For most families, and especially for families who are doing this for the first time, an agency is the lower-risk starting point. That is not a universal answer, but it is the honest one.
Here is what changes between the two options.
When you hire through an agency, you are paying more per hour — typically $30 to $50 in most US markets — but that premium buys you things that are easy to underestimate until you need them. Background checks are handled. Criminal history, abuse and neglect registries, reference verification. If your regular caregiver calls in sick, the agency sends someone else. If things do not work out with a particular person, you call the agency and request a change. Payroll, taxes, and insurance are not your problem.
When you hire privately, you pay less — often 20 to 40 percent less — but you become the employer. That means you are responsible for running or commissioning background checks, verifying references, arranging backup coverage when the caregiver is unavailable, handling payroll taxes, and carrying the legal exposure if something goes wrong. For families with the time and capability to manage all of that, it can work well. For families who are already overwhelmed, it often adds stress rather than removes it.
There is a third consideration that matters specifically for parents with dementia or cognitive decline: consistency. For someone who is confused or anxious, a familiar face arriving at the same time each day is not a luxury — it is a meaningful part of how they stay calm and oriented. Agencies sometimes rotate staff, which is a legitimate criticism. But private hires have no-show days too, and without a backup system, that leaves your parent unsupported.
The approach many families end up taking is to start with an agency, learn what the role actually requires, and then transition to a trusted private caregiver once they have a clear picture of what they are looking for. That is a reasonable sequence.