User Guide

All questions that appear in our checklists serve a purpose and help you gather the right information to make an informed decision about a provider. However, the implications associated with some of the questions may not be completely obvious.

This user guide addresses those questions in particular; it is organized to match checklist categories.

Service questions:

Some states license and regulate home care agencies, and others do not, which means there are differences in the way caregiver hours are scheduled and what caregivers can and cannot do for their clients. The questions in this section allow you to determine what kind of care an agency caregiver provides in your state.

Agency policy and procedure questions:

Here are some of the benefits you should receive when you use an agency, as opposed to hiring a caregiver directly, and part of the reason why agency caregivers usually cost more:

A professional, such as a nurse or social worker, conducts an in-person assessment prior to the start of service so that the caregiver who is selected for you has the skills to meet your needs and is a good match.

  • You are able to reach a live person 24/7 to address concerns and deal with any problems that arise.
  • The agency is responsible for finding you a substitute caregiver if your caregiver is unable to come for any reason.
  • An agency staff person is responsible for supervising and supporting your caregiver.

Many long-term care insurance companies require that policy holders use an agency that adheres to the policies and procedures described above.

Caregiver screening questions:

There are various types of caregivers, with various types of background. Here’s some information to help you determine what is most appropriate for you:

  • Licensed practical nurses, who work under the supervision of a nurse, are able to do medication setups, wound care and other medical procedures for clients. They are more expensive than caregivers with less training.
  • Most caregivers, whether they are certified nursing assistants (CNAs) or home health workers, who have some formal training, are employed to assist clients with activities of daily living, such as personal care, and instrumental activities of daily living, such as errands and chores in the household. In some states, they may be permitted to provide specified types of nursing care, under supervision from a nurse.
  • Homemakers have no formal training, although they may have skills that they have gained from experience working with older adults.

Caregiver screening and ongoing training are particularly important.

Good agencies do criminal background checks on caregivers prior to hire. However, a state criminal background check will not uncover a crime committed in another state. For that reason it is important that the agency does thorough reference checks as well.

Caregivers who work with an agency that provides and/or requires training are more likely to be knowledgeable and provide good care.

Note that many long-term care insurance companies require that the policy holder use a certified nursing assistant (CNA).

Agency & staff questions:

It is important for you to know whether a caregiver is a direct employee or sub-contractor with the agency you are using. Employees are covered by the agency’s worker’s compensation and liability insurance. Sub-contractors are not. Although no one wants to think about accidents or theft, it’s best to be protected and compensated.

The questions about the length of time the director and average caregiver have worked for the agency are also important because stable employees, at every level, usually reflect good management and translate into good performance.

Licensure and accreditation questions:

If an agency operates in a state that requires licensure and does not have a license, or has a license that is not in good standing—run. Similarly, if an agency does not carry worker’s compensation and liability insurance—run.

Home care agencies rarely seek accreditation because it is an onerous and costly process. If an agency is accredited by an accreditation organization, it indicates that they are committed to continuing quality improvement and excellence.

Agencies are not required to join any professional organization. However, membership in professional organizations suggests, at a minimum, that the agency is concerned with its reputation. While it is not a guarantee of superior performance, many agencies that join professional organizations do so because they are committed to high standards in their industry.


Before you decide to work with a particular agency, ask yourself the following five simple questions.

When you first called the agency, were you able to reach a staff person in a timely manner?

Did you feel you were well-treated by the person you spoke with on the phone?

Did the person answer your questions to your satisfaction?

Do you feel that the person who came out to do the initial assessment understood your needs and concerns?

Were costs and contract terms explained so that you could fully understand them?