How to Choose a Home Care Agency: 15 Questions to Ask

When a parent needs help at home, hiring a caregiver feels urgent — and it often is. But moving too fast is one of the most common (and costly) mistakes families make.

A caregiver will be in your parent's home, often for hours at a time, sometimes when no one else is around. They'll know where things are kept. They'll have access to medications, finances, and your parent's most private moments. Choosing who fills that role — and the agency that employs them — deserves careful vetting even when time is short.

This guide covers the critical difference between home health and home care, the distinction between agency-employed caregivers and registry caregivers, and 15 specific questions to ask before you hire anyone.

First: Home Health vs. Home Care — Know the Difference

These two terms are often used interchangeably, but they are different services with different funding, different providers, and different purposes.

Home health is medical care delivered at home by licensed clinicians: registered nurses, physical therapists, occupational therapists, speech-language pathologists, and medical social workers. Home health requires a physician's order and is appropriate following a hospitalization, surgery, or documented need for skilled care. It is covered by Medicare Part A and B when the criteria are met — specifically, the patient must be homebound (meaning it's a significant effort to leave home) and require a skilled service.

Home care (also called personal care, non-medical home care, or home care aide services) provides help with the activities of daily living: bathing, dressing, grooming, meal preparation, light housekeeping, medication reminders, and companionship. Home care workers are not licensed clinicians, and this type of care is not covered by Medicare. It's paid for privately, through long-term care insurance, or in some states through Medicaid waiver programs.

Most families who are searching for help with an aging parent — help getting up in the morning, preparing meals, managing medications, not being alone for 12 hours a day — are looking for home care, not home health.

Important: If your parent was recently discharged from the hospital, they may be entitled to Medicare-covered home health services. Contact their doctor immediately. That's a separate benefit from ongoing non-medical home care, and it often goes unused because families don't know to ask.

Agency-Employed Caregivers vs. Registry Caregivers

Before calling any agency, understand the employment model, because it changes your legal exposure significantly.

Agency-employed caregivers are W-2 employees of the agency. The agency handles payroll taxes, Social Security, workers' compensation insurance, and unemployment insurance. If the caregiver is injured in your parent's home, the agency's workers' comp coverage applies. The agency is also legally responsible for background checks, training, and replacing the caregiver if they're sick or quit.

Registry caregivers are independent contractors referred to you by a placement registry. The family — not the registry — is the legal employer. That means the family is responsible for withholding and paying payroll taxes, purchasing a workers' compensation policy, and handling any employment disputes. Registries often charge lower placement fees or hourly margins, but the administrative burden and legal liability shift to you.

Neither model is universally better. Families with a stable long-term situation and a trusted individual sometimes prefer the registry model for its cost savings. For most families, particularly those new to hiring caregivers, agency-employed caregivers provide much more support and protection.

The 15 Questions to Ask Before You Hire

Staffing and Matching

1. Do you employ your caregivers directly, or are they independent contractors?

This establishes the employment model upfront. Get a clear answer — some agencies use a hybrid model or try to blur the distinction. If they're 1099 contractors, understand what that means for your liability.

2. How do you match caregivers to clients?

You want more than "we assess the situation." Ask what factors they consider: personality, specific care skills, availability, language, hobbies, experience with particular conditions. Good agencies ask about your parent as a person, not just a diagnosis.

3. Will the same caregiver come each time, or will it rotate?

Consistency matters enormously for older adults, particularly those with cognitive decline. A different caregiver every day is significantly harder on a person with dementia than a familiar face. Understand what consistency they can promise — and what happens when the regular caregiver is unavailable.

4. What is your caregiver turnover rate?

High caregiver turnover is endemic in the industry, but there's a wide range. An agency that can tell you their retention rate and explain what they do to retain staff (competitive pay, flexible scheduling, caregiver support programs) is a more stable operation than one that shrugs at the question.

Screening and Training

5. What background checks do you conduct, and how recently?

At minimum you want: criminal background check, check against the state's nurse aide or caregiver registry (which tracks substantiated abuse complaints), and reference verification. Ask if they re-run background checks periodically for existing employees or only at hire.

6. Do you conduct drug testing?

Not universal, but worth knowing. Some agencies test at hire, some test randomly, some don't test at all.

7. What training do your caregivers receive before their first placement?

Ask about initial orientation training and any ongoing training requirements. Specific questions: Are caregivers trained in dementia care techniques? In safe transfer and fall prevention? In recognizing signs of a medical emergency? In medication reminders (not administration, which requires licensure, but reminders)?

8. Is there a supervisor who visits clients regularly to check on care quality?

Supervision structures vary widely. Some agencies have care managers who make periodic home visits to assess how care is going. Others essentially place a caregiver and consider the work done. Agencies with active care management catch problems earlier.

Backup Plans and After-Hours Support

9. What happens if my caregiver calls in sick on short notice?

This will happen. What's the agency's protocol? Do they have a pool of backup staff? How quickly can they find a replacement? A good agency has a clear, tested answer to this question.

10. Is there a 24/7 on-call number for families and clients?

Things happen at night, on weekends, on holidays. You need to be able to reach a real person — not just leave a voicemail — when something goes wrong.

Contracts and Billing

11. What is your minimum hourly commitment per shift or per week?

Most agencies have minimum visit lengths (often 3–4 hours per visit) and sometimes minimum weekly hours. Understand this before you assume you can hire someone for two hours twice a week.

12. What is your hourly rate, and does it change for nights, weekends, or holidays?

Get the full rate structure in writing. A base rate of $28/hour that becomes $35/hour on Saturdays and $42/hour on holidays changes the monthly math significantly.

13. How is billing handled, and what are the terms for ending service?

Ask about the billing cycle, payment methods, and what notice period is required if you decide to end service. Some agencies require 2 weeks' written notice; others require more.

14. Does your agency bill long-term care insurance, and can you help with paperwork?

If your parent has an LTC insurance policy, this is important. Many agencies have experience billing insurers and can reduce the administrative burden on the family.

Red Flags in the Conversation

15. Can you provide references from current or recent client families?

Any reputable agency should be able to provide 2–3 references. If they're reluctant, evasive, or tell you they "can't share client information" (while providing no alternative), that's a concern. References may not be unfiltered, but the willingness to provide them matters.

Red Flags to Watch For

Beyond the 15 questions, these are patterns that should make you pause:

• Pressure to sign a contract quickly. Good agencies don't rush you. The urgency is yours; they should be patient.
• Vague or evasive answers about licensing. Every state has different requirements for home care agencies, but they should be licensed. Ask for the license number and verify it with your state's health department.
• No written service agreement. Verbal arrangements are not adequate. Everything about rates, hours, services provided, and termination terms should be in writing.
• Inability to give you a direct answer on background checks. If an agency hedges on whether they check the state caregiver registry, that's a problem.
• The caregiver "really liked" your parent's home and comments on valuables. Not a common problem, but financial exploitation by caregivers is real. Families should remove or secure jewelry, prescription medications, financial documents, and spare keys.

Verifying Licensing in Your State

Home care agency licensing requirements vary by state. In most states, agencies providing personal care services must be licensed by the state's health department or department of aging services. The license is usually public record and searchable online.

Some states distinguish between agencies that provide only companion/homemaker services (no personal care) and those that provide hands-on personal care — these may have different licensing requirements. Ask the agency what their specific license covers.

If you're looking at a Medicare-certified home health agency (for skilled medical services), you can verify certification and review quality ratings on Medicare's Care Compare at medicare.gov/care-compare.

For more on how home care compares with facility-based options, see our full guide to home care services.

A Note on Private Hire

If you're considering hiring a caregiver privately — through a personal referral, an online caregiver marketplace, or a registry — understand what you're taking on.

As the legal employer, you're responsible for:

• Federal and state payroll taxes (FICA, FUTA, SUTA)
• Workers' compensation insurance (required in most states)
• Liability coverage if the caregiver is injured in the home
• Backup coverage when the caregiver is unavailable

For a trusted individual in a long-term stable arrangement, private hire can work well and is often less expensive. For most families starting out, the agency model provides significantly more support and protection.

Looking for vetted home care providers in your area? Search the DigitalCare60 directory to find licensed agencies near you and start comparing your options.