What to Ask Before Hiring a Home Care Agency — A West LA Family’s Checklist

Most families I talk to have already called three to five agencies before they call us. They're tired. The websites all look the same. The intake conversations all sound the same. Nobody's telling them what's actually different about how care gets delivered.

Here's the list of questions I'd want my own family to ask before hiring anybody, including us.

License and insurance. California requires home care organizations to be licensed by the Department of Social Services under the Home Care Services Consumer Protection Act. Roughly 15-20% of entities advertising home care services in the state operate without proper licensing. Ask for the HCO license number. Verify it through the CDSS online registry. Ask for a current certificate of liability insurance — minimum $1 million general liability is industry standard. Ask whether caregivers are W-2 employees with workers' comp coverage or 1099 contractors (it matters legally if a caregiver gets hurt in your home).

Caregiver recruitment, training, and retention. The home care workforce nationally has about 65% annual turnover. In LA, often higher. High turnover means inconsistent care, which is linked in study after study to worse outcomes for older adults. Ask: How do you recruit? What screening beyond the state-mandated background check? What initial training and ongoing continuing education? How long does the average caregiver stay with the agency? An agency that pays well, trains thoroughly, and supports its caregivers will have meaningfully better tenure than one that treats them as interchangeable.

Supervision. Ask how often a supervisor or care manager visits the home. Monthly is the standard the research supports. Agencies that conduct regular supervisory visits catch and correct quality issues 45% faster than agencies that wait for complaints. Ask who the named care manager is, how often they review the care plan, and what the escalation process looks like when something goes sideways.

Initial assessment. The intake should be in person, not phone-only. The person doing it should be a registered nurse, licensed social worker, or trained care manager — not a sales representative. Plans built from in-person assessments produce 25% fewer ER visits. Ask who does the assessment and what's covered: physical, cognitive, emotional, environmental, preferences.

Caregiver matching and continuity. Continuity matters enormously. Clients with consistent caregivers experience 35% fewer behavioral incidents and slower functional decline than clients with rotating caregivers. Ask: How do you select caregivers for a particular client? What if the match isn't working? What's the backup plan when the regular caregiver is sick or on vacation? The best agencies have a named, small backup team familiar with the client's care plan, not a different person every time.

Communication. About 60% of family complaints about home care are about communication failures, not the quality of hands-on care. Ask about the protocols. Dedicated point of contact. Real-time documentation. Family communication portal. 24/7 emergency line staffed by someone who knows the client. Agencies using digital documentation and communication score 40% higher on family satisfaction than paper-based agencies.

Pricing and contract. LA-area home care rates run $35-40 an hour for standard care, $40+ for specialized. Twenty to forty hours a week runs $3,000-7,000 a month. Ask for a written breakdown: minimums, overtime, holidays, cancellation policy. Read the contract. Hidden fees for assessments, plan development, and admin charges are common. About 30% of home care contracts contain unclear or potentially misleading terms about total cost. If you're using long-term care insurance, VA benefits, or IHSS, confirm the agency accepts these and understands the documentation.

Red flags. Pressure to sign immediately. Inability to provide references or verifiable credentials. Background checks limited to the state minimum. Unusually low rates without a clear explanation. Reluctance to put commitments in writing. The Better Business Bureau and the CDSS complaint database are both useful for checking history before you commit.

The honest meta-question to ask yourself: does this agency feel like they're answering my questions or selling me a service? You're not buying a product. You're inviting someone into your parent's home, daily, for an unknown number of months or years. The answer-quality matters.

We welcome every question on this list. We'd rather have an informed family choose us — or choose someone else — than have an uncertain one sign a contract.

— Patrick