We have someone, too. Our aide is through an agency, and it was a humongous relief when we first got her. Trepidation about a stranger coming into the house is normal and they are used to that. Most aides are in this line of work because they are naturally caring, big-hearted people—if you have reluctance, I think ultimately you will be happily surprised. And if you do not like your aide for any reason, you can always just call the agency and tell them you would like to try someone else. It happens. No biggie. They will accommodate you.
At the lowest level of unskilled care, the aide comes in and sits with a person, does light housekeeping, and will prepare an easy meal (make a sandwich or reheat leftovers). She has received training with a Hoyer lift, but it's unclear how much she has actually used one. She cannot give medication, even a vitamin, or use my husband's feeding tube, by law. Our local ALS Association partners with a few for-profit agencies, and we are looking into switching (their aides receive specific ALS training from the ALSA and may be better suited to complex, long-term care). Our aide now has been with us for several years and has become like a close friend, which has its ups and downs. She is used to the routine and as my husband has experienced changes, she has not kept up with his needs.
An LPN will be able to use the feeding tube, and an RN to give medication, or at least that's the way it works with agencies in PA, where we live. Skilled care is much more expensive ($35-$50 per hour), which is just not in the cards for us. My FIL comes in most days to help and I have started going back to school, just to get out of the house a little and have my own independent thing going on (a very important thing both for PALS and CALS). But my FIL is not in the best of health, so we are going to hire privately, either through care(dot)com—which I've heard excellent things about—or through a job listing at the local library or nursing school.
I have heard that if you hire privately, it is important to get something called "umbrella" insurance on your homeowner's. This will cover in the case of a lawsuit, if someone is hurt by slipping on ice if you can't get out to clean it, etc. I don't know if it would cover injury in the line of care-taking.