AgingCare has created this guide to help you select the in-home care agency that is the best fit for your needs and your budget. It outlines what basic standards home care providers should meet, what reasonable expectations you should have as a consumer, and the specific questions you can ask to determine if a potential provider is a good match.
You should interview multiple agencies before making a final decision. If you know what qualities to look for in a provider, you can be confident you are making an informed decision.
AgingCare will assist you in finding home care companies that match your needs. A Care Advisor will arrange three interviews with agencies in your community free of charge.
Click here to get started »
Starting Your Search for a Home Care Agency
Begin your search by identifying your home care needs and determining the level of care you require. To do this, it is important to understand the two basic levels of in-home services: home health care and non-medical home care.
Although these two types of services are different, note that there may be some overlap in their provision. For example, a home health care company may also provide “homemaker” services if you identify a need for such household assistance in your plan.
Think in-home care might not be the right type of care? See an overview of all care options here.
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?” There is a great deal of information that needs to be exchanged during a first phone call or consultation, and because home care services are personalized for each client, an accurate quote is based on all of these details. Companies should provide a range of hourly rates for reference and begin a conversation to learn more about the care recipient and their service needs.
Although budget is a driver in your search, a better reflection of your true costs will only be possible once you have worked with the company to devise a care plan.
Neither the company nor the consumer wants any surprises when it comes to determining rates. 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. Instead, ask about their policies regarding payment and billing.
- Inquire as to hourly rates and how those rates vary depending on services needed and training of caregivers.
- Find out how frequently the company bills.
- Determine whether they accept credit cards or require a deposit for services.
- Ask if the company accepts long-term care insurance and whether they will bill the insurance company directly or require you to pay up front and then seek reimbursement.
Within the cost analysis, be aware that different levels of care require differing amounts of service, which is measured in hours.
Many companies set a minimum hourly requirement for visits—usually around two to four hours. This means that if you need approximately an hour of services one day in order to be driven to and from a doctor’s appointment, you will likely be subject to the minimum hourly requirement.
It is crucial to follow the steps below to establish a realistic care schedule (and associated cost estimate).
- Work with the provider to evaluate how many hours of service you realistically need.
- Inquire about hourly minimums per visit.
- Determine the process for adjusting care hours for changing needs.
- Find out if adjusting the number of hours will require a change in caregiver.
Types of Home Care Agencies
The size, composition, ownership and business models of home care companies vary widely. Generally, these businesses operate under two models: franchise or independent ownership. Each has pros and cons.
Franchised agencies often have a more widely recognized reputation due to established marketing plans, and franchisees may rely on the franchisor for policy and procedure decisions, pricing recommendations, and staff training programs. Alternatively, independent operators establish their own policies and procedures, pricing structure, and training processes.
It takes direct interaction with staff, either in person or over the phone, to determine if the core values of the company are a good match and are being put into practice on a daily basis throughout all levels of the organization.
Ask how long the agency has been providing care in your community. Your final decision relies heavily on the contact you have with a company’s employees and your overall impression of how the business operates.
- Determine who owns the company and how long the current owner has been in place.
- Look for consistency in answers to your procedural questions between people throughout the company.
Verify that the Home Care Agency is Licensed, Bonded & Insured
Licensing laws vary by state. If you are seeking home care services in a state that requires licensing, any companies you are considering should be operating legally and have their paperwork in order.
Home care companies often “bond” their employees as a means of covering themselves in case a client reports a theft. Bonding functions as insurance for the company and provides peace of mind for you. This is not a foolproof method of protecting consumers, but it does serve as an indicator of a company’s commitment to its clients.
- Ask if the company has bonded its caregivers and the value at which they are bonded.
Every business should have insurance coverage in place.
- Request a copy of a company’s “insurance declaration page” as proof of coverage.
Think about it; 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.
Certification and Accreditation
There are various certifications and accreditations that home care agencies and their individual employees can voluntarily pursue.
- Ask what certifications and/or accreditations the company and its caregivers hold and who provided them.
Caregiver Hiring and Training Procedures
Education and credential requirements, background checks and drug screenings are standard practices home care agencies use in the process of hiring professional caregivers.
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 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).
- Determine what training is provided to the different levels of caregivers within the company.
- Ask who provides the training.
- Find out if your state requires a specific amount of ongoing education and/or workshops each year.
- Ask the provider what they require on an ongoing basis as the mandatory minimum to keep their employees’ skills sharp.
Each state sets its own rules for running background checks on health care workers like CNAs and HHAs. Even in states that do not mandate background checks, many companies will conduct their own statewide or nationwide checks before hiring. Home care companies may also contact their state’s registry to verify the prospective employee’s licensing and check for existing complaints.
- Ask the company how they vet employees.
- Are all employees subject to the same standards? (For example, are office staff members also required to pass a background check?)
- Determine if the company runs a nationwide criminal search, countywide search, drug screening, and/or credit check.
- Find out how often drug screening and criminal searches are repeated on existing employees.
Learn the details of the process the home care company uses to get acquainted with a new client—how they prefer to do an initial assessment, how a care plan is composed, 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 every client.
- Ask if the agency creates plans of care, how frequently they are reviewed and updated, and if they conduct regular quality assurance checks.
Be prepared to answer leading questions about the care recipient’s health conditions and daily challenges and needs. This will allow a care coordinator to help you determine which services would be a good fit and how often they will be needed to improve and maintain the recipient’s quality of life. It is crucial for you to provide as much information as possible and refrain from holding back any details.
Any problems or alterations to an existing care plan should always be directed to a manager, such as a care coordinator, the head of staffing, or, in the case of smaller home care agencies, the owner.
- Ask how the provider handles changes in health and the level of care needed.
Be aware that care plans may vary widely. Similar to gathering estimates on how to fix a roof leak, one contractor might tell you to patch it, while another will tell you a new roof is needed. Reviewing care plans from a few different companies should help ensure that the providers are offering a similar scope of services to cover your needs.
The initial consultation process also helps the agency determine which of its caregiver(s) would be the best fit for your situation. During this meeting, it is important to communicate your needs and who you are comfortable with having in your home.
Caregiver preferences can be difficult to discuss, but they are an important part of making sure your home care experience is a successful one.
For example, if your loved one has Alzheimer’s disease, a home care company should narrow down your selection to caregivers who are experienced and trained in dementia care. Furthermore, some clients are more comfortable with caregivers of a specific gender or ethnicity or require someone who speaks a language other than English.
Some companies also offer interviews with selected caregivers after the initial consultation and before services begin to ensure their personality will be a good match with the person receiving care.
It is important to keep in mind that the first few visits function as a kind of “warming up” period. However, if there is a major personality clash or some discomfort remains after a couple of shifts, the company should be happy to assign someone who is a better fit.
Communication with Family
Initiating a clear communication plan with the company is an important part of monitoring a loved one’s care. Typically, the individual paying for home care services can dictate who is able to receive updates and who is off limits.
- Ask about policies for communicating with you and other interested parties.
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 care has power of attorney (POA) for the care recipient. The company should receive a copy of that document for their files.
Some companies also offer electronic communication and regular reports on care. This can be especially helpful for long-distance family members who are intent on making sure the services are worthwhile.
- Ask about additional costs if care reports are something you're interested in.
After-Hours and Emergency Calls
Identify how an agency handles special circumstances and who is responsible for making sure these calls are returned and acted on.
- Ask how the company handles changes in care needs on short notice or when something happens after the office has closed.
- Determine if the emergency procedure is acceptable to you, and find out if extra charges are incurred in these instances.
Review Home Care Policies and Procedures
Every company should have policies in place stating that complaints, caregiver changes, schedule changes, and other issues are to be handled internally.
One of the benefits of hiring a home care company is that you are not directly responsible for managing your caregivers’ work.
Specific procedures regarding provider issues and staff contact information should be outlined in the service agreement.
- Ask how to file a complaint and what the procedure is for investigation.
- In the event of an unexpected absence, question how a temporary caregiver is assigned.
- Determine the process of making a schedule change.
- Ask how to formally request a new caregiver.
- Ask how far in advance you need to request a schedule change or cancel a visit.
Check the Home Care Company’s Reputation
Check the reputation of local home care companies by asking neighbors, a minister or pastor, friends, coworkers, an elder law attorney, a financial advisor, or anyone you trust about their experiences with hiring home care.
If you don’t know anyone who has previously hired these services, consumer reviews and ratings are another way to learn about others’ experiences with specific companies in your area.
There are a million ways people can get referrals, but if you’ve found a company that fits your needs and has a great reputation around town, that is key in establishing trust and making a confident decision.
Home Care Agency Checklist
As you speak with potential providers, use this Questions to Ask a Home Care Company worksheet to keep track of the criteria that are important to you.
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.