Many caregivers feel compelled to handle a loved one's care needs on their own, but that’s rarely a sustainable solution. When you’re ready to seek outside help, we can assist you in finding the best home care agency for your needs and budget. Use this step-by-step guide to evaluate providers and feel confident about who you hire to care for your aging loved one.
The following sections outline basic standards home care companies should meet, reasonable expectations you should have as a consumer, and questions to ask a potential home care provider to determine if they’re a good match.
Find the right home care for your loved one
Begin your search by identifying your home care needs and determining the level of care that’s required. To do this, it’s important to understand the two basic levels of in-home services: home health care and nonmedical home care. There are many similarities between home health agencies and supportive service providers, but this guide focuses on the process of hiring nonmedical home care.
Nonmedical in-home care is provided by senior care aides who can help with activities of daily living (ADLs), household chores, meal preparation, and more. They also offer social interaction and companionship opportunities in addition to transportation services.
Begin by developing a general idea of what services you and your loved one would benefit from. Next, contact providers in your area to set up interviews and get a feel for the staff. Be sure to interview multiple agencies and compare the results before making a final decision.
There’s no doubt that finding in-home care for elderly parents or loved ones is a process. Follow these steps to learn how to choose a home care agency:
- Explore the different types of in-home care companies.
- Understand the costs of care and how they fit your budget.
- Verify that the home care agency is licensed, bonded, and insured.
- Request information on caregiver hiring, training procedures, and accreditations.
- Ask about care management procedures.
1. Explore the different 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. These agencies often have a more widely recognized reputation due to established marketing and advertising plans. Franchised companies typically have preestablished policies and procedures, pricing, and staff training programs.
Independent agencies. With an independent agency, individual operators have the ability to establish their own policies and procedures, pricing structures, and training processes.
When you’re interviewing a home care provider, asking specific questions about their background and experience will allow you to:
- Find out how long an agency has been providing care in your community.
- Determine who owns the company and how long the current owner has been in place.
- Look for consistency in answers to your questions from different people in the organization.
Direct interaction with staff will give you a feel for the core values of the company to determine if they’re being represented at all levels of the organization.
Check the home care company’s reputation
In addition to talking to providers directly, do some research to verify the reputations of local home care companies. Talk to trusted medical providers, family members, and friends about their experiences with hiring home care. Consumer reviews and ratings are another way to learn about differing experiences with 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. Your final choice will likely rely heavily on the contact you have with a company’s employees and your overall impression of how the business operates.
2. Understand the costs of care and how they fit your budget
One of the first questions most families ask when contacting a home care provider is “How much do you charge?” There’s a great deal of information that must be exchanged during an initial consultation — from unique needs to specific preferences. Because home care services are personalized for each client, an accurate quote is based on all these details.
Request cost information or an individual quote
Companies should provide a general range of hourly rates and then begin a conversation to learn more about the care recipient and their unique needs. Neither the company nor the consumer wants any surprises when it comes to determining rates.
In initial fact-finding consultations, ask about general policies regarding payment and billing.
- Inquire as to hourly rates and how those rates vary depending on services needed, caregiver qualifications, and training. Don’t forget to ask about overnight, weekend, and holiday rates as well.
- 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’ll bill the insurance company directly. Some agencies require you to pay up front and then seek reimbursement.
Ask about time minimums
Be aware that increased levels of care require different amounts of service, which companies normally measure in hours. Many companies set a minimum hourly requirement for home visits — usually between two and four hours. Even if a client only needs an hour of care, they’ll likely be subject to paying the minimum hourly requirement to schedule a visit.
Be sure to address the following points to establish a realistic care schedule and understand the associated cost estimate:
- Work with the provider to evaluate how many hours of care are needed.
- 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.
Although budget is a driver in your search for a home care provider, a better reflection of your true costs will only be possible once you’ve worked with the company to create an initial care plan.
3. Verify that the home care agency is licensed, bonded, and insured
Licensing laws vary by state. If you’re seeking home care services in a state that requires licensing, any companies you’re considering should be operating legally and have their paperwork in order. States that require licensing typically offer an online provider database where you can look up license status, inspection or investigation results, and complaints.
Home care companies often “bond” their employees as a means of covering themselves in case a client reports an instance of caregiver theft. Bonding serves as insurance for the company and provides peace of mind for you. While bonding isn’t a foolproof method of protecting consumers, it does serve as an indicator of a company’s commitment to its clients.
To check whether a home care provider is up to date on key regulations:
- Ask if the company has bonded its employees and the value at which they’re bonded.
- Request a copy of the company’s “insurance declaration page” as proof of coverage. Every proper business should carry liability insurance.
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’s not out of line to ask the same of the company that will be caring for your loved one.
4. Request information on caregiver hiring, training procedures, and accreditations
Home care agencies often establish specific requirements for their professional caregivers as part of the hiring process. These policies and certifications will help you feel confident in choosing the right home care agency and a skilled professional caregiver.
Background checks
Each state sets its own rules for running background checks on health care workers. Even in states that don’t mandate background checks, many companies will conduct their own statewide or nationwide checks before hiring. Home care providers may also contact their state’s registry to verify the prospective employee’s licensing and certification status or to check for existing complaints.
Bring up these key points to learn more about a company’s hiring process:
- Ask the company how they vet employees.
- Find out if all employees are subject to the same standards. For example, are office staff members also required to pass a background check?
- Determine if the company conducts a countywide or nationwide criminal search, a drug screening, or a credit check for new employees.
- Find out how often drug screening and criminal searches are repeated on existing employees.
Caregiver training, education, and accreditations
In most states, there are no education or training requirements for providing nonmedical services. 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 state training requirements even exceed the federal minimum in their examination and certification processes.
There are also various certifications and accreditations that home care agencies and their individual employees can voluntarily pursue. Any agency that’s gone through the process of accreditation demonstrates a strong commitment to high-quality care.
Add the following discussion points to your list when talking with a potential home care provider:
- Determine what in-house 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 each year.
- Ask the provider what trainings they require on an ongoing basis to keep their employees’ skills sharp.
- Determine what certifications or accreditations the company and its caregivers hold and who provided them.
5. Ask about care management procedures
You should work to learn more about the process that a home care provider uses to assign caregivers, get acquainted with new clients, and manage 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 licensure, care plan development is mandatory for every client.
Be prepared to answer questions about the care recipient’s health conditions, daily challenges, and unique needs. This will allow a care coordinator to determine which services would be a good fit and how often those services will be needed to improve and maintain the recipient’s quality of life. It’s 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 upper-level management.
To determine how care plans are managed, make sure to:
- Ask if the agency creates care plans, how frequently they’re reviewed and updated, and if they conduct regular quality assurance checks.
- Inquire about 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
An initial consultation will help the agency determine which caregiver(s) would be the best fit for a client’s situation. Communicate with your loved one about what qualities you want to look for in a caregiver, and discuss any traits that may be deal breakers. Caregiver preferences can be difficult to discuss, but they’re an important part of making sure the 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 may be more comfortable with caregivers of a specific gender. Other clients may require someone who speaks a language other than English.
Some companies offer interviews with potential caregivers after the initial consultation and before services begin. This helps ensure their skills and personality will be a good match with the person receiving care.
It’s important to keep in mind that the first few home care visits function as a kind of “warm up” period. However, if there’s a major personality clash, or if some discomfort remains after a couple of visits, the company can work to select a different companion who’s 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 should and shouldn’t receive updates.
The Health Insurance Portability and Accountability Act, commonly known as HIPAA, restricts the information that companies are legally able to share about their clients. Generally, you’ll complete a HIPAA form when you hire a new home care agency. Similarly, if the person arranging care has power of attorney (POA) for the care recipient, the company should receive a copy of the POA documents for their files.
Some companies also offer electronic updates and regular reports on care. These 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.
When discussing the development of a communication plan:
- Inquire about policies for sharing updates with family members and other interested parties.
- Ask about additional costs of frequent care reports.
Review caregiver policies and procedures
Home care providers should have policies in place stating that complaints, caregiver and schedule changes, after-hours emergencies, and other issues will be handled internally. One of the benefits of hiring a home care company is that you’re not directly responsible for managing your caregivers’ work.
Specific procedures regarding provider issues and staff contact information should be outlined in the service agreement, but be sure to:
- Ask how to file a complaint and what the procedure is for investigation and resolution.
- Question how a temporary caregiver is assigned in the event of an unexpected caregiver absence or a no-show.
- Ask how the company handles changes in care needs on short notice or when something happens after the office has closed.
- Identify how an agency handles special circumstances for emergencies, and find out if extra charges are incurred in extreme instances.
- Ask how far in advance you need to request a schedule change or cancel a visit, and if there are costs associated.
- Find out how to formally request a new caregiver.
AgingCare can help find the right home care for your family
Now that you understand how to choose a home care agency and what to look for in a specific caregiver, are you ready to take the next steps in your search?
AgingCare can assist you in finding in-home care agencies in your area. A trained Care Advisor will discuss your needs and arrange interviews with local companies free of charge. Save valuable time and energy by working with a Care Advisor who can facilitate your search and streamline the hiring process.
The information contained in this article is for informational purposes only and is not intended to constitute medical, legal, or financial advice or to create a professional relationship between AgingCare and the reader. Always seek the advice of your health care provider, attorney, or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; AgingCare does not endorse the contents of the third-party sites.