agency vs. registry

Nearly every family I talk to asks some version of the same question in the first ten minutes: what's the difference, and which one do we want? It's a fair question and almost nobody answers it straight, usually because they only offer one of the two.

Gilgal operates both. So I can tell you honestly which is better for which family, including the times the answer is "not us."

The one difference everything else hangs on

Who employs the caregiver.

That's it. That single fact determines the cost, the paperwork, the control you have, what happens when someone calls out sick, and who's liable if something goes wrong.

In an agency, the caregiver is the agency's employee. The agency hires them, pays them, withholds their taxes, carries workers' compensation, and assigns them to you.

In a registry, the caregiver is an independent worker. The registry screens them, verifies their clearances, and introduces them to you — but doesn't employ them. You engage them directly.

Both are licensed by the Pennsylvania Department of Health under Chapter 611. Both must meet the same clearance requirements. Neither is a loophole or a lesser option — they're two legitimate structures with genuinely different trade-offs.

What it costs, with real numbers

Let's start with the market, because families are routinely shocked here.

$33–34/hr

The median cost of in-home care in Pennsylvania — about $77,792 a year for a home health aide at 44 hours a week, per the Genworth and CareScout Cost of Care Survey.

Pennsylvania runs above national costs. And the national figure keeps climbing — the median for a non-medical caregiver reached $35 an hour in 2025, up 3% year over year.

One change worth knowing about: CareScout now reports homemaker and home health aide as a single category, because the two rates have converged. Two-thirds of agencies surveyed charge the same for both. So the old strategy of asking for a cheaper "homemaker" rate to save money mostly doesn't work anymore.

For context on the alternative — a semi-private nursing home room in Pennsylvania runs about $141,985 a year. Assisted living is around $73,206. In-home care sits between them, and for a lot of families it's the option that preserves the most of what actually matters.

Where the models diverge

A registry generally costs less per hour, because the overhead is lower. No payroll taxes, no workers' comp premium, no unemployment insurance, no benefits administration — those costs don't exist, so they aren't in your rate.

An agency costs more per hour, and part of what you're buying is that the agency absorbs all of it. You write one check. Nobody hands you a tax question.

	Registry	Agency
Who employs the caregiver	Nobody — independent worker	The agency
Hourly cost	Generally lower	Generally higher
Who withholds taxes	The worker, for themselves	The agency
Choosing the individual	You choose	The agency assigns
Setting the schedule	You and the worker	The agency
If someone calls out	You may need to arrange cover	The agency sends a replacement
Supervision	Primarily you	The agency
Workers' compensation	Worker's responsibility	Agency carries it
Best when	You want control and continuity	You want it handled

The question that decides it

Forget the models for a second. Ask yourself this instead:

When something goes wrong at 6am on a Tuesday, who do you want solving it?

If your answer is "I want to handle it, because I know my mother and I know what works" — that's a registry. You'll have a relationship with the individual caregiver. You'll build the schedule together. When the arrangement needs to flex, you flex it, without going through anyone.

If your answer is "I want to call someone and have it dealt with" — that's an agency. You pay more per hour and you get a phone number that answers. For a family already at capacity, that's not laziness. It's a rational purchase.

The honest version

The registry model gives you more control and asks more of you. The agency model asks less of you and gives you less say. Neither of those is a flaw. They're the trade, and the right answer depends entirely on how much bandwidth your family actually has.

Continuity — the thing nobody mentions until it matters

Here's something families discover three months in.

Under a registry, you tend to have the same person. You chose them, they work for you, and the relationship is direct. For someone with dementia — where a familiar face genuinely affects how a day goes — that continuity can be worth more than any other single factor.

Under an agency, staffing is the agency's problem to solve, which is a real benefit when someone is sick. But it can also mean a different face more often, particularly if the agency is stretched. Ask any agency directly how many different caregivers a typical client sees in a month. A good one will tell you honestly.

What a registry does not mean

There's a persistent misconception that registry means unvetted, and it's wrong — at least where the registry is licensed and doing its job properly.

Every worker on the Gilgal registry completes all required Pennsylvania clearances before placement: PA State Police criminal background check, PA Child Abuse History Clearance through ChildLine, and FBI fingerprint clearance where required. We verify identity, review employment history, and assess each person against our own standards.

What a registry doesn't do is employ them. That's a legal and financial distinction, not a screening one.

The tax question, answered plainly

Under a registry model, the caregiver is an independent worker responsible for their own taxes and insurance. Depending on how the arrangement is structured, you may have obligations of your own — this is the "household employee" question, and it's genuinely fact-specific. Ask any registry to explain it in writing before you start, and if the answer is vague, that tells you something. A licensed provider should be able to state clearly which model applies and what it means for you. We put it in writing every time.

Questions to ask any provider

Whether you talk to us or someone else, these separate the good from the rest:

• Are you a licensed agency, a licensed registry, or both — and which model applies to my situation?
• Who employs the caregiver, and will you put that in writing?
• What clearances does every worker have, and how do you verify they're current?
• What happens if my caregiver is sick — who arranges cover, and how fast?
• How many different caregivers would a typical client see in a month?
• What's the actual hourly rate, and what makes it go up?
• What happens if the match isn't working?
• What are you not able to do?

That last one matters most. Any provider who claims they can do everything is either misunderstanding your question or not being straight with you. We can't provide skilled nursing, physical therapy, or medication administration. If you need those, we'll tell you and help you find who can.

So which should your family choose?

A registry tends to fit families who want a say in who comes into the house, who have some capacity to coordinate, who value having the same person consistently, and who are cost-sensitive — which is most families, honestly.

An agency tends to fit families who are already at capacity, who are managing care from another state, who need coverage guaranteed regardless of who's available, or who simply want a single point of contact and are willing to pay for it.

And plenty of families start with one and move to the other as needs change. That's normal. Nothing about this decision is permanent.

One last thing

If you've read this far, you're probably deciding something on behalf of someone you love, and you're worried about getting it wrong.

You're less likely to get it wrong than you think. Both models are licensed, both are regulated, and the difference between them is structural rather than a difference in quality of care. What actually determines whether this goes well is the individual caregiver and whether the fit is right — and if it isn't, you change it. That's true either way.

Start by talking to someone. Ask the eight questions above. If the answers are clear and specific, you're probably in good hands. If they're vague, keep looking.

Gabrielle Dibonge is the founder of Gilgal Home Care & Registry in King of Prussia, Pennsylvania, licensed by the PA Department of Health under Chapter 611 and serving Montgomery, Chester, Delaware, Bucks, and Philadelphia counties. She has six years in healthcare and human services and an MBA — and Gilgal operates under both the agency and registry models, which is why this article doesn't argue for one.

Not sure which fits your family?

Fifteen minutes, free, no pressure. Tell us what's going on and we'll tell you honestly which model makes sense — including if the answer is that you need something we don't provide.

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Sources: Genworth and CareScout Cost of Care Survey (2024 and 2025 data releases), including Pennsylvania state medians. 28 Pa. Code Chapter 611, Pennsylvania Department of Health home care agency and registry regulations.

This article is general information, not legal, tax, or medical advice. Consult a qualified professional about your specific situation.