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Choosing an Agency

Once you have determined what home care services are needed, how to pay for them, and where to find them, you are ready to compare the quality and cost of the services offered by different agencies. There are essentially three stages to this process: screening, evaluating, and monitoring.

Screening Home Care Agencies

Before you take an in-depth look at a particular agency, you may want to screen a few agencies with these preliminary questions:

  • Is the agency Medicare or Medicaid certified?
  • Does the agency offer the specific care we need (e.g., skilled nursing care vs. personal care and meals)?
  • Is the agency recommended by a hospital/rehab discharge planner, social worker, or doctor?
  • Does the agency have staff who can communicate effectively in a language other than English, if needed?
  • Does the agency do background checks on all staff?

Evaluating Home Care Agencies

When you have found several agencies that meet all these criteria, you may want to choose one or two for an in-depth evaluation. The following questions can guide you:

  • How will the agency assess needs? Most agencies begin by sending someone to make an initial assessment of needs. Although you may have performed a needs assessment for the elder in your care, you should ask the agency how it determines the appropriate level of services. The elder's needs may increase or decrease over time, and the agency should have a process to assess any change in the services needed.
  • What is the training and experience of the caregivers? Ask what training the agency provides to its caregivers, and if the home care aides are certified by the agency. Does the agency require that its caregivers participate in a continuing education program? Ask if the caregivers are trained to identify and report changes in service needs and health conditions.
  • What specific caregivers will be assigned to your elder? Do the caregivers have experience or receive special training in the type of care that is needed, such as Alzheimer's care? Do they have training with a particular type of assistive technology, such as a hoyer lift? How long have they been working in the home care field?
  • What services are provided? Sometimes an aide who helps with bathing and dressing can't cook meals, or someone who cleans and does shopping isn't licensed to drive with the elder in the car. Aides also may not be able to administer medications.
  • How does the agency develop the elder's care plan and supervise the caregiver? Does a medical professional or experienced supervisor evaluate and supervise the caregiver in the elder's home and get input from the elder? How much control and personal independence does an agency provide to its clients? How does an agency involve elders and family members in the process of assigning and supervising caregivers? Does the agency seek input from the elder on his or her care plans?
  • How does the agency assure continuity of care? Having your elder cared for by a limited number of people (and the same people if possible) is less confusing and more comforting for the elder. Can the agency reasonably ensure that the same caregiver(s) will provide the home care services each week? How long do caregivers stay with the agency? What is the turnover rate? If a substitute caregiver is sent, when does the agency provide notice to the client? Ask how the agency assures that the substitute caregiver will be familiar with the care plan and individual needs of the client and the family.
  • What special or support services are provided? For instance, does the agency provide a 24-hour phone line?
  • How can the agency be paid? If you will be paying for service, compare the billing process and payment plans offered by different agencies. Compare how often you will be billed and whether you will be required to pay in advance. Ask if there are additional costs, such as fees or deposits, not included in the price quoted. Will you have to pay extra for holidays and weekends? If the elder needs special equipment, will it be covered by the elder's insurance or will the agency pay for it?
  • How much will the caregiver be paid? Does the caregiver earn enough to be dependable? Paying a decent wage, although costly for you, will minimize turnover. (Note: If you are paying for services directly, pay by check or get receipts for all cash payments.)

*These evaluation guidelines were adapted from the Home Care Alliance of Massachusetts' "How to Choose a Home Care Agency" guide © 2005.

Monitoring Home Care Agencies

Once you choose an agency, your job as a caregiver is only half done. Now you must change hats from an evaluator to a monitor—an ongoing job as long as you are using home care services. The Center for Medicare and Medicaid Services (CMS) offers a useful publication, "Medicare and Home Health Care," on the Medicare.gov Web site. The publication, which includes a checklist to evaluate staff once they start caring for an elder, can be downloaded for free or obtained by calling 800-MEDICARE (800-633-4227 toll free) for a free copy.

Don't forget that the most important source of information on the quality of the home care service you have chosen is the quality of the relationship between the elder and the home health care provider. Check in with both the provider and the elder in your care on a regular basis. (See also Protecting Elders' Rights.)

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