Choosing a home care agency is one of the most important decisions a family can make for an aging loved one. The right agency can make it possible for a senior to remain safely and comfortably at home for years. The wrong choice can result in unreliable care inconsistent caregivers safety risks and financial problems.
This guide explains what home care agencies do the different types of home care how to evaluate agencies what questions to ask and what red flags to watch for.
What Is Home Care?
Home care is assistance provided to a person in their own home to help them with daily activities and personal needs. Home care allows seniors and people with disabilities to remain in their homes rather than moving to a nursing home or assisted living facility.
Home care is different from home health care. Home health care involves skilled medical services — such as nursing wound care physical therapy and medication management — provided at home by licensed medical professionals and typically ordered by a physician. Home care — also called personal care or custodial care — involves non-medical assistance with activities of daily living and is provided by home care aides or personal care assistants.
Both types of care can be provided at home and both may be needed at different stages of a person’s care journey.
Types of Home Care Agencies
Understanding the different types of home care providers is the first step in choosing the right one.
Medicare-certified home health agencies
These agencies are certified by Medicare to provide skilled home health services — nursing physical therapy occupational therapy and speech therapy — covered by Medicare when medically necessary. Medicare-certified agencies are subject to federal quality standards and oversight. If your loved one needs skilled nursing or therapy services at home look for a Medicare-certified agency.
Licensed home care agencies
These agencies provide non-medical personal care services — help with bathing dressing grooming meal preparation light housekeeping and companionship. Licensing requirements vary significantly by state. Some states require home care agencies to be licensed and inspected. Others have minimal requirements. Check with your state health department to understand what licensing requirements apply in your state.
Registry or staffing agencies
These are not traditional home care agencies — they are registries that match clients with independent home care workers. The client typically becomes the employer of the caregiver and is responsible for payroll taxes workers compensation insurance and supervision. Registries are often less expensive than full-service agencies but come with significantly more responsibility for the family.
Independent caregivers
Some families hire caregivers directly without going through an agency. This is the least expensive option but also carries the most risk and responsibility — including employment taxes workers compensation insurance background checks and managing the caregiver relationship directly.
What Home Care Agencies Provide
A full-service home care agency typically provides the following services:
Personal care
Assistance with bathing showering grooming dressing and personal hygiene. This is often the most critical service for seniors who can no longer manage these tasks safely on their own.
Companionship and supervision
Social interaction conversation accompaniment to appointments and activities and supervision for seniors with dementia or cognitive impairment who should not be left alone.
Meal preparation
Planning and preparing meals according to the client’s dietary needs and preferences.
Light housekeeping
Laundry dishes vacuuming and other light household tasks that keep the home safe and comfortable.
Medication reminders
Reminding clients to take medications as prescribed. Note that most non-medical home care agencies cannot administer medications — that requires a licensed nurse.
Transportation
Driving clients to medical appointments grocery shopping and other errands.
Respite care
Temporary care provided to give family caregivers a break from their caregiving responsibilities.
How Home Care Is Paid For
Understanding payment options before selecting an agency is important because not all agencies accept all payment sources.
Private pay
Most home care is paid for privately — out of pocket by the client or family. Home care costs vary significantly by location but nationally average approximately $30 per hour in 2026. Full time home care — 40 hours per week — costs approximately $5,000 to $6,000 per month.
Long term care insurance
If the client has a long term care insurance policy it may cover home care costs. Review the policy carefully to understand the daily or monthly benefit amount the elimination period the types of care covered and whether the policy requires care to be provided by a licensed agency.
Medicaid HCBS Waivers
Most states offer Medicaid Home and Community Based Services waiver programs that pay for home care for eligible low income seniors and people with disabilities. Eligibility requirements vary by state. See our state resource pages for information about HCBS waiver programs in your state.
Veterans benefits
Veterans and their surviving spouses may be eligible for VA Aid and Attendance pension benefits that can help pay for home care. See our guide to VA Aid and Attendance for more information.
Medicare
Medicare does not cover non-medical personal care services. Medicare does cover skilled home health services when medically necessary — but this is a separate benefit from personal care home care.
How to Evaluate Home Care Agencies
When evaluating home care agencies consider the following factors.
Licensing and accreditation
Ask whether the agency is licensed by the state — if required — and whether it holds any national accreditation such as accreditation from the Joint Commission or the Community Health Accreditation Partner — CHAP. Accreditation indicates the agency has voluntarily met higher quality standards.
Background checks and screening
Ask how the agency screens its caregivers. A reputable agency conducts criminal background checks reference checks and employment history verification on all caregivers before placing them with clients. Ask specifically whether background checks include national criminal databases or only state databases.
Training and supervision
Ask what training caregivers receive before being placed with clients and what ongoing training is provided. Ask how the agency supervises caregivers in the field — do supervisors make regular in-home visits to check on care quality?
Caregiver consistency
Ask how the agency handles caregiver absences and turnover. Frequent caregiver changes are disruptive and stressful for seniors especially those with dementia. Ask how many different caregivers you can expect to see on a regular basis.
Insurance and bonding
Ask whether the agency carries general liability insurance and workers compensation insurance for its caregivers. If a caregiver is injured in your home or damages your property the agency’s insurance should cover it — not your homeowner’s policy.
Care planning
Ask whether the agency conducts an in-home assessment before starting services and whether they develop a written care plan that outlines the specific services to be provided. The care plan should be reviewed and updated regularly as needs change.
Communication
Ask how the agency communicates with family members — especially family members who do not live with the client. Does the agency provide regular updates? Is there a 24-hour on-call number for emergencies?
Availability
Ask what hours and days of the week care is available. Can the agency provide weekend and holiday coverage? What happens if a scheduled caregiver calls in sick?
Questions to Ask When Interviewing Home Care Agencies
Use these questions when interviewing potential home care agencies:
- Are you licensed by the state? If so can you provide your license number?
- Do you hold any national accreditations?
- What background checks do you conduct on caregivers?
- What training do caregivers receive before placement?
- How do you supervise caregivers in the field?
- How do you handle caregiver absences and schedule changes?
- Do you carry general liability and workers compensation insurance?
- Do you conduct an in-home assessment before starting care?
- Do you develop a written care plan?
- How will you communicate with our family about my loved one’s care?
- What is your hourly rate and minimum hours per visit?
- Do you accept long term care insurance? Medicaid? Veterans benefits?
- Can you provide references from current or past clients?
- Is there a 24-hour emergency contact number?
Red Flags to Watch For
Be cautious of home care agencies that exhibit any of the following warning signs.
No in-home assessment
A reputable agency will always conduct an in-home assessment before starting services to evaluate the client’s needs and match them with an appropriate caregiver. Agencies that offer to start immediately without an assessment may not be providing personalized care.
Pressure to sign quickly
Reputable agencies do not pressure families to sign contracts immediately. Take time to compare agencies and read contracts carefully.
Vague answers about background checks
If an agency is evasive about its caregiver screening process that is a significant red flag.
No written care plan
Care should be guided by a written care plan developed from a professional assessment. Agencies that cannot provide a written care plan are not providing professional quality care.
High caregiver turnover
While some caregiver turnover is inevitable in the industry unusually high turnover suggests problems with agency management compensation or work culture — all of which ultimately affect care quality.
No workers compensation insurance
If a caregiver is injured in your home while working for an agency without workers compensation insurance you could be personally liable. Always verify insurance coverage.
Unusually low prices
Home care is labor intensive and quality care costs money. Agencies offering rates significantly below the local market average may be cutting corners on caregiver screening training or compensation.
Finding Home Care Agencies in Your Area
The following resources can help you find and evaluate home care agencies in your community.
- Eldercare Locator — eldercare.acl.gov — 1-800-677-1116 — a free government service that can connect you with local home care resources
- Your local Area Agency on Aging — Area Agencies on Aging maintain lists of local home care providers and can help families navigate options
- Medicare Home Health Compare — medicare.gov — compare Medicare-certified home health agencies by quality ratings
- Your state health department — can provide information about licensed home care agencies in your state and any enforcement actions
- National Association for Home Care and Hospice — nahc.org — provides a home care agency locator
- Your loved one’s physician or hospital discharge planner — can often provide referrals to reputable local agencies
The information in this article is for general informational purposes only and does not constitute legal or financial advice. Home care agency licensing requirements and Medicaid home care programs vary significantly by state. Always research the specific requirements and options in your state.
Last updated: July 2026