Home Care Agencies Vary Widely in Caregiver Hiring, Screening & Supervision

Home care agencies are often used to help older adults stay in their homes after physical or cognitive decline. In fact, home health aide work is the fastest-growing occupation in the US. Home care workers, most of whom are foreign-born and female, receive low wages despite providing crucial, often complicated support to older adults, such as medication adherence, organizing and attending medical appointments, and nutritional and hygiene assistance.

Despite the crucial role in caregiving played by home care workers, little is known about how home care agencies hire, screen and train these workers. A recent article in the Journal of the American Geriatrics Society reports on an investigation into the hiring practices of a sample of home care agencies in the Midwest and Southwest US. Overall, there was much variation in the screening practices of these agencies, and screening and training were often apparently of poor quality. The authors caution that using such agencies, which are subject to fairly minimal regulation, may provide a false sense of security to consumers in need of paid caregiving.

Researchers from Northwestern University contacted home care agencies, posing as prospective clients who were looking for a caregiver for an older adult family member. Agencies were located by online, print and word-of-mouth referrals. The researchers collected data through phone interviews with 180 agencies, using a script designed to elicit information about employee background checks, employee training, health and English language literacy, and other skills and assessments. Research staff asked the agency representatives if their staff were capable of a variety of responsibilities, and then asked how these competencies were assessed. Researchers also asked about costs and supervision practices.

Most (91.9%) of the agencies reported that they perform criminal background checks in their state of business, but none reported checking outside of the state. No agencies performed health literacy assessments, and just under one-third reported administering drug testing. Most agencies relied on self-reporting to assess the competencies of employees and potential hires, although just over one-third reported administering skills tests. Some agencies offered training programs that included certificates of completion, but the researchers were unable to find any evidence of accreditation or any other evidence of the usefulness of these programs. Further, some agencies gave possibly false, certainly misleading responses to questions about the screening process: in response to questions about which screening instruments the agency used, many agencies replied with unverifiable, misleading responses, such as an alleged “National Scantron Test for Inappropriate Behaviors.” Such responses, whatever their intent, are likely to give consumers the misleading impression that the agency is putting its employees through rigorous, reputable tests or databases.

The authors include a list of recommended questions to ask agencies before hiring a caregiver, including questions about CPR and other health-related training, whether or not caregivers are insured or bonded through the agency, and how the agencies assess and supervise caregivers.


Lindquist LA, Cameron KA, et al. Hiring and screening practices of agencies supplying paid caregivers to older adults. Journal of the American Geriatrics Society; (2012). 60(7): 1253-1259.


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