Questions to ask a home care agency: a checklist for Pennsylvania families

How can this checklist help your family?

Think of it as a script for the phone calls you are dreading. Print this page, call two or three agencies that serve your parent's county, and ask each one the same questions. Jot the answers in the margin.

Then ask the agency you like best to go over the important answers again at the in-home consultation. A good agency expects these questions and answers them plainly. Hesitation, vague promises or "we'll figure that out later" are answers too.

You will not need every question. If your parent needs a few hours of companion care a week, the overnight questions matter less. If you are arranging 24-hour care, they matter most.

Is the agency licensed, and who employs the caregivers?

Ask about the license first, because every other answer rests on it. Pennsylvania's Department of Health licenses and inspects home care agencies and home care registries.

Our guide to checking a Pennsylvania home care license shows exactly where to look, and our guide to hiring privately vs. using an agency explains the employer question in more depth. It's Your Home Care is licensed as a home care agency, and every caregiver is our W-2 employee.

Who will actually be coming to the house?

Ask how caregivers are screened, trained and matched to your parent. Pennsylvania sets minimum requirements, including a criminal background check (plus an FBI check for anyone who has not lived in the state for the past two years), tuberculosis screening, and proof of skills before a caregiver works with a client. Good questions include:

• What background checks do you run before hiring? Do you include a ChildLine (child abuse) clearance?
• Is every caregiver screened for tuberculosis before starting?
• How do caregivers show they can safely help with bathing, moving from bed to chair, and the toilet? How often is that checked again?
• What training do caregivers have for memory loss and dementia, and for noticing changes worth reporting?
• How do you match a caregiver to my parent? Can we ask for a woman or a man for bathing, a non-smoker, someone comfortable with pets, or someone who speaks a particular language?
• Will we meet the caregiver before the first visit?
• What if the match is not working? How do we ask for a different caregiver?
• What will your caregivers not do? (Listen for: no injections, no wound care, no giving medications, no filling pill boxes from bottles.)

At It's Your Home Care, caregivers complete background checks, ChildLine clearance, TB screening and skills training before they are assigned. We match on needs, personality, language and location, and we introduce the caregiver before the first shift when schedules allow.

What happens if the caregiver is sick or the weather is bad?

Ask about the hard days, because every agency sounds the same on a good one. Caregivers get sick, cars break down, and snow closes roads on Route 322 and the Turnpike. How an agency handles those mornings matters more than anything in a brochure.

• If the regular caregiver calls out, who comes instead, and how will you let us know?
• Who do we call at 6 a.m. or 10 p.m.? Is someone on call for current clients?
• Is there a minimum visit length or a minimum number of hours a week?
• How much notice do you need for a schedule change, a hospital stay, or a week away?
• Can you help with overnights, weekends and holidays? Can you add hours after a hospital stay?
• How many different caregivers should we expect in a typical month?
• If my parent lives in the country, how many of your caregivers live nearby, and are longer shifts easier to fill than short ones?

Honest answers to that last question depend on the county. In parts of Fulton, Huntingdon, Juniata and Perry counties, for example, scheduling depends on which caregivers live within reach, and longer or regular shifts are easier to fill than a one-hour visit. An agency that says "no problem" to everything without asking where your parent lives is guessing. We would rather tell you honestly what we can staff.

How will you know how Mom is doing?

Ask how you will hear about each day, especially if you live out of town. Families caring from a distance often say this matters most.

• Will we get a written care plan? Who writes it, and how often is it reviewed?
• Do caregivers keep daily notes, and can the family see them?
• Who is our main contact at the office, and how quickly do you usually return calls during office hours?
• How does the office check on the caregiver's work: phone check-ins, visits, or both?
• What does the caregiver do if my parent falls, refuses care, seems confused, or will not open the door?
• Will you work with the home health nurse, the hospice team or the doctor's office if we give permission?
• How do I raise a concern, and what happens next?

How is care paid for, and what will we see in writing?

Ask how billing works and what the agency needs before the first invoice, so nothing comes as a surprise. Many families combine private funds, long-term care insurance, VA benefits and county or state programs.

• Is care billed by the hour, by the shift, or by the day for live-in care? Are nights, weekends and holidays billed differently?
• How often will we get an itemized invoice, and how do we pay it?
• Is there a deposit, a contract term, or a notice period to reduce or stop care?
• Do you work with long-term care insurance, and will you provide the care plan, daily notes and itemized invoices the insurer asks for? (See long-term care insurance and home care.)
• Do you accept VA benefits? Can you explain how that works for a veteran or a surviving spouse?
• Are you a provider for OPTIONS through our county Area Agency on Aging, and for Community HealthChoices plans?
• If a program covers some hours, can we pay privately for more, and will you bill them separately?

Before care starts, a licensed agency must give your parent a written description of the services, the hours and the charges, along with how to reach the Department of Health and the long-term care ombudsman. Our guide to how to pay for home care in Pennsylvania walks through every funding source.

What should you ask if Medicaid or a state program is paying?

Ask whether the agency works with your parent's program and plan, and know your parent's rights before anyone asks you to switch. Your parent may choose any willing and qualified provider in the plan's network.

• Do you work with my parent's Community HealthChoices plan (UPMC Community HealthChoices, PA Health & Wellness or AmeriHealth Caritas)?
• Do you work with OPTIONS, the OBRA waiver or Act 150 in our county?
• If the service coordinator approves a certain number of hours a week, can you staff all of them, including weekends?
• What if the approved hours are not enough? (A good answer: they will help you ask the service coordinator for a new assessment.)
• Will you tell the service coordinator if a shift is missed?

One red flag: no agency may offer gifts, cash or other incentives to get someone on Medicaid to choose it or switch to it. If that happens, say no and tell the service coordinator. Our Community HealthChoices guide covers the whole process.

What rights does your parent have once care starts?

Your parent has the right to help plan the care and to have reasonable preferences respected. A licensed agency must give at least 10 days' written notice before ending services, except in narrow situations such as a threat to the caregiver's safety. No one connected with the agency may serve as your parent's power of attorney or guardian. The information the agency gives you must include the Department of Health's complaint hotline and the local ombudsman's number. Our guide to your rights with a home care agency in Pennsylvania explains each one.

What red flags should make you pause?

• No license number, or a license under a name the company will not explain.
• Calling itself an agency while describing caregivers as independent contractors.
• Offering nursing or medical care without a home health license.
• Pressure to sign a long contract today, or to switch from another provider.
• No clear answer about who comes when the regular caregiver is sick.
• Reviews you cannot trace to real people.

If something feels off, trust that feeling and keep calling. The right agency will be patient with your questions.

What is a good next step?

Pick two or three agencies, set aside an hour, and work through the list. You do not have to decide on the first call.

We welcome every question on this page. Call It's Your Home Care at (717) 695-2704 or request an in-home consultation, and ask us anything here. If it helps, we are glad to put our answers in writing so you can compare them side by side.