How To Hire Professional
Elder Care Help

Questions to Ask Before You Hire A Homecare Agency

In most states an homecare agency that is licensed must post a significant bond and maintain adequate insurance.  Licensed agencies will be monitored by the licensing agency and will have to adhere to strict guidelines about who they hire to provide care and how they do business.

Employees of an agency will receive a W2 form every year for income tax purposes. If the agency is providing a W2, this verifies that their workers really are employees of the agency.  The agency is properly managing tax withholding and mandatory Social Security payments. 

If the agency is providing their *employees* with 1099 Income Statements, this means that their caregivers are not employees. They are not insuring their caregivers, their caregivers are not having taxes withheld, and the agency is not making Social Security contributions. You, as the employer, are assuming liability and the obligation for payroll taxes. The worker is your employee, not the agency's (remember *Nannygate*?).

Some agencies carry pitifully little (or no) insurance. If you
come across an agency that offers services for fees a lot lower  than the competition, there's a good chance that they aren't paying for insurance. A good agency will be willing to send you proof that they have:

  Professional and General Liability Insurance

  Workers' Compensation Insurance

  Dishonesty Bonding for their care workers

If the agency you hire doesn't have this insurance, you might  be assuming liability if an employee is injured in your home or if valuables come up missing.

Thorough background checking is mandatory. Does the agency do a criminal background check in every location where the prospective caregiver has resided for the last 5 years? Many of the people who do this kind of work move frequently. Doing a local background check on someone who has recently moved from another state isn't enough. 

Does the agency routinely do drug screens? How does the agency verify that a caregiver has the skills she says she has? How many references does the agency check, and how far back do they go? 

If you are unhappy with a caregiver, what is the agency's replacement policy? The agency should guarantee that they will work with you until you have the right person on the job. Sometimes an elder will be unhappy with the first caregiver who comes into the home no matter how good he or she is. This can be a matter of wanting control, rather than a problem with the caregiver.  Will the agency be supportive of the elder's need for control and send another caregiver? 

Some excellent agencies will work with you by *saving* their best caregiver as a replacement for the first caregiver they send. They will take their cue from you if your elder is likely to fire the first person who comes.

If an employee doesn't show up for work, does the agency have someone who will immediately come to fill in? If a homecare agency tells you they have *a* good person in your area, is this the only caregiver they have? If so, avoid this agency as there will be no backup for the inevitable absences due to illness, vacation, car problems, children problems, or just not feeling like working that day.

If the Manager is the person who will come to fill in, does the Manager have the skills to do the job? What happens if two caregivers don't show? The Manager can only be in one home at a time. Will the Manager spend most of his or her time in your home fielding questions and problems from the office, rather than attending to your elder?

What is the hourly rate for the kind of eldercare assistance you need? What is the homecare worker permitted to do in your home?

  Bathing
  Cooking
  Feeding
  Incontinence Care
  Help with walking and/or transferring
  Driving
  Housekeeping
  Laundry
  Animal care

What is the minimum number of hours the agency requires you to use per day or per week? Is there a discount if you use more than a certain number of hours in a week or a month? What is the maximum number of hours an employee can work in one day or in one week? What will cause the fees to go up? How much notice do you have to give if you wish to discontinue services?

Does the agency have a system for verifying that workers arrive and leave when they are supposed to? Asking a frail, sick or confused elder to confirm that a caregiver was on the job is a bad policy.

Does the agency work together with you to prepare a written care plan so the caregiver has something to refer to? What system does the agency use to communicate with caregivers about changes in the care plan or other issues? How is the employee instructed to communicate with family members about problems or concerns? If the worker is receiving instructions directly from family members, how does the agency know what is going on? Does a supervisor visit employees on the job?  How often?

Will a Manager come to the elder's home to assess personality and needs so the right caregiver can be matched to the job? What if your need is urgent and you need someone there *now*? How long does it take to get help in an urgent situation? Does the agency need documents from a doctor? Will you have to pay a deposit? How much?

Ask for references from several years ago as well as current clients. Understand that the agency probably won't give you contact information for clients who were unhappy.