How to Choose a Home Care Agency

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Finding the best home care agency for your needs and budget doesn’t have to be complicated. Use this step-by-step guide to evaluate providers and feel confident about who you hire to care for your aging loved ones.

The following sections outline basic standards home care companies should meet, reasonable expectations you should have as a consumer, and specific questions you can ask to determine if a potential provider is a good match. Be sure to interview multiple agencies and compare the results before making a final decision.

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How to Find the Right Home Care Agency

There’s no doubt that finding in-home care for elderly loved ones is a process. Begin your search by identifying your home care needs and determining the level of care that’s required. To do this, it is important to understand the two basic levels of in-home services: home health care and nonmedical home care.

Read: The Difference Between Home Health Care and Nonmedical Home Care Services

There are many similarities between home health agencies and homemaker/companion service providers (many organizations provide both types of care), but this guide focuses on the process of hiring nonmedical home care services that are paid for privately. Once you have a general idea of what services you and your loved one would benefit from, you can begin contacting providers in your area to conduct interviews, get a feel for the staff, and gather information from the categories below.

Request Cost Information

The first question most families ask when contacting a provider is, “How much do you charge?” There is a great deal of information that must be exchanged during an initial phone call or consultation. Since home care services are personalized for each client, an accurate quote is based on all 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 unique care 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 an initial care plan.

Neither the company nor the consumer wants any surprises when it comes to determining rates. It’s best to leave your cost estimate for 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 general policies regarding payment and billing.

  • Inquire as to hourly rates and how those rates vary depending on services needed and caregiver qualifications/training.
  • Find out how frequently the company bills.
  • Determine whether they accept credit cards or require a deposit for services.
  • If applicable, 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.

Ask About Time Minimums

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 home visits—usually between two to four hours. Even if a client only needs approximately one hour of care on a particular day, they will likely be subject to paying for the minimum hourly requirement to schedule services.

Be sure to address the following points to establish a realistic care schedule (and associated cost estimate):

  • Work with the provider to evaluate how many hours of care you need.
  • Inquire about hourly minimums per visit.
  • Determine the process for adjusting care hours to meet changing needs.
  • Find out if adjusting the number of hours will require a change in the caregiver(s) assigned to you.

Understand the Types of In-Home Care Companies

The size, composition, ownership and business models of home care agencies 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 and advertising 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 get a feel for the core values of the company and determine if they’re being represented on a daily basis at 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

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. States that require licensing typically offer an online facility/provider database where you can look up license status, inspection and/or investigation results, and complaints. For example, consumers in Florida can use FloridaHealthFinder.gov to find information that the Agency for Health Care Administration has on file for home care providers.

Bonding

Home care companies often “bond” their employees as a means of covering themselves in case a client reports an instance of caregiver 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 employees (e.g. companions, certified nursing assistants, home health aides, nurses) and the value at which they are bonded.

Insurance

Every business should have insurance coverage in place.

  • Request a copy of the 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.

Inquire About Certification and Accreditation

There are various certifications and accreditations that home care agencies and their individual employees can voluntarily pursue. Any agency that has gone through the process of accreditation demonstrates a strong commitment to high quality care.

  • Ask what certifications and/or accreditations the company and its caregivers hold and who provided them.

Request Information on Caregiver Hiring and Training Procedures

Home care agencies should establish education and credential requirements for their professional caregivers and conduct background checks and drug screenings as part of the hiring process.

Caregiver Training and Education

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 receive some amount of training. Federal home health aide (HHA) standards require a minimum of 75 total classroom and clinical training hours. Some states choose to exceed this minimum training requirement in their examination and certification processes.

  • Determine what in-house training is provided to the different levels of caregivers within the company and how their proficiency is assessed.
  • 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.

Background Checks

Each state sets its own rules for running background checks on health care workers like certified nursing assistants (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/certification status 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 for new employees.
  • Find out how often drug screening and criminal searches are repeated on existing employees.

Ask About Care Management Procedures

Learn the details of the process the home care company uses to get acquainted with a new client, assign caregivers, begin services and manage their ongoing care.

Care Planning

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 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 with 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. 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 preliminary care plans from a few different companies should ensure that the providers are offering a similar scope of services to cover your needs.

Caregiver Selection

The initial consultation process also helps the agency determine which caregiver(s) would be the best fit for a client’s 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.


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Some companies also offer interviews with selected caregivers after the initial consultation and before services begin. This ensures their skills and personality will be a good match with the person receiving care.

It is important to keep in mind that the first few home care 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 a different companion or aide who is a better fit.

Communication With Family Caregivers

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 the information that 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 their POA documents 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 monitoring their loved ones from afar and making sure the services are worthwhile.

  • Ask about additional costs if care reports are something you are interested in.

Inquire About 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 Caregiver 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 and resolution.
  • In the event of an unexpected absence (no-show), question how a temporary caregiver is assigned.
  • Verify the process for 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. Are there any fees associated with these changes if advance notice is not given?

Check the Home Care Company’s Reputation

Do some research to verify the reputations of local home care companies by asking your medical provider, neighbors, religious leader, 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.

Use a Checklist to Simplify Evaluating and Comparing Home Care Providers

As you speak with and vet potential home care 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 this information, you can easily compare the results, make a final selection, begin services, and enjoy some respite and peace of mind.

Sources: Office of the Federal Register, National Archives and Records Administration. "42 CFR 484 - CONDITIONS OF PARTICIPATION: HOME HEALTH AGENCIES (https://www.govinfo.gov/content/pkg/CFR-1999-title42-vol3/pdf/CFR-1999-title42-vol3-part484.pdf); What does the HIPAA Privacy Rule do? (https://www.hhs.gov/hipaa/for-individuals/faq/187/what-does-the-hipaa-privacy-rule-do/index.html?language=en)

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