How to Evaluate Local Home Care Agencies: A Step-by-Step Guide for Families

By Your Health Magazine Contributor

Your Health Magazine Contributor

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How to Evaluate Local Home Care Agencies: A Step-by-Step Guide for Families

Making the decision to get care for someone you love is hard enough. Trying to figure out what’s the best care for them can be overwhelming. If you’ve landed on home care as the right path, the pressure’s on there too. How do you know the care you’re bringing into your loved one’s most private space is high quality and safe? There’s no perfect template for choosing the best home care partner. We developed these profiles here at Ready to help you think through where you land on the situation.

Step 1: Define What Your Loved One Actually Needs

Before you reach out to an agency, put pen to paper and audit the care needed. There are two different types of “home care,” and two different kinds of licensure that agencies must hold.

Non-medical home care is “personal” care, bathing, dressing, toileting, meal preparation, medication reminders, light housekeeping, and companionship. These are Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).

Home health care is wound care, physical therapy, skilled nursing visits, and other physician-directed services. If your family member needs home health care, the agency must hold a different licensure.

Both types of care are conducted inside the home, creating confusion. Most families need non-medical home care. If you need home health care, sometimes a formal physician order is required. Start with what you need before your first conversation.

Step 2: Ask the Employment Question Directly

W-2 employees or W-2 contractors is the tell-tale differentiation between a professional agency and a staffing arrangement that turns much of the responsibility over to you and potentially an asset-less 1099 caregiver. Here’s how you might be at risk:

You’re responsible for complying with minimum wage, overtime, and other HR laws for household employees. A W-2 agency will ensure that’s all taken care of. You’re required to secure insurance that protects you should an employee become injured on the job. A W-2 agency handles that.

You’re legally required to withhold and pay taxes for all household employees. Yet another thing a W-2 agency can take off your plate. W-2 or a similar on-the-books arrangement (e.g. W-4’s are the similar for household employee withholding) will involve the professional payment of wages and taxes via check or direct deposit, not cash, as well as maintaining related records.

In other words, if all you’re doing is writing a check or making an electronic payment to the caregiver, and the rest is handled by a Registered Tax Return Preparer working to the Form 1040 Schedule H for household employment taxes or an agency that only submits employees to W-2s, you could be dangerously close to acting as a private employer.

Step 3: Verify Local Licensing and Community Standing

Licensing requirements can vary by region, so it’s hard to say exactly what is needed where you are. But home care agencies should be registered with the state or local health authority. When families search for home care Philadelphia, for example, verifying that the agency holds current state licensure and has established relationships in the local community tells you something meaningful about operational stability. You can also ask the agency for the information and follow up by calling the health authority.

Step 4: Press on Staffing and Backup Protocols

High turnover rates among home caregivers are prevalent throughout this industry. The growing popularity of in-home care has seen to that. The AARP says 77% of us wants to stay in our homes as long as possible. And when demand for talented, kind-hearted caregivers outstrips supply as it does nearly everywhere, you get retention problems.

Ask agencies directly about their turnover rate. If they dodge the question or are taken aback, you know all you need to. Then, beyond turnover, you need a written backup protocol. What if the caregiver calls in sick on a Sunday morning? There should be a direct answer to that, a dedicated on-call supervisor, a bench of backup caregivers, a response time. We’ll figure something out is not a protocol.

Step 5: Read the Contract Before You’re Emotionally Committed

It’s key to get the specifics of your agreement in writing before anyone shows up for their first shift. Details that are broadly interpreted and cause conflict later, often when memories between family members differ: minimum shift length (four hours is typical), holiday rate premiums, required deposits, and notice of cancellation.

Ask explicitly: how many days’ notice do you need to give to end services without a financial penalty? Some agencies require 30 days. Some require two weeks. But if your medically fragile husband falls and you’re hospitalized with a head injury, this little provision could ruin you.

Also ask explicitly whether the agency employs a care management platform, software that automatically records the arrival and departure times of the caregiver and family member, as well as fixed and random task prompting throughout the shift. Your loved one may not need the software’s service of flagging when a diaper change was missed, but for families out of arm’s reach managing care, real-time care logs are not a luxury. They are a must-have tool for verifying accountability.

Making the Final Call

Ask how cases are staffed. Are the same caregivers sent to the house for each visit? If not, why? Your loved one will thrive on routine and familiarity. They need to have the same caregivers whenever possible. A good agency understands this and will make every effort to keep a consistent team in place.

Frequent caregiver changes can be unsettling for clients, particularly those living with dementia or cognitive decline, so it’s worth asking what the agency’s staff turnover is like and how they handle situations where a regular caregiver is unavailable. Finding out whether there’s a backup system means no one is left without support at short notice.