How to choose a home care agency: questions to ask before you hire

Start by asking whether the agency is Medicare-certified, then ask for the plan of care, the costs and the complaint process in writing. Star ratings help, but CMS calls them one tool among several.

This guide covers two kinds of agency. A home health agency provides skilled care, such as nursing and therapy, and Medicare pays when you meet its rules. A home care agency provides non-medical help with daily living, and Medicare generally does not pay for it. Home health care vs home care explains the split.

Step 1: Medicare-certified or not

Medicare.gov says that to get home health services, a doctor or other health care provider must see you in person, confirm you need home health care and order it, and a Medicare-certified home health agency must provide it. Your provider should give you a list of agencies that serve your area.

The patient rights in step 2 are written for Medicare-certified home health agencies. For a private home care agency that does not bill Medicare, ask what license, registration or inspection your state requires of agencies like it, and ask to see proof. Carevo has not summarized state rules, which vary, and does not vouch for any agency.

Step 2: What a Medicare-certified agency must give you

42 CFR 484.50 sets patient rights for home health agencies. Use it as a checklist, and ask the agency to confirm each point.

• Written notice of rights during the first evaluation visit, before care starts, in a form you can understand, including language access and accessibility for people with disabilities, with the administrator's contact information for complaints.
• A say in your plan of care. You can take part in and consent to or refuse assessments, the plan of care and changes to it, and you must receive all the services in the plan.
• Cost information, orally and in writing: what Medicare, Medicaid or other federal programs are expected to pay, what you may owe, and any charges due before care begins, updated before the next visit if it changes.
• Advance written notice before a service that may not be covered is provided, and before care is reduced or ended.
• The state complaint hotline, with its hours and purpose, and contact information for outside resources such as your Area Agency on Aging.
• Respect and protection from abuse, neglect and misappropriation of property, with a right to complain without reprisal.
• Limits on transfer and discharge. The agency may transfer or discharge you only in the cases the rule lists.

Medicare.gov adds that the agency should tell you, verbally and in writing, if Medicare will not pay for any items or services it provides.

Step 3: Check the ratings, then look past them

CMS publishes two home health star ratings on Care Compare: a quality of patient care rating built from patient assessments and Medicare claims across seven measures, and a patient survey rating built from the Home Health CAHPS survey. Both are updated quarterly.

Know the limits CMS states:

• An agency needs enough data to get a rating. The quality rating needs data on at least five of the seven measures, with minimum case counts, and the survey rating needs at least 40 completed surveys over four quarters. An unrated agency is not necessarily a poor one.
• CMS says the ratings are intended as one tool among several for choosing a provider.

Our care ratings by state page and methodology explain how we report CMS ratings. We show the rating CMS publishes and do not make up our own.

Step 4: Questions for any agency

Use these for both home health and home care. They are questions, not findings.

1. Who employs the caregivers, the agency or me? Who pays payroll taxes and insurance?
2. How are caregivers screened, trained and supervised? What is the supervisor's name and number?
3. What happens when the regular caregiver is sick or leaves? How fast is a replacement sent?
4. Is there a minimum number of hours per visit or per week?
5. What exactly does the rate cover, and what costs extra, such as nights, weekends, holidays or mileage?
6. How much notice do you give before changing the rate, and how much do you need from me to cancel?
7. Can I meet or approve the caregiver before they start?
8. Which languages do your caregivers speak?
9. What is the process for complaints, and will I get it in writing?
10. Can you give me the contract to review before I sign, and can I have someone else read it?

Step 5: Compare costs side by side

Get the rate and the hours in writing from at least three agencies. The home care hours and cost calculator turns hours a week and an hourly rate into weekly, monthly and yearly cost, and the care cost comparison puts that next to an assisted living quote. To see if Medicare may cover skilled care, use the Medicare home health checker.

Where to look for agencies

Browse home care agencies and home health agencies in our directory. For help in your community, the Eldercare Locator, a public service of the Administration for Community Living, is at 1-800-677-1116 and connects you to your local Area Agency on Aging.

Carevo is a connection platform. It does not provide care and does not vouch for any provider.