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My aunt has had a live in home care aide for over a year. The agency went bankrupt but we want to keep her aide. Can we pay her to stay without any agency, and how do we deal with the aide paying taxes and my aunt writing it off as a medical expense. She is bedridden and this aide is wonderful!

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Get a copy of the current contract. Take that to an attorney and have him write a similar contract between the aide and the aunt. He can also advise your aunt on how to set up a payroll and insurance.
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Thank you for your advice, is it possible to pay her aide and just give her a w2 or 1099 for taxes? My aunt can not afford a lawyer.
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