Home Care Agencies: The Good, the Bad, and Ten Questions to Know the Difference

It’s official – I’m angry.

Those who know me understand that this is a rare occurrence (I don’t even get angry when the Cubs go on a 9-game losing streak – I just get despondent). But when someone’s actually getting hurt, my blood starts to boil.

In this case, the people getting hurt are older adults receiving home care. Why are they getting hurt? Because a lot of home care agencies aren’t screening their caregivers to ensure they are hiring qualified, competent, ethical people.

Granted, not all agencies are like this. I’ve personally heard from many caregivers around the country who have been very happy with their home care services. But a study recently published in the Journal of the American Geriatrics Society (read the abstract here) found that many agencies recruit caregivers without conducting drug testing or national criminal background checks. Several do not require any caregiving experience, nor do they provide initial or ongoing training. Some agencies even lied about the screening instruments they used to evaluate caregiver applicants.

(c) National Cancer Institute
© National Cancer Institute

The researchers, based at Northwestern University’s Feinberg School of Medicine, surveyed 180 home care agencies around the country about their hiring procedures, screening instruments, training protocol, and skills assessment and supervision practices. Here are a few of the disturbing gems they found:

  • A mere 55% of the agencies conducted a federal background check, meaning that a crime committed out-of-state would not be detected.
  • Only one-third of the agencies performed drug testing.
  • Just one-third of the agencies assessed caregiver skills and competencies. Of those that did, a common assessment method was to wait for clients to contact the agency to report that a caregiver was not doing the job correctly (I swear, I am not making this up).

Hence, my anger. Family caregivers and the older adults in their care are right smack in the middle of one of the most challenging periods in their lives. They are vulnerable and they need help. Moreover, we encourage them to reach out and seek help! The thought that families would garner the strength and courage to actually do this, only to experience a negative – and potentially harmful – home care experience is deplorable to me.

If you are a family caregiver, I’ve encouraged you in the past to become an advocate for your loved one’s care. This concept applies to choosing home care as well. To help you ensure that quality caregivers are coming into your home, here are 10 questions to ask home care agencies. These questions were suggested in Northwestern’s press release by Lee A. Lindquist, MD, MPH, MBA, who served as the lead investigator in the study.

  1. What is your process for recruiting and hiring caregivers?
  2. What screenings do you perform (state and/or federal criminal background checks, drug tests, etc.)?
  3. Do your caregivers have health-related training, including CPR certification?
  4. Are caregivers bonded and insured?
  5. What skills do you require your caregivers to have before sending them into a home (personal care, dementia care, etc.)?
  6. How do you assess those skills?
  7. If the regular caregiver you assign to my home cannot perform the services agreed upon, what is your policy for providing a new caregiver?
  8. May I ask for a new caregiver if I am dissatisfied with the one you assign?
  9. Does a supervisor evaluate your caregivers’ work? How often?
  10. How does supervision take place (over the phone, staff meetings, or home visits with the caregiver)?

One more thought. Although I’m angry, let me reiterate that I don’t think all home care agencies are evil. There most likely are more good ones than bad, but it’s crucial to know the difference. I am confident that you can find high quality, compassionate home care for your family member. I’m simply encouraging you to do your homework first.


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  • The idea of putting my grandmother into a long term nursing home did not sit well with me and the research of trying to find a good reputable home care agency was trying. The idea of home care to me is best because it still gives my grandmother the sense of independence with the assurance of knowing if there is something she needs and she cannot obtain it, someone will be there to help her when she needs it. It also gives me and our family the peace of mind knowing she is taken care of. We live in the Atlanta Georgia area and I highly recommend Abundant Life Assisted Services. They have been angels to us! Check them out! http://www.alascare.com/about_us.php

  • In reply to PeterJ0NES:

    Hi Peter,

    Thanks so much for your comment! I'm glad that you were able to find a home care agency that provides high quality, compassionate care. I appreciate the feedback!

    Take care,

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