Choosing Your FMHC Care Arrangement
A practical decision guide for FMHC families — compare agency, contractor, and direct-hire arrangements, and find the path that fits you and your family.
Care Arrangement Overview
One of the first decisions a Family-Managed Home Care family makes — usually during Meeting 1 with Ontario Health atHome — is how to structure care. You have three options: contract with a registered agency, hire a care worker as an independent contractor, or hire them directly as an employee. The choice shapes your administrative load, your effective hourly rate, and the legal relationship between you and the person providing care.
There's no universal right answer. Below is a closer look at each path, a side-by-side comparison, and a short quiz to help you find a starting point.
The Three Options at a Glance
Working with a Registered Agency
You contract with a home care agency. They employ the care workers, manage all payroll and HR, and send you monthly invoices. You pay the invoices from your FMHC bank account and report them on your monthly Schedule G&H.
Hiring an Independent Contractor
You find a specific caregiver who works as a self-employed contractor. They send you invoices for their services; you pay them from your FMHC account. They handle their own income tax, CPP, and insurance.
Hiring a Direct Employee
You become the employer of record. You register a CRA payroll account, run payroll each pay period, withhold and remit source deductions, register with WSIB if hours warrant, and file T4s at year-end. Your bookkeeper handles the mechanics; the legal responsibility sits with you as the contract holder.
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A Closer Look at Each Path
Working with a Registered Agency
The simplest path administratively. The agency employs the care workers and handles all of their payroll, taxes, insurance, and HR. Your role is to receive monthly invoices and pay them from your FMHC bank account. From a reporting standpoint, Schedule G&H is straightforward — each invoice is a single line item with the agency's name, hours, and amount.
The main trade-off is rate. Agencies charge an hourly rate that includes their margin, which can leave less budget room for other eligible expenses compared to a contractor or direct-hire arrangement. Continuity of caregiver(s) also depends on the agency — some assign the same worker(s) consistently, others rotate based on shift coverage and worker availability.
Best suited for families who want minimal administrative load and want a turnkey arrangement. Often the right starting point for families who are still figuring out what their care needs look like in practice.
Side-by-Side Comparison
| Factor | Agency | Independent Contractor | Direct Hire (Employee) |
|---|---|---|---|
| Administrative complexity | Lowest — pay invoices, report monthly | Moderate — track invoices, manage the relationship | Highest — full employer obligations |
| Hourly cost structure | Agency rate (includes their margin) | Contractor's rate paid directly to them | Wages + employer payroll costs (CPP, EI, WSIB) |
| Caregiver continuity | Depends on the agency's scheduling | Consistent — your chosen contractor(s) | Consistent — your chosen employee(s) |
| Worker management | None — agency handles recruitment, scheduling, and backup | You recruit, screen, onboard, and arrange backup coverage | You recruit, screen, onboard, and arrange backup coverage |
| Payroll & year-end tax obligations | None | None — they invoice you and file their own taxes | Full: CPP, EI, income tax remittance + T4s by Feb 28 |
| Insurance requirements | Agency carries | $2M CGL + $25K Abuse Liability — they carry | $2M CGL + $25K Abuse Liability — they carry |
| Time to set up | Fastest | Moderate | Longest |
| Best suited for | Families wanting minimal admin | Families with chosen caregiver(s) who meet CRA's contractor criteria | Families with admin capacity who want full control |
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How to Choose
The right path depends less on what's "best in general" and more on what fits your family's situation. Three questions can help you orient.
How much administrative work can you reasonably take on?
Agencies require almost none — pay an invoice, file the report. Contractors require some — track invoices, verify credentials, arrange contingency care. Direct hire requires real ongoing commitment — payroll calendars, CRA deadlines, T4 season, WSIB if applicable.
How important is having the same caregiver every visit?
Direct hire and independent contractor arrangements give you direct control over who provides care, so consistency is built in. With an agency, consistency depends on the agency's scheduling and worker availability — some agencies prioritize keeping the same worker assigned, others rotate based on shift coverage.
How well does the working relationship match CRA's criteria for contractor versus employee?
The CRA doesn't go by what your contract says — they look at who controls the work, who provides the tools, and who bears the risk of loss. If you're uncertain how to classify your situation, that's a question for a tax advisor or CRA directly (Form CPT1, Request for a CPP/EI Ruling).
Whatever path you choose, you'll need a qualified bookkeeper before Ontario Health atHome releases your first funding deposit. Schedule O of your agreement specifies the required bookkeeper qualifications. Tabber supports families across all three models, and our services are structured to fit within the bookkeeping allowance built into your FMHC budget — no out-of-pocket cost to you.
Frequently Asked Questions
Have Questions?
Every FMHC situation is different. If you're unsure which path makes sense for your setup, feel free to reach out — we're happy to talk it through.
Tabber is an independent bookkeeping provider and is not affiliated with Ontario Health atHome. Program requirements can change and may vary by agreement. This page provides general information only and is not legal, tax, payroll, medical, or eligibility advice. Families should follow their own signed agreement and confirm current requirements with their Ontario Health atHome care coordinator. For legal, employment, payroll, tax, or SDM questions, consult an appropriate qualified professional.