Home care agency or home care registry in PA?

The one difference between an agency and a registry

An agency employs its caregivers; a registry refers independent contractors. Both need the same Department of Health license, and both answer to the same hiring rules.

Pennsylvania's definitions are almost word-for-word twins. An agency supplies, arranges or schedules employees to provide home care, and a registry supplies, arranges or refers independent contractors to do the same work. Everything else in the two definitions, including the client directing the care and the fee changing hands, is identical.

So the choice is really about who carries the employer's obligations. With an agency, you run payroll, withhold taxes and cover the workers under your insurance. With a registry, the caregiver is running their own small business and you are the matchmaker, which shifts those obligations but does not make them disappear.

Pennsylvania defines a home care agency as an organization that supplies, arranges or schedules employees to provide home care services for a fee. — 28 Pa. Code § 611.5, Pennsylvania Code, retrieved 2026-09-27

A home care registry is defined as an organization that supplies, arranges or refers independent contractors to provide home care services for a fee. — 28 Pa. Code § 611.5, Pennsylvania Code, retrieved 2026-09-27

Scenario one, a companion agency with six employees

Picture a founder who hires six part-time companions as W-2 employees, schedules every visit, and sets how each Tuesday companion visit runs. That is an agency.

The founder controls the schedule, the tasks, the uniform and the pay rate. Those are the facts the IRS looks at when it decides whether a worker is an employee: behavioral control, financial control, and the type of relationship. When all three point toward the business, calling the workers contractors on paper does not change what they are.

Operationally the agency route is heavier: payroll, unemployment registration and workers' compensation from the first hire, covered in the payroll page. It is also the route clients understand. They are buying care from your company, and your company answers for it.

The IRS weighs behavioral control, financial control and the type of relationship when deciding whether a worker is an employee or an independent contractor. — Internal Revenue Service, retrieved 2026-09-27

Scenario two, a registry that refers independent caregivers

Picture instead a founder who keeps a roster of self-employed caregivers, introduces them to families, and lets each caregiver and family agree the schedule and tasks between themselves. That is a registry.

The registry model only holds if the independence is real. A registry that sets the caregiver's hours, trains them on its own methods, and disciplines them for being late is exercising exactly the control the IRS test looks for. If a determination is ever needed, Form SS-8 exists for it, but the IRS warns a ruling can take at least six months.

Nothing about the registry model relaxes the screening rules. Registries must collect the same criminal history reports, references, health screening and competency proof for every caregiver they roster, as the background check guide walks through.

at least six monthsThe IRS says a determination on Form SS-8 about whether a worker is an employee may take at least six months. — Internal Revenue Service, retrieved 2026-09-27

two referencesChapter 611 requires a home care agency or registry to obtain at least two satisfactory references before hiring or rostering a direct care worker. — 28 Pa. Code § 611.51, Pennsylvania Code, retrieved 2026-09-27

What the client has to be told about worker status

Before care starts, every client must be told in writing whether their caregiver is an employee or an independent contractor, and what tax and insurance obligations follow from that.

This is where the registry model gets practical. A family using a registry caregiver may take on responsibilities they did not expect, and the disclosure exists so they find that out before the first visit rather than after an injury. The Department supplies a Consumer Notice of Direct Care Worker Status form for this, and its FAQ says the form belongs in the client packet.

Agencies give the same notice. For them it is short: the caregiver is our employee, and we carry the employer obligations. The rest of the packet is covered on the caregiver training page.

Pennsylvania requires agencies and registries to disclose the employee or independent contractor status of the direct care worker and the resulting tax and insurance obligations. — 28 Pa. Code § 611.57, Pennsylvania Code, retrieved 2026-09-27

The Department of Health says its Consumer Notice of Direct Care Worker Status form must be included in the packet given to the consumer. — Pennsylvania Department of Health, Home Care Agency/Registry License FAQ, retrieved 2026-09-27

The federal overtime rule points toward the agency model

Since the Labor Department's 2013 rule, third-party employers such as home care agencies cannot claim the companionship or live-in exemptions from federal minimum wage and overtime.

For an agency, that means caregivers are owed federal minimum wage and overtime, however light the work feels. Some founders are drawn to the registry model partly to avoid that. It is a weak reason: if the caregivers are really employees, the overtime obligation follows them regardless of the label.

The rule may change. The Labor Department published a proposal on July 2, 2025 to return to its 1975 regulations, but its own page describes that as proposed, not final. Plan payroll on the rule in force today.

The U.S. Department of Labor says its 2013 rule precluded third-party employers like home care agencies from claiming the companionship or live-in exemptions. — U.S. Department of Labor, Wage and Hour Division, retrieved 2026-09-27

July 2, 2025The Department of Labor published a proposed rule on July 2, 2025 that would return to its 1975 companionship regulations. — U.S. Department of Labor, Wage and Hour Division, retrieved 2026-09-27

How to pick, and what to do next

Choose the agency model if you want to control how care is delivered; choose the registry model only if caregivers will genuinely run their own schedules and terms.

Some organizations meet both definitions and hold one license covering both, since Chapter 611 applies to entities that meet both. Whichever you pick, it goes on the application, and changing your mind later means updating the Department.

The model also shapes your risk. An agency's employees are your liability, which is a reason to hold the license in a company rather than your own name. Read how the entity types compare before filing anything.

Chapter 611 applies to home care agencies, home care registries and entities that meet both definitions. — 28 Pa. Code § 611.3, Pennsylvania Code, retrieved 2026-09-27

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