How to Choose the Right Home Care Agency

By Shanda Browning Vaughn, RN · 2026-02-28

How to Choose the Right Home Care Agency

Selecting a home care agency is one of the most important decisions you'll make for your loved one. The right agency provides skilled, compassionate care — the wrong one can lead to neglect, frustration, and wasted money.

Types of Home Care Agencies

#### Licensed Home Health Agencies

Provide skilled medical services (nursing, physical therapy, wound care)
Medicare-certified and regulated by state and federal agencies
Require a doctor's order to begin services
Staff includes RNs, LPNs, physical therapists, and home health aides

#### Non-Medical Home Care Agencies

Provide personal care and companion services (bathing, meals, transportation, companionship)
State-licensed but not Medicare-certified
No doctor's order required
Staff includes certified nursing assistants (CNAs) and home care aides

#### Registry/Referral Services

Connect families with independent caregivers
The caregiver is technically your employee, not the registry's
You're responsible for taxes, insurance, and supervision
Generally the least expensive option but most responsibility

Key Questions to Ask Every Agency

#### About the Agency

1. How long have you been in business?

2. Are you licensed and bonded? (Ask for proof)

3. Do you carry liability insurance and workers' compensation?

4. What is your Better Business Bureau rating?

5. Are you accredited by any industry organizations?

#### About the Caregivers

6. What is your hiring process? Background checks? Drug testing?

7. What training and certifications do your caregivers have?

8. How do you match caregivers to clients?

9. What happens if our regular caregiver is unavailable?

10. Can we meet the caregiver before care begins?

#### About Services and Costs

11. What services are included in your standard rate?

12. What is your minimum hours requirement?

13. Are there additional charges for weekends, holidays, or overnight care?

14. How do you handle billing — weekly, biweekly, monthly?

15. Do you accept long-term care insurance or VA benefits?

#### About Quality and Communication

16. How do you supervise caregivers in the field?

17. How often does a supervisor visit the home?

18. How do you handle complaints or concerns?

19. Can I see references or testimonials from current clients?

20. How do you communicate with families about their loved one's care?

Red Flags to Watch For

No written contract or vague terms of service
Reluctance to provide licensing information or references
No background checks or minimal screening of caregivers
High caregiver turnover — frequent changes in who shows up
Pressure to sign immediately — reputable agencies give you time to decide
Significantly below-market rates — If it seems too cheap, quality may suffer
No supervisor visits — Good agencies check in regularly
Poor communication — Difficulty reaching the office or getting callbacks

What to Expect in the First Week

1. Initial assessment — A care coordinator visits your home to evaluate needs

2. Care plan development — A written plan outlining services, schedule, and goals

3. Caregiver introduction — Meet and greet before care begins

4. Adjustment period — The first few days may feel awkward; this is normal

5. Follow-up check-in — The agency should contact you within the first week

Managing the Relationship

#### Set Clear Expectations

Provide a detailed list of duties and household preferences
Share your loved one's routines, likes, and dislikes
Establish communication protocols — How should the caregiver reach you?
Define off-limits areas or activities

#### Monitor Quality

Drop in unexpectedly during care hours occasionally
Talk to your loved one about their experience
Check the care log — Most agencies have caregivers document activities
Address concerns immediately — Don't let small issues become big problems

CareBridge Navigator can help you organize your care team and track expenses. Keep everything in one secure place.

What is the difference between an agency and a registry?

This is the question that protects you financially. An agency employs its caregivers, withholds taxes, carries workers' compensation and liability insurance, runs background checks, supervises the work and covers missed shifts.

A registry or referral service introduces you to an independent caregiver. The caregiver is then your employee or contractor. If they are hurt in your parent's home, if they do not show up, or if taxes go unpaid, that is the family's problem. Registries are cheaper per hour for exactly that reason.

Ask the question directly: are your caregivers your employees, and do you carry workers' compensation? Get the answer in writing.

Which credentials should you verify yourself?

State license, current and in the agency's legal name.
Liability insurance and a bond covering theft.
Workers' compensation coverage.
Background checks, including a national check, and how often they are repeated.
Medicare certification if you need skilled nursing or therapy visits paid by Medicare.
For skilled care, look the agency up on Medicare's Care Compare for its quality and patient-survey scores.

Ask for the documents rather than the assurance. A good agency sends them without hesitation.

What questions predict whether the care will be reliable?

What is your caregiver turnover rate?
Who covers a shift when the regular caregiver calls out, and how quickly?
Will the same caregiver come every time, and how many different people should we expect in a month?
May the caregiver give medications in this state, or only remind?
Who writes the care plan, does a nurse do the assessment, and how often is the plan reviewed?
Who do we call at 9 p.m. on a Sunday, and is that a person or a message service?
How do you document each visit, and can the family see those notes?
What is your process when we are unhappy with a caregiver?

Then ask for two current client references and call them.

What should the contract say?

Read the whole agreement before signing and look for the clauses that cost money later.

Hourly rate, minimum shift length and minimum weekly hours.
Premium rates for nights, weekends and holidays.
Whether mileage and errands are billed.
How live-in and 24-hour care are priced, and whether sleep time is deducted.
Notice required to cancel a shift without being charged.
Notice required to end services.
Whether the agency may raise the rate mid-contract, and with how much notice.

How do you tell in the first two weeks whether it is working?

Watch the small things. Does the caregiver arrive on time, in uniform, and leave notes? Does the house look better rather than the same? Does your parent speak about them by name?

Drop in unannounced once during the first fortnight. Then call the agency with one small correction and see how they respond. How an agency handles a minor complaint tells you what it will do with a serious one.

How this guide was written and reviewed

CareBridge Navigator guides are drafted with writing software and research tools, then checked line by line by Shanda Browning Vaughn, RN, a registered nurse since 2000. Shanda confirms every figure against the official sources listed on the page before a guide is published, and updates the guide when Medicare, Medicaid or VA rules change.

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How to Choose the Right Home Care Agency