We have used an agency and paid for private in home sitters. I refused to pay under the table and instead kept up with their pay and put it all on an easy to fill out 1099 form. That way I can take the expenses off on taxes, and they add to their social security. For the ones that were afraid to lose food stamps, WIC etc., I did not flinch and they could leave or lose benefits and make legitimate money, and be proud of providing for themselves WITHOUT government assistance. However, I have used an agency and independent people. I have decided to stay with the agency. Less check writing, they handle the schedule, and I can enjoy my hubby more. If someone calls out, a replacement is sent. We have had a few glitches, but I called and the problem was remedied immediately. I also have a list of preferred caregivers (that took a bit of time to develop with the agency) and those are the only ones that come here. They are 24/7, they are paid weekly, I approve the schedule in advance, and they are covered by the agency's insurance.
We also have the Veteran's Direct Care of 40 hours a week. This person has to be an independent contractor or a family member. However, homeowners insurance will tell you they are covered...this is not true. When I asked if someone is in our home as an employee, and gets hurt, is it covered. The answer is not as long as they are getting paid for work. They must have their own insurance. (The VA will sell workman's comp insurance for a reasonable fee. )
My dad was in a facility. It cost $8,700 a month for a room. Even at that rate, it was understaffed and cleanliness for him and the room was an issue. My siblings and I visited him three times a day because we loved him dearly AND to be sure his needs were met. It was exhausting.....I will not do that to my hubby as the facilities in this area, regardless of cost, all seem to have similar issues with staffing, care, food.....etc.
I hope maybe I have shown some positives about each one (except the "reputable facility").
Very happy with using a nationwide agency! I just have to be very specific about who I prefer to have in our home. (I did use a mom and pop agency for a bit and that was not near the quality of the one we use that is also a VA approved agency.)
Sorry for rambling..please excuse errors...hubby needs me!