How To Evaluate Home Care Companies

Ask any older adult where they want to age, and it's likely you'll get some variation of "in my own home". Indeed, a 2021 AARP study confirms that despite the benefits associated with aging in a structured senior living community, most seniors want to age in place for as long as they can.

If you have an aging family member who wishes to stay in their own home but requires some assistance (either with medical or non-medical care), you're probably considering engaging the service of a home health agency. In-home care allows families to tailor the care provided to fit your loved one's exact needs, whether they require a few hours of assistance each week or full-time care - or something in between. From providing quality care to providing socialization, the best caregivers support so many vital functions.

But the process of evaluating home care providers is tricky, to say the least. In most cases, caregivers are alone with care recipients for hours on end - so trust, confidence and peace of mind are paramount. If you're exploring in home care solutions, you'll need to do a bit of research and interview several candidates before you find the right caregiver. But how to start? We've outlined a step-by-step process for deciding on the right care solution for your loved one.

Step 1: Assess the level and complexity of care needed

While home care is often the preferred option for older adults, the decision to engage home care services or support will often come down to a financial one. Like many other services, the cost is dependent on two factors: how much care your loved one needs, and the level of complexity of the care. If, for example, skilled nursing services are needed around the clock, it may be more financially prudent to consider assisted living or a skilled nursing facility. On the other hand, if the only care needs are more limited - say, household support and socialization, the financial burden will be less taxing.

As you narrow down the type of care your loved one needs, you'll start with this basic question: Do you need a caregiver who will live in the home and be available 24/7? Or will home health care for your loved one be fine with someone who comes in daily or even just a few hours a week?

To make this choice, assess how much care your family members really need. Are they safe and comfortable during nighttime hours, or could they run into trouble in the middle of the night? The National Caregivers Library has a helpful worksheet that allows family members to gain clarity on the level, quality and complexity of care needed.

Step 2: Determine care solution

In home care vs senior living community

If you've filled out the National Caregivers Library worksheet and decided that in-home health care is your preference, you've already got the answers to some important questions. Does your loved one need medical care (e.g. IV change, insulin injections, wound care), or just help with the activities of daily living (e.g. dressing, feeding, meal preparation, getting around)? Do they need simple medication reminders or will they require medication management?

Once you've gained clarity on the type of care needed, you'll want to decide on the right care environment. Generally speaking, when care needs are more complex and time-intensive, families should consider a structured senior living solution, such as an assisted living or skilled nursing facility. While cost is the deciding factor for most families, the coordination of care should also be a consideration. In a one-on-one environment, routine occurrences like sick days or vacation time can put serious strain on family members to support the continuity of care. If you've filled out the worksheet above and concluded that the level of care may be too complex for in-home care, Seniorly has created a great assessment tool to help families determine the right type senior living community.

Home health agency vs independent caregiver

If you've decided that home care is your preferred solution, Next you'll want to consider what type of home care solution you want. You can engage the services of a health care agency, or you can hire an individual caregiver who meets your needs. While home care agencies are generally more expensive, they do provide some valuable services that many families do not want to manage. In particular, agencies tend to manage things for employees, like payroll services, background checks, coverage for sick or vacation time, and generally provide expertise, oversight and structure for more complex care needs.

Impact on family members

Whatever you decide, this is an important time to check in with any other family members who may be impacted by the decision. Each family member may be called upon to coordinate care from time to time, it's vital to ensure that everyone is on the same page and has a chance to share input before you proceed.

Step 3: Evaluating your options

Evaluating home health agencies

To make sure that your loved one stays safe and healthy at home, most families choose to work with an agency to support more complex care. While you should ask any and every question that comes to mind, we've compiled a list of six questions that we think are worth covering in any interview.

1. How will the agency determine your loved one's health care needs?
   Someone from the home care agency you're considering should conduct a full assessment of your loved one's needs. For many agencies, this involves coming to your loved one's home, meeting them in person, and checking out the home environment as part of determining the right home care provider and level of care. If your loved one has significant medical needs, this initial assessment should be performed by a registered nurse or the equivalent. You may be asked to outline hygiene assistance needs, provide copies of medical records, lists of medication, or actual care plans to help explain their health conditions and treatment plan.
2. What conduct does the home care agency expect of its caregivers?
   Practical and medical skills are important, of course, but you also want to find a caregiver who displays exemplary character core values. Because you're inviting the caregiver into your home, you want to find someone who will treat both your loved one and their belongings with respect. You can ask the agency to provide a copy of their standards of conduct. Caregivers may be restricted from performing certain tasks or need prior approval. It’s good for you to know this upfront to avoid misunderstandings.
3. How are caregivers supervised?
   Does the home care service agency arrange for unscheduled visits to make sure the caregiver is living up to expectations? The supervisor who performs these visits should also be a point person you can contact freely if there are issues you don't want to discuss with your caregiver. Are you given an opportunity to provide feedback to the service agency about the caregiver’s performance?
4. How will you communicate with the agency?
   Related to the previous question is the issue of ongoing communication with the home care agency. If you have questions or concerns, will you contact the same person every time, or do you just speak to whoever is manning the phones? You should also ask if you'll be notified of any change in your loved one's condition, since a daily caregiver may pick up on issues that you might not notice yourself. Be clear on what type of information needs to be communicated to the caregiver directly versus the agency. There may be some areas that you wish to be formally noted on your file with the home care provider or health agency in case a substitute or replacement is needed.
5. What is the agency's availability?
   Your loved one might need assistance at any time of day or night. Even if you have live-in care, your caregiver might be taken ill or have another emergency on a holiday weekend or at 3 a.m. If this occurs, will you be able to reach the home care agency? How does the agency ensure coverage when your designated caregiver is out sick, on vacation, or leaves the home health agencies agency?
6. Does the agency have enough staff on board to find a cultural or language fit for your loved one?
   Older adults may have specific preferences, or reservations, about a caregivers’ background. That could be both cultural as well as connected to limitations in their own English-language proficiency. If the agency cannot guarantee a caregiver that speaks your loved one’s language or are from a very different culture, will they still be comfortable and receptive? 

Evaluating home care caregivers

Before you engage or hire an in-home caregiver for your loved one, you'll want to meet them and get a sense of whether they'll be a good fit. Caregivers have an extremely intimate relationship with their clients, and they can become very close emotionally. During your interview, you're looking for more than just the professional qualifications and skills needed. You're also looking for someone who's trustworthy and who's a good match in personality for your loved one. Here are five questions to get you started when interviewing prospective caregivers.

1. What time off and vacation time do you expect?
   This question is particularly important if you're hiring a live-in caregiver. If you're working with a senior care agency, they may be able to arrange for substitute workers or caregivers. Ask the caregiver as well about how they'll prepare your loved one for their absence.
2. What experience do you have with specific tasks?
   You already have a good idea of how many hours the areas in which your loved one needs assistance. Now focus on those areas with the prospective caregiver. Ask them to describe previous clients who needed help with bathing, toileting, dressing, and grooming. Ask what types of food they tend to cook. If you need the caregiver to provide transportation then ask for a driver’s license and proof of a clean driving record. Or the agency may have this on file.
3. What will you do when my loved one....?
   You know your loved one's most negative tendencies. Maybe they become cranky at certain times of the day, or get combative when being urged to take a shower. You may have seen moments of aggression or anger. Whatever those negatives are, make sure you bring them up to a prospective caregiver. You want to know how they'll respond when those behaviors surface, and you also don't want a caregiver to quit because they weren't fully informed of what to expect.
4. Are there any services you won't or can't provide?
   If you need to hire a caregiver to drive your loved one on errands, you don't want to learn after hiring them that they can't drive after sunset. Go through the full list of services your loved one needs, and make sure none of them pose issues for the prospective caregiver.
5. How will you respond if my loved one offers you a gift?
   As seniors become emotionally attached to their caregivers, they often offer them gifts. In many cases, this isn't a problem. However, it's good to ensure clarity from the start about the caregiver's obligation to report any gifts given and the monetary limit with which you're both comfortable. A ten dollar gift certificate may not be an issue, but a $1,000 ring might not be within acceptable limits.  

Your interview with your caregiver provider will help you determine if you've found the right provider or correct match while also providing the caregiver with enough information to decide whether they will accept the position.

If you're still feeling stuck, it may be helpful to engage the services of a professional senior living advisor. These individuals are very familiar with care options in your area and usually provide consultative services free of charge (they are compensated on a referral basis by the agency or community with which you ultimately engage).  If you'd like to speak to someone in your area, simply call us at 855-606-1009 and the Seniorly team will connect you with someone in your area.