How to Choose a Home Care Agency: Questions, Licensing, and Red Flags

Hiring in-home help is often the step that lets a parent stay in their own home safely. It is also a big leap of trust: someone new will be bathing, feeding, or driving the person you love. A careful search takes a few days, not weeks, and it protects your parent and your peace of mind.

First, know which kind of care you need

"Home care" covers two different services, and they are regulated and paid for differently.

• Non-medical home care (also called personal care or companion care): help with bathing, dressing, toileting, meals, light housekeeping, errands, and supervision. Most families pay privately, through long-term care insurance, or through Medicaid or VA programs.
• Home health care: skilled services such as nursing, physical therapy, or occupational therapy ordered by a doctor. Medicare covers this on a part-time or intermittent basis when your parent is homebound and qualifies. These agencies must be Medicare-certified to bill Medicare.

This guide focuses mostly on non-medical home care. Not sure what level of help your parent needs? Our level-of-care guide can help you sort it out.

Agency vs. registry vs. private hire

There are three common ways to find an in-home caregiver. Each shifts responsibility differently.

The Family Caregiver Alliance notes that some agencies operate as employment agencies whose workers are contractors. Always ask who actually employs the caregiver and who carries liability insurance and workers' compensation.

Check licensing first

Licensing rules for non-medical home care vary widely. Many states require a license; some do not. Some states license agencies but not registries. Before you call any agency:

1. Find your state's licensing agency. It is usually the state health department or the agency that oversees aging services. Your Area Agency on Aging can tell you; find it through the Eldercare Locator (1-800-677-1116).
2. Look up the agency. Confirm the license is current and ask whether any complaints or enforcement actions are on record.
3. For skilled home health, use Medicare's Care Compare tool to check certification and quality ratings.

Questions to ask every agency

Print this list or keep it on your phone during calls.

About the agency

• Are you licensed by the state? Can you send proof?
• How long have you been in business here?
• Are caregivers your employees or independent contractors?
• Are you bonded and insured? Can I see the certificate of insurance?
• Do you carry workers' compensation?

About caregivers

• What background checks do you run, and how far back? Do they include criminal history, abuse registries, and driving records?
• What training do aides receive? Do you have staff trained in dementia care?
• Are aides certified (for example, home health aide or certified nursing assistant)?
• Can we meet the caregiver before the first shift?
• What happens if the aide is sick or the match is not working?

About care and cost

• Who creates the care plan, and how often is it updated?
• Does a nurse or supervisor visit the home? How often?
• What is the hourly rate? Is there a minimum shift length or weekly minimum?
• Are nights, weekends, and holidays billed differently?
• Do you accept long-term care insurance, Medicaid, or VA benefits?
• How much notice is needed to change or cancel service?
• How are concerns or complaints handled, and who do I call after hours?

Ask for two or three references from current clients, and call them. A good agency will not hesitate.

Background checks: what to verify

The Family Caregiver Alliance calls background checks essential for private hires, and you should confirm them with agencies too. Ask what the check covers and whether it is repeated periodically. If you hire on your own:

• Check your state's criminal record repository and sex offender registry.
• Check any state abuse or nurse aide registry.
• Verify any certification directly with the issuing body.
• Run a driving record check if the caregiver will drive your parent.
• Call past employers, not just personal references.

Some states require written consent from the person being checked. Follow federal and state rules on using background reports for hiring.

Read the service agreement

Before care starts, the agency should give you a written agreement. Take it home and read it before signing. Look for:

• The services included and any tasks the aide is not allowed to do (some states limit what non-medical aides can do, such as giving medications)
• Hourly rates, minimum hours, and how overtime, holidays, and mileage are billed
• How and when you will be billed, and what happens if a bill is disputed
• Notice required to change the schedule, pause service during a hospital stay, or cancel
• Whether there is a deposit and how it is refunded
• Any clause restricting you from hiring the caregiver directly, and the fee if you do
• Who to contact with complaints, including the state licensing agency

If something is unclear, ask for it in writing. A reputable agency will explain its terms without pressure.

How families pay for agency care

Most non-medical home care is paid privately. Other possible sources include long-term care insurance, Medicaid home and community-based services programs in many states, and VA programs for eligible veterans, such as homemaker and home health aide services or the Aid and Attendance pension benefit. Each has its own rules, and not every agency accepts every payer, so ask early. See our Medicaid long-term care guide and VA Aid and Attendance guide.

Red flags

Setting up the first few weeks

1. Write a simple care plan. Daily routine, medications, allergies, emergency contacts, and what your parent enjoys. Our care plan guide walks you through it.
2. Be there for the first shift if you can, or arrange for a trusted neighbor to stop by.
3. Agree on communication. A shared notebook or a quick daily text helps.
4. Check in with your parent privately. Ask how they feel about the caregiver.
5. Review after two weeks. Adjust hours or tasks, or ask for a different match.

Cost is often the biggest unknown. Before you sign, compare likely monthly costs for in-home care with other options.

For more on what in-home care includes and how families combine it with adult day programs and respite, see our in-home care guide and cost of care overview.

Last reviewed October 19, 2026. General information only, not medical, legal, or financial advice. Benefit rules and amounts change, so confirm with the agency before you decide. See our disclaimer.