How to Select a Home Care Company
Deciding to hire a caregiver to help your loved one is often stressful, a little worrisome and somewhat confusing. Where exactly should you begin? The first step is choosing a provider, but this is typically easier said than done.
There are countless online directories that can help you find a building contractor, a nanny, a doctor, you name it. Better yet, there are specific questions that you can ask each of these service providers to determine if they can be trusted with your remodel, your health, or the care of your children. You know that your loved one deserves only the best care, but what should you ask to distinguish a quality home care company from one that just goes through the motions and doesn’t prioritize customer service? Where should a family caregiver start when it comes to searching for home care, and what quality indicators and red flags should they keep an eye out for?
To get the inside scoop on this matter, AgingCare spoke with Cheryl Rizk, MA, who has over 30 years of experience as the owner of a home care and geriatric care management company and has also hired these services for a loved one. Rizk knows all too well what families are looking for and how these needs and expectations do not always match up with the way providers conduct their businesses. Below she explains what basic standards these companies should meet and what reasonable expectations you should have as a consumer. (Bonus: Download the Questions to Ask a Home Care Company Worksheet at the end of this article to help you put this knowledge to use during your provider search.)
Starting Your Search
Google tends to be the one-stop shop for information of any kind these days, and elder care is no exception. Although the internet is an incredible tool, it can easily lead to information overload instead of a clear choice or direction.
“Before the internet,” Rizk says, “people would pick up the yellow pages and just start calling companies. Also, there was a time when hospital nurse case managers or social workers would help families make a decision. Sadly, these professionals just don’t have the time any more. Between the national nursing shortage and the amount of paperwork that is required by Medicare and insurance companies, they are just too busy to help. So upon a loved one’s discharge from the hospital, families are handed a list of home care companies and told to start calling, which only adds to an already stressful and confusing situation.”
Families may feel alone when it comes to narrowing down their options, but fortunately there are many resources that could prove useful in this process. Rizk suggests seeking recommendations from your neighbors, minister or pastor, friends, coworkers, elder law attorney, financial advisor—anyone you trust who may have had some prior experience with hiring home care.
“Reputation, reputation, reputation,” Rizk emphasizes. “There are a million ways people can get referrals, but if you’ve found a company who has a great reputation around town, that is what’s important.”
When Time Is of the Essence
In many situations, though, families do not have the time to research their options, ask around for referrals, or call through the hospital’s massive provider list. If a loved one has an accident, falls ill or is suddenly discharged from acute care, the turnaround can be very quick. Rizk cites this common scenario which can send family members scrambling: “If you find out on Friday at 5 PM that they’re going to discharge your mom at 11 AM on Saturday morning, what are you going to do?”
One of the first signs of a good home care company that values customer service is how quickly they can staff a case. An excellent company should do everything possible to accommodate the needs of a client, even if it is short notice.
“Any company that wants business will figure out a way to staff a case,” Rizk assures. “At my company we used to tell the client, ‘This may not be your permanent caregiver, but you can be certain that we will have someone there for you tomorrow morning.’ If you’re dealing with a quality provider, then they will make it happen.”
The Bottom Line
The size, composition, ownership and business models of home care companies vary widely, so it can be challenging to boil down what exactly consumers should look for in a provider. A family’s final decision relies heavily on the interactions they have with the employees and their overall impression of how the business operates.
“It has to do with the way the company runs things, starting with the owner and all the way down,” says Rizk. “You want to get a feel for what is important to them, what they believe in, and what they are willing to do to make these things happen.”
Of course, companies provide their mission statements and mottos in their brochures and on their websites, but it takes some direct interaction with staff (either in person or over the phone) to determine if these core values are being put into practice on a daily basis throughout all levels of the organization.
While some families may only have the bandwidth to feel out the overarching character of the company and its front-of-the-house employees, there are some more nuanced aspects of a home care company to seek out and avoid. For those who have the time and energy to thoroughly vet potential care providers, Rizk shares her insights below on which traits and policies should be nonnegotiable, which characteristics tend to vary widely, and which ones may be less important than they seem.
Licensed, bonded, and insured are three important buzzwords that are often thrown around by home care companies vying for the public’s trust. But what do these terms actually mean, and should they be determining factors when selecting a provider?
One would assume that any home care provider worth its salt would be subject to some sort of oversight process, but the fact is there are a number of states that do not require licensing for companies that provide unskilled care. Obviously, if you are seeking home care services in a state that requires licensing by law, any companies you are seriously considering should be operating legally and have their paperwork in order. Just make sure this is mandatory where you live before turning your nose up at an unlicensed provider.
Home care companies often “bond” their employees as a means of covering themselves in case a client reports a theft. Not only does bonding function as insurance for the company, but it can also provide peace of mind for you and your loved one. A typical bond amount for a caregiver is around $5,000. In the event a caregiver does engage in theft, the bonding company will reimburse the client for the items stolen up to the bond amount, BUT only once the thief has been convicted of this crime in a court of law. Because of this caveat, bonding itself is not a foolproof method of protecting consumers, but it does serve as an indicator of a company’s commitment to their families’ comfort and trust.
Lastly, insurance is a must. A home care company’s job is to hire caregivers to care for vulnerable clients. These caregivers provide transportation to doctor’s appointments, help transfer clients in and out of bed, remind them to take medications, and much more. Their work is invaluable to the families they serve, but these daily activities can easily result in an accident that injures the client and/or caregiver or damages private property. The liabilities are huge, and this is why every reputable company should have comprehensive insurance coverage in place. Requesting a copy of a company’s “insurance declaration page” is the best way to cover your bases.
“It is really important to ask for this document, but most people don’t think about it or know they can request it,” Rizk acknowledges. “A company can tell you it’s insured, but you still need to see proof. If it turns out that they’re not, or they don’t have enough insurance and something horrific happens, then as a consumer you have no recourse. If a roofing company comes out to fix your roof, you’re going to want to see their proof of insurance. It is not out of line to ask the same of the company that will be caring for your loved one. If they can’t produce it, that’s a red flag.”
Requesting Cost Information
The first piece of information most families want to find out when they contact a provider is, “How much do you charge?” In reality, this is one of the very last things a company should discuss with a prospective client. There is a great deal of information that needs to be exchanged during this first phone call or consultation, and because home care services are personalized for each client, an accurate quote for services is based on all of these details.
“There are some companies where a receptionist will just quote you a price over the phone and that’s the end of the call. Those are the ones you don’t want to speak with,” Rizk warns. “If they quote a price right up front, they’re either going to charge you too much or too little. You may find out that, although you were quoted $19/hour, your loved one needs a higher level of care and the cost is actually $25/hour. It really varies.”
Instead, a properly trained company should provide a range of hourly rates for reference and begin a conversation to learn more about the care recipient and the challenges they face in order to match them with services. The nationwide average for private pay in-home care is $20 per hour, but citing an average can still be misleading since hourly rates can range from $15 to $28. Neither the company nor the consumer wants any surprises when it comes to determining rates.
A few questions regarding payment that you should ask when initially speaking with a company include how frequently they bill, whether they accept credit cards or take deposits for services, and if they accept long-term care insurance. Leave the cost estimate to the very end of your fact-finding phone call, or wait to get a more accurate rate during a face-to-face consultation.
Caregiver Hiring and Training
Any company can devise extensive policies and set high business and customer satisfaction goals, but success boils down to the quality of the caregivers they hire. Unless the staff follow these guidelines and prioritize these goals, little can be said about the overall operation. And, of course, families are typically interested in the expertise and personality of the caregiver(s) who will be providing services directly. After all, these are going to be the people interacting with your loved one on a regular basis.
It is a company’s job to hire individuals who are compassionate, trustworthy, knowledgeable about elder care, and share the organization’s fundamental values. This should be evident in their hiring process. Education and credential requirements, background checks and drug screenings are the most common baselines companies use for hiring professional caregivers.
Education and Credentials
A caregiver’s education level will vary by state and depend on the level of care they are able to provide. For example, in most states, there are no education or training requirements for providing nonmedical services, such as companionship, light housekeeping, and transportation for appointments and errands.
When personal care services and assistance with activities of daily living are added to a caregiver’s responsibilities, they must typically go through training and examination to become a certified nursing assistant (CNA) or home health aide (HHA). “Most companies will tell you, ‘We hire CNAs and HHAs and we also have some companions,’ ” Rizk says. Certain states also require a specific amount of ongoing education and/or workshops each year. A point of pride for some companies is providing more than the mandatory minimum to keep their employees’ skills sharp.
Background checks are yet another component of hiring reliable caregivers. When someone applies to become a CNA or HHA, the state will typically run criminal background checks before approving them for the program. Most companies will conduct their own subsequent checks (especially for companions, who have no certifications), which can be nationwide or statewide. They should also contact the state’s registry to verify the prospective employee’s licensing (if any) and check for complaints. A quality company will do everything in its power to thoroughly vet its employees, both to protect clients and itself from any mishaps and liabilities.
One of the biggest quality indicators for a company is how they direct and monitor their clients’ care. As any experienced family caregiver knows, new challenges and concerns crop up all the time. It is crucial that the provider you choose will be able to respond quickly to any changes in your loved one’s health and personal needs.
“It is up to the company to explain to the consumer what they are able to do and how,” explains Rizk. “They should detail their process for getting acquainted with a new family—how they prefer to do an initial assessment, how the care plan is composed and what it’s based on, and how they make sure it is followed and adjusted accordingly.”
A care plan is an organized, customizable schedule of services for a client that the company can regulate and family members can follow along with. In states that require home care companies to obtain licenses, care plan development is mandatory for each and every client. If this does not come up during your initial phone call, ask if they create plans of care, how frequently they are reviewed and updated, and if they conduct regular quality assurance checks.
Much like providing a new physician with a comprehensive medical history, a home care company needs some baseline information in order to craft a plan for your family. Home care’s version of “new patient paperwork” is typically referred to as an intake form, which is completed by a care coordinator with your input. In quick turnaround cases, the intake process can be conducted over the phone, but many companies prefer to meet in person to fully gauge a client’s physical and mental abilities, personality, and likes and dislikes. This first meeting (also known more formally as a consultation or in-home assessment) can take place at your home, a coffee shop, the hospital, the company’s office, you name it.
By answering leading questions about your loved one’s health conditions, daily challenges and needs, a care coordinator will help you determine which services would be a good fit and how often they will be needed in order to improve and maintain their quality of life. Because of this, it is crucial for families to provide as much information as possible and refrain from holding back any details.
This initial consultation process also helps the company determine which caregiver(s) would be the best fit for your situation. For example, if your loved one has Alzheimer’s disease, they may narrow down your selection to a handful of caregivers who are experienced with and trained in dementia care. Some clients are more comfortable with caregivers of a specific gender or ethnicity or require someone who speaks a language other than English. These preferences can seem somewhat unorthodox and be difficult to discuss, but they are an important part of making sure your home care experience is a successful one. Some companies also offer interviews with selected caregivers after the initial consultation and before services start to ensure their personality will be a good match with the person receiving care.
“It is more commonplace now than ever for people to meet the individual caregivers before starting services,” Rizk points out. “My company charged a fee for interviews because we had to pay the caregiver to go out and meet the client. Also, we stressed to the consumer that they were hiring our company, not a particular caregiver, and we were going to work hard to make sure the caregivers we sent out were a good fit for their loved one.”
It is important to keep in mind that the first few visits function as a kind of “warming up” period. Both parties are still getting to know one another, and it could take a little time to get into a groove. However, if there is a major personality clash or some discomfort after a couple of shifts, the company should be happy to assign someone who is a better fit.
Caregiving is never black and white, and this applies to both family and professional caregivers. Trying to work around the emotions, opinions, personalities and schedules of all involved can be like navigating a minefield. Companies try their best to formulate policies and regulations that make in-home services run as smoothly as possible, and this is another area that consumers should focus on when evaluating a provider.
Most companies set a minimum hourly requirement for visits—usually around three or four hours. This means that if your loved one only needs approximately an hour of services one day in order to be driven to and from a doctor’s appointment, you’ll still need to pay for the four-hour minimum. Some providers are more flexible with their clients and hours, but this type of policy makes scheduling far less complicated and easier to staff.
Communication with Family
In situations where numerous family members are interested in monitoring a loved one’s condition and the services they receive, it can be difficult for a company to know who to contact with updates or in emergencies and who to share information with. Typically, the individual paying for home care can dictate who can receive updates and who is off limits. If this is a concern for you, be sure to ask about their policies for communicating with you and other interested parties.
“If I decide to pay for my dad’s home care,” Rizk explains, “then I will be the one to sign the agreement for services and I will typically be the one who says, ‘This is who you can share information with: my stepmother, my stepsister and Dad’s physician. But if my troublemaker brother calls, you can’t share anything with him.’ ”
HIPAA (the Health Insurance Portability and Accountability Act) restricts what information companies are legally able to share about their clients, and a HIPAA form should be a standard part of the agreement for services. The same applies if the person arranging a loved one’s care has power of attorney (POA). The company should receive a copy of that document for their files.
Some companies also offer electronic communication and regular reports on a loved one’s care. This can be especially helpful for long-distance family members who are intent on making sure the services are worthwhile. Some of these features may involve fees, though, so be sure to ask about additional costs if this is something you are interested in.
After-Hours and Emergency Calls
Responsiveness is also a key characteristic of a good company. If something happens after the office has closed and your loved one needs care on short notice, will someone be able to take your call? Depending on the level of care your loved one needs and their proximity to you and other family members, this could be a deal breaker.
“I would say that about 99% of companies will route after-hours calls to someone on their staff,” Rizk estimates. “At my company, our nighttime calls would roll over directly to a staff member who had access to all of the caregivers’ schedules. It’s important to ask how a company handles this. If they say, ‘Well, your call will go to an answering service,’ that may not fly. How long will it take for the answering service to get ahold of someone on staff, and who is really responsible for making sure these calls are returned and acted on?”
Every company should have a policy in place stating that complaints, caregiver changes, schedule changes, and other issues are to be handled internally. It is not a client’s responsibility to discipline their caregiver, or try to adjust their schedule of services.
“The whole point is the caregivers are the company’s employees, so if there is a problem, contact the office immediately so that they can handle it,” assures Rizk.
Any problems or alterations to an existing care plan should be directed to a manager, such as a care coordinator, the head of staffing, or, in the case of smaller companies, the owner. Specific procedures and contact information should be provided in the service agreement.
Taking the Plunge
Finding someone else to help your loved one can be a delicate process, but if you know what questions to ask and qualities to look for in a provider, you can be sure you are making a confident and informed decision. Use this Questions to Ask a Home Care Company worksheet to keep track of the criteria that are important to you and the answers you receive from the providers you interview. Once you’ve gathered all of this information, you can easily compare the results, make a final selection, and enjoy some respite and peace of mind.