How to Choose a Home Care Agency Without Adding More Stress to the Caregiver

In December of 2006, I was already stressed out. I was in the biggest job of my career as an HR executive, supporting a completely new and different client group, and the learning curve was steep. Working long hours, commuting almost two hours a day to and from work, and having many openings on my team, I was stressed out. Then I received the phone call…..

The Situation    

 …my father had a stroke, and I had to jump on a plane immediately to support my mother caring for him. Not knowing anything about caregiving, I was struggling to figure out a way to get my father back home safely. I knew nothing would be the same—his speech and his ability to stand and walk independently had been severely impaired. 

Never having used EAP, I contacted the only resource I could think of and desperately asked them for any kind of help they could provide.  All they gave me was a list of home care agencies in alphabetical order that I could call in my parents’ city. I had no idea what a home care agency was, what to ask them, or why I needed them! Long story short, I picked the first one on the list, they took my credit card, and charged me for two weeks, non-fundable. My mother fired them after their second visit. My mother went on to care for my father by herself with little to no help, and this impacted her physically and emotionally. This really stressed me out more.

Ironically, I started a home care agency with my wife just a few years later. In the 13 years we ran it, we helped over 500 families care for their family loved ones, and we hired over 700 professional caregivers. I have learned quite a bit about how to choose a home care agency without adding more stress to your life. 

Helpful Considerations

First, it is very important to understand what support the family member needs.  Before calling agencies, clarify if they need personal care (bathing, dressing, toileting), companionship and supervision, Dementia-specific care, and Medication reminders. Or do they need skilled nursing or therapy services, which may require a licensed home health agency instead of non-medical home care? When we ran the agency, we used to get panicked and very emotional phone calls on a Friday afternoon by a caregiver who all of a sudden, had been told they had to hire an agency because their loved one was being discharged that day by the hospital or rehab center.  They were a lot like me when I first called an agency. I was clueless, not knowing what my father needed.

Second, it is important to know that not all agencies are created equal! Depending on how you go about selecting a home health agency (hospital social worker recommendations, word of mouth referrals, late night google searches, etc.), you may find that quality and costs vary significantly. It is always best to do your research and interview at least three before picking one. Families usually wanted to hire me immediately after I did a home visit because they were desperate. I would always try to push back and ask them to interview at least one other agency before selecting me because “you are not hiring an electrician or painter…. you are hiring someone who will be coming into your home to help care for your family loved one. This is very important!”

Questions to Ask Before Selecting a Home Care Agency 

Here is a list of questions I highly recommend you ask when interviewing a home care agency, and why I strongly urge you compare responses. 

 1. Are you licensed, bonded, and insured? 

• Every state has different regulations, and it is important to find an agency that is held to a high industry standard and is licensed.

• It is very important that their caregivers are employees, not independent contractors (more control and protection), and that they are covered by workers’ compensation. (If an aide is injured in the home and not covered, liability can fall on the family.)

2. How are caregivers screened, trained, and managed?

• Extremely important that complete and thorough background checks are performed and references verified, along with drug testing. Some agencies cut corners if they can because these screening processes are costly, but you do not want someone in your home who has not been thoroughly screened. 

• An agency may say they specialize in certain areas like dementia or mobility issues. Ask how they are trained and assessed as qualified to conduct specialized care. How often do they train their caregivers?  Who manages them—hopefully it is an RN. Remember, you’re not just hiring a warm body—you’re trusting someone with a vulnerable adult.

• Is there a written care plan compiled by a nurse who manages the caregiver? How is the care plan followed, and how does an agency make sure it is followed? How often does the care plan change? What documentation does each caregiver complete during their visit, and how do they and the agency communicate issues, changes, and suggestions to the family?

3. How do you match caregivers to clients?

• This is also very important. Preferably, they are not just picking anyone who can do the shift. A good agency does its due diligence to make sure the caregiver and the care recipient are a good fit. I used to have an aide who could barely speak English, but she was one of the best caregivers when it came to caring for someone who was bed-bound.  No one had bed sores under her care! 

• Also very important to ask about their process in replacing aides if they are not a good fit. I usually allowed a caregiver at least two shifts before deciding if it was not a good fit, unless something significant happened on the first visit. 

4.  How does the agency handle after-hours calls?  And Agencies should have oversight—not just scheduling.

·         The biggest challenge in running an agency is being available 24/7 for your families and your ability to replace a caregiver when they call out. My wife was one of the best in hiring, managing, scheduling, and retaining great caregivers. It is possible. Don’t tolerate anything less than above average in this area. Have I mentioned that this agency and caregiver are taking care of your family’s loved one?!

·         Ask if there is guaranteed coverage and how quickly they can replace or backfill a caregiver. Things happen out of our control, but how well an agency responds to an issue is indicative of how well they run their home care agency and hire great caregivers. 

5. How do you handle concerns or complaints?

• Is there a formal process?  Who is the point of contact?  A strong agency welcomes feedback. Defensive answers are red flags!

6. What are the costs—and what’s included?

• Is there a minimum number of hours?  Are there additional fees (holidays, transportation, care plan updates)? How is overtime handled (if you need the same caregiver for more than 40 hours a week)?  How are live-ins handled?

• Do you accept long-term care insurance or VA benefits?  Would you be willing to assist me in processing claims?

• Is there a deposit? How is that handled and returned? Get everything in writing.

Conclusion

I made a lot of mistakes when I hired my first home care agency to help my mother care for my father.  I was “sold” over the phone. I could not get anyone to return my calls in a timely manner. The caregivers were rude to my mother, telling her, “We do not need to listen to you…We are here caring for your husband.” I did not interview them. I did not interview others.  I was panicking and desperate. I was also feeling guilty about living 600 miles away when my parents needed me most. 

Remember that the right agency becomes a partner. The wrong one becomes another stressor.  I highly believe this and the more advanced timing you can have with the least emotional stress when researching home care agencies, the more likely you will find the right agency!

I also realize that trying to find a home care agency while you are working can be very stressful.  Have conversations with your manager or HR and let them in on what is going on in your life. That way, you can feel less stressed about leaving work to handle a home care agency issue or to interview agencies, or going to work late because a caregiver called out and you had to sit with your parent or spouse before the agency was able to find a replacement.

And for employers, leaders, and HR reading this, please know we, family caregivers, are now the backbone of long-term care in the United States. And most of us are sitting in someone’s workplace. When employers acknowledge the complexity of choosing home care — and offer flexibility, resources, and understanding — they help stabilize families. 

And stable families create stable employees.

Until next time! Thank you for being here, for reading, and for caring!