How Do I Select A Home Care Agency For My Parents?

WHEN YOUR PARENTS BEGIN TO NEED HELP AT HOME, you’d better know the most important questions to ask in order to help them select the best home care company for them. Every home care company promises that they are the best and that you will be happy with them if you choose them. If you really know what makes the difference in home care services, you are better prepared to make the best choice.

When you need to find help for your loved ones, it’s always a good idea to ask people you trust for recommendations and referrals. Keep in mind, though, that knowing the right questions to ask, as outlined below, will be the most important part of the selection process.

Believe it or not, in California there are absolutely no laws governing how non-medical home care agencies select, hire, and supervise home caregivers, so it is up to you and your parents to be thoughtful and thorough in selecting the home care company that will be safest and best for them.   Here’s a list of questions to ask each company.

(In California, before anything else ask the company,  “Is your company a CAHSAH-Certified Home Care Aide Organization?”  If the answer is, “Yes!”, then most of the concerns listed in the questions below will be taken care of.  CAHSAH, the California Association for Health Services At Home, has created a certification program to protect home care recipients, their families, and home care workers by independently verifying that each CAHSAH-certified company meets the certification standards.  Look here more information about: “The CAHSAH Home Care Aide Organization Certification”).

FIRST, ask this: “Who is the employer of the caregivers that your company will send into my parents’ home?”

A home care business that answers, “The caregivers are employees of our company” will be the best choice in the long run.

Why? Because when the company is the employer, then the company pays for workers compensation insurance and payroll taxes. Also, when the company is the employer, the company is able to provide employee honesty “bond” coverage for the caregiver (and you should ask the company if it does so!)

If the company does not act as the caregiver’s employer, then the burden lies with you and your parents to determine whether the caregiver is an employee of you or your parents. If you or your parents are the employer, then you or your parents are responsible for making sure that payroll taxes and workers compensation insurance are paid for. Some agencies will claim that the caregivers are “Independent Contractors”, which leaves you at risk for second-guessing later by the authorities.

Also, caregivers from non-employer agencies are not covered by any sort of employee honesty “bond” that those agencies may otherwise claim to have, because only true employees may be covered by such bonds. In fact, some non-employer agencies will claim to be “bonded”, but when you ask for specifics you will find that only the staff that works in the company’s office is really covered by the bonding, not the caregivers.

SECOND, ask this: “What criteria do you use to select and hire your caregivers?”

In other words, will they hire just anyone off the street regardless of training, experience, and criminal history and then send them to your parents’ home? Or, does the company enforce important standards with respect to whom and how they hire their caregivers? Here are some specific questions to ask about the company’s minimum standards for hiring:

  • Do they conduct thorough criminal background checks? If not, how can you be certain that your parents and their property will be safe from harm?
  • Do they require that the caregivers have current TB test results on file? If not, how can you be certain that your parents will not be exposed to TB?
  • Do they require that the caregivers have a car, proof of auto insurance, and a good driving record? If not, how can the caregivers safely take your parents to doctor appointments and the store, or how can they safely evacuate your parents to a safe place in event of an emergency?
  • Do they train, monitor and supervise the caregivers? If not, how can you be certain that your parents will receive top-quality care? Who will come and fill-in for the caregiver when the caregiver is unable to come to work due to illness or babysitting problems?
  • If the caregivers need additional training, coaching and mentoring in order to take care of specialized needs for a particular case, does the company have the tools and personnel in place to deliver that training?

THIRD ask this: “What kind of training, monitoring and supervision do you provide?”

A good home care company will want their staff trained to do a good job providing the requested services. The caregiver is not only on the job to meet the client’s needs, but is also an ambassador for the company, and for a good long term solution to care at home, must know not only how to do their job, but also how to know when there is an emergency and what to do then.

Also, a good home care company will perform supervision visits regularly so that you and the company can be assured that the caregivers are doing a proper job of caring for your loved one.

FOURTH ask this: “Do you have insurance for professional liability, workers compensation, automobile liability and employee bonding?”

Naturally, you always hope that there won’t be any problems and that therefore you won’t need to worry about whether the company has proper insurance coverage. However, it would be irresponsible for you to do business with a company without asking about their insurance coverage. Any reputable company will have the insurance coverage mentioned above and should be able to provide you with a certificate of insurance if you request one.

FIFTH ask this: “How do you determine what my mom needs?”

A reputable company that really cares about matching clients with the appropriate caregivers will conduct an in-home, in-facility or in-hospital interview and work with you and your parents as to the best plan of care for the appropriate price.

SIXTH ask this: “What will this cost?

In order to assess the cost, you need to know what causes one company to be higher priced than another. In order to understand this you must consider the answers to the preceding questions.

If the company does not employ the caregiver, then they can provide care at lower costs because they are not taking responsibility for meeting the expensive requirements of being an employer.

Non-employer companies are sometimes referred to as “registries” or “placement agencies”. They may appear to be cheaper because they sometimes (but not always) charge a lower hourly fee rate.

HOWEVER, there are costs that someone has to bear, and if the company isn’t accepting that responsibility, the client or the client’s family must assume them. Such costs include payroll taxes, unemployment taxes, workers compensation insurance and bonding. Also, the “registry” company is NOT accepting responsibility for supervising the caregivers, so the client or client’s family will have to do that.

The bottom line is this: someone has to employ the caregiver, and that someone has to bear all the employment related expenses and time costs. For peace of mind it makes sense to pay a bit more and have a legal, monitored, supervised, checked-out and guaranteed care provider with your parents.


If you follow the advice in this article and apply good judgment and common sense, you will be more likely to make a great selection in choosing a home care company for your loved ones. Remember to ask good questions, make sure that you get clear answers to them, check references and get recommendations from people you trust, and keep in mind that you get what you pay for.

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Originally posted 2008-05-18 04:29:37.

Tim Colling
Tim Colling

Tim Colling is the founder and President of A Servant's Heart In-Home Care, which provided in-home caregiving services in San Diego County, and also of A Servant's Heart Geriatric Care Management, which provided
professional geriatric care management services and long term care placement services in San Diego County. Tim has more than 30 years of experience in management in a variety of industries. He held a Certified Care Manager credential from the National Academy of Certified Care Managers. Tim is also a Certified Public Accountant (retired), and received his Bachelor’s Degree in Accounting from California State University at San Diego. In addition to writing blog posts here for the Servant’s Heart blog, Tim also is a regular contributor to and to as well as blogs of other eldercare services provider companies. Finally, Tim is also the president of A Servant's Heart Web Design and Marketing, which provides home care marketing as well as website design and online marketing for those who serve the elderly and their families.

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