Finding and vetting a home care agency the ten questions, the red flags, and what a fair contract looks like

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To find and vet a home care agency, start with your state's licensing board and the Eldercare Locator at eldercare.acl.gov. Ask every agency the same ten questions on licensing, background checks, backup coverage, and training before you sign.

You have decided your parent needs help at home. The harder decision comes next: who actually gets hired. This is someone with access to medications, financial paperwork, and the private, unglamorous parts of daily life, so the vetting matters as much as the search.

Agency-employed aides or an independent hire: the trade-off that decides everything else

There are two different ways to bring someone into your parent's home, and the difference shapes every question that follows.

Agency-employed aides work for the agency. The agency runs the background check, carries workers' compensation and liability insurance, handles payroll taxes, and lines up a replacement when your regular aide is sick. If something goes wrong, the agency carries the legal and financial exposure, not you. That coverage is most of the gap between the $35 hourly rate a family pays and the aide's own median wage, which the Bureau of Labor Statistics puts at $16.78 an hour in 2024.

Independent caregivers are self-employed contractors, and they typically cost less per hour, sometimes considerably less. But hiring one directly can make you a household employer under IRS rules: the IRS says you have a household employee whenever you hire someone for household work and control not just what gets done but how, which brings payroll-tax obligations with it. You also have to verify the caregiver carries their own liability insurance, and there is no backup if they do not show up. Ask an insurance agent, not a search engine, whether your homeowner's policy covers an injury to someone working in the home before you rely on it.

Plenty of families use independent caregivers successfully, and the arrangement can work well when someone in the family has the time to manage it. What an agency sells beyond the hourly rate is risk transfer and a backup system. For a family already stretched thin, that premium is often the more affordable option once an unplanned gap or an injury is factored in.

What a non-medical home care agency covers

Most families searching for a "home care agency" want non-medical, or custodial, care. A non-medical home care agency typically provides:

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

A non-medical home care agency does not provide the services Medicare classifies as skilled home health care, such as wound care, injections, or physical and speech therapy. Those come from a licensed home health agency, staffed by RNs and licensed therapists, which is a different category entirely and is typically ordered by a physician after a hospital stay or a change in condition.

It is worth pausing on a mix-up that comes up constantly, because it shapes what families expect Medicare to pay for later in this guide. Home health, the skilled service just described, is not the same product as the non-medical home care this article is about, and confusing the two leads families to expect coverage that will not arrive. If your parent needs medical care at home instead of help with daily tasks, ask their doctor whether they qualify for a home health referral. From there, Medicare's Care Compare tool can help you find and compare Medicare-certified home health agencies in your parent's area. That is a separate conversation from finding custodial home care.

Finding agencies worth calling, beyond a Google search

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

Eldercare Locator (eldercare.acl.gov): a free national service from the U.S. Administration for Community Living that connects families to their local Area Agency on Aging. Those agencies often keep referral lists of vetted local providers. As of this writing the Eldercare Locator's own site describes itself as "a public service of the Administration for Community Living connecting you to services for older adults and their families," reachable by phone, text, or email at 1-800-677-1116. Treat its referrals as a place to start, and check quality yourself.

Your state's home care licensing board: most states license non-medical home care agencies. Your state health department's website should have a license lookup tool where you can confirm that any agency you are considering holds a current, active license. The National Institute on Aging makes the same recommendation for any home care service: check for complaints filed against the company with the state and local agencies that regulate it, before you sign anything.

A geriatric care manager: the National Institute on Aging describes this as usually a licensed nurse or social worker who specializes in geriatrics, works with families to identify needs, and can suggest services, including agencies they trust from direct experience. Our guide to hiring a geriatric care manager covers what that costs and when the fee is worth paying.

Matching services: services such as Hire a Helper, Carefound, and Care.com Business aggregate local agency profiles and connect you with several vetted providers at once. They have a commercial interest in the agencies they list, and they pre-screen for basic licensing and insurance, which saves time early in the search.

Discharge planners and social workers: if your parent is being discharged from a hospital or rehab facility, the discharge planner or social worker usually has a working list of agencies they refer to regularly, built from what the facility's own staff has seen hold up in practice.

Ten questions that separate a good agency from a risky one

Ask these of every agency you seriously consider, and write down the answers. The National Institute on Aging publishes its own worksheet of questions to ask before hiring a care provider; this list overlaps with it and adds the agency-specific items that worksheet leaves general. The quality of the response tells you as much as the content.

Red flags that justify walking away

Availability pressure makes warning signs easy to miss. These are worth pausing for:

• No license, or a vague answer about licensing. Where licensure is required, operating without one is illegal. This is a hard stop.
• Cannot answer basic questions about background checks. If the intake coordinator does not know the process, that is a gap in operational standards, not an administrative slip.
• Pressure to sign quickly. A quality provider gives you time to compare. Pressure to sign before you have looked elsewhere should prompt a harder look, not less time.
• No clear backup plan. If the agency cannot describe one specifically, your parent's care continuity is unpredictable by design.
• Vague about training. "We hire experienced aides" is not a training program. Ask what specific training a new aide completes before a 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 home. An agency offering to send someone tomorrow without that step should explain why.

What a real in-home assessment looks like

Before a quality agency places an aide, a care coordinator or nurse visits your parent's home. This visit typically covers your parent's care needs and daily routine, the home environment and any safety concerns, your parent's preferences and communication style, and the hours and days of coverage needed.

The assessment is how the agency matches the right aide to your parent's actual situation. An agency that skips it and offers to send someone immediately, based on a phone call alone, is saving itself time at your parent's expense.

Treat the visit as an evaluation, not an intake to sit through. Does the coordinator speak directly to your parent, or only to you? Do they ask about preferences and history, or just check boxes? That interaction is a preview of the agency's broader culture.

Caregiver turnover, and the question most families never think to ask

Home care has notoriously high staff turnover. The median annual turnover rate for professional caregivers was 75.0% in 2024, down from 79.2% the year before, according to the Home Care Association of America, citing the Activated Insights Benchmarking Report. For your parent, that number translates into a real chance that the familiar aide they have come to trust will leave, and the replacement will be someone different.

Ask directly: "How long do your aides typically stay with one client?" and "What is your agency's average aide tenure?" An agency with turnover well below that industry median has likely built a workplace aides want to stay in. For someone with dementia or significant cognitive change, a new face every few weeks is disruptive, not a minor inconvenience.

The answer will not always be the one you hope to hear. Ask for it anyway, and ask what the agency is doing to bring the number down.

What home care costs, and what Medicare and Medicaid actually cover

The national median hourly rate for a non-medical caregiver was $35 in 2025, a 3% increase from $34 in 2024, according to the CareScout Cost of Care Survey. Rates run higher in major metro areas and lower in rural markets, and most agencies set a minimum number of hours per visit, so ask about that minimum before you compare quotes.

Medicare does not cover non-medical home care. Medicare's own coverage rules state plainly that it does not pay for "custodial or personal care that helps you with daily living activities... when this is the only care you need." Medicare Part A or B may cover a limited, separate benefit instead: skilled home health services such as nursing visits or physical therapy. That benefit is narrow. It applies only to someone who is homebound and needs part-time or intermittent skilled care, not to ongoing help with bathing or meals alone. Medicaid also pays for some skilled home health costs, but the National Institute on Aging notes that "these benefits vary by state," which is a separate question from the HCBS waiver coverage described below.

Medicaid may cover home care if your parent qualifies, through a Home and Community Based Services (HCBS) waiver program, which lets Medicaid pay for services in the home instead of in an institution. These programs are run at the state level, eligibility criteria vary, and not every home care agency participates. If there is any chance your parent could qualify 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. Our guide to how Medicaid covers long-term care walks through the eligibility rules in more detail.

For families weighing in-home care against a move to a facility, the cost comparison is part of the decision, not the whole of it. Our article on in-home care versus assisted living walks through that comparison directly.

Getting quotes from several agencies without forty phone calls

Calling agencies one at a time is slow and makes comparison hard. Matching services like Hire a Helper, Carefound, and Care.com Business exist for exactly this: describe your parent's needs and location once, and the service connects you with several vetted local agencies that can provide coverage. That is particularly useful when time is short or there is no personal referral to start from.

These services pre-screen for basic licensing and insurance, which filters out the weakest options before you spend time on them. They give you a broader starting pool than a cold search. From there, ask the ten questions above before you sign with any of them.