Some people are lucky to find private care workers who are not provided through an agency. These private in-home care situations are usually a more positive experience than home care services provided by an agency because the relationship is built and developed between one or two people. The caregivers are working and paid directly by the patient and the family and have the ability to provide a family- like service, many times actually becoming part of the family and developing a personal interest in the patients and families they serve. This is a great service if you can find it. The downfall of relying solely on assistance from one private caregiver is not having an extra support system or back up plan in place, if and when the caregiver gets sick or needs to take a leave of absence. One can envision limitations when the care needs increase and 2 caregivers or 24hr care is needed to accommodate the care needs. This plan also lacks any higher level of medical management and coordination of the increasingly complex and disconnected Health Care System.