Hiring A Home Care Agency and Caregiver Services

It benefits you to have answers to these important questions, thoughts, and concerns when selecting a home care agency and caregiver(s).


Hiring a home care worker can be a daunting task.  Where do you begin the search?  Maybe you ask your doctor or a good friend?  You worry about the stories you’ve read or heard where unscrupulous caregivers take advantage of vulnerable clients.  It quickly becomes apparent that to hire a trustworthy, reliable caregiver, you need the expertise and support of a reliable HOME CARE AGENCY.  

However, not all home care providers offer the same services, and there are some important, but often unrecognized issues to consider when hiring a caregiver.  Home care services are best when provided through an AGENCY that employs, trains, background checks, bonds and insures its caregivers.  This provides you with the peace of mind knowing that you are bringing someone into your home that you can trust assuming the plan and person serves the needs well for the loved one requiring care.  In addition, the agency will provide a level of financial protection and take care of any legal or liability issues that occur should the caregiver or client be injured on the job.  

On the other hand, a HOME CARE REGISTRY is an organization that helps you locate a caregiver and places one in your home on an independent contractor basis.  Registries do not employ caregivers, nor do they take responsibility for their training and supervision.  A private caregiver or an independent contractor with a home care registry may be highly compassionate, lower in cost, and an overall good fit with the client, but remember you will be liable for the payroll taxes and possible work-related injuries or liabilities of the caregiver.

Hiring an independent contractor as a caregiver that is not background checked on a yearly basis or continuously trained by an agency that employs him or her creates a situation where you don’t know if the caregiver has the skills to perform the needed tasks, and potentially exposes you to the risks of using a caregiver with an unknown background.  This becomes your responsibility and it is vital to also check a private caregiver’s criminal and sexual abuse records at least annually.

The first and most important thing you need to know is if you’re dealing with a HOME CARE AGENCY does it (1) employ its own caregivers, and (2) find out if the agency or provider performs unannounced quality assurance visits to the client’s home.  These are two of the most important activities that home care agencies should be performing.

Questions to Ask About Using And Hiring a Home Care Agency / Caregiver(s)

How long has the agency been providing private duty home care and does it have proper state licensing?  Ask for references and check them out.  You might even want to inquire with the state licensing agency to see if any complaints have been filed against the home care agency.

Do you triple-screen your caregiver employees carefully, including the use of reference checks, driving records, and criminal background investigations?

Does the agency mandate ongoing training of its employees to continually update their skills?

Does the agency manage all payroll and employee-related matters and adhere to state and federal guidelines with its employment practices, such as withholding appropriate taxes and providing workers’ compensation and other benefits?

Are your caregivers licensed and bonded?

Do you also use independent contractors?  If so, who employs the person and what type of background checks are done on them?  Also, who pays the mandated taxes and withholdings?

Is a written, customized plan of care developed in consultation with the client and family members, and is the plan updated as changes occur?

Do you closely supervise the quality of care, including maintenance of a daily journal in the client’s home and non-scheduled supervisory visits?

Does the agency employ registered nurses, social workers, or other qualified professionals to make regular visits to the client’s home?

Do you provide a written document that states the rights and responsibilities of the client, and explains the company’s privacy policy and code of ethics?

Does the agency have a staff of equally trained and qualified caregivers that can act as a backup option if the primary caregiver has an emergency?

How are emergencies handled after normal business hours?

How often does your hourly rate increase?

Are there any hidden charges?

What Kind of Licensing And Certification Programs Do Your Caregivers Take?

Licensing is a general term that can cover many different kinds of certifications.  And the rules for certification vary according to which type of care a caregiver is providing.  They also vary from state to state.  As a general rule, caregivers who help with the tasks of day-to-day living, such as cooking, companionship, and personal care, may not need to be licensed; licensing or certification is required for home health aides (HHAs), certified nursing assistants (CNAs), and others providing medical care.

Hiring a caregiver who has completed a certification course gives you the peace of mind of knowing that one has received a certain level of training and completed a testing process.

One more thing:  You can generally assume a caregiver hired through an agency will have undergone medical screening and be certified that her vaccines are up to date.  If you’re hiring a caregiver privately, you may need to verify this information yourself.

What Does “BONDING” Mean For In-Home Caregivers?

Bonding is used as a means to reassure you that you don’t need to worry about theft.  So what does it really mean to be “bonded?”

Bonding is a legal term for a type of insurance taken out from a bonding company that covers theft by an employee.  If you hire a caregiver from an agency, it’s very likely that they have bonded the caregivers they employ.  Independent caregivers also can bond themselves, though this is not as common.

This means that the agency has purchased a bond that will compensate you (the client) should you be the victim of theft by a caregiver.  The bonding company would repay you the value of the items stolen up to the amount of the bond.  The bonds issued for caregivers are typical $5,000, which means you could theoretically be reimbursed up to $5,000.  You may want to verify how much does the agency bond its caregivers for?  

Does Bonding Assure That All Missing Items Are Covered?

Bonding is not, however, as strong a protection as it sounds.  This is because typically the bonding company does not have to reimburse you unless the theft you’ve reported has been validated in a court of law.  This means the caregiver has to be arrested, charged, and convicted in criminal court before the bond is paid out.  As you can imagine, only a small percentage of caregiver thefts get this far in the legal system.  And even when they do, theft is very difficult to prove, meaning that convictions aren’t guaranteed.


Long-term care insurance will reimburse you for the home care services you choose.  Some policies will require that you use a licensed home care agency rather than paying for private caregivers or independent contractors who don’t work for a home care service.  Make sure you understand how home care benefits are paid out in your policy.  Some long-term care insurance pays indemnity benefits.  You can use the money any way you want and hire anyone you want to provide care once you qualify for benefits.  Keep in mind the potential hidden costs of private caregivers or independent contractors as mentioned above and becomes your responsibility.

You want your insurance benefits, of course, to last as long as possible.  Know what the cost of care is in advance regardless if you’re using long-term care insurance benefits or not.  If asked whether insurance will pay your care, you can tell them “yes”.  Just don’t tell them what your benefits are or assign them.  Otherwise, why would they charge a lower amount if they know your insurance benefits pay a higher amount?

Marc Maretsky Personal Insurance Services based in Beverly Hills, serves all of California and the United States.  I help my clients acquire life, disability, long-term care, and critical illness insured solutions, as well as enroll them into Medicare when eligible.

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