How do I select a non-medical home care agency?

If you need caregiving assistance in your own home or that of a loved one, you first have to determine whether you will need non-medical home care or home health care.
If you need caregiving assistance in your own home or that of a loved one, you first have to determine whether you will need non-medical home care or home health care.

Hiring a home care worker can provide valuable assistance and make your life much easier. The question is, how do you know which company to hire?

If you need caregiving assistance in your own home or that of a loved one, you first have to determine whether you will need non-medical home care or home health care. As a result, unless your doctor has prescribed care as part of a medical care plan, you’re looking for non-medical home care.

While non-medical home care can be called by many different names (including personal care, companion care or homemaker services, among others), the services they offer are generally the same. These include assistance with activities of daily living (ADLs) and can include:

  • Bathing
  • Companionship
  • Dressing
  • Feeding
  • Grooming
  • Laundry
  • Light housework
  • Meal preparation
  • Medication reminders
  • Mobility assistance
  • Shopping
  • Toileting
  • Transportation

As home care is generally paid for out-of-pocket (although long-term care insurance, the VA or Medicaid may help pay for it), you’ll want to interview multiple companies. This will ensure you get the services you need, the best value for your money and that the company you select is a good match.

You can get referrals from family, friends, physicians, online listings or senior centers. When you narrow down your search and begin calling, you’ll want to ask:

About their fees. . .

While certainly, the hourly rate is a prime consideration, you will find that the answer depends upon how much care you or your loved one will need. As an accurate quote depends on your unique situation, be prepared to spend time discussing your situation in detail and being very specific in exactly what you may need. For them to give you the most honest pricing, you have to give them the most honest information about the situation.

As a result, you may want to leave this question until the very end of the call or save it until you have the opportunity to meet face-to-face. At that time, in addition to their hourly rate, you’ll also want to know:

  • Do you have an hourly or daily minimum? Most companies will require a 3-4 hour minimum. If you or your loved one is residing within a community where multiple people are receiving care, these minimums might be lowered. Also be aware that you may be charged less per hour if the company isn’t paying all the taxes, insurance and bonding (see below) for its home health aides. A lower hourly rate could put you at risk.
  • Based on what I’ve told you about our situation, how many hours a day do you think you’ll need to provide assistance for me? If the answer varies widely from one company to another, something is not being communicated properly.
  • What additional charges or fees might apply?
  • Do you accept credit cards and/or require a deposit for services?
  • What kind of service agreement is required?
  • How often will you bill me?
  • (If applicable) Do you accept long-term care insurance and, if so, will you bill them directly or require me to pay up front and then seek reimbursement? If you do have long-term care insurance, you’ll want to verify the home health company’s acceptability to your insurer before you proceed.

Home care can be wonderful as it allows the person receiving care to remain in their own home amid familiar surroundings. Services can also be used to fill in the gaps of time when you can’t be present to care for a loved one. However, it isn’t inexpensive.

Depending upon the rates and the number of hours you’re looking at, you may find it’s actually less expensive to look into private caregivers, adult day care or make a move to an assisted living community.

According to the Genworth annual cost of care survey, home care through and agency averages $135 a day, while a privately hired aide averages $131 a day. However, adult day care, where available, averages $70 a day. And placement in an assisted living facility with three meals a day, activities and transportation to outings averages $123 a day—24 hours a day, 7 days a week.

About their business. . .

Selecting a home care agency is much the same as selecting any professional service. You want to make sure they’re legitimate, that they have a good track record in the business and that they can provide the care you’ll need—both today and down the road tomorrow. To do that, you’ll want to learn more about their background and history, what they offer, and how secure they are. You’ll want to ask:

  • Who owns the company? Are you independently owned or a franchise? If the company is independently or locally owned, they will set their own policies and procedures. If they are a franchise, they will have to meet regional or national standards. That doesn’t mean one is better or worse than the other. A local organization, with deep ties into the community, may have exceptionally high standards. On the other hand, if they’re a fly-by-night operation, they may have none at all.
  • How long have you been in business? While longevity in the business is certainly a good measure of stability, a company that has only been in business a short time may also have just been opened by someone with great depth and experience in the industry.
  • Are you licensed by the city and/or state? Can I see current copies of those licenses? Not every city or state requires licensure. However, if yours does, you want to ensure that the company you hire is operating legally and above board.
  • Is your company insured? Can you provide me with a copy of your insurance declaration page? You wouldn’t want a plumber to come to your home without insurance. A caregiver who would be there when you’re at your most vulnerable is no different.
  • Can I get the names and phone numbers of some of your former or current clients for their recommendation?

About their care plans. . .

In states that require licensing, they are also required to develop a customized, organized schedule of services that the company can regulate and which you can agree upon. This will be developed after consultation with you to determine exactly what is needed, how often and for how long. As a result, this will have a direct bearing on the cost of services provided. You’ll want to know:

  • Will your company be creating a care plan for me to review?
  • If so, how often will this care plan be reviewed by your staff and/or revised? The needs of you or your loved one will change. It’s important that any care being given keeps up with those changes.
  • Do you conduct regular quality assurance checks to see that the plan is being followed by the caregiver? Having a good plan is great. Ensuring that it’s actually being followed is even better.

About their caregivers. . .

Choosing the specific person who will come out and provide care can be similar to dating. You may want to “go out” a few times together in the comfort of your home to see if they’re a good fit.

It’s a fact that caregivers in the industry can tend to come and go. On the other hand, if they’re a good enough fit, a caregiver can be with you for years, taking part in family events and, in effect, becoming part of your family. Ask the company you’re speaking with about:

  • What type of background checks and drug screening do you do on your staff? A simple credit check can tell if someone is in over their head in debt and may be more likely to steal. There are also local, statewide and national professional registers of criminal or unprofessional activity (such as nurse aide registries).
  • How often do you randomly repeat drug screening and criminal background checks? Just because they passed the tests when they were hired doesn’t mean they’ve stayed clean and out of trouble in the meantime.
  • Do you have standards of conduct for your staff? If the company has well thought out, formal policies in place, you should expect that the care you receive will be the same no matter who shows up for duty.
  • What training do you provide? You’ll want to learn if this is formal training through a recognized state or national resource or is it just something that has been thrown together. If you’re looking for care for a loved one with dementia, you’ll want to inquire about specific training for that.
  • Who provides the training and what are their certifications? If the background and training of the person doing the training are good, the chances are much better than your caregiver will be correctly trained.
  • Are the employees of your company or independent contractors? If they’re actual employees, the company may charge more as they have to pay local and state taxes, federal unemployment taxes, liability or worker’s comp insurance, and health insurance. If they’re independent contractors, the company may charge less, but then they’re less likely to have health insurance (which could impact your health), liability insurance (in the event they damage something in your home) and/or bonding (see below).
  • Are they bonded? Bonding serves as insurance for the company in the event you report a theft. While it can’t prevent theft, it can give you additional peace of mind that the company is committed to protecting you and your possessions.
  • Do they receive regular immunizations for flu, tuberculosis and other communicable diseases? Ask to see the proof for any worker that may be coming into your home.
  • Will we see the same care worker consistently or will they change out frequently? Just because you like the caregiver who first came out doesn’t mean you will keep them. The agency may need them somewhere else or the caregiver may prefer a closer location to their own home. The fact is, 65% of caregivers are always looking for a new job.
  • Am I required to provide meals to the caregiver? Realize that this may mean more than just sharing lunch at home. If the caregiver’s assistance is required when dining out, they would be eating, as well.
  • Will changing the hours I need care change the caregiver? It could be that a caregiver travels a great distance or uses public transportation. It may not be worth their while to visit your home for lesser hours.
  • How far in advance do I need to make you aware of a schedule change or cancel a visit? Emergencies happen. It’s best to know how to proceed and if you’ll be charged even if a caregiver doesn’t need to come.
  • How do you handle changes in care needs on short notice or after hours?
  • Can I interview different caregivers and choose which one I want to work with? Either yourself or your loved one may be dealing with very personal challenges. Much the same as dating, you’ll want to ensure a good match.
  • What’s the backup plan if my caregiver is sick? You want to make sure that your care is covered if the caregiver is unable to come.
  • Are your caregivers legal residents of the United States?
  • If I have a complaint about my caregiver, whom do I contact?
  • How do you handle conflicts between a caregiver and a client?
  • If I’m unhappy with my caregiver, how do I formally request a new one?

Once you’ve contacted three to four different companies, compiled your information and compared your result, you can move forward on making an initial selection. From there, you’ll want to interview the caregiver and determine whether they are as good a fit as their company appeared to be.


Finding the right non-medical home care agency can be challenging. However, as you journey along the gray mile, you can make the right decisions by asking the right questions.

Tom Text


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