How do you choose a home health aide agency when there are so many options?

Agency is a smart move because you get the backup you're looking for. Just choose a licensed and accredited one. You can ask for references from other families close to you.
A good agency will have a clear plan for what happens if your regular aide can't make it, and they should be easy to talk to about any concerns you have.

A big red flag is an agency that seems unwilling to talk about this stuff or gives you vague answers.
Also, it's a good idea to meet a specific aide they've chosen for your mom before they start working, just to make sure it feels like a good fit for everyone.

I had accounts with 3 agencies.

I got better service from the locally owned ones over the national franchised ones.

Join Nextdoor in the area and ask others close by who’ve they’ve had a positive experience with. You’ll get real feedback, both good and bad, to help you decide