How to Choose a Home Care Agency: Costs, Questions and Red Flags
Home care ran about $35 an hour in 2025. Here's how to pick an agency worth it: what to ask, what to listen for and when to walk away.
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First decide whether your parent needs non-medical help (bathing, meals, company) or skilled care from a nurse or therapist, because Medicare only pays for the second, part time. Then interview at least three licensed agencies. Ask who employs the caregivers, how they're screened, trained and supervised, what happens when someone calls out, and what the minimums and fees are. The 2025 national median was $35 an hour, per CareScout.
The first agency you called said someone could start Monday. That sounded like a relief until you hung up and realized you hadn't asked a single real question: who this person is, whether they've done this before, what happens when they're sick. You're about to let a stranger into your parent's home, often for hours at a time, sometimes to help them shower. It's okay to be picky. The good agencies expect it, and the way they answer your questions tells you most of what you need to know.
Home care or home health: know which one you need
These sound alike and work very differently.
Home health is skilled care ordered by a doctor: a nurse, a physical or occupational therapist, sometimes an aide. Medicare pays for it in full when your parent is homebound and needs part-time skilled care, usually up to 8 hours a day and 28 hours a week combined. You can compare Medicare-certified agencies on Care Compare.
Home care is non-medical help with daily life: bathing, dressing, meals, housekeeping, errands, company. Medicare doesn't pay for it when it's the only care your parent needs, and it doesn't cover 24-hour care. This is the help families usually pay for out of pocket, and it's what the rest of this page is about.
Agency or private caregiver
You can hire through an agency or hire a caregiver yourself. The Family Caregiver Alliance lays out the trade-off:
An agency handles screening, hiring, pay and taxes, and sends a substitute when your parent's regular caregiver is sick or on vacation. You pay more per hour for that. Watch for one catch: some agencies work as registries that only match you with workers who are independent contractors, which can leave insurance and backup coverage to you.
A private hire typically costs less, but you become the employer: hiring, firing, payroll, taxes, insurance and disputes. If you pay one household employee $3,000 or more in cash wages in 2026, Social Security and Medicare taxes apply, per IRS Publication 926. Check that your parent's homeowner's insurance covers a household employee, and always run a background check and call references.
If you need help fast, or you're managing from another city, an agency is usually the easier start.
What home care costs
In CareScout's 2025 survey, the national median for a non-medical home caregiver was $35 an hour. At 44 hours a week, that's $80,080 a year. Prices vary a lot by state and city, and CareScout's site lets you look up your parent's area. Put the quotes next to your parent's income on the care budget sheet to see what your parent can afford.
Ask about minimums before you compare prices. Some agencies only book shifts of a set length, such as four hours, or charge more per hour for shorter visits. Dementia care may cost more than basic companionship.
To help pay: a long-term care insurance policy may cover home care, but check how many days must pass before it starts paying and whether it only pays agencies or licensed aides. Some communities have sliding-scale help through the local Area Agency on Aging, which you can find through the Eldercare Locator at 1-800-677-1116. For the full monthly picture, see what aging in place really costs.
Most agencies book a minimum shift, and the rest of the day is your parent's own. Tiina keeps them company in those hours: dinner ideas, a question they're curious about, or the agency's first bill read back in plain words.
Where to find agencies worth interviewing
Start with people who've seen agencies up close. The Family Caregiver Alliance suggests asking your parent's doctor and their staff, friends who have used an agency, a faith community or the local senior center. A hospital discharge planner or social worker can also suggest local agencies.
One more good source: call the Area Agency on Aging and ask which home care agencies it contracts with for its own clients. An agency it contracts with has already met that program's requirements. Then read recent reviews, and treat a pattern of no-shows or billing complaints as a warning.
The 12 questions to ask every agency
Interview at least three. Ask the same questions of each and write the answers on a call notes sheet from your Survival Guide, one page per agency, so you can compare them side by side. Notice who answers clearly and who gets vague.
- Are you licensed by the state, and how long have you been in business? Many states require a license; ask for the number.
- Are your caregivers your employees, or independent contractors?
- Who pays their taxes, workers' compensation and liability insurance? Can you send proof of insurance?
- Are caregivers bonded and background-checked? What does the check cover?
- What training do they have? Are they certified nursing assistants or home health aides? Is there dementia training?
- Who supervises the caregivers, and how often does a supervisor visit the home?
- If the caregiver is sick or quits, how fast do you send a replacement?
- Can we meet the caregiver before the first shift, and ask for someone else if it isn't a fit?
- Is there a written care plan, and who updates it when my parent's needs change?
- What are your hourly, weekend and holiday rates, and what's the minimum shift?
- What's the deposit, the billing schedule and the notice to cancel?
- Can you give me references from current clients?
Red flags that mean keep looking
Trust your gut, and walk away from any agency that does any of these:
- Can't or won't show a license or proof of insurance
- Is vague about whether caregivers are employees or contractors
- Has no plan for when your caregiver calls out
- Pushes you to sign a long contract or pay a large deposit before anyone has met your parent
- Offers no supervisor visits and no written care plan
- Won't give references, or gives references who can't be reached
Make the first two weeks go well
Be there for the first shift if you can, or arrange for someone your parent trusts to be. Leave a one-page house guide: how your parent likes their coffee, where the towels are, what they're proud of, what upsets them, and who to call.
Lock away jewelry, checkbooks and spare cards before the first visit. Theft by caregivers is rarer than many families fear, the Family Caregiver Alliance says, but putting valuables away protects everyone, the caregiver included.
After a week, ask your parent privately how it's going, and call the agency early if something isn't right. A good agency would rather swap caregivers in week one than lose you in month three. And if managing all this is becoming a job of its own, a geriatric care manager can take it on.
Dad has home care in the morning and good company at night.
The aide handles the shower and the lunch. At 9 p.m., when the house is quiet, Dad taps Call Tiina and talks about the ballgame or the old job with someone patient who never rushes him, in a conversation that stays his own.
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Methodology & editorial policy
Reviewed and updated October 31, 2026 by the Tiina Editorial Team. Facts, programs and prices in this guide come from the sources listed below.
About composite scenarios. The opening scene is a composite.
About Tiina. Tiina is a voice-first AI companion for older adults: an app for iPhone and iPad that your parent opens whenever they want someone to talk to, day or night.
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Sources. 6 references: CareScout, Medicare.gov, Family Caregiver Alliance, IRS, Administration for Community Living.View all
- CareScout. Cost of Care Survey 2025. carescout.com
- Medicare.gov. Home health services. medicare.gov
- Medicare.gov. Care Compare: home health agencies. medicare.gov
- Family Caregiver Alliance. Hiring In-Home Help. caregiver.org
- IRS. Publication 926 (2026), Household Employer's Tax Guide. irs.gov
- Administration for Community Living. Eldercare Locator. eldercare.acl.gov
