Look in the phone book under homecare, home health care, and nursing. If you live in a very small community and there's no agency listed, look in the phone books for surrounding larger communities.

Ask friends and acquaintances, health care professionals such as your doctor, and others, such as pastors, who frequently have contact with those that need services . Don't limit yourself to asking older people-- young ones may know an agency through their parents.

Call your nearest Area Agency on Aging.

Call your state government, especially if agencies in your state have to be licensed.

Do an internet search. Go to Google or another search engine and plug in search terms such as "homecare", "caregiver", "home health aide", and "personal care aide". Be sure to include the name of your city and state, or you will get hundreds of thousands of sites.

Contact companies such as ElderWeb that refer to agencies. Be careful of this option, however. Depending on the company, it may only refer to agencies that have paid a fee to be listed. The fees can be extremely steep and the number of referrals provided tiny, so most agencies do not list with these companies. 

Consult the General Consumer Information page on this site for specific websites and phone numbers for most of the above.

If you can only find one agency, you don't have much choice. If you live in a large city, however, you may have dozens of agencies to choose from. If you have more choices than you can sift narrow down the list to a manageable number by considering recommendations from people you know and trust. If you must arbitrarily pick from a huge list in the phone book, I'd recommend looking for a medium-sized ad. You want an agency prosperous enough to afford more than the minimum listing-- hopefully this will mean that they have pleased a significant number of clients. 

When you have narrowed down the list, it's time to call each agency. Before making the call, make sure you are prepared.  Plan to give the call your complete mental attention and to have at least 30 minutes free to make the call. In other words, don't try to squeeze it into a 10 minute coffee break on a frantically busy work day. A good agency will ask a lot of questions about your situation and will want to give you a lot of information. Try not to call around lunch time, when the agency is likely to be a little short-handed. Have a pencil & paper to write down information.

Picking a homecare agency is an art, not a science. When you call you will  be asking questions and listening to answers. You will also quietly be observing other things about the agency that will help you decide which one to use. Below are suggestions about what questions to ask. If you like, you can print a Agency Screening Worksheet with the questions on it to take notes. To view the worksheet, you must have the free Adobe Acrobat Reader installed. This free, safe, easy and handy reader is available here.

Call the agency. When you get to a real person, don't launch into the whole story immediately, as you are probably not talking to the right person. Just explain you are looking for a caregiver and would like to talk to someone about your needs. If your situation is urgent (help for your mother, who is getting out of the hospital this afternoon and needs help tonight, for example), let the person know.

While you are waiting to talk to the right person, start making notes.

How do you rate the answering system?

If there is an automated system, is it user-friendly? If you leave a message, is it responded to quickly? If a real person answers the phone, is the person friendly and helpful? Are you connected to the right person reasonably quickly? These are you first clues to the agency's quality.

How long has the agency been in business?

Longer is better. You'd be surprised at how complicated providing caregivers can be. Experience matters.

Is the agency a franchise?

A franchise operation can overcome some of the disadvantages of short time of operation, as the larger corporation has hopefully developed good policies and procedures over a long period of time. 

Are there people with a good medical background available to manage problems? 

Having people with a medical background available within the agency is critical. When a caregiver calls the office to report a medical problem, you want people available who are competent to decide whether to call the doctor, the family, or go straight to 911. When a caregiver mentions that a client is not eating, you want the agency to react appropriately. Someone with medical knowledge should be available outside of office hours as well. If the answer to any of these questions is no, I highly recommend you not use the agency.

How many caregivers does the agency employ?

Having a good number of caregivers will mean if one caregiver doesn't work out, there are others to choose from. On the other hand, a huge number of caregivers may mean a huge agency where you may be lost in the crowd, although a well-run experienced agency can overcome that disadvantage by dividing up the caseload.

Are the caregivers employees or independent contractors?

Caregivers being employees is generally easier for you, as the agency pays employment taxes. If the agency has independent contractors, sticky questions can arise. Be sure to consult an accountant first if you are tempted to go this route.

Are caregivers insured and bonded?

Don't consider the agency if it isn't.

What kind of training and/or experience is required of caregivers?

Obviously, if the answer is "none", that's not so great.

What does the agency charge?

Some agencies have a simple dollar per hour charge, others have more complicated charge systems  that vary with the length of shift and/or the needs of the client. One is not necessarily better than the other. The important thing is to understand the fee system so you can decide what's best for your situation. 

What kind of support does the agency have during times when the office is closed?

The agency should have someone available 24 hours a day to solve scheduling problems, as well as someone competent to problem-solve medical and other types of problems. Even if you need only day-time help now, your needs may change, and you want to have good support available at all times.

How much notice does the agency need to set up care?

Give them an idea of when you will be needing help. Can they start by then?

If an insurance company will be paying for all or part of the care, will they bill the company directly?

If they will bill directly this will save you enormous amounts of time and headaches.

At this point, if you haven't already, explain more about what you need. This should turn out to be a longish conversation, because you will be answering a lot of questions.

How knowledgeable does the person you are talking to seem?

If you say you need someone to help give a bath, for example, you should be asked more detailed questions such as, tub, shower, or bed bath?  Need for shower bench? Grab bars? If you say the client has heart failure, are you asked how easily the person gets short of breath? Are you asked about psychological issues, such as the willingness of the person to receive help? Are you given suggestions about overcoming problems? If you aren't sure how much care is needed, are you given good clear information that will help you decide?

Does the person you talked to seem professional, kind, and interested in your situation? 

Naturally, you want an agency whose office personnel care about their clients. Someone who seems rushed or bored is not a good sign. You should also not be subjected to high-pressure sales tactics. Bad-mouthing other agencies is not professional. 

Before you hang up, be sure to write down the name and title of the person you talked to. If you decide to use the agency, ask for that person when you call back.

When you have talked to all the agencies, go over your notes. In deciding which will best serve your needs, don't just go with the least expensive agency.  Consider the whole picture. Go with the one you have the best overall feeling about. Even if your needs are minimal right now (help once a week for shopping, for example), they will likely increase over time. You don't want to have to change agencies when that happens.  

Choosing the right agency is important, especially if you've never used homecare before. A bad experience may sour the person receiving help on the whole idea. If you can, take time to think it over carefully, maybe with the help of a trusted friend or family member. The good news is that there are lots of great agencies in this country. We hope this article helps you find them.

©2004 by Sharon Emerson

360-331-7441 or 360-678-4090