How to Choose the Right Home Care Provider

In the last part of our series on home care services, we discussed the difference between skilled and custodial home care services, which is good preparation for this month's topic, the selection process. Why? Because it helps to know what kind of care you need before choosing the right home care provider for yourself or a loved one.

To begin with, those needs are typically based on a physician's, case worker's or your own assessment of what's needed. If both skilled and custodial care are required, you could work with an agency that provides both, or just as easily, hire an agency with certified nursing assistants that works directly with your physician and/or nurse case manager. There are also individual or independent caregivers with nursing backgrounds who may offer both kinds of care and who work with other nursing professionals.

Depending on the scope of services required, your first decision may be whether to go with an agency or an individual, since the selection process for each will be quite different and require very different time commitments.

Spelling Out Services/Fees/Hours

When interviewing prospective home care agencies, start by asking if they provide free estimates (surprisingly, not everyone does). At the top of most people's list of the questions are fees: they may be listed as hourly, daily and/or weekly. Ask if there are minimum and maximum hours of service and if there are limitations as to the tasks and/or times of the day when services are provided.

Some agencies provide a customized plan of care, with all of the services, duties and responsibilities, including financial arrangements, outlined in detail. Having a care plan can help you keep track of the care being delivered to ensure it's what you expected and/or what the doctor ordered. A care plan is especially important to adult children who live away from parents for whom they've contracted services. On the other hand, having a plan and executing it are entirely different things.

That's why at Helpful Hands, we developed a remote computerized system that allows us to keep tabs on our caregivers using the clients' own telephone. Caregivers simply dial into our computer and are automatically checked in and out for the day. The system also helps us provide substitutes (often our own supervisors), if the regular caregiver can't make it in one day; it matches special needs with unique caregiver skills, as well.

A home care company may or may not offer a contract, but before you sign anything, make sure you carefully review it. For example, make sure you understand who will be providing the care and whether they are home care specialists, licensed practical nurses or registered nurses, and who will be supervising the caregivers (preferably some type of nursing professional). With an individual caregiver, chances are you will be the supervisor, so ask yourself if you'll be comfortable in that role.

Third Party, Independent Quality Measures

One way to judge the quality of an agency is to ask what kind of training it provides caregivers and how often they receive subsequent training to maintain their skills. You might also ask whether the agency's caregivers are "W2 employees" or "1099" independent contractors. Your preference should be for the former, since they are more likely to have liability, workers compensation and other forms of insurance coverage that contractors seldom have.

Among the most important questions to ask: Are caregivers bonded? and What kind of background checks, tests and screens are conducted (e.g., law enforcement, personnel, drug and history of infectious disease)? You'd be surprised how many agencies don't conduct criminal background checks and drug screens.

Find out how long the agency has been in business, or if an individual, how much experience he or she has in providing home care services (both on her own and working in a facility or an agency). References for both individuals and agencies can include health care professionals who know them by reputation and consumers who have used the service (or know the individual); check every one thoroughly.

Also, find out if any complaints have been filed with the Better Business Bureau, state consumer protection agency or state attorney general's office. On the positive side, another quality measure is whether or not the agency staffs its phones 24 hours a day, in case you, your loved one or a caregiver needs help for any reason.

To some, this may seem like a long list of issues to consider. The truth is, I've barely scratched the surface here. When you consider that you're allowing perfect strangers into your home to perform highly personal services, I think you'll agree that it's important to be thorough and to ask a lot of probing questions.

Of course, uncertainty can be minimized by using a reputable agency, which can screen, train and hire professional caregivers on your behalf, in addition to protecting you against theft and other types of loss. What's more, if the first caregiver doesn't happen to work out, you can always try another one from the same agency, without having to go through the hiring process all over again, as you would with an individual.

Selecting Home Care Services: A Checklist Individual or Agency?
  • Fees
  • Hourly Daily Weekly Live-In
  • Minimums? Maximums? Limitations?
Plan of Care? Contract?
Who provides care? When? Supervised by whom?
  • Qualifications
  • Training/re-training
  • Background
Checks ...Screens/Tests
  • Caregiver Monitoring System?
  • Complaints
  • References