Ten Things to Ask Before Hiring a Home Care Agency

Today's seniors have more options available to them then ever before. One option more and more seniors are turning to when their physical capabilities diminish or while they recover from a short-term disability is to be treated in the comfort of their own homes by a personal nurse’s aide or companion. Home care is considered by many to be one of the most desirable options because it allows seniors to maintain their independence while remaining in the one place where they feel most comfortable.

However, as in choosing any type of long-term care, there are many pitfalls to watch out for when hiring a homecare worker to care for yourself or a loved one. In any given city, a quick look through the Yellow Pages may reveal dozens of competing companies offering what appear on the surface to be the same services. It's up to you to investigate the differences and find the one company that best suits your home health care needs.

To help with this task, we've provided the following checklist of questions to ask each home care agency during the initial phone call. If they can't answer these questions to your satisfaction, move on to the next agency until you find one that can.

1) How long has your company been in business?

There are a lot of new companies entering the marketplace, many of which have little experience or expertise in the special challenges of running a successful home care company. The office staff cannot be relied upon like well-established companies because they experience a high turnover rate. This puts newly formed companies at a distinct disadvantage because they do not have extensive records of caregivers’ past performances, and they often attract caregivers who can't get a job at a reputable agency.

2) Are your workers bonded and insured?

Few people like to think about accidents or possible problems at the outset of retaining help, but the fact is many people get into accidents every day, such as car accidents, sprained backs, twisted ankles, etc. Also, from time to time, important things in a client's home can be damaged or disappear through a caregiver's negligence or dishonesty. The company you want to work with must have extensive insurance, including Professional and General Liability, Non-Owned Auto, a Dishonesty Bond, and Worker's Compensation policies. Believe it or not there are some companies that have minimal insurance coverage and others who have none at all.

3) How extensive are your criminal and background checks?

As you know, there are many of unscrupulous people looking for work. You don't want them in your home or in the home of someone you love or care about. Therefore, you must do business only with companies that provide a criminal background check on each person they employ. Because unsavory characters drift around from place to place, it's important that they not only run a check on the last place their caregiver worked but also on all the places they've lived for at least the last five years. Also ask them if they can provide you with written reference check reports.

4) Does your company have a Licensed Vocational Nurse or RN on staff?

Most reputable agencies have a licensed nurse on staff to assure that proper protocol is being followed in the care of a client. A trained nurse can help a caregiver identify safety hazards, recognize symptoms, observe special diets, familiarize them with infection control procedures and universal precautions, establish hygiene standards, and more. In most cases, home health care aide agencies that have a licensed nurse on staff are going the extra mile to provide quality assurance to the services their caregivers provide.

5) How do you select your employees?

Many agencies hire home care aides that have little experience and even less credentials—not a caregiver you want caring for you or your loved one. Reputable agencies, however, have minimum requirements for years of experience and levels of certification. The best agencies will even take into consideration such factors as demeanor and professionalism, weeding out the unacceptable workers so you don't have to. Make sure you choose an agency that sets high standards in its hiring policies.

6) Can you send me information describing your services and fees?

This may seem like a basic question, but a company that has not spent the time developing important informational materials such as these probably hasn't done many other important tasks either. Not only will these materials help you compare their services to those of other agencies, but they may also provide useful details that you hadn't thought of earlier. More than likely, an agency that sends you detailed, carefully considered materials for your review has also gone the extra mile in other aspects of its business.

7) What is the company's replacement policy or guarantee?

If you want to avoid getting “a lemon,” ask about the company's replacement or guarantee policy. In most cases, a good agency will give you as many replacements as needed whenever needed without limitation. For those people wanting a caregiver on a referral basis, wherein you handle the payroll and insurance obligations, you should get at least three months to see if the individual will be suitable to you (of course, the more the better, but certainly no less than three months).

8) What are your financial procedures? Are your rates negotiable?

Most agencies have a lot of fixed costs to incorporate into their quoted rates. However, they also know that not all clients have the same ability to pay. Some agencies may be prepared to make a deal. If you're flexible about the age, number of years of experience of the caregiver, or English speaking abilities, perhaps you can get reduced rates. Most agencies come in contact with eager, honest and hardworking people who are anxious to gain experience and English skills. So if money is an issue, this approach may work for you. Even if you choose not to negotiate, ask to see written statements explaining all of the agency's costs and payment plan options. This will clear up any discrepancies before they occur.

9) Would you mind providing me with references?

It pays to find out if the Agency's clients are satisfied with the services they're getting. Sometimes old references don't reflect current management conditions, so it's best to ask for testimonials from their more recent jobs. You might also want to ask to talk with clients who have had a long history with the agency so that you can get a good sense for how they do business and what you can expect from them.

10) Can we set up a time to meet to discuss the details of my care needs?

It's always a good idea to meet the Agency's principal(s) or representative(s) and to see their setting if possible. It's also good to have them come over to your place so that you can meet them at your convenience. Home care can get expensive, so you want to be sure that the people you'll be dealing with can be relied upon to give you the best service possible. Also, the advantage of going to their office is that you can make some assessments about them that you can't just by talking on the phone. Are they a boiler room operation or are they organized and corporate? Are they a small company or a large one?


Shirley Cohen is the founder and managing director of Home Sweet Home Care, Inc., a private duty home care agency providing quality home care aide services to seniors and convalescing adults in the San Francisco Bay Area since 1990. Shirley founded Home Sweet Home Care in response to her own urgent need and desire to find the right home care help for her mother, who had suffered a sudden and paralyzing stroke.

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