If you’re running a registry agency, you already know this isn’t a set-it-and-forget-it business.
In today’s environment — with growing regulatory scrutiny, rising caregiver expectations, and clients demanding more choice — operating a successful registry takes skill and discipline.
You’ve moved past the basics. You know how a registry works. Now it’s about running one that is compliant, competitive, and built to last. However, be aware of the hidden costs associated with operating a registry agency—such as payroll, taxes, training, and liability—which can be significant and are often overlooked by new operators.
Here are 10 must-know tips for strengthening your registry agency in 2025:
Registry agencies—sometimes called private duty registries or staffing services—play a unique role in the healthcare staffing landscape. Unlike traditional staffing agencies that employ their workers, registry agencies act as intermediaries, connecting families with a pool of potential caregivers. These agencies typically charge a finder’s fee for their services, but do not serve as the caregiver’s employer.
When families hire through a private duty registry, they often become the caregiver’s employer themselves. This means they take on important responsibilities, such as performing thorough background checks, contacting previous employers, and discussing duties, expectations, and compensation directly with potential caregivers. Families must also navigate the complexities of tax laws, including withholding taxes and proper reporting. Failing to comply can result in civil fines or even criminal penalties if caught paying “under the table.”
For families, the key difference with a registry agency is the level of involvement required in the hiring process and ongoing management. While registry agencies facilitate matches and provide access to a network of healthcare staffing professionals, the ultimate responsibility for compliance and oversight rests with the family. Understanding these distinctions is crucial for anyone considering a registry as their healthcare staffing solution.
If there’s one place registry operators can’t afford to cut corners, it’s here.
Your IC relationship must be well-documented and clearly structured:
Proper documentation should also clarify when the client or family is acting as the caregiver's employer. This status means the client is responsible for payroll, taxes, supervision, and other legal obligations associated with being the caregiver's employer.
Why it matters: Inconsistent documentation and “gray area” practices are the top reason registries end up in legal trouble.
Your client agreements are just as critical as your IC documents.
Clients should understand exactly what the registry does — and what it doesn’t do. Your agreement should clarify:
Clear, transparent agreements protect your business and strengthen client trust.
Your payment process is a major point of compliance risk.
Avoid third-party escrow services that don’t fit the registry model, and ensure your payment workflows:
Technology platforms like Ally can support this — but you must understand your obligations regardless of the system you use.
Your front-line team needs to understand how a registry operates legally.
If your office staff uses terms like “assigning shifts” or “employing caregivers,” you’re sending the wrong message — internally and externally.
Ongoing training on compliance and optics is essential for everyone who interacts with clients and caregivers.
Improper training or misunderstanding of compliance requirements could inadvertently result in an illegal act, making thorough education critical to protect your agency and staff.
Yes, caregivers are independent — but that doesn’t mean you can’t build a strong relationship with them.
Top registry operators focus on:
Happy caregivers stick with registries that respect their independence but still provide value.
Registry laws and IC classification rules vary by state — and they’re changing fast.
Strong registry agencies monitor:
Failure to comply with state and federal tax laws can result in hefty tax evasion penalties.
Proactive compliance beats reactive panic every time.
Manual systems can leave dangerous gaps. The right technology should help you:
Technology can’t replace good business practices — but it can make compliance much more achievable.
How you present your registry to the public, caregivers, and clients matters.
Small details — like language on your website or the way your team talks about your services — influence how your model is perceived. Using language or branding that blurs the line between a registry and a professional agency can create confusion and compliance risks, as professional agencies are licensed, regulated entities that provide trained, supervised, and insured caregivers.
Good registry optics reinforce your compliance story and protect your model. Poor optics can invite scrutiny, even if your internal practices are sound.
Over time, some registries drift toward agency-like behavior — especially under pressure to fill more cases.
Watch out for red flags like:
A strong registry stays disciplined about its model, even as it grows.
The most successful registries today treat their operation as a serious business — not a side hustle.
That means:
In today’s environment, a well-run registry agency can absolutely thrive — but it takes intention and operational excellence.
For a healthcare staffing agency to thrive in today’s competitive environment, a strategic approach to marketing and growth is essential. Building a strong online presence is the foundation—this means optimizing your website and content with relevant keywords like “healthcare staffing agency” and “certified nursing assistants” to ensure you’re visible to both clients and caregivers searching for services.
Leverage social media platforms to showcase your expertise, share success stories, and engage with your audience. Regularly posting about your services, industry trends, and caregiver opportunities can help attract both families and qualified professionals. Additionally, forming partnerships with healthcare facilities and organizations can expand your reach and credibility, opening doors to new referral sources and collaborative opportunities.
Don’t overlook the power of targeted digital advertising and local community outreach. By combining these efforts, your staffing agency can build a robust pipeline of clients and certified nursing assistants, fueling sustainable growth in the healthcare staffing sector.
Operating a healthcare staffing agency comes with its share of challenges, from ensuring the quality and reliability of caregivers to managing fluctuating staffing needs and staying compliant with regulations. To overcome these hurdles, it’s essential to implement thorough background checks and contact previous employers for every potential caregiver. This helps safeguard vulnerable elders and maintain your agency’s reputation.
Providing professionally developed training ensures that caregivers are well-prepared to meet client needs and handle assigned tasks safely, reducing the risk of work-related injuries. Having a clear process for addressing performance issues—including the ability to quickly provide a different caregiver if necessary—helps maintain high standards of care and client satisfaction.
Staying vigilant against dishonest individuals who may abuse vulnerable elders or create liability risks is critical. By prioritizing comprehensive screening, ongoing training, and responsive staffing solutions, your healthcare staffing agency can confidently meet staffing needs while protecting both clients and caregivers.
Tracking performance metrics is vital for any healthcare staffing agency aiming for continuous improvement and long-term success. Key indicators such as client satisfaction, caregiver retention, and placement rates provide valuable insights into your agency’s effectiveness.
Monitor response times to client inquiries, caregiver show-up rates, and the frequency with which clients request a different caregiver. Collecting and analyzing caregiver evaluations and client feedback can highlight strengths and pinpoint areas for development. By regularly reviewing these metrics, your staffing agency can make informed decisions, enhance service quality, and strengthen its position in the healthcare staffing market.
The future of healthcare staffing is rapidly evolving, driven by technological advancements, changing regulations, and shifting demographics. Registry agencies must embrace innovation by adopting online platforms and mobile apps that streamline operations, improve communication, and enhance the client and caregiver experience.
Staying current with employment laws and tax compliance is more important than ever, as regulatory landscapes continue to shift. Additionally, the growing demand for home health care services presents both opportunities and challenges for staffing agencies. By proactively investing in technology, adapting to new regulations, and anticipating the needs of an aging population, healthcare staffing agencies can position themselves for success in the dynamic future of healthcare staffing.
Operating a successful registry agency in 2025 isn’t about cutting corners — it’s about building something compliant, trusted, and sustainable.
Families value the flexibility and personalization that registries provide. Caregivers appreciate the autonomy. And with the right approach, registry operators can build businesses that serve both groups well — while standing strong in today’s regulatory climate.
When registry agencies operate compliantly and transparently, families experience greater peace knowing their loved ones are in good hands.