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Choose the Right Home Health Agency – Before You Need It

If you wait until you're in a health crisis, you may not make the best decision

By Elizabeth Hanes

Shortly after my father moved in with me, I knew a home care provider was in our future. Dad's dementia was progressing rapidly, and Lee (my husband) and I both worked full time. In the back of our minds, I think we each harbored anxious visions of the house ablaze or, on a smaller scale, the indoor-only cats escaping through the patio door as Dad fumbled with his walker.

We went through a premature, aborted attempt to have “the conversation” with Dad about hiring a helper for him when he first moved in. We brought in a home agency representative without telling him in advance, which was a big mistake. We should have prepared him for the visit and explained we were looking out for future care, even if we started sooner.

Instead, I made the mistake of telling Dad I thought it would be better for him not to spend the day alone. Hurt feelings and anger ensued. How could we doubt that an 80 year-old man could care for himself? Did we think he was a child? That he needed a babysitter? I relented—end of conversation.

The turning point came when I returned from work one day and saw awful bruises on Dad's face. He'd fallen in the backyard and didn't remember to push the button on his emergency alert wristband. He said he'd struggled for half an hour (by his recollection; it may have been much longer) to get himself up off the ground and into the house. That incident left him shaken enough to submit to our engaging a caregiver to come in a couple of times a week to make him a hot meal and provide companionship.

Avoid Deciding in Crisis Mode

Despite the fact I, as a nurse, should have known better, we began our search for a home care agency when we were in crisis mode – as many families do. My advice? Don't do that. Start your search well before you think you'll need such care. Get referrals from friends, check the National Association for Home Care and Hospice (NAHCH) website for member agencies, check at the Better Business Bureau to make sure there are no complaints against the agency, and then set up interviews with a few providers.

NAHCH offers a great list of questions to ask when evaluating an agency. But gut feelings also play a big part in choosing a home care agency; don't ignore yours. For example, if an agency representative doesn't seem particularly caring, take note of it; their staff may not be especially caring either. If a person seems to be “all about the sale,” mark them off the list. Make sure you and your loved one truly click with the agency's representative before you sign on the dotted line.
We hired an agency based on the fact Lee's parents had previously used them. My mother-in-law chose them because she “liked their name.” Needless to say, this isn't the best methodology for picking a provider that's going to send strangers to invade your home several days a week. With luck, you'll have the same aide every day, but agencies reserve the right to send any caregiver on any given day. Luckily, things worked out well for us with this agency, but we should have taken a number of additional steps to vet the outfit, despite feeling time-crunched.

Anticipate Needs, Vet Agencies Thoroughly

For one thing, I wish we'd considered how Dad's needs would escalate over time. When he eventually went into home hospice care, he needed a caregiver who could actually administer medications (as opposed to reminding him to take a pill, himself), and it turned out the agency we'd hired didn't offer that level of service. We did find another agency that offered medication assistance, but clarifying the original agency's scope of services in advance would have saved my having to scramble a second time – when Dad was dying – to find a different provider.

Also, I should have checked references. I should have asked for the names and contact information of several current and past clients and then had a candid chat with them by phone to find out what problems they'd had and what they'd liked about the agency. Most important, I should have asked if they'd recommend the provider. Although we didn’t have problems, we might have…and asking the right questions helps ensure that you engage a professional agency with responsible staff.


It's also worth asking about accreditation and background checks. Accreditation doesn't necessarily ensure higher quality service, but it does mean the agency's gone through an external process that evaluates core service values, such as ethics, client safety, and emergency planning. Two organizations that accredit private duty home care agencies are CHAP (Community Health Accreditation Program)and the Private Duty Home Care Association. If your agency claims to be accredited, check the website of the accrediting body to make sure they really are.

Surprisingly, it didn't occur to me to ask if our chosen agency conducted background checks on employees. I just assumed they all did, but that’s not necessarily the case. I discovered when researching this blog that as of April, 2011, only about half of the states in the US require non-medical caregivers or agencies to hold any sort of licensure or certification, and many states don't even require a simple background check.

Understand that the business of non-medical home care is largely unregulated at this point, and so you need to perform your own rigorous due diligence. Key questions to ask agency management include:

  • Do you perform criminal background checks on all of your caregivers?
  • Are all of your caregivers bonded?
  • Do you provide worker's compensation insurance for your caregivers (a clue that the agency is run like a legitimate business)?

If the caregiver is going to drive your loved one to appointments, make sure he or she has a valid driver's license. Also, make sure your auto insurance policy covers any accident that occurs while the caregiver is driving.

Despite our lackadaisical approach, we were fortunate to find a reputable agency that provided a caregiver who doted on Dad. And the house never went up in flames, and the cats never escaped, and eventually Dad passed away peacefully at home, which was his fervent desire. But I’m sure that if Mom ultimately needs home care, I won't pick the agency just because I like its name.

Elizabeth Hanes is a registered nurse who writes regularly about health, wellness, nutrition and caregiving. She won a 2010 Online Journalism Award for "Dad Has Dementia," her 36-week journal about caring for her late father. She lives in New Mexico where she also writes about art, antiques and collecting. Read More
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