How I Find, Hire and Keep a Great Care Attendant

Early on in my injury, I didn’t want to do it. It was horrifying enough to have my mom and grandma help me with personal care. But a stranger? No way! 

And then I had to. Between my mom working full-time and her already-existing back problems, and Grandma being, well, a grandma, it needed to happen.  

And having outside help was the best thing that could have happened. For everyone. 

Success – and Failure 

Thankfully, after eight years I had been accepted to receive reimbursement for wages through the Personal Care Attendant Program in Kentucky. (Check with your state’s independent living centers for options near you.)  

For years I used small agencies and was fairly successful finding good people to help me with bathing, dressing and the bowel program. By using an agency, I wasn’t responsible for payroll, withholding or paying taxes.  

But my luck finally ran out with agencies. After a string of bad apples through the only affordable company, I finally decided to hire someone myself.  

But how do you find a good, reliable personal care attendant? How do you do payroll and taxes?  

I was overwhelmed.   

Finding a Personal Care Attendant  

When I first ventured out on hiring a caregiver, I hired a friend. I’d sworn I was never going to do that. But she had experience and needed a job. And I needed a PCA.  

Thankfully, it was a match made in heaven. Yasmin is not a morning person, but she showed up on time, did what was needed, all while singing Disney melodies (that would stay stuck in my head the rest of the day).  

But Yasmin decided to return to school, which would interfere with the morning schedule. I was clueless as to where to look for someone new 

I tried the obvious: posting information at nursing, OT and PT schools and rehab facilities. No luck there (but I know many other people who have). So I tried This service requires a monthly fee to communicate with potential employees, but in my case in was worth every penny. I hit the jackpot when I found Trish. (There are other companies like this that you can check out, too.) 

After a year and a half, Trish needed to care for her own family. I was crushed, but also fully understood her reasons for leaving. Read the letter I wrote to her here 

Louise had been cleaning for me, but had previously done home health. She stepped in to Trish’s place seamlessly. And I’ve given her name to a number of friends. Right now Louise juggles four of us in her schedule… and keeps us all up and going and living life. 

I always try to connect my friends via word of mouth with other reliable caregivers who are looking for additional work.   

The Responsibilities of Hiring a Caregiver 

When I was being reimbursed from the state program, they required that I give a caregiver a W-2 and withhold taxes as part of the program. I sought out an online payroll service to take care of withholding Social Security, Medicare taxes, unemployment tax and state taxes. 

An online payroll service allowed me to enter the hours worked and the system would automatically withhold taxes and pay the salary via direct deposit. I was responsible for writing checks for quarterly taxes and printing out W-2s at the end of the year.  

I currently use HomePay, but quite a few online payroll services are out there. Compare prices as well as the services they offer.   

Is a Payroll Service Really Worth It? 

When the cost of the payroll service went up, I had ask myself: Is the expense really worth it? 

For me, yes.  

Not only does the online service handle payroll, they also pay quarterly taxes for me (withdrawing from my checking account) and submit all state and federal forms and my caregiver’s W-2. All I do is enter the hours worked on a bi-weekly basis. Since I’m already juggling a full-time job and then some, I feel it is worth saving my brain-power and energy for other things  

Employee or Contractor? 

Several people have suggested that rather than giving my PCAs a W-2 and having to withhold and match taxes, that I could hire PCAs as contractors. I could simply file a 1099 and not be responsible for taxes.  

So, what’s the difference between an employee and an independent contractor? It can be a fine line.   

After desperately seeking advice from the IRS, accounting software quizzes and accountants, it boils down to who is in charge of how the work is done: 

  • Are you telling someone what time report? 
  • Are you, as the employer, explaining how the job (i.e., your care) should be done?  
  • Is the person going to be hired for an indefinite period of time (until they quit or you fire them)?

If your answer is yes to the questions above, then more than likely that caregiver is an employee – not an independent contractor.    

With that being said, talk with an accountant to discuss your specific situation.   

Keeping Your Care Attendant 

If you have a great PCA, maintain a good working relationship. Appreciate a job well done. Say thank you. Be polite. Even when I have a day off from work, my PCA doesn’t. I’m grateful for her thoughtfulness, attention to detail and punctuality.  

Where Do I Start? 

If you are just beginning the process of hiring a care attendant, here are some ideas on how to begin: 

  • Write down what you need help with. How often do you need assistance? How long will you need a PCA each day/visit? 
  • How much can you afford? A good PCA is worth their weight in gold. You get what you pay for.  
  • What are your needs on holidays? Will you pay time and a half? Adjust your schedule?  
  • If your caregiver is sick, do you prefer them to not come? 
  • How much notice do you request an attendant to give before vacations – or quitting?  
  • Write a contract detailing your expectations.  
  • How will your caregiver enter the house? Will you give the PCA a key – or get a keypad entry? 
  • Do you want to take on the responsibilities of payroll or will you hire an accountant or online payroll service? 
  • Do a trial run. With your current caregiver present, allow the interviewing PCA see how things are done. Do they really know what a bowel program is? 
  • Understand that a routine takes time to develop. It’ll typically get smoother over time. If it doesn’t, you guys might not be a good fit. And that’s okay. 
  • Most often, a personal care attendant becomes much more than an employee; they become a friend. But remember your role. If you need to speak up and make some changes, do it. Don’t be taken advantage of. 


To keep you informed of new stories from Jenny, please click on the link below to 'Join Our Community'. All we need is your name and email address.