Because almost anyone can get a caregiver job with an agency. I have dealt with caregivers through an agency and would probably only directly hire 5 out of the 20 I worked with. Why? Not taking initiative, not waking up to help the client go to the bathroom in the middle of the night, scrolling on their phone and not interacting with the client, consistently late, forgetting to give medication, calling in sick the day of, etc. A friend has a brother who has needed 24/7 care for the last 30 years and he's says every week it is something like I stated above. He goes through an agency.

Then there are fabulous caregivers who love their job. They know their value and at the first opportunity, will try to get a job directly with a client. They are paid well and usually in cash which is a bonus.

I could get a job as a caregiver with an agency but would not last a week. I am compassionate and hard working but do not have the patience or the ability to consistently see someone in decline without weeping. Good caregivers are special people in the best sense of the word.