Emma's family didn't know what to do. Her son put grab bars in the shower. Her daughter brought lunch over every day. The neighbors checked in often. But at 82 Emma needed more help. She wasn't able to manage her medicines, and she was having a regular problem with incontinence. Then she forgot to take her key out of the front door, and she left the water running in the kitchen sink all night. Staying home alone just wasn't working for Emma.

Agencies will typically be the most expensive; independent providers will be the least expensive. However, home care agencies are also easier to use, since the agency finds and places the provider, handles payroll and any problems that may arise, and usually provides coverage for sick or absent providers. Agencies that are licensed and bonded are generally a good choice, although there are always exceptions. You have avenues of recourse (complaints, legal action) when dealing with agencies that are liable for problems. There is no real recourse (except firing) when dealing with independent providers or ones found through registries.

It used to be pretty simple.  So long as you were independent, you lived in your own home, or moved to a retirement community.  If you needed a little help with personal care, and your meals provided, you went into board and care.  If you needed quite a bit of help with personal care, or skilled nursing care, you went into a nursing home.