject is Does health insurance cover home care? This article explores how insurance can cover certain costs related to home care, which can influence the decision between directly employing a caregiver or going through a provider.
