1. How Long Has The Agency Been In Business? Running a home care agency is a complicated business.  New agencies are less likely to have the necessary know-how or the experienced employees to cover your needs. Look for an agency that has been in business at least three years, and preferably five. This  will weed out the new companies that are destined to fail because they don't know what they are doing and don't have the financial resources to do it right.

2.  Is the Agency Licensed? In Texas a licensed home care agency must post a significant bond and maintain adequate insurance. Licensed home care agencies will be monitored by the licensing agency and will have to adhere to strict guidelines about who they hire and how they do business.

3.  Does the Agency Provide an Annual W2 to Every Employee? Employees of a home care agency will receive a W2 form every year for income tax purposes. If the homecare 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 they are not insuring their workers, their workers are not having taxes withheld, and the agency is not making Social Security contributions. You, as the ultimate employer, may be assuming liability and the obligation to pay payroll taxes. The homecare worker may actually be your employee, not the agency's.

4.  What Insurance Does The Agency Carry? Some home care agencies carry 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, and Dishonesty Bonding for their employees.

If the homecare 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.

5.  How Does The Agency Screen Employees? Thorough background checking is mandatory. Does the agency do a criminal background check in every location where the prospective employee 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 an employee has the skills she says she has? How many references does the agency check, and how far back do they go? 

6.  What Is the Employee Replacement Policy? If you are unhappy with a home care agency employee, what is the agency's 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 real problem with the caregiver. Will the agency be supportive of the elder's need for control and send a replacement caregiver? 

If an employee doesn't show up for work, does the agency have someone who will immediately come to fill in? If the home care agency tells you they have "a" good person in your area, is this the only employee they have? If so, avoid that 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 agency manager is the person who might come to fill in, does the Manager have the skills to do the job? What happens if two employees 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?

7.  What Are The Agency Fees? What is the hourly rate for the kind of assistance you need? 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?

8.  How Does The Agency Monitor Employees? Does the agency have a system for verifying that workers arrive and leave when they should? Asking a frail, sick or confused elder to confirm that a worker was on the job is a bad policy. Does the agency work together with you to prepare a written care plan so the employee has something to refer to? What system does the agency use to communicate with employees 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?

9. What is the Agency's process for starting services?  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?

10. Will the Agency Provide References You Can Call? Ask for references from several years ago as well as current clients. 

Follow these guidelines and both you and the agency you ultimately hire should be a good match. You'll be assured that your agency is professional in every aspect of their business. You'll both know what to expect from each other, and you'll know how best to communicate with each other. 

Even though you'll still have the ultimate responsibility to make sure your elder is receiving good care, you'll have several new quality team members who will work with you to make your job easier.

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