When James Yates split his femur after a total hip replacement last year, he needed help at home. He got from Tina Webster, who is an employee of senior care agency Home Instead Senior Care.
"I was too sick and hurting and anything else at the moment. It could have been someone homeless off the street, I couldn't have cared," says Yates.
With guidance from the hospital he went the agency route. Like other agencies, Home Instead does background checks, extensive interviews, training, and requires references, but it does not require a license.
"Non-medical homecare is unlicensed in California. There have been various attempts to develop some licensure guidelines, not there yet," says Cathy Murray from Home Instead Senior Care.
Murphy says that's why an agency is so important -- taking care of background checks and supervising caregivers.
"This population is very vulnerable, and if the only relationship that exists is between the caregiver and the client, that's not enough," says Murray.
But Webster has worked independently and when asked if she'd advise people to hire a caregiver not with an agency, she had this response.
"That's kind of hard for me to answer because I would definitely hope someone would hire me if I'm not with an agency," says Webster.
Short of state licensing, Murphy says agencies adhere to guidelines from the national private duty association; most agencies are members.
"If you're really looking for peace of mind, high quality service, and the least amount of risk in having someone come into your home and take care of a senior, you're not going to want to be looking for services on Craigslist," says Kelly Osterling, president of San Francisco's Senior Helpers.
If you do choose to bypass an agency, remember you will be responsible for all those government requirements like payroll taxes, healthcare insurance and in San Francisco, paid sick leave.