Are all support agencies for in-house care merely "referral" companies?

This is not the case for all agencies. I work for a Home Care Company and our care givers are employees. We provide them training, certify them by the state regulations of New Jersey, and then once they are licensed, we hire them.

Gatorguy, go to the blue box on your right where it says "Find Care and Housing", click on "Home Care" and type in your zip code. Check other nearby zip codes, too.

I used a company called Home Instead and all their caregivers are employees of the company. I was quite pleased with the Agency. The Agency was licensed, bonded, insured, and had workman's comp for their employees. You pay the Agency and the Agency pays the caregivers.

The Agency sent out a Rep to check over the house and to meet my Dad, thus the Rep interviewed me, Dad, and I interviewed her, she asked the right question. Dad had a variety of caregivers who come in to help him and from that group he told me which one he enjoyed having around the house, who had his same crazy sense of humor, and he felt comfortable talking. It is so important to find a Caregiver, as Gladimhere above had mentioned, that is a good match :)

No. Many have their own employees. What they often do is refer their employees to you for interview to see if you think that person will be a good fit in your situation. Elderly can be very hard to please and often have decided they do not want help or do not want someone in their home.