Alternatives to Care.com for elder care
A marketplace is one of four ways to find a caregiver in Massachusetts, and they differ less on price than on a single question: who is responsible when the caregiver is sick, hurt, or not the right fit?
There are four routes: an online marketplace, a caregiver registry, a home care agency, or a provider referred through a state programme. With a marketplace or a registry you generally become the caregiver's employer, which in Massachusetts brings workers' compensation at 16+ hours a week and payroll taxes past $3,000 a year. With an agency, the caregiver is the agency's employee. With a state-referred provider, the programme arranges and often subsidises the care.
The four routes at a glance
| Route | Who employs the caregiver | Cover for a missed shift |
|---|---|---|
| Marketplace (Care.com and similar) | You | You find someone |
| Registry (referral service for independent caregivers) | Usually you — check the contract | They may refer a replacement; not guaranteed |
| Agency (Westmark and others) | The agency | The agency sends a replacement |
| State-referred provider (through your ASAP) | The contracted provider | The provider |
| The employment question drives almost everything else: taxes, insurance, liability, and who spends Sunday evening on the phone when Monday's caregiver calls in sick. | ||
1. Online marketplaces
You search profiles, interview, and hire. The hourly rate is the lowest of the four routes and the control is the highest — you choose exactly who comes, and you can pay them directly.
What comes with it: you are the household employer. Massachusetts requires workers' compensation insurance for a domestic employee working 16 hours a week or more, and an employer without it can be issued a stop work order and fined a minimum of $100 a day until covered. Once cash wages pass $3,000 in a year, Social Security and Medicare apply — 7.65% from you — reported on Schedule H with your own return. And when your caregiver has flu, the schedule is yours to fix.
We have worked the full arithmetic out on a separate page: what Care.com actually costs once the second bill is counted.
2. Caregiver registries
A registry sits between a marketplace and an agency. It maintains a roster of independent caregivers and refers one to you, often for a placement or ongoing fee. The screening is usually more than a marketplace does and less than an agency does.
The detail that matters is buried in the contract: in most registry arrangements the caregiver remains an independent contractor and you — not the registry — are the party responsible for taxes, insurance and supervision. Before signing, ask three questions in writing:
- Am I the employer of this caregiver, or are you?
- Do you carry workers' compensation and liability insurance covering work in my home?
- If this caregiver stops coming, what exactly do you do, and by when?
3. Home care agencies
The caregiver is the agency's employee. One hourly rate covers wages, employment taxes, workers' compensation, liability insurance, background screening, supervision and cover for missed shifts. You are a customer rather than an employer, and the rate is higher because it contains all of that.
An honest caveat, because you will not read it on many agency websites: Massachusetts does not licence non-medical home care agencies. There is no state inspection to rely on, so quality varies between agencies and the burden of checking falls on you. Ask any agency, including us, for proof of liability insurance and workers' compensation, their screening process, what happens when a caregiver cannot come, and their rate card in writing. Ours is published.
If clinical care is needed — wound care, injections, skilled nursing — that is a different category: a Medicare-certified home health agency, which is licensed and is usually ordered by a doctor.
4. State-referred providers
If your parent has MassHealth or a modest income, the Aging Services Access Point for their town can assess them and arrange care through contracted providers, sometimes at no cost or on a sliding scale. This route is slower to start and you have less choice of caregiver, but it is the only one where somebody else may pay.
Start with MassOptions, 1-800-243-4636, Monday to Friday, 9am to 5pm. It is free and independent of anyone selling care, us included.
And the fifth route nobody lists: word of mouth
Councils on Aging, church boards, neighbours and the discharge planner at the hospital all know caregivers. The person you find this way is often excellent and cheaper than any of the above. Be clear-eyed that it is still a direct hire — the same employer duties apply, and there is no backup — and check references yourself even when the recommendation came from someone you trust.
How to choose
- Few hours, someone you already know and trust: hire directly, and keep an eye on the 16-hour and $3,000 lines.
- Regular hours, working family, no capacity to manage a schedule: an agency, because cover is the product you are actually buying.
- Limited income or MassHealth: call MassOptions first. Do not pay privately for something the state may arrange.
- Hands-on personal care, transfers, or dementia: whichever route you take, insist on documented training and supervision. Companion care and personal care are not the same job.
Common questions
Is Care.com cheaper than an agency?
The hourly rate is lower. The total often is not, once workers' compensation, the 7.65% employer share of payroll taxes past $3,000 in wages, and cover for missed shifts are counted. The full arithmetic is here.
What is the difference between a registry and an agency?
An agency employs the caregiver and is responsible for taxes, insurance, supervision and replacement. A registry generally refers an independent caregiver and leaves those responsibilities with you. Ask in writing which one you are signing.
Are home care agencies licensed in Massachusetts?
Non-medical home care agencies are not licensed by the state. Medicare-certified home health agencies, which provide skilled nursing and therapy, are. For non-medical care, ask directly for proof of insurance and screening rather than relying on a licence.
How do I find a caregiver without paying an agency?
Marketplaces, registries, Councils on Aging and word of mouth all lead to independent caregivers. Budget for the employer duties that come with it: workers' compensation at 16 hours a week or more, payroll taxes past $3,000 a year, and your own backup plan.
Can the state help pay for a caregiver in Massachusetts?
It can, depending on income and need. MassOptions on 1-800-243-4636 will connect you with the Aging Services Access Point for your parent's town, which assesses eligibility for state home care programmes at no charge.
What should I ask before hiring any caregiver?
Who employs them, who insures them, what background checks were done and when, what happens when they cannot come, and what the total hourly cost is with everything included. Get the answers in writing, from a marketplace, a registry or an agency alike.
Want a number to compare against?
Whatever route you are weighing, it helps to have one all-in figure on the table. Ours is free, in writing, with no obligation — and if your best option is a state programme or someone your neighbour recommends, we will tell you that too.
Sources
Household employment taxes and the $3,000 cash wage threshold for 2026: IRS Publication 926, Household Employer's Tax Guide. Workers' compensation for domestic employees at 16+ hours a week, and the stop work order and minimum $100/day penalty: Mass.gov, Workers' Compensation Insurance Requirements. Aging Services Access Points and MassOptions: massoptions.org. Licensing: Massachusetts licenses home health agencies providing skilled services; non-medical home care agencies are not state-licensed. Westmark rates are our published rates as of September 2026.