The short answer, before you hire anyone
If you already have a candidate lined up, a nurse a friend recommended, someone from Care.com, or a business card from a hospital hallway, here is the compressed version, sourced in full further down.
- Hiring directly usually makes you an employer. If your family controls the nurse's schedule, duties, and pay, the IRS and California generally treat that nurse as your household employee, not an independent contractor you simply pay on a 1099.
- There is a real tax bill attached. Once you pay one household worker $3,000 or more in cash wages in 2026, you owe Social Security and Medicare tax on those wages, per IRS Publication 926. California adds its own registration requirement once you pay $750 in a calendar quarter.
- Two burdens fall entirely on you. The background check and the backup plan. An independent hire means your family verifies the license, runs the background check, and has no one to call if that one nurse is sick, on vacation, or quits.
- It is not always the wrong choice. Families who already run payroll for other household staff, or who need very limited part-time help, sometimes have the infrastructure in place already. What matters is knowing you are taking on the employer role on purpose.
This page is educational, not tax or legal advice. Confirm your family's specific obligations with a CPA, the EDD, or the IRS directly.
What does it actually mean to hire a nurse independently?
Hiring independently means your family finds and pays a nurse directly, with no agency or practice standing between you, often through a site like Care.com, a flyer, a hospital hallway referral, or word of mouth from another family. There is nothing improper about wanting that, many families like the idea of one familiar face and a personal arrangement. What most families do not realize is what that arrangement actually makes them, in the eyes of the IRS and the state of California.
Two terms explain it. A household employer is a family that pays someone to work in their home and controls how that work gets done, the schedule, the duties, and the pay rate, the way a business controls an employee, rather than simply being a client of an outside company. An employer of record is the entity that is legally responsible for a worker's payroll taxes, insurance, and employment paperwork. When you hire a nurse directly, your family is usually both the household employer and the employer of record, whether or not anyone ever wrote that down. When you go through an agency or a practice instead, the agency or practice is typically the employer of record, and your family is not.
Calling the arrangement informal, calling the nurse a contractor, or simply never putting anything in writing does not change which of those two categories your family falls into. The IRS and California both look at who actually controls the work, not what the arrangement is called.
What happens to your taxes when you hire a nurse directly?
Once you pay one household worker, and this explicitly includes a private nurse, not only nannies or housekeepers, $3,000 or more in cash wages in 2026, your family owes Social Security and Medicare tax on those wages, per IRS Publication 926. That combined tax is called FICA, and the rate is 15.3 percent, split evenly: 6.2 percent plus 6.2 percent for Social Security, and 1.45 percent plus 1.45 percent for Medicare, with the employer and the worker each owing half.
Federal unemployment tax adds a second trigger. Per the same IRS Publication 926, once your family pays $1,000 or more to household workers in any single calendar quarter, federal unemployment tax applies as well.
California adds its own, separate requirement, and its threshold is lower and faster than the federal one. Per the California EDD, a household employer must register with the EDD within 15 days of paying $750 or more in cash wages in a calendar quarter to household workers, using form DE 1HW. Once registered, State Disability Insurance withholding also applies.
What about workers' comp, and can I just pay a 1099?
There is a workers' compensation requirement, separate from the tax picture above. California law requires employers, including household employers, to carry workers' compensation insurance to cover employees hurt on the job, according to the California Department of Industrial Relations. A standard homeowner's insurance policy generally does not provide real workers'-comp-equivalent coverage for a household employee injured while working in your home, a gap many families never discover until after an injury happens.
One more thing worth knowing before you consider a workaround. Under California's worker-classification standard, an in-home caregiver whose schedule, duties, and pay are controlled by the family is generally treated as an employee, not an independent contractor. Paying a controlled household worker as a 1099 contractor instead of as an employee is a real compliance risk the IRS treats as employee misclassification, not a paperwork shortcut, so the "just 1099 them" workaround is usually not actually available under California law.
Who runs the background check when there's no agency in the middle?
You do, entirely. When you hire a nurse independently, verifying the license, running a criminal background check, checking references, and watching for anything that changes later are all your family's responsibility, with no second set of eyes and no institutional process behind you.
At minimum, verify any nurse's license yourself before care starts. Search by license number, not name, at the California Department of Consumer Affairs license search, search.dca.ca.gov, because common names can return the wrong person, sometimes one carrying discipline on record. Beyond the license, ask directly: has this person had a criminal background check, and can you see the result? Who are two families willing to talk to you about their experience? If something about their background changed six months from now, who would even know?
A vetted agency model handles license verification, a criminal background check, and reference checks before a nurse is ever placed in a home, and keeps watching standing afterward. That does not mean every agency does this well, ask any provider to show you the process, not just describe it, but it does mean the burden is not sitting entirely with a family that has no way to cross-check what it is being told.
What happens when your one independent nurse is sick, on vacation, or quits?
Care stops until you find someone else. An independent hire is one person, so a cold, a planned vacation, a family emergency, or a resignation leaves your family with zero coverage that day, at exactly the moment your family member still needs the same care.
Finding a second nurse of equal skill on short notice is hard precisely because vetting the first one properly already took real time and effort: the license check, the background check, the reference calls, the weeks it took that nurse to learn your family member's routine. Doing that twice, under pressure, with no notice, is a genuinely difficult position, and it is one of the most common gaps families discover only after they are already in it.
A model backed by a team is built around exactly this problem. Instead of one person with no backup, a supervised group of licensed nurses means a qualified replacement is something the practice can typically arrange, rather than something your family has to find from zero, on top of everything else already happening that week.
Is hiring independently ever the right call?
Sometimes, yes, if you go in with your eyes open. A page that only ever says "always use an agency" is not being straight with you, so here is the honest version.
- You already run household payroll. A family that already employs a nanny or a housekeeper, and already has EDD registration, payroll processing, and workers' comp coverage in place, has most of the infrastructure a nurse hire would need. Adding one more household employee is a smaller lift than starting from nothing.
- The need is small and short. Very limited, short-term, part-time help changes the math, because the exposure, the tax thresholds, the vetting effort, and the risk of a coverage gap, are all smaller when the arrangement itself is smaller.
- You already know the person well. A retired nurse who is a known family friend, with a clear written agreement and an eyes-open acknowledgment of the employer obligations above, is a different situation than a stranger found on a listing site the week of a hospital discharge.
How WholeHealth Concierge's model addresses each risk
WholeHealth Concierge places and supervises a vetted nursing team under the clinical oversight of a critical-care RN, so your family is not the nurse's legal employer, is not responsible for payroll tax or EDD registration, and is not the one running the background check. WholeHealth Concierge is insured and bonded, and because care is backed by a team rather than one individual, coverage does not depend on a single nurse's availability the way an independent hire does. Our private duty nursing page explains how nurses are placed and clinically supervised.
Federal tax rules and 2026 thresholds: IRS Publication 926, Household Employer's Tax Guide, irs.gov/publications/p926. California registration and disability insurance: the California Employment Development Department, edd.ca.gov, including its household employer registration guidance and its "Am I Required to Register as an Employer" pages. California workers' compensation requirement: the California Department of Industrial Relations. This page is general education, not individualized tax, legal, or insurance advice. Thresholds, forms, and rates change, so confirm your family's specific obligations with a CPA, an employment attorney, or the EDD and IRS directly. WholeHealth Concierge is not a Medicare-certified home health agency and does not bill Medicare.
Private duty nursing across the Inland Empire, Orange County, and LA
WholeHealth Concierge is based in Chino Hills, at the meeting point of San Bernardino County, Riverside County, Orange County, and Los Angeles County, so wherever your family is weighing an independent hire against a vetted team, we can be at your kitchen table within a day, not a week.
Chino Hills · Rancho Cucamonga · Ontario
Home-base coverage across the western and central San Bernardino Valley.
Corona · Eastvale · Temecula
Private duty nursing for Inland Empire families closest to our Chino Hills base.
Irvine · Newport Beach · Lake Forest
Post-discharge and complex care support across coastal and central OC.
Pasadena · San Gabriel Valley
RN-led, agency-employed private nursing across the LA metro.
Wherever your family lands on this decision, our private duty nursing program places a vetted, insured, team-backed nurse in your home, so no one in your family has to become an employer to get the care right.
Talk to a nurse before you decide how to hire.
A short call can walk through what your family actually needs, what an independent hire would mean for your taxes and your backup coverage, and whether a vetted, insured, team-backed nurse is the better fit. No pressure, and no obligation either way.
Agency-employed or independent hire, answered.
What does it mean to become a household employer when I hire a nurse directly?
A household employer is a family that hires someone, in this case a nurse, to work in their home and controls that person's schedule, duties, and pay, the way an employer would, rather than simply being a client of an outside business. Most families who hire a private nurse directly, off a site like Care.com, from a flyer, or through word of mouth, meet that definition without realizing it, because an informal arrangement does not change how the IRS and California see the relationship.
When do I have to pay Social Security and Medicare tax on a nurse I hire directly?
Once you pay that nurse $3,000 or more in cash wages in 2026, per IRS Publication 926. At that point your family owes Social Security and Medicare tax, known together as FICA, on those wages. The combined rate is 15.3 percent, split evenly: 6.2 percent plus 6.2 percent for Social Security, and 1.45 percent plus 1.45 percent for Medicare, with the employer and the worker each owing half. Publication 926 is explicit that this rule covers private nurses, not only nannies or housekeepers.
Do I have to register with California as an employer if I hire a private nurse myself?
Yes. Once you pay $750 or more in cash wages in a calendar quarter to household workers, including a private nurse, California requires you to register as a household employer with the EDD within 15 days, using form DE 1HW. Once registered, State Disability Insurance withholding also applies. Source: the California Employment Development Department, edd.ca.gov.
Can I just pay an independent nurse as a 1099 contractor instead?
Usually not, legally, in California. If your family controls the nurse's schedule, duties, and pay rate, which is true of almost every private hire, California's worker-classification standard generally treats that nurse as your employee, not an independent contractor. Paying a controlled household worker on a 1099 instead of as an employee is a real compliance risk the IRS treats as employee misclassification, not a paperwork shortcut.
Does my homeowner's insurance cover a nurse who is hurt while working in my home?
Typically, no. California law requires employers, including household employers, to carry workers' compensation insurance to cover employees hurt on the job, according to the California Department of Industrial Relations. A standard homeowner's insurance policy generally does not provide real workers'-comp-equivalent coverage for a household employee injured while working in your home, which is a gap many families do not discover until after an injury happens.
Who does the background check when I hire a nurse directly instead of through an agency?
You do, entirely. When you hire independently, verifying the nurse's license, running a criminal background check, checking references, and monitoring standing over time are all your family's responsibility, with no second set of eyes. At minimum, verify any nurse's license yourself by number, not name, at the California Department of Consumer Affairs license search, search.dca.ca.gov, since common names can return the wrong person. A vetted agency model, by contrast, handles license verification, background checks, and reference checks before a nurse is ever placed in a home.
What happens if the one independent nurse I hired is sick, on vacation, or quits?
Care stops until you find someone else. An independent hire is one person, so an illness, a vacation, a family emergency, or a resignation leaves your family with zero coverage that day, and finding a second nurse of equal skill on short notice is hard precisely because vetting the first one already took real effort. A model backed by a team can typically arrange a qualified replacement instead of leaving your family to start the search over from nothing.
Is it ever okay to hire a private nurse independently instead of through an agency?
Sometimes, yes, if you go in with your eyes open. A family that already runs payroll for other household staff, and already has EDD registration and workers' comp in place, has much of the infrastructure already built. The same is true for very limited, part-time help, where the exposure is smaller. What matters is knowing you are taking on the employer role and its obligations on purpose, not discovering it after the fact.
How does WholeHealth Concierge's model address these risks?
WholeHealth Concierge places and supervises a vetted nursing team under the clinical oversight of a critical-care RN, so your family is not the nurse's legal employer, is not responsible for payroll tax or EDD registration, and is not the one running the background check. WholeHealth Concierge is insured and bonded, and because care is backed by a team rather than one individual, coverage does not depend on a single nurse's availability the way an independent hire does. Our private duty nursing page explains how nurses are placed and clinically supervised.