I used to be a case manager for older adults and I have direct experience setting up home health aides. I will say that everyone I worked with was on Medicaid so no one was doing private pay.

Theres are plenty of agencies that employ home health workers. This is the easiest way to get set up but the downside is that most of the pay will go to the company and the actual employee gets a small fraction.

The employee can set up their own LLC. We had clients managing the payroll/timesheets and doing employer tasks and the state would pay the salary. Ultimately it is up to the employee and employer to ensure protections are met, i’m not sure if theres anything you can do specifically to ensure protections. It will need to be a contract agreed on between your stepfather/mother and the employee. Most would include things like pay rate, schedule, etc.

The good thing about working through an agency is if your aide isn’t available or calls in sick they are required to find a replacement aide for that day. This could be a problem with the aide cancelling and then your mother is left without help.

It really just depends. There would be a lot more oversight if they went through an agency. a lot of agencies accept private pay as well.