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  • Writer's pictureMeg Pemberton

Five Questions to ask Home Care Agencies

At some point along your eldercare journey your parent(s) may need more assistance than you can provide. There may be gaps in what you or your family can provide. However, your parent(s) may not yet need care provided in an assisted living facility or nursing home. Perhaps they are still largely independent. They may need minimal assistance with their “activities of daily living,” (ADLs), have some limitations with their mobility, or need gentle reminders to eat or take their medications. There are options available. Non-medical in home care agencies provide personal care, companion care, transportation, and some will provide light housekeeping. They are different than home health agencies which provide skilled nursing care. There are five questions to ask home care agencies as you explore this option.

Caregiver Training

Home care agencies hire Certified Nurses’ Aides (CNAs), Personal Care Aides (PCAs), and in many cases, unskilled workers who demonstrate a desire to care for the elderly. Agencies that hire unskilled caregivers provide some training upon hire and/or on the job. Some level of training should be provided for all new hires. Training is necessary in order to obtain and maintain a license to operate. Requirements will vary state to state. Actual training will vary agency to agency. It’s important to ask any agency you are considering about their training. Here is what you should ask:

· What skill level is required for hiring (CNA, PCA or other)?

· Are their skills validated upon hire? Annually after hire?

· What is included in new hire training?

· Who provides the training? Look for a Nurse as the trainer/educator.

· What annual training is required?

· What are the state requirements for training and ongoing education? You can find this information on your own. However, it’s important to know that the agency knows too.

Any company that values their clients will ensure quality of care with thorough training, annual skills validation, and continuing education.

Accreditation and Gold Seal Approvals

Accreditation indicates that an agency has been granted approval status after rigorous review of policies, procedures, and metrics related to quality and service. The Joint Commission is an organization that provides accreditation to hospitals and home health agencies. Such agencies who wish to be reimbursed by Medicare must be accredited. This is not yet the case with home care agencies who do not provide skilled care. However, the Joint Commission, and other like organizations, do offer accreditation for home care agencies. Ask the agency you are considering if they are accredited? If they are not, ask if they are pursuing accreditation. Their answer will tell you a lot about their commitment to quality care.

Gold seals of approval, much like the Good Housekeeping seal of approval, indicate the agency excels in one or more of several areas. Home Care Pulse is just one of many organizations providing awards or “gold seals” in recognition of excellence in quality. A home care agency can be awarded as a provider of choice, an employer of choice, or as a leader in excellence. Awards are given based upon surveys completed by clients and caregivers. Survey results are tracked and compared against like agencies. Home care agencies use the results to drive performance improvements. Ask the home care agency about their survey results. Do they have any awards? Be aware that agencies pay for the surveys and many may choose not to participate. In this case, ask if they have earned any local or state recognition? Have any of their staff or caregivers earned recognition awards?

Caregiver Consistency

Consistency in caregivers is important to most all home care clients. It is also a goal of most of these agencies. Your parents, and you, will develop a relationship with the caregivers assigned. Once the relationship is established, it is hard to have a new caregiver on board. For the senior with dementia consistency takes on greater importance. The home care agency will likely recommend a team of caregivers be assigned to your loved one. In reality, you really must have more than one caregiver. They have lives, families of their own, and they call out when sick (as they should). Having a known alternative is important in reducing stress and anxiety in the elderly. Here are some questions to ask the home care agency:

· What ratio of caregivers to clients do they employ? The ratio should be at least 3:1. More then 3:1 is better.

· How many open shifts do they average per day? The answer will vary based upon the size of the agency. However, shifts left unfilled should be zero; single digits at the most. Every open shift means that a senior is going without care. This may also mean you have to miss a day of work.

· Does the agency provide caregivers for hospitals, nursing homes, or assisted living facilities in addition to private clients? If yes, who takes priority? Your parent, a private client, should be prioritized.

· What policy do they have in place regarding inclement weather? You may need a backup plan.

· Can you meet potential caregivers prior to their assignments to care for your loved one? If not, ask if a staff member form the agency is available to assist with introductions and answer further questions the first time a caregiver is in the home.

Insurance and Liability

Home care agencies are required to provide proof of insurance or indemnity coverage for initial licensure. Insurance coverage is important in the event the caregiver is injured while in your home. The coverage should also cover any losses related to theft or other abuse you loved one may suffer at the hand of a caregiver. Ask the agency if they are insured.

Cost Structure

Finally, as you comparison shop agencies, consider their cost structure carefully. Keep in mind that the cheapest is likely not the best. Be aware of hidden costs. Here are a few questions to ask:

· What is the hourly base rate charged?

· Are there additional charges for evenings, nights, weekends, and holidays?

· Is there an administrative fee to initiate services? If yes, what does it cover?

· Is there a charge for assessments provided (and required by state health department regulations) by a nurse? Is there a charge for required reassessments?

· Do they accept long term care insurance, Medicaid, or Veterans Administration clients? Non-medical in home care is generally considered private pay.

Is Home Care a Good Option?

The answer is yes! Don’t be put off by the questions and research necessary to choose an agency that fits your needs and more importantly suits your loved one best. Non-medical in home care can provide as little as a few hours a week to 24/7 care. Such care reduces family caregiver strain, improves the livelihood of the senior through companionship, reduce loneliness, and can reduce trips to the emergency room, hospital admissions, and readmissions. The need for caregivers in the non-medical home care arena is growing every day. New agencies are joining franchises providing care across the country at a fast pace. Agencies come in all shapes and sizes and this is why it’s important to ask the five questions. Rather, it’s important to ask all of the questions noted in the five areas highlighted in the blog. You may come up with a few more questions on your own. Don’t be afraid to ask them.


Your elderly parents may require more care in their home than you can provide. A non-medical home care agency may provide the assistance you and your parent need. There are five questions to ask home care agencies as you look for the one best suited for you and your parent.


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