Maybe your mother came home from the hospital weaker than before. Maybe your father is still sharp but can no longer manage a shower safely on his own. Either way, you have decided some help at home would make life safer, and now you face a list of home care agencies that all promise compassionate, reliable care.
The way to tell them apart is to ask good questions and listen closely to the answers. The National Institute on Aging suggests getting as much information as you can about services, terms and restrictions before signing anything3. This guide gives you the questions to ask a home care agency, why each one matters and what a good answer sounds like. If you are still deciding between care at home and a move, start with assisted living vs. home care.
First, know what kind of help you need
Home care agencies provide nonmedical help: bathing, dressing, toileting, meals, light housekeeping, companionship, errands and reminders. Home health agencies provide skilled services a doctor orders, such as nursing, wound care and physical therapy2. Some agencies offer both. Our guide to home care vs. home health explains the difference in detail.
Before you call anyone, write down what your parent needs help with, which times of day are hardest and how many hours a week you think are needed. Note any conditions that need special skill, like dementia, diabetes, a recent stroke or a high fall risk. A clear list makes it easier to compare answers and keeps a sales call focused on your parent rather than on packages.
Questions about licensing and the agency
- Are you licensed by the state? Licensing rules for home care vary by state. Ask which license the agency holds and check it with the state agency that oversees home care3.
- Are you Medicare or Medicaid certified? This matters if either program will pay. Certified home health agencies are inspected against federal standards4.
- How long have you served this area? A track record in your community suggests stability and local knowledge.
- Are your caregivers employees or contractors? Employees are usually covered by the agency's insurance, payroll taxes and workers' compensation. Ask what happens if a caregiver is injured in your parent's home.
- Are you bonded and insured? Ask for proof of liability insurance and coverage for theft or damage.
- Can you give me references? Talk to two or three current clients' families, and ask your parent's doctor or hospital discharge planner what they have heard3.
You can also check for complaints with the state and local agencies that regulate health services2. For Medicare-certified home health agencies, Care Compare shows quality ratings and patient survey results5, and the State Survey Agency can share inspection reports4. Our guide to checking licenses and inspections shows where to look.
Questions about the caregivers
The person who walks through the door matters more than the agency's brochure. Ask:
- How do you screen caregivers? Ask about criminal background checks, reference checks, driving records and drug testing3.
- What training do caregivers get? Ask about initial and ongoing training, and whether aides are certified3.
- Do you have dementia experience? If your parent has memory loss, ask what dementia training caregivers receive and how they handle wandering, refusals and agitation. See when a parent with dementia refuses to shower.
- Will it be the same caregiver each time? Consistency builds trust and is less confusing for older adults3. Ask about caregiver turnover.
- Can we meet the caregiver first? A short introduction lets your parent weigh in on the match.
- What can caregivers not do? Some aides can't give medications, drive your parent or do certain hands-on tasks. Know the limits before you count on them.
Ask how the agency matches caregivers with clients, including language, personality and cultural preferences. Medicare's checklist specifically suggests asking whether an agency can meet special needs like language or cultural preferences4. And ask what happens if your parent and a caregiver simply don't get along. A good agency will make a change without fuss.
Questions about the care plan and supervision
- Who assesses my parent's needs? Many agencies start with a home visit by a nurse or care manager. Ask who does it and whether there is a written care plan.
- How is the care plan updated? Needs change after a fall, illness or hospital stay. Ask how often the plan is reviewed and how changes are made.
- Who supervises the caregiver? Ask whether a supervisor visits the home and how often, and who checks that the plan is being followed.
- How will you communicate with me? Ask about care notes, phone calls, apps and who you contact when there is a problem3.
- Can my parent and I help shape the plan? Your parent should have a voice in when help comes and how tasks are done.
If your parent lives far away, ask whether the agency can send short updates after each visit. Our guide to long-distance caregiving has more ideas.
Questions about scheduling and backup coverage
- Is there a minimum number of hours? Many agencies require a minimum per visit or per week3.
- What happens if a caregiver is sick or late? Ask how quickly a substitute is sent and how you will be told.
- Do you cover nights, weekends and holidays? Medicare's checklist suggests asking whether staff are available nights and weekends for emergencies4.
- Can hours increase quickly? After a hospital stay, your parent may need more help for a few weeks. See hospital discharge planning.
- Is someone reachable around the clock? Ask whether there is a 24-hour phone line and who answers it3.
Missed visits are among the most common complaints families have about home care. Ask the agency directly how often shifts go unfilled and what it does when that happens. A confident, specific answer is a good sign.
Questions about costs and the contract
Ask for all costs in writing before services start, and ask what is included and what is not3. Compare billing schedules, deposits and whether rates differ for weekends, holidays or overnight shifts. Then read the service agreement closely.
- How do I stop or change services? Ask how much notice is required to cancel or change visits3.
- Do you work with insurance or benefits? Ask whether the agency accepts long-term care insurance, Medicaid waiver programs or VA programs. See long-term care insurance and Medicaid waivers.
- Is there a no-hire clause? Some contracts limit hiring a caregiver privately. Know this before you sign.
- What is your complaint process? Ask who handles complaints and how quickly.
Medicaid home and community-based services programs in many states pay for personal care at home for people who qualify6, and the PACE program covers home care in some areas. Our guide to paying for senior care covers the other options.
Agency or private caregiver?
Some families hire a caregiver directly instead of using an agency. A private caregiver can offer flexibility, but the family takes on screening, scheduling, backup coverage and supervision. If you pay a household worker above a set amount, you may also become a household employer responsible for payroll taxes7. An agency handles those duties for you. Our guide to home care agency vs. private caregiver compares the two in detail.
Some states also let family members be paid caregivers through Medicaid programs. See how to get paid to care for a parent.
Include your parent in the decision
Many older adults resist help at home at first. They may worry about losing privacy or independence, or feel embarrassed about needing help with personal care. Involving your parent from the start makes it far more likely the arrangement will work.
Invite your parent to sit in on agency interviews, or at least the meeting with the caregiver. Let them choose small details, like the time of a visit or which tasks come first. Frame the help as a way to stay at home longer, which is what most people want. If your parent refuses outright, our guide to when an elderly parent refuses help offers ways to start the conversation and small first steps, such as a few hours of companionship a week, that can ease them in.
Warning signs after care begins
Hiring is not the end of your job. In the first weeks, visit at different times, read the care notes and ask your parent how things are going. Watch for:
- Missed or shortened shifts. Compare the hours billed with the hours you know were worked.
- Changes in your parent. New bruises, weight loss, poor hygiene, fear or withdrawal deserve a prompt conversation.
- Money concerns. Missing cash, new charges or a caregiver asking about finances. See elder financial abuse.
- Poor communication. Calls that go unreturned or vague answers about who is coming.
Raise concerns with the agency supervisor first. If something seems unsafe, contact your state's adult protective services or the agency that licenses home care. The Eldercare Locator can connect you with local help8. If you are the main family caregiver, bringing in help is also good for you. See caregiver burnout and respite care.
