Finding and vetting a home care agency What to ask, what to watch for, what the contracts say

To find a home care agency, start with the Eldercare Locator at eldercare.acl.gov and your state's home care licensing board. Ask every agency the same 10 questions about licensing, background checks, backup coverage, and supervision before signing. Matching services help you get quotes from multiple vetted local agencies at once.

You have decided that your parent needs help at home. Now comes the part nobody prepares you for: figuring out who to actually hire. You are considering letting a stranger into your parent's home, often with access to medications, financial documents, and the most private moments of daily life. Getting this decision right matters.

This guide walks through how to find agencies, what to ask, what to watch for, and how to avoid the most common mistakes families make when hiring in-home care for the first time.

Agency-employed aides vs. independent caregivers: understanding what you are buying

There are two fundamentally different ways to hire in-home care, and the distinction matters more than most families realize before they start looking.

Agency-employed aides work for the agency. The agency handles background checks, workers' compensation insurance, liability coverage, payroll taxes, and backup coverage when your regular aide is sick or on vacation. If something goes wrong, the agency carries the legal and financial exposure. You pay a higher hourly rate because that rate covers all of this infrastructure.

Independent caregivers are self-employed contractors. They typically cost less per hour, sometimes significantly less. But when you hire an independent caregiver, you become the employer under IRS rules. That means you are responsible for payroll taxes, you need to verify that they carry their own liability insurance, and you have no backup coverage if they do not show up. In some states, if an independent caregiver is injured in your parent's home, you could face workers' compensation liability if they are not covered.

Neither approach is wrong. Many families use independent caregivers successfully. But the comparison is not simply hourly rate vs. hourly rate. When you use an agency, you are paying for risk transfer, backup systems, and administrative management that independent caregivers cannot provide. For families who cannot afford the time or stress of managing these responsibilities directly, the agency premium is usually worth it.

What non-medical home care actually covers (and what it does not)

Most families searching for a "home care agency" are looking for non-medical or custodial care. This is important to understand because a non-medical home care agency provides:

• Help with bathing, dressing, grooming, and toileting
• Meal preparation and feeding assistance
• Light housekeeping, laundry, and errands
• Medication reminders (but not medication administration in most states)
• Companionship and supervision
• Transportation to appointments

A non-medical home care agency does not provide skilled nursing care, wound care, physical therapy, speech therapy, or medication administration. Those services require a different category of provider: a licensed home health agency, which employs RNs and licensed therapists. Home health care (the skilled kind) is typically ordered by a physician and may be covered by Medicare under specific conditions. If your parent needs medical care at home, ask their doctor whether they qualify for a home health referral. That is a separate conversation from finding custodial home care.

Where to find home care agencies (beyond Google)

Most families start with a Google search and end up with a mix of national aggregators, paid listings, and local agencies with good SEO. That is a reasonable starting point, but it is not a vetting tool. A few better resources:

Eldercare Locator (eldercare.acl.gov): A free service from the U.S. Administration for Community Living that connects families with local Area Agencies on Aging. These agencies often maintain referral lists of vetted local providers and can help you understand what is available in your parent's county. It is a starting point, not a guarantee of quality, but the Eldercare Locator is one of the most underused resources families have.

Your state's home care licensing board: Most states license non-medical home care agencies. Your state health department website should have a license lookup tool where you can verify that any agency you are considering holds a current, active license. The requirements vary by state, but an unlicensed agency is a serious red flag.

AARP's caregiver resources: AARP's caregiving hub maintains guides to finding local care and can point you toward your local Area Agency on Aging.

Matching services: Services like Hire a Helper, Carefound, and Care.com Business aggregate local agency profiles and let you get quotes from multiple vetted providers at once. They are not neutral, but they do pre-screen agencies for basic licensing and insurance requirements, which saves time during the initial search phase.

Discharge planners and social workers: If your parent is being discharged from a hospital or rehabilitation facility, the discharge planner or social worker often has a working list of local agencies they refer to regularly. These referrals are not endorsements, but they reflect what the facility's staff has seen performing reliably in the community.

The 10 questions to ask every agency

Ask these questions of every agency you seriously consider. Write down the answers. The quality of the responses will tell you a lot.

Red flags worth taking seriously

Most families are so relieved to find an agency with availability that they minimize warning signs. These are the ones worth pausing for:

• No license or vague answers about licensing. In states that require licensure, operating without one is illegal. This is a hard stop.
• Cannot answer basic questions about background checks. If the intake coordinator does not know what background check process they use, that is a gap in operational standards, not just an administrative oversight.
• Pressure to sign quickly. Urgency tactics are not how a confident, quality provider operates. Any agency that needs you to sign before you have time to compare options should prompt a harder look.
• No clear backup plan. If the agency cannot describe a specific backup process, your parent's care continuity will be unpredictable by design.
• Vague about training. "We hire experienced aides" is not a training program. Ask what specific training new aides receive before their first solo assignment.
• No in-home assessment before placement. A quality agency will not place an aide without first meeting your parent and assessing the care environment. If an agency is willing to send someone tomorrow without that step, ask why.

The in-home assessment: what a good first visit looks like

Before a quality home care agency places an aide, they will send a care coordinator or nurse to your parent's home for an assessment. This visit typically covers your parent's care needs and daily routine, the home environment and any safety concerns, your parent's preferences (likes, dislikes, communication style), and what hours and days of coverage are needed.

This assessment is not bureaucratic overhead. It is how the agency matches the right aide to your parent's specific situation. An agency that skips this step and offers to send someone immediately based only on a phone conversation is saving themselves time at your parent's expense.

Use the assessment visit as an evaluation opportunity. How does the care coordinator treat your parent? Do they speak directly to your parent, or only to you? Do they ask about your parent's preferences and history, or just check boxes on a form? The quality of that interaction tells you something about the agency's broader culture.

Caregiver turnover: the question most families forget to ask

The home care industry has notoriously high staff turnover. Annual turnover rates above 60 percent are common in the industry, according to data from the Home Care Association of America. For your parent, this means that the consistent, familiar aide they have come to trust may leave, and the replacement may be someone very different.

Ask specifically: "How long do your aides typically stay with one client?" and "What is your agency's average aide tenure?" An agency with low turnover has likely built a workplace where aides want to stay. For your parent, a consistent caregiver is not a luxury. For someone with dementia or significant cognitive changes, a new face every few weeks is genuinely disruptive.

The answer will not always be what you hope to hear. But an agency that is honest about turnover and has concrete programs to address it is a better long-term partner than one that glosses over the issue entirely.

What home care costs and what Medicaid covers

Non-medical home care from an agency typically runs $25 to $35 per hour in most markets, with higher rates in major metropolitan areas. Most agencies require a minimum of 3 to 4 hours per visit, which makes the practical cost $75 to $140 per visit at a minimum. Overnight care and live-in arrangements use different pricing structures.

Medicare does not cover non-medical home care. Medicare Part A may cover skilled home health services (nursing visits, physical therapy) under specific conditions after a qualifying hospital stay, but this is a different category and has nothing to do with the custodial care that most families are looking for.

Medicaid may cover home care if your parent qualifies, through what is called a Home and Community Based Services (HCBS) waiver program. These programs are administered at the state level, eligibility criteria vary, and not all home care agencies participate. If there is any chance your parent may qualify for Medicaid based on income and assets, contact your state Medicaid office or your local Area Agency on Aging and ask specifically about HCBS waivers before committing to private pay. For a full explanation of how to navigate the financial side of home care, see our guide to financial navigation for caregiving families.

For families comparing in-home care to facility-based alternatives, understanding the real cost comparison is an important part of the decision. Our article on in-home care vs. assisted living walks through that comparison in detail.

Getting multiple quotes at once

Calling agencies one at a time is time-consuming and makes it hard to compare. Matching services like Hire a Helper, Carefound, and Care.com Business are designed for exactly this situation: you describe your parent's care needs and location, and the service connects you with multiple vetted local agencies that can provide coverage. This is particularly useful when you need to move quickly or when you do not already have a referral from someone you trust.

These services pre-screen agencies for basic licensing and insurance requirements, which filters out the worst options. They do not replace your own vetting process, but they give you a better starting pool than a cold Google search.