Questions to ask a home care agency

Most people want to stay in their own homes as they age. About 3 in 4 adults over 50 (75 percent) say so, according to AARP's 2024 survey, and bringing in paid help is often what makes that possible. It is also a genuinely hard thing to get right. You are trusting someone you just met with the safety of a person you love, frequently while you are exhausted and deciding quickly, which is the worst state in which to remember a long conversation (people forget 40 to 80 percent of what they are told in a stressful one). Writing the answers down is how you actually compare your options instead of going on a feeling.

One thing to keep in mind as you call around: the agencies are selling you their service, so the questions that protect your parent are not always the ones they lead with. This is the neutral version, and it is the in-home counterpart to our checklist on touring assisted living, the other answer to the same question of how to get a parent more help. Talk to two or three agencies and fill one out for each.

There are two ways to bring help in, and the difference is bigger than the price. Through an agency, the agency employs the caregiver: it screens and background-checks them, carries the bonding and liability insurance, handles payroll taxes, supervises the work, and sends a backup when your regular caregiver is sick. You pay more per hour for all of that being handled.

Hiring someone directly is usually cheaper by the hour, but it makes you the employer, and that comes with real obligations most families do not see coming. The IRS generally treats an in-home caregiver you hire and direct as your household employee, which means you may owe payroll taxes (the so-called nanny tax), and you take on workers' compensation, liability, the background check, and the scheduling yourself. Crucially, there is no backup: if your caregiver is sick, the gap is yours to fill. Neither path is wrong, but go in knowing which one you are choosing. If you hire directly, talk to an accountant about the household-employer rules before the first paycheck.

This is the costliest misunderstanding in the whole process, so clear it up before you budget. Medicare covers skilled home health: part-time or intermittent nursing or physical, occupational, and speech therapy that a doctor orders when your parent is homebound, plus a home health aide only while that skilled care is going on. What Medicare does not pay for is the kind of help most families are actually hiring: long-term, non-medical personal care (bathing, dressing, meals, companionship) when that is the only care needed, along with 24-hour care and homemaker services. In Medicare's own words, that is custodial care, and you pay for it yourself.

Medicaid is the program that can help with long-term, non-medical care for those who qualify, through home and community-based services, though the rules and programs vary by state and some states even let you direct your own care or pay a family member. For private pay, budget realistically: in-home non-medical care runs about $35 an hour nationally, roughly $80,000 a year at 44 hours a week, according to CareScout's 2025 Cost of Care Survey. One more useful distinction: Medicare's Care Compare gives Medicare-certified home health agencies a star rating you can look up, but non-medical home care agencies are not on it. They are generally licensed at the state level, with rules that vary, so ask the agency directly about its license and record.

A few questions do most of the protective work, and they are the ones easiest to skip when an agency is warm and reassuring on the phone. Ask whether caregivers are the agency's own W-2 employees (rather than contractors the agency just refers), because an employer is accountable in ways a referral service is not. Ask whether they are background-checked, bonded, and insured, and ask the question almost no one thinks to: who is liable if the caregiver is injured in the home, or if money or medication goes missing? With a real agency, the answer is the agency. With a direct hire, the answer is usually you.

Then nail down backup, because it is where in-home care most often falls apart. What happens when the regular caregiver calls out sick, and how fast can someone else come? Who answers the phone at 9 p.m. on a Sunday? A good agency has a clear, practiced answer. A vague one is telling you something. Ask for two or three references from current families, and check the agency for complaints with your state licensing body and the Better Business Bureau before you sign anything.

Once you have chosen, the first day goes far better when the caregiver walks in with the information they need instead of piecing it together. Hand them one current medication list, a simple care plan, and an emergency-info sheet: what your parent takes, what they can and cannot do, what to watch for, and who to call. When more than one person shares the care, a shared daily log keeps everyone, including you, on the same page about what happened each day.

That handoff is the gap KeptWell is built to close. Upload your parent's records once and the binder reads them, keeps the medication list current, and gives the whole circle (you, your siblings, and the people you hire) one shared, up-to-date picture, so nobody is working from a half-remembered version of the care plan. Here is how it works, and it is free today with an honest plan for what comes next.