Questions to Ask Before Hiring Home Care, Stage by Stage

The first call is only the beginning

A list of questions for the first phone call is a good start. It is how you tell one agency from another. Once you have chosen, though, the decisions that shape the care get made in other rooms: during the assessment visit, when you meet the caregiver, and when you sign.

The questions to ask before hiring home care change with each stage, because the person who can answer them changes. Before you call, the questions are for your own family. On the first call they are for the agency's intake staff. At the assessment they are for the person who will write the plan. When you meet the caregiver they are for the caregiver, and your parent should get to ask some too. Before you sign, the questions are for the agreement itself. Once care starts, there is a short set for the first check-in.

Ask each person the question only they can answer.

If you are still comparing agencies, start with how to choose a home care provider in Ontario , which covers the three routes to care and the questions that separate one agency from another on the first call. This guide picks up from there, and the other Navigating Home Care guides cover the decisions around it.

Before you call: questions for your own family

Agencies ask families what they need, and families often answer with a diagnosis or a number of hours. A short conversation at home first makes the calls faster and the answers easier to compare. Five questions cover most of it.

What has to happen, and at what time of day? Be concrete: the shower on Tuesday and Friday mornings, lunch on the days nobody visits, someone there in the late afternoon when Dad gets restless. Times matter as much as tasks, because they decide which kind of worker you need and how long the visit has to be. What a PSW does will help you sort which tasks belong to a personal support worker and which need a nurse.

What does your parent want, and will they be part of the calls? A parent who has agreed to help in principle may still have firm views about who helps with bathing, whether a man or a woman, and what language is spoken in the house. Ask them before an agency does.

Who decides, and who will the agency deal with? If three siblings are involved, agree on one contact for the agency and one place where updates are shared. Agree, too, on who is paying and who signs.

What is already in place? If your parent has publicly funded care through Ontario Health atHome, have the plan in front of you so any private hours fill the gaps rather than duplicate the visits. Anyone can make a referral to Ontario Health atHome, including you, and a care coordinator does the assessment. Private vs. public home care sets out which jobs tend to go to which.

What can the family afford each month, honestly? A ceiling agreed in advance stops a quote from becoming the budget. The ranges in what home care costs in Ontario are a starting point for that conversation.

Write the answers on one page. You will read from it on every call, and you will hand a copy to the assessor.

On the first call: three questions about what happens next

The questions that compare agencies belong to the first call, and they are covered in the guide to choosing a provider. Add three about the process itself, because that is the part a comparison call rarely covers.

• What happens between this call and the first visit, and how long does each step usually take?
• Who will come to do the assessment, and what is their role?
• Is there a charge for the assessment, and will we be asked to sign anything that day?

At the assessment: what they ask you matters too

The assessment visit is when an agency learns enough to write a plan and propose a caregiver. It is also a good chance to learn about the agency, partly from what the assessor asks.

A careful assessor wants to know more than the diagnosis and the medication list: what a good morning looks like for your parent and what a bad one looks like, what they find hardest to accept help with, what time they like to eat, what happens in the evening, who else visits, and what the family is doing now that it cannot keep doing. Expect them to look at the bathroom, and to speak to your parent first and wait for the answer.

If the visit is quick, focused only on hours and price, and nobody asks your parent anything, that tells you how the plan is likely to be written.

Then ask your own questions. These are the ones only the assessor can answer:

• What did you notice today that we did not mention?
• Is there anything here you would not take on, and who would you suggest for that part?
• What kind of caregiver do you have in mind for my mother, and why?
• When will we see the plan in writing, who writes it, and how often is it reviewed?

Ontario's Patient Bill of Rights for publicly funded home and community care is a useful benchmark here. Among other things, it gives a patient the right to choose a person to be present during assessments, to raise concerns without fear of reprisal, and to be told in writing how to make a complaint. Private agencies are not bound by it, but it is reasonable to ask whether they work to the same standard.

When you meet the proposed caregiver

Not every agency offers a meeting before the first visit, so ask for one. A short introduction, ideally with your parent in the room, lets everyone see whether the match is likely to work before the first bath depends on it.

Keep the questions about the work. The caregiver is the agency's employee or contractor, and questions about their age, religion, family, or immigration status are not for this meeting. If something personal matters to your parent, such as language, raise it with the agency. Questions that work well:

• How do you usually start a visit with someone you have not met before?
• What would you like to know from us before your first shift?
• My father sometimes says no to a shower. What do you do when someone refuses help on the day?
• If something worries you during a visit, who do you tell first?

Help your parent prepare one or two questions of their own. Even a simple one, such as what the caregiver likes to cook, changes who the meeting is for. Watch whether the caregiver answers your parent directly or turns to you.

Ask the agency for the caregiver's full name before the first visit. A personal support worker who is registered with the Health and Supportive Care Providers Oversight Authority appears on its public register, which shows registration status and conduct history. Registration is voluntary at this time, so a PSW who is not listed has not necessarily done anything wrong. Every nurse registered in Ontario appears on the College of Nurses of Ontario's Find a Nurse.

Before you sign the service agreement

Ask for the agreement and the written plan to take away, and read them at home rather than at the end of the assessment. The money terms (minimum hours, cancellation notice, holiday rates, rate increases, a hospital stay) are covered in the guide to choosing a provider. These are the other questions to put to the paper:

• Who is the agreement with? Is your parent signing, or are you, and does the agreement say on whose behalf?
• Does the plan match what was said? Check the tasks listed, the tasks left out, and the visit times against your one-page notes.
• Keys, codes, and money. How are house keys and alarm codes handled? If the caregiver will shop or run errands, how is cash handled, and how are receipts kept?
• A fee for hiring the caregiver directly. Some agreements charge a fee if you later employ the caregiver yourself. Find out whether this one does, how much, and for how long.
• Deposits and renewal. Is there a deposit, and when is it returned? Does the agreement renew automatically, and how much notice ends it?
• Insurance. Ask whether the agency carries liability insurance and whether it is registered with the WSIB for its caregivers, and ask for proof of both.
• Complaints. How is a concern raised, who responds, and how quickly? Ask for it in writing.
• Notes and updates. What does the caregiver record after each visit, who in the family can see it, and who decides?

Ontario consumer law gives a cooling-off period on some contracts, including services bought from a salesperson who comes to your door, generally 10 days from the day you receive a copy of the contract. Whether that covers a home care agreement signed in your parent's home depends on how it was arranged, so ask the agency what its cancellation terms are in the first days. This is general information, not legal advice.

If care has to start quickly, after a hospital discharge for example, it is reasonable to ask for a short first term in writing so you are not committed to terms you have not had time to read.

Two to three weeks in: the first check-in

Set the date before care begins. The first weeks are an adjustment for everyone, and what no one tells you about the first week explains what is normal. The check-in is a few questions, asked of three people separately.

Your parent. Open questions work better than yes or no. "What is it like when she comes?" gets a fuller answer than "Do you like her?" Ask what they would change, and listen for the small things, such as the time of the visit or how the bathroom is left.

The caregiver. What has been harder than you expected? Is there anything about the house, the routine, or the family that would make the visits work better?

The supervisor or care manager. Has anyone from the office visited since care started? Does the plan need to change? What have the visit notes shown?

A check-in is for patterns. Anything that cannot wait, such as missed visits, a caregiver who does not arrive, or your parent being upset after care, goes to the agency the same day. If your parent's health changes suddenly, seek medical care first.

Solid answers and weak ones

At every stage, the difference is usually specificity. A solid answer names a person, a time, or a document. A weak one is a reassurance.

If you hear weak answers at more than one stage, raise it with the agency before you sign, or go back to the next name on your list.

Where Arcadia fits

Our care assessment is carried out in the home by a member of our clinical or care management team, not a sales representative, and the plan that comes out of it is a recommendation, not a contract. You can read it before you decide anything. When a family wants one person to hold the whole arrangement, across the agency, Ontario Health atHome, and the rest of the family, that is what case management is for.

If you would like to work through these questions with someone, call (844) 977-0050 or book a free consultation. Bring your one-page notes and any agreement you have been given, including one from another agency.