How to Choose In-Home Care

Over the years, our family has used three agencies for home health care for both Dad and Mom. In all three cases, we chose agencies based on personal and professional recommendations from people my mother knew in her assisted living community. My mother’s advisers were more experienced than we kids were, and we had good—not perfect—in-home care from all three agencies.

My mother may not use one agency again, however, because the nursing supervisor aggressively, repeatedly, tried to upsell my mother on services she didn’t need. We nicknamed her “the barracuda.” The barracuda’s agency provided good service but will lose our future business. Although frequent supervision of home care workers is important to look for in an agency, a comfortable, open rapport with the supervisor is also critical.

No in-home care is perfect, and you need to be able to communicate and solve problems with the supervisor. If you have time to meet several times with each prospective caregiver supervisor, give yourself that gift. Ask pointed questions about typical problems and how they get solved and—better yet—prevented. If the person who initially comes to your house to sell the agency’s services is not the supervisor, please don’t sign on the dotted line until you have established that the supervisor is someone you can easily work with.

Choosing in-home care is worth careful research. Only recently have I read that the home health care industry is largely unregulated, which places extreme importance on an agency’s internal safeguards. What background checks do they perform on workers? Criminal records in just your state or other states as well? Are they licensed and bonded? What if the worker charges personal items on your credit card? Who is liable if the worker is injured in your home? What if Dad suffers adverse effects because the worker gave him the wrong medication? Who pays if the worker and Mom are in a car accident? What training does the agency give each worker? Ask these questions!

And do check the agency’s website for a list of services provided. If you want light housework, be sure that’s on the list. Even if it is, you might ask the supervisor to expand on the agency’s idea of light housework. Vacuuming and dusting the whole house weekly? Washing windows twice a year? How about cooking? Can you expect the worker to plan meals and list groceries needed? Inquiring about this helps the supervisor choose a worker with initiative and organizational strengths. Your questions should result in a better caregiver match for you.

To start your research, check out AARP’s article, Types of In-Home Care Providers. This will help you know if you need a medical professional, a home health aide, or home care aide. This article discusses paying for care as well. A related article, Choosing an Agency for In-Home Care, gives you additional questions to ask to safeguard your family in this important decision.

Last but not least, I highly recommend using an agency. Resist the temptation to just hire an individual on your own, no matter how nice or highly recommended the person is. If the injury and theft legal liabilities mentioned above are not enough to convince you, consider your liability with the IRS if you fail to get an employer identification number; withhold Medicare, Social Security, and other taxes from your employee’s wages; and pay your portion of payroll taxes.