How to Choose a Home Care Agency: Questions to Ask and Red Flags to Watch For

To choose a home care agency, first confirm what oversight or licensing applies in your state, who employs and supervises the caregivers, what background and reference checks are performed, how caregivers are trained, and what happens when a caregiver calls out. Ask for a written care plan and a complete fee schedule, including minimum hours, weekend and holiday rates, cancellation rules, transportation charges, and rate-increase policies. Strong agencies should be able to explain their screening, supervision, backup-care, complaint, and caregiver-replacement processes clearly. Be cautious about vague answers, pressure to sign immediately, unclear worker classification, missing written agreements, or an agency that cannot explain who is responsible when something goes wrong.

Choosing a home care agency can be one of the most important decisions a family makes for an older adult, particularly when that decision is happening after a fall, hospitalization, dementia diagnosis, or sudden change in someone's ability to live safely at home.

And families are increasingly likely to face that decision.

Approximately 63 million American adults, nearly one in four adults, provided ongoing care to someone with a medical condition or disability in 2025, according to AARP and the National Alliance for Caregiving. Nearly two-thirds of adult caregivers help with at least one activity of daily living, such as bathing, dressing, toileting, feeding, or mobility.

At the same time, professional home care represents a massive and growing workforce. The U.S. Bureau of Labor Statistics counted approximately 4.35 million home health and personal care aide jobs in 2024 and projects employment to grow 17% between 2024 and 2034, with roughly 765,800 openings each year over the decade.

Those numbers tell families something important: home-based care is no longer a niche service. But a growing industry also means families need a reliable way to distinguish a well-run agency from one that may not be able to provide consistent, accountable care.

This guide walks through the questions that matter most.

THE 5 QUESTIONS TO ASK FIRST

Before discussing schedules or hourly rates, ask:

1. Who legally employs the caregiver?
2. What screening and training do caregivers complete?
3. Who supervises the caregiver after care begins?
4. What happens when the regular caregiver cannot work?
5. Exactly what will we pay, and under what circumstances can that price change?

Clear answers to these five questions can reveal a great deal about how an agency operates.

First: Know Whether You Need Home Care or Home Health Care

The terminology surrounding care at home can be confusing.

Nonmedical home care generally focuses on assistance with everyday activities and supervision. Depending on the provider and state rules, services might include:

• Bathing
• Dressing
• Grooming
• Toileting
• Mobility assistance
• Meal preparation
• Light housekeeping
• Laundry
• Transportation
• Shopping and errands
• Companionship
• Safety supervision
• Medication reminders

Home health care, by contrast, generally refers to medically oriented services such as skilled nursing, physical therapy, occupational therapy, speech-language pathology, and certain home health aide services provided under clinical supervision.

CMS defines a Medicare-participating home health agency as an organization primarily providing skilled nursing and other therapeutic services while meeting federal Conditions of Participation and applicable state or local licensing requirements.

This distinction matters because the way you verify a provider, and the way services may be paid for, can differ.

Medicare's Care Compare tool, for example, allows consumers to compare Medicare-certified home health agencies based on quality information. It is not a universal directory of every nonmedical private-pay home care company.

Home Care vs. Home Health

Original Medicare generally does not pay for ongoing custodial or personal care when that is the only care someone needs.

1. Verify Licensing, Registration and Oversight

One of the first questions to ask is:

"What state license, registration, certification, or other authorization applies to your agency?"

Do not assume every state regulates every type of home care provider in exactly the same way.

Requirements can vary depending on the state and whether an organization provides nonmedical personal care, skilled home health services, staffing services, or another category of care.

Ask the agency for:

• Its legal business name
• State license or registration number, if applicable
• Name of the state agency that regulates it
• Date the license expires
• Any other certifications relevant to the services being provided

Then verify the information independently through the appropriate state regulator.

For a Medicare-certified home health agency, CMS requires compliance with federal Conditions of Participation as well as applicable state or local licensing requirements.

Ask this:

"Which government agency regulates you, and where can I independently verify your status?"

A strong provider should be able to answer without hesitation.

RED FLAG

Be cautious if an agency repeatedly avoids explaining what regulation applies to it, gives you a license number but cannot identify the issuing authority, or discourages you from independently verifying its credentials.

An agency legitimately operating in a jurisdiction should understand the rules governing its own business.

2. Ask Who Actually Employs the Caregiver

This is one of the most important, and frequently overlooked, questions.

Ask:

"Is the person coming into my home your employee, an independent contractor, or someone referred through a registry?"

Those arrangements are not necessarily equivalent.

If the agency employs the caregiver, ask whether the agency handles:

• Payroll
• Payroll tax withholding
• Workers' compensation requirements
• Unemployment insurance requirements
• Scheduling
• Supervision
• Performance management
• Training
• Replacement coverage

If workers are contractors or are simply referred to families, ask exactly which responsibilities remain with the agency and which shift to the family.

Why worker classification matters

Families sometimes assume that anyone they hire privately can simply be called an "independent contractor."

That is not necessarily true.

The IRS states that in-home caregivers are typically employees of the person receiving the services when that individual has the right to direct what work will be done and how it will be done, although the facts and circumstances determine the classification.

That means hiring someone directly can potentially create household-employer responsibilities involving payroll and employment taxes.

IMPORTANT QUESTION

Ask the agency:

"Who is legally responsible for payroll taxes, workers' compensation, unemployment insurance, and employment compliance for the caregiver?"

Do not settle for "We handle everything." Ask what "everything" specifically means.

3. Ask About Insurance Before Care Begins

Ask the agency to explain the insurance protection associated with its caregivers.

Depending on applicable state law and the agency's business structure, relevant coverage may include:

• General liability insurance
• Professional liability coverage
• Workers' compensation insurance
• Bonding or employee dishonesty coverage
• Commercial automobile coverage when employees transport clients

Avoid assuming that every type of policy is legally required in every jurisdiction. Instead, ask what the agency carries, why it carries it, what it covers, and whether the policy is current.

Questions to ask

• What liability insurance does the agency carry?
• Are caregivers covered while working in a client's home?
• Is workers' compensation coverage provided where required?
• What happens if a caregiver is injured in my home?
• What happens if a caregiver accidentally damages property?
• Is client transportation covered by an appropriate policy?
• Can you provide proof of applicable insurance?

AARP notes that one difference families should investigate when comparing agency care with direct hiring is who bears responsibility for insurance, accidents, payroll and other employment matters.

4. Find Out Exactly How Caregivers Are Screened

"All of our caregivers are background checked" sounds reassuring.

But it isn't enough information.

Ask what the background check actually includes.

Possible screening components may include:

• Identity verification
• Criminal history searches
• State or federal fingerprint checks when applicable
• Sex offender registry checks
• Driving record reviews for caregivers who transport clients
• Professional license or certification verification
• Abuse or neglect registry checks where available and applicable
• Employment verification
• Personal or professional references
• Drug screening, if part of agency policy

Federal Veteran Directed Care guidance illustrates how comprehensive screening may involve state or federal fingerprint checks as well as sex-offender and professional or occupational registry searches, depending on applicable program and state policies.

For providers participating in federal health programs, the HHS Office of Inspector General also maintains the List of Excluded Individuals/Entities, which can be searched for individuals or organizations excluded from federally funded health care programs.

Ask these questions

• What background checks do you perform?
• Is the check state-only, multistate, federal, fingerprint-based, or another type?
• Are abuse and neglect registries checked when applicable?
• Do you verify prior employment?
• How many references do you check?
• Do you verify professional licenses and certifications?
• Are driving records reviewed for caregivers who transport clients?
• Are screenings repeated after hire?
• What would disqualify someone from employment?

RED FLAG

An answer such as "We do a full background check" without explaining what that means is incomplete.

Ask the agency to describe its actual screening process.

5. Ask How Caregivers Are Trained

A background check tells you something about a caregiver's history.

It does not tell you whether that caregiver knows how to safely assist your family member.

Training becomes particularly important when a person has:

• Dementia or Alzheimer's disease
• Parkinson's disease
• Mobility limitations
• A history of falls
• Stroke-related disabilities
• Incontinence
• Difficulty transferring
• Behavioral symptoms
• Swallowing difficulties
• Diabetes
• Hearing or vision impairment
• A need for extensive personal care

The Bureau of Labor Statistics notes that training and qualification requirements vary, and aides working for certified home health or hospice agencies may be subject to formal training or competency requirements.

Ask:

• What orientation does every new caregiver complete?
• How many hours of initial training are required?
• Is continuing education required?
• How is competency evaluated?
• What dementia-specific education is provided?
• What transfer and mobility training is provided?
• How are caregivers trained to respond to falls?
• Are caregivers trained in infection prevention?
• Are CPR or first-aid certifications required?
• Who decides whether a caregiver is qualified for a particular client's needs?

Don't ask only whether training exists

Ask how the agency determines that the caregiver can actually perform the required tasks.

There is an important difference between:

"Our caregivers receive dementia training."

and:

"Before a caregiver is assigned to a client with dementia, we verify completion of our dementia curriculum, assess competency, explain the client's behaviors and routines, and provide supervisory follow-up."

The second answer tells you much more about the agency's process.

6. Ask How the Agency Assesses Your Loved One Before Starting Care

Care should begin with an understanding of the person's actual needs.

A proper assessment may cover:

• Bathing and grooming
• Dressing
• Toileting
• Continence
• Eating
• Walking
• Transfers
• Fall history
• Cognitive status
• Dementia-related behaviors
• Medication routines
• Nutrition
• Sleep patterns
• Transportation
• Household tasks
• Social needs
• Safety risks
• Emergency contacts

The Administration for Community Living's consumer guidance recommends asking whether an agency develops a plan of care with input from the person receiving care and family and whether that plan is updated as needs change.

Medicare's own home health checklist similarly tells consumers to consider whether a provider offers the specific services and personal care assistance they need and whether staff can provide care when it is required.

RED FLAG

Be cautious if an agency is willing to promise complex care based only on a five-minute sales call.

The more complicated someone's needs are, the more important it becomes for the provider to understand those needs before assigning a caregiver.

7. Ask Who Creates and Updates the Care Plan

Once the assessment is completed, ask:

"What will be written down?"

A care plan may describe:

• Tasks the caregiver should perform
• Personal care routines
• Mobility assistance
• Meal preferences
• Dementia routines and triggers
• Safety precautions
• Transportation expectations
• Household responsibilities
• Schedule
• Family communication instructions
• Changes the caregiver should report
• Emergency procedures

Then ask:

"How often is this plan reviewed?"

A plan that was appropriate six months ago may no longer be appropriate after:

• A hospitalization
• A new fall
• A medication change
• Worsening dementia
• New incontinence
• Declining mobility
• Weight loss
• Increased nighttime needs

For Medicare-certified home health care, CMS requires individualized plans of care and clinical records.

Nonmedical home care requirements vary, but families should still ask for a documented plan explaining what care is expected.

8. Ask How Caregivers Are Matched With Clients

Caregiver matching is more than assigning whoever happens to have an open calendar.

A good match may take into account:

• Experience
• Training
• Physical ability
• Personality
• Communication style
• Language
• Cultural considerations
• Pets in the home
• Smoking preferences
• Driving requirements
• Dementia experience
• Schedule
• Client preferences

Ask:

"What happens if the caregiver is technically qualified but my parent simply isn't comfortable with them?"

Then ask:

"Can we request a different caregiver without being treated as a difficult client or paying a penalty?"

Families should know that compatibility matters.

A caregiver may be excellent at the job and still not be the right fit for every household.

GREEN FLAG

Strong agencies usually recognize that caregiver compatibility is an important part of successful home care and have a clear process for handling a mismatch professionally.

9. Ask Whether You Can Meet the Caregiver Before the First Regular Shift

Whenever possible, ask about an introduction before ongoing care begins.

This gives the family and caregiver an opportunity to review:

• The home
• Daily routines
• Mobility needs
• Bathroom setup
• Meals
• Emergency procedures
• Communication preferences
• Pet care considerations
• Personal preferences

It also lets the person receiving care become familiar with the caregiver.

For someone with dementia, introducing a new caregiver gradually may be particularly helpful.

An agency may not always be able to guarantee a pre-service meeting, especially when care must begin urgently. But it should be able to explain how introductions and transitions are handled.

10. Ask Who Supervises the Caregiver

Hiring the caregiver should not be the end of the agency's involvement.

Ask:

• Who is the caregiver's supervisor?
• What qualifications does the supervisor have?
• How frequently does the supervisor communicate with the caregiver?
• Are supervisory visits made in the home?
• How is caregiver performance evaluated?
• How does the agency know whether the care plan is actually being followed?
• Who should the family call with a concern?
• Is support available after regular business hours?

Federal consumer guidance recommends asking how closely supervisors oversee care, how complaints are resolved, and whether agency staff are available when problems occur.

Medicare's home health quality checklist similarly emphasizes whether staff explain the care plan, respond promptly to requests, react appropriately to health or behavioral changes, and tell families what to do during emergencies.

11. Ask What Happens When a Caregiver Calls Out

This question separates a scheduling company from a true care-management operation:

"If our caregiver calls out at 6:00 tomorrow morning, what exactly happens next?"

Do not accept only:

"We'll find somebody."

Ask for the process.

Find out:

• Is an on-call scheduler available?
• Does the agency maintain backup caregivers?
• Are replacement caregivers already trained on the client's care plan?
• How quickly does the agency notify the family?
• Can the family reject an unfamiliar replacement?
• What happens if no replacement is available?
• What happens on nights, weekends, and holidays?

Medicare's consumer checklist specifically recommends evaluating whether an agency has staff who can provide the needed care when required and whether assistance is available at night and on weekends for emergencies.

THE BACKUP-CARE TEST

Ask the agency to walk you through a real scenario:

"It's Sunday morning. The caregiver scheduled for 8:00 a.m. is sick. My mother cannot safely get out of bed by herself. What happens?"

The specificity of the answer can tell you far more than a general promise of "reliable staffing."

12. Ask How the Agency Communicates With Family

This is especially important when adult children live in another city or state.

Ask whether families can receive:

• Shift notes
• Caregiver visit confirmations
• Updates through a family portal
• Phone or text updates
• Notifications about missed visits
• Reports about changes in condition
• Supervisor updates
• Incident reports

Also ask:

"What changes require the caregiver to immediately contact the office or family?"

Examples might include:

• A fall
• New confusion
• Refusal to eat
• Sudden weakness
• Skin changes
• Medication concerns
• Significant behavioral changes

Families should know how important information moves from the caregiver in the home to the people responsible for making decisions.

13. Understand What Caregivers Can and Cannot Do

Never assume that because a family needs something, a particular caregiver is legally or professionally permitted to do it.

Ask about tasks such as:

• Medication reminders
• Medication administration
• Injections
• Wound care
• Blood glucose monitoring
• Transfers
• Mechanical lifts
• Feeding assistance
• Toileting
• Catheter care
• Transportation

Scope-of-practice and delegation rules vary by state and by caregiver credential.

If your family member needs clinical services, confirm whether you actually need a home health agency, nurse, therapist, or another licensed professional rather than solely nonmedical home care.

14. Get a Complete Explanation of Cost

Do not ask only:

"What's your hourly rate?"

Ask:

"What could appear on my invoice besides the normal weekday hourly rate?"

Possible charges can include:

• Minimum hours per visit
• Minimum hours per week
• Weekend rates
• Holiday rates
• Overnight rates
• Live-in rates
• Transportation or mileage
• Assessment fees
• Cancellation fees
• Late-payment fees
• Deposits
• Short-notice scheduling fees

Also ask:

• Is there a minimum commitment?
• How much notice is required to cancel?
• Do rates increase annually?
• How much notice is provided before a rate increase?
• Is the caregiver paid when the client is hospitalized?
• How does billing work if the caregiver leaves early?
• Is travel time billed?
• Who pays mileage while running errands?

Get the complete fee structure in writing.

15. Read the Service Agreement Before Signing

The contract should answer basic questions about the relationship.

Look for provisions covering:

AARP's guidance on caregiver agreements emphasizes documenting responsibilities, schedules, compensation, liability, termination, and other expectations rather than relying entirely on verbal agreements.

RED FLAG

Be cautious when a representative pressures you to sign immediately or discourages you from reading the agreement.

Urgent care needs are real, but urgency should not prevent a family from understanding the price, cancellation policy, responsibilities, and termination provisions.

16. Ask About Complaints and Problems

Even excellent caregivers and agencies occasionally have problems.

The important question is how the organization responds.

Ask:

• Who handles complaints?
• Is someone available outside normal office hours?
• How quickly should families expect a response?
• How are complaints documented?
• What happens if a caregiver violates the care plan?
• What happens if property goes missing?
• What happens after a fall or injury?
• How does the agency investigate an incident?
• When is a supervisor involved?

A good agency does not promise that nothing will ever go wrong.

It explains what happens when something does.

Red Flags to Watch For

One concerning sign does not automatically mean an agency is unsafe. But several of these together should cause a family to investigate further.

Green Flags That Suggest a Well-Run Agency

Families should also look for positive signs.

GREEN FLAGS

A strong agency can usually explain:

• Who employs its caregivers
• What screening is completed
• How caregiver qualifications are verified
• What initial and ongoing training is provided
• How care needs are assessed
• How caregivers are matched
• Who supervises caregivers
• How families receive updates
• What happens after a missed shift
• How complaints are resolved
• How quickly a caregiver can be replaced
• What every service costs
• What is included in the written agreement

Transparency is itself useful information.

A Simple Home Care Agency Comparison Scorecard

When possible, interview at least two or three providers using the same questions.

Do not evaluate only whether an agency answered yes.

Pay attention to how it answered.

A company that has strong systems in place should usually be able to describe them specifically.

Home Care Agency vs. Hiring a Caregiver Directly

Neither arrangement is automatically right for every family.

The biggest difference is often how much responsibility the family wants to take on.

The IRS cautions that caregiver classification depends on the actual working relationship. A caregiver hired directly by a family may be a household employee when the family controls both what work is performed and how it is performed.

That makes it important to discuss payroll and tax responsibilities with an appropriate tax professional when hiring independently.

Should You Choose the Cheapest Home Care Agency?

Price matters.

For families paying for many hours of care every week, even a relatively small difference in the hourly rate can become significant.

But the lowest hourly price should not be evaluated in isolation.

Consider what is included:

• Caregiver recruitment
• Screening
• Training
• Supervision
• Payroll administration
• Insurance
• Scheduling
• After-hours support
• Backup coverage
• Family communication
• Care management

A low rate is not automatically a red flag, and a high rate is not proof of quality.

The better question is:

"What am I receiving for this rate, and what responsibilities remain with my family?"

Does Medicare Pay for Home Care?

This is one of the most common sources of confusion.

Original Medicare may cover qualifying home health services for eligible beneficiaries, including intermittent skilled nursing and therapy. Part-time or intermittent home health aide services can be covered when the person is also receiving qualifying skilled care.

But Medicare does not generally cover:

• 24-hour care at home
• Meal delivery
• Homemaker services unrelated to the medical care plan
• Ongoing custodial or personal care such as bathing and dressing when that is the only care needed

Families needing ongoing nonmedical home care may need to investigate private payment, Medicaid programs, veterans benefits, long-term care insurance, or other state and local programs depending on eligibility. Our payment options guide covers common ways families pay for care.

The Bottom Line

Choosing home care should involve more than comparing hourly prices and online reviews.

You are evaluating the systems behind the caregiver.

Ask who employs the caregiver. Verify applicable licensing or registration. Understand the background check. Ask about training. Find out who supervises care. Review the care plan. Test the agency's backup process. Understand every potential charge. Read the contract before signing.

And perhaps most importantly, pay attention to how the agency responds when you ask detailed questions.

The U.S. home health and personal care aide workforce already includes more than 4.3 million jobs, and the Bureau of Labor Statistics expects demand to continue growing rapidly over the coming decade. Families have options, but those options are not necessarily interchangeable.

A strong home care agency should not merely tell you that your loved one will be in good hands.

It should be able to explain the systems it has built to make that happen.

Sources and Further Reading

1. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook: Home Health and Personal Care Aides. National employment, job-growth, training and occupational information for the home health and personal care aide workforce.
2. Centers for Medicare & Medicaid Services, Home Health Agencies. Federal definitions, certification requirements and Conditions of Participation for Medicare-certified home health agencies.
3. Medicare, Care Compare. Federal comparison tool for locating Medicare-certified home health agencies and reviewing available quality information.
4. Medicare, Home Health Services Coverage. Explanation of qualifying Medicare home health benefits and services that Original Medicare does not cover when personal or custodial care is the only need.
5. Medicare, Home Health Agency Checklist. Consumer questions for evaluating services, staffing, availability, personal care needs and costs when selecting a home health agency.
6. Administration for Community Living, Consumer Guidance on Home Health Care. Questions involving care plans, caregiver screening, supervision, emergency coverage and complaint procedures.
7. Internal Revenue Service, Family Caregivers and Self-Employment Tax. Federal guidance explaining when caregivers may be employees rather than self-employed independent contractors.
8. U.S. Department of Health and Human Services, Office of Inspector General, Exclusions Database. Federal database for identifying individuals and entities excluded from participation in federally funded health care programs.
9. AARP & National Alliance for Caregiving, Caregiving in the U.S. 2025. National research on the prevalence and responsibilities of family caregivers, including assistance with activities of daily living.
10. AARP, Hiring an In-Home Caregiver. Consumer guidance comparing agency and direct-hire arrangements, including screening, insurance, employment and backup responsibilities.