As Rajiv Nagaich observes regularly, the vast majority of seniors claim they want to live out their lives in the comfort and security of their own homes. Yet fewer than one in three will actually succeed in realizing their powerful desire to age in place. Seventy percent of seniors are at high risk of becoming a burden to their loved ones and ending their days in some form of institutional care.
But the fact remains that most seniors will need some sort of assistance with activities of daily living as they age. Successful aging in place means you have made arrangements for necessary care to come to you, and you’ve made provisions to cover the cost.
One of the key elements in successful aging in place involves choosing the right home care agency as your health care partner. A bad choice can prove disastrous, costing you thousands for substandard and unreliable care. But the right agency can help ensure that your life can indeed be lived out on your terms, with high quality professional care coming to you.
Choosing from a Bewildering Array of Agencies
With that in mind, how can a family choose the agency that will reliably meet their needs? The choice can be harder than it might seem.
In preparing this article for the Blog, we did some quick research and discovered that there are currently about 11,500 licensed home health agencies in the U.S. (Ironically, that figure is about 1,000 lower than it was in 2013.) Add in the number of licensed home care agencies able to provide non-medical support – things like bathing, dressing, and meal preparation – and the total figure edges closer to 30,000 licensed agencies nationwide.
The choices can appear bewildering. But fortunately, there are helpful tools to make the selection more fruitful and far less overwhelming. One such aid comes from our partners at Homewatch CareGivers, a handy workbook titled simply, How to Choose the Right Home Care Agency. This reference guide and checklist will help you and your family navigate through a maze of choices to make a smart selection.
Let’s take a look at the kinds of questions this guide recommends asking.
Different Types of In-home Caregivers for Different Needs
Caregiving is a diverse industry, and before diving in, it can be helpful to understand the terminology and different styles of care services available. The Homewatch workbook explains the different labels.
A home care agency is a full-service provider; they recruit, screen, manage, and train caregivers, as well as handling all employment responsibilities, insurance, and any backup coverage.
Home care registries are matchmaking services that connect caregivers with families in need of care. In this model, the family becomes the direct employer of the caregiver, with all the associated responsibilities.
Caregivers employed directly through personal networks or one-on-one platforms are called private hire caregivers. This gives the family complete control over the process, but also all of the responsibility for vetting potential candidates, paying them properly and on time, and any insurance involved.
The Homewatch guide focuses entirely on choosing the right home care agency through which to hire a caregiver, noting the four essential advantages of vetting, training, backup, and insurance that a professional agency provides.
The Four Non-Negotiables: Vetting, Training, Backup, and Insurance
Vetting is of utmost importance when hiring a caregiver, and the guide explains that agencies can differ in how thoroughly they screen caregivers: “Quality providers conduct national criminal background checks. They verify references carefully. They monitor caregivers on an ongoing basis.” The deeper the screening, the better your chances of receiving care from a trusted professional.
Quality agencies also ensure that their caregivers receive comprehensive and ongoing training. “Look for at least 40 hours of initial training plus ongoing education,” the guide suggests. “Well-trained caregivers build more meaningful connections with the people they serve. They understand how to provide care that honors each person’s preferences and dignity.”
One advantage of hiring a caregiver through an agency is backup coverage, should your caregiver ever require an absence or time off. “They maintain backup caregivers who already know your loved one’s preferences and routines,” the guide explains. “You should never have to scramble to find coverage during emergencies or planned absences.”
And finally, insurance protection is a non-negotiable for professional agencies. They carry both workers’ compensation as well as general liability insurance, giving your family financial peace of mind.
These Red Flags Should Alert You to Potential Problems
Like any industry, the workbook warns us, caregiving also has specific practices and vulnerabilities that should present red flags to a discerning family looking for care.
For example, rushed placement processes and vague screening details could mean that an agency is being less than thorough about assessment or trying to disguise poor standards of background checking or training.
Bad or delayed communication in general with an agency is a red flag—it’s unprofessional, and could imply deeper issues in the organization as a whole. Moreover, any vague or reluctant communication about fees and finances is also a problem. Such hesitancy could be hiding a fee structure that will pop up with surprise charges later on.
Finally, high caregiver turnover is worth paying attention to, as well as inadequate guarantees of backup coverage. Both could be clues to substandard staffing, employee dissatisfaction, or other internal problems in the agency.
Starting the Search Means Beginning with the Basics
When starting the search for an agency, the guide provides a list of essential questions to ask in various categories, which we will explore below.
But first, the basics: Using referrals and online research, the guide suggests narrowing your potential agencies down to 3-5 options.
Next, do a little digging. Check the state licensing status for each agency and review online testimonials and Better Business Bureau ratings.
Finally, when you’ve picked a prime candidate or two, schedule your initial phone consultations, and consider the following questions to help you vet your top picks.
Essential Questions: How Agencies Screen their Caregivers
As mentioned above, making sure that an agency properly screens potential caregivers is of paramount importance to the wellness and safety of your loved one.
To that end, consider asking the following questions from the guide:
“Can you walk me through your background check process?”
“How do you determine if a caregiver is the right fit for your organization?”
“How do you verify employment history and references?”
“How often do you update background checks for active caregivers?”
“Can you walk me through your complete vetting timeline?”
High Quality Agencies Emphasize Ongoing Professional Training
Training should be ongoing and comprehensive; remember that 40-plus hours of training for new caregivers is considered high quality training in the industry.
You could ask:
“How many hours of initial training do new caregivers receive?”
“What specific topics does your training program cover?”
“Do you provide hands-on skill assessments?”
“What ongoing education requirements do you have?”
“Does the training meet the care needs of your loved ones?”
Maintaining Quality Standards and Handling Client Concerns
Clients should be able to access 24-hour support from the agency to ask questions or express concerns. The best agencies use real-time communication platforms to make this easy. Also, regular supervisor visits and check-ins are important to maintain quality of care.
To find out how each agency handles these topics, you could ask:
“How do you ensure ongoing quality in the relationships between caregivers and clients?”
“What frequency of care do you recommend for my loved one?”
“What’s your process for handling complaints or concerns?”
“How do you measure caregiver performance?”
“Who can families contact after business hours?”
“What’s your backup plan when regular caregivers are unavailable?”
“How do you use technology to keep families connected to care?”
Going Beyond the Basics: the “Extra Mile” of In-Home Care
Aside from the typical, standard questions, the guide provides the following “extra credit” things to ask that can give you a fuller picture of how an agency operates:
“What technology do you use for care coordination?”
“What percentage of your caregivers have been with you for over 2 years?”
“Do you provide family access to real-time care updates and communication?”
“How do you handle care plan adjustments without service interruption?”
“What advanced certifications do your supervisors maintain?”
Remember to Verify Licenses and Check References
If an agency has answered your questions to your satisfaction, there are still a few steps to tackle before you can sign with confidence on the dotted line.
Make sure you request and verify current licensing certificates, review insurance documentation (like workers’ compensation and general liability), and confirm bonding and proper legal compliance.
It can also be a good idea, the guide says, to ask for client references with similar care needs. In those references, look for notes that demonstrate caregivers building genuine connections with their clients. In references or reviews, the agency should be shown to have open communication, reliable support, and responsiveness to problem-solving.
Trust Your Gut: “Intangibles” Can Provide Added Insight
High-quality agencies have clear documentation: detailed screening protocols, comprehensive training curriculum, clear service agreements (and no hidden clauses), transparent pricing structure, and up-to-date insurance and licensing.
But some of the best “proof” of a good agency is largely invisible, says the guide. Professionalism and good organization, willingness to thoroughly answer questions, clear explanations, genuine interest in your loved one’s specific needs, and transparency about costs and procedures are all clear signs of a well-run agency.
Making Your Selection: Choosing with Confidence
When narrowing down your choices, the guide suggests taking a few extra steps to make the most confident decision possible.
Ideally, contact and speak with at least two client references per agency, and schedule in-home consultations with representatives from your top two or three choices. Ask to meet potential caregivers and trust your instincts about their professionalism and communication; if something feels off, it almost certainly is.
Finally, review and understand all documentation and service agreements and make sure everyone is clear on the expectations for ongoing monitoring and feedback.
When to Seek Help from a Professional
The guide notes that some situations are more complicated than others, and there may be circumstances when it’s ideal to bring in a professional to help with the process of hiring the right caregiver.
You may want to seek out help from a Geriatric Care Manager (GCM) if you or your loved one has a complex medical condition that requires specialized coordination of care, or multiple service providers all needing to work together. A GCM can be an essential support if there’s disagreement among family members when it comes to care decisions or agency selection. They can also answer insurance questions, such as navigating Medicare or Medicaid funding options.
In the agency selection process, an Elder Law Attorney can step in to help review and clarify complex service agreements or contracts. They can also address liability concerns or insurance questions, plan for long-term care funding strategies, or deal with any disputes over care quality or payment issues.
Bottom Line: a Major Life Choice Demands Extra Measure of Diligence
The guide concludes with the encouragement that choosing the right agency really is as much a matter of the heart as it is about asking the right questions, if not more so.
“Quality agencies welcome your questions about their approach to care,” the guide states. “Their openness and genuine interest in understanding your loved one’s needs often indicate the kind of caring relationship they’ll build together.”
Thanks once again to our partners at Homewatch CareGivers. The workbook titled, How to Choose the Right Home Care Agency, is available for download. Use this reference guide to help navigate through a maze of choices in in-home care.
The post A Critical Choice: Your Guide to Selecting the Right Home Care Agency appeared first on Home.
