How to choose a home health agency: 10 questions every family should ask

Choosing a home health agency means choosing the people who will enter your family member’s home, provide intimate personal care, and become a regular presence in their daily life. It deserves the same careful evaluation you would give any significant decision.

These 10 questions cut through agency marketing to help you evaluate what actually matters: quality, safety, reliability, and fit.

how do you choose a home health agency?

A good home health agency employs trained, background-checked caregivers; maintains appropriate state licensing; has a clear process for matching clients with compatible aides; provides supervision and backup coverage; and has a track record of quality care. The most reliable starting points are referrals from physicians, hospital discharge planners, or Area Agencies on Aging, combined with a structured evaluation conversation with the agency before signing any agreement.

Question 1: is the agency licensed and Medicare or Medicaid certified?

Licensing requirements for home care agencies vary by state. Medicare-certified agencies have met federal quality and oversight standards that non-certified agencies are not held to. Ask for the agency’s license number and certification status, and verify them independently with your state health department.

Question 2: how do you hire, screen, and train your caregivers?

This is the most important question. Ask specifically:

• What background checks are conducted? (Criminal, sex offender registry, abuse registry?)
• What training does every caregiver complete before being placed with clients?
• Are caregivers employees of the agency or independent contractors? (Employees have more accountability and agency oversight)
• What ongoing training and competency evaluation do caregivers receive?

An agency that cannot clearly answer these questions is a red flag. Reputable agencies employ caregivers trained through programs like NCOOA’s HHA and PCA certification courses.

Question 3: how do you match caregivers to clients?

Compatibility matters. Ask whether the agency considers the client’s personality, preferences, language, cultural background, and specific care needs when making assignments. Ask whether the client will be able to meet the caregiver before the first care day.

Question 4: what happens if the assigned caregiver is sick or unavailable?

Service continuity is critical. Ask specifically about backup coverage procedures, how quickly a substitute caregiver can be placed, and whether substitute caregivers are given adequate information about the client before arriving.

Question 5: who supervises the caregivers providing care?

For Medicare-certified agencies, a registered nurse must supervise HHA services. Ask how often supervisory visits occur, how performance issues are handled, and who the family can contact if they have concerns about the caregiver.

Question 6: what is your complaint and resolution process?

Even good agencies have problems sometimes. What matters is how they are handled. Ask about the formal process for raising a concern, who you speak with, and what the typical resolution timeline looks like. An agency that cannot describe a clear process is concerning.

Question 7: can you provide references from current or former clients?

Request references from families whose situation is similar to yours. Ask references specifically about reliability, caregiver quality, communication, and how the agency handled any problems that arose.

Question 8: what does your pricing include and what are the billing practices?

Understand exactly what is included in the hourly or daily rate. Ask about minimum hours per visit, cancellation policies, how overtime or holiday rates work, and whether the agency accepts Medicare or Medicaid assignment. Request a written service agreement before committing.

Question 9: how do you handle medical emergencies or changes in the client’s condition?

Ask about the protocol when a caregiver observes a concerning change in the client’s condition. Is there a nurse on call? How quickly can a supervisory nurse respond? What documentation is maintained and shared with the family and healthcare providers?

Question 10: what do state inspection reports show?

For Medicare-certified agencies, inspection and survey reports are publicly available through Medicare’s Care Compare tool at medicare.gov. These reports document deficiencies found during inspections and complaints received. Review them before choosing an agency.

Additional sources for finding quality agencies

• Physician and hospital discharge planner referrals are often the most reliable source
• Area Agency on Aging referrals: eldercare.acl.gov
• Medicare’s Home Health Compare: medicare.gov/homehealthcompare
• State licensing boards and home care association directories
• Word of mouth from families with similar experiences

FAQ: choosing a home health agency

Is a Medicare-certified agency always better than a non-certified one?

Certification indicates that an agency has met federal quality standards, which is meaningful. However, non-certified agencies may also provide excellent care for non-Medicare services. The key factors remain staff training, background checks, supervision, and accountability.

What is the difference between a home health agency and a home care agency?

Home health agencies provide skilled medical services such as nursing and therapy, and are typically Medicare-certified. Home care or personal care agencies provide non-medical personal care and daily living support. Some agencies provide both; others specialize in one or the other.

Trained caregivers make agencies worth choosing

Behind every reputable agency are caregivers with proper training and professional credentials. NCOOA’s HHA and PCA certification programs train the home care workforce that quality agencies rely on.

>> Register for NCOOA’s caregiver certification programs