Hiring a home care agency is one of the most important decisions you'll make for your parent. The right agency provides reliable, compassionate care. The wrong one creates more problems than it solves—or worse, puts your parent at risk.
This guide walks you through the process of evaluating agencies, asking the right questions, and ensuring you get quality care.
This guide focuses on agencies. Private hire (hiring caregivers directly) costs less but comes with more risk and responsibility—you handle screening, backup, taxes, and liability. Agencies cost more but manage these complexities for you.
Types of Home Care
Non-Medical Home Care
Help with daily activities, not medical treatment:
- Personal care (bathing, dressing, grooming)
- Meal preparation
- Light housekeeping
- Companionship
- Transportation
- Medication reminders (not administration)
Home Health Care
Medical care provided at home:
- Skilled nursing
- Physical, occupational, speech therapy
- Wound care
- Medication management
- Usually requires doctor's order
- Often covered by Medicare (temporarily)
Know What You Need
Before contacting agencies, clarify:
- Hours per day/week needed
- Specific tasks required
- Level of care (companionship vs. skilled nursing)
- Schedule (same caregiver daily? Weekend coverage?)
- Any special needs (dementia, mobility, language)
Finding Agencies
Sources for Referrals
- Hospital discharge planners
- Doctor's office
- Local Area Agency on Aging
- Word of mouth from friends, support groups
- Online directories (caring.com, AgingCare)
- State licensing agency
Initial Screening Questions (Phone)
- Are you licensed and insured?
- Do you provide the services we need?
- What's your coverage area?
- What's your hourly rate? Minimum hours?
- How quickly can you start?
- Are caregivers employees or independent contractors?
Agencies that use employees (not contractors) are responsible for payroll taxes, workers' compensation, and liability insurance. Contractor-based agencies may leave you exposed. Ask specifically—and verify.
Key Questions to Ask
About the Agency
- How long have you been in business? Look for at least 3-5 years.
- Are you licensed? Verify with state licensing board.
- Are you accredited? (Joint Commission, CHAP, ACHC are good signs)
- What insurance do you carry? Liability, workers' comp, bonding.
- Who owns the agency? Local ownership often means better oversight.
- What's your caregiver turnover rate? High turnover is a red flag.
About Caregivers
- How do you screen caregivers? Background checks, drug tests, reference checks.
- What training do caregivers receive? Initial and ongoing.
- Are caregivers certified? CNA, HHA certifications add credibility.
- How do you match caregivers to clients? Skills, personality, language.
- What happens if a caregiver doesn't work out? Replacement policy.
- Is there backup if a caregiver is sick? This is critical.
About Service
- What's your minimum hours requirement? Some require 4-hour minimums.
- Can we meet the caregiver before starting? Good agencies allow this.
- Is there a care plan? How often is it reviewed?
- Who supervises caregivers? How often are they checked on?
- How do you handle complaints? Get a clear process.
- What's your cancellation policy? Can be expensive for short-notice.
About Costs
- What's the hourly rate? Ask for specific services you need.
- Are there additional fees? Admin, assessment, holiday rates.
- How is billing handled? Weekly, bi-weekly, monthly.
- What payment forms are accepted? Long-term care insurance, VA, private pay.
- Is there a contract? What's the commitment?
Any agency worth working with will provide a written agreement detailing services, costs, cancellation policy, and responsibilities. Read it carefully before signing. Never rely on verbal promises.
Red Flags
During the Search
- Can't provide proof of licensing or insurance
- Won't let you meet caregivers before starting
- High-pressure sales tactics
- Vague answers to specific questions
- No written contract
- No background check process or won't share it
- Can't explain their supervision process
After Service Starts
- Caregivers arriving late or not at all
- Frequent caregiver turnover without explanation
- Caregivers not doing agreed-upon tasks
- Not returning calls or addressing concerns
- Surprise charges not in the contract
- Caregivers asking for cash payments or tips
- Signs of elder abuse or neglect
If something feels wrong, it probably is. Your parent's safety matters more than avoiding awkward conversations. Don't hesitate to switch agencies or report concerns. Document everything.
Evaluating and Comparing
Get Multiple Quotes
Interview at least 3 agencies. Compare:
- Hourly rates for your specific needs
- Minimum hours requirements
- Quality of caregiver screening
- Supervision and oversight
- Backup caregiver availability
- Overall professionalism and responsiveness
Check References
- Ask for current client references (and call them)
- Check online reviews (but take with grain of salt)
- Verify licensing with state agency
- Check Better Business Bureau
- Ask hospital social workers about reputation
Trial Period
- Start with a short trial (one week)
- Observe caregiver-parent interaction
- Check that tasks are being completed
- Note any concerns immediately
- Don't feel locked in if it's not working
Working Successfully with an Agency
Set Clear Expectations
- Provide detailed care plan with specific tasks
- Tour the home with caregiver, show routines
- Introduce caregiver to parent properly
- Share parent's preferences and triggers
- Leave emergency contact information
Communicate Regularly
- Check in with the agency supervisor periodically
- Provide feedback—positive and constructive
- Document concerns in writing
- Ask for care notes or logs
Monitor Care Quality
- Drop by unexpectedly occasionally
- Ask your parent how things are going
- Look for signs: parent's condition, cleanliness, mood
- Check that medication reminders are happening
- Notice if supplies are being used as expected
Cost Considerations
National Average Costs (2025)
- Non-medical home care: $27-35/hour
- Home health aide: $29-37/hour
- Skilled nursing: $50-75/hour
Costs vary significantly by region—some areas are 50% higher.
Ways to Pay
- Private pay: Out of pocket
- Long-term care insurance: Check policy carefully
- Medicare: Limited home health only (not custodial)
- Medicaid: Varies by state; may cover some home care
- VA benefits: Aid and Attendance for eligible veterans
Good agencies can help navigate payment options. They may know about programs you don't—veteran benefits, state programs, non-profit assistance. Ask specifically about help paying for care.
When to Switch Agencies
Consider changing agencies if:
- Repeated scheduling problems or no-shows
- Quality doesn't improve after complaints
- You suspect abuse or exploitation
- Billing irregularities persist
- Communication is consistently poor
- Your parent is unhappy or declining under care
Switching agencies is your right. Review your contract for cancellation requirements, but don't stay with poor care out of inconvenience.
Home Care Agency Comparison Worksheet
Our Caregiver Kit includes an agency comparison worksheet, interview questions, and quality monitoring checklists.
Get the Complete Caregiver Kit- Know exactly what services you need before contacting agencies
- Verify licensing, insurance, and background check processes
- Interview at least 3 agencies and check references
- Understand employee vs. contractor status
- Get everything in writing—services, costs, cancellation policy
- Meet caregivers before they start
- Monitor care quality and address concerns immediately
- Don't hesitate to switch if quality is poor