We get more emails about this topic than almost anything else we cover. And the question is almost always some version of the same thing: “I know my dad needs help, but I have no idea where to start.” If that’s you right now, take a breath. You’re already doing the right thing by researching.
Sarah went through this process with her own family a few years ago — helping her aunt find an aide after a stroke — and the biggest lesson was that finding the right person matters more than finding the cheapest rate or the biggest agency. Her aunt went through two aides who were perfectly qualified on paper before they found someone whose personality actually clicked. That third aide stayed for over a year and became like family.
This guide walks you through everything we’ve learned from that experience and from talking to hundreds of families since: the difference between skilled and non-skilled care (it’s confusing and it matters for insurance), whether to go through an agency or hire someone directly, how to interview candidates, and what a background check actually involves. We wrote it the way we wish someone had explained it to us when we were starting from scratch.
One more thing — the caregiver shortage is making this harder than it used to be. Wait times are longer, good aides get hired fast, and costs have gone up about 4% a year. Starting your search sooner rather than later gives you better options. If you’re feeling stuck at any point, email us at [email protected] — helping families figure this out is literally what we do.
Skilled vs. Non-Skilled Home Health Aides
Before you start searching, it’s important to understand that home care falls into two broad categories: skilled and non-skilled (also called custodial).
Non-Skilled (Custodial) Care
Custodial care is non-medical support. Although it’s sometimes initiated based on a physician’s recommendation, a custodial aide focuses on needs that affect daily well-being rather than clinical health. These services typically fall into three areas:
- Personal care: Help with bathing, dressing, grooming, and medication reminders.
- Household care: Cooking, cleaning, laundry, yard maintenance, mail retrieval, and bill management.
- Emotional care: Companionship, conversation, and overall emotional support. Research from the University of Alberta found that over 88% of caregivers are responsible for providing emotional support to the person in their care.
Loneliness is a serious health concern among older adults — studies link chronic isolation to a higher risk of premature death than obesity in people 65 and older.
Skilled Care
Skilled care requires the services of a trained, licensed professional. It is most often prescribed when a senior needs:
- Physical, occupational, or speech therapy
- Wound care and dressing changes
- Intravenous injections or infusions
- Medication administration
- Catheter or colostomy management
- Vital sign monitoring
If your loved one needs any of these services, make sure any aide or agency you consider has the appropriate credentials. Expect to pay more per hour than you would for custodial care.
Agencies vs. Private Hires
Once you know the type of care required, you’ll need to choose between hiring through an agency or independently.
Why Work With an Agency?
- Pre-screened candidates: Most agencies conduct thorough background checks, verify certifications, and confirm citizenship — steps that are time-consuming and difficult to do on your own.
- Qualified, trained caregivers: Agency employees are typically better trained than independently hired caregivers, and the agency assumes responsibility for their conduct.
- Needs assessment: Many agencies offer a free in-home assessment to identify what level of care is appropriate before placing a caregiver.
- Easy replacement: If your caregiver calls out sick or moves away, the agency handles finding a qualified substitute — often within days.
Downsides of agencies:
- Cost 20 to 30% more per hour than private hires.
- Often require minimum shift lengths — usually three to four hours — and sometimes weekly minimums of 20 hours or more.
Why Consider a Private Hire?
- Lower cost: Privately hired caregivers typically cost 30% less per hour than agency staff.
- More control: You set the job description, qualifications, and schedule directly.
Downsides of private hires:
- You handle all background checks and drug screenings.
- You are the employer — responsible for taxes (including half of Social Security and Medicare), minimum wage compliance, and workplace injury coverage.
- If your caregiver is sick or unavailable, finding a replacement falls entirely on you.
We generally recommend agencies for most families, particularly those who are new to arranging professional care.
Finding Home Care Agencies
Not all agencies are equal. The best ways to identify reputable options include:
- Ask your loved one’s doctor or medical team. They regularly refer patients to agencies and can recommend ones with strong track records.
- Contact your state or local health department or Area Agency on Aging. These organizations maintain lists of licensed providers.
- Ask trusted friends, neighbors, or family members who have navigated this process.
- Research each agency’s website, looking for information on services, fees, and any accreditation or certifications.
Questions to Ask Agencies
When interviewing potential agencies, go in with a prepared list:
- Can you provide a written breakdown of all costs?
- What hours and days are caregivers available?
- Which services are included, and what costs extra?
- Are your caregivers bonded through the agency?
- Is the agency Medicare/Medicaid certified?
- How do you handle client concerns or requests to change caregivers?
- Do caregivers receive ongoing training?
- What are your quality standards and how are they enforced?
- What screening process do employees go through?
- Is the agency licensed by the state?
Finding the Right Individual Caregiver
Once you’ve selected an agency you trust, the next step is choosing the specific caregiver for your loved one. Technical skills matter, but so does personality fit.
Key Traits to Look For
The best home health aides combine clinical skill with genuine warmth. Look for evidence of these traits when reviewing resumes and conducting interviews:
- Attentiveness and active listening
- Calm demeanor and patience
- Dependability and reliability
- Relevant training or credentials
- Compassion and empathy
- Enthusiasm and positive attitude
- Honest and trustworthy
- Sense of humor
- Initiative — proactively identifies needs without being prompted
- Resilience in challenging situations
- Resourcefulness and problem-solving ability
9 Questions to Ask a Caregiver
In your interviews, questions like these help you evaluate fit beyond credentials:
- What draws you to working with seniors?
- Do you have any specialized training?
- Tell me about your experience with [your loved one’s specific needs].
- What’s the biggest challenge you face in this work?
- How would you handle [a likely or past difficult scenario]?
- Are you comfortable with pets?
- How long do you expect to stay in this role?
- How do you navigate disagreements in a work setting?
- What are your greatest strengths as a caregiver?
The Meet and Greet
Before making a final decision, arrange for your loved one and the caregiver candidate to meet. Observe how they interact. A caregiver who is technically skilled but fails to connect with your loved one may not be the right fit — caregiving is as much about relationship as it is about task completion. Narrow your candidates to one or two before scheduling this meeting.
Trial Period
Request a two-week trial period before committing to a long-term arrangement. Most agencies will honor this. It gives everyone time to get comfortable and allows the caregiver to demonstrate their approach in a real setting.
References and Background Checks
Even the most impressive interview is not a substitute for thorough verification. Reference checks provide first-hand insight into how a caregiver has performed with actual clients. Elder financial abuse is unfortunately common, costing older adults an estimated $2.9 billion annually — and the majority of cases go unreported.
- Agency hires: The agency typically handles background checks as part of their vetting process.
- Private hires: Budget $30 to $80 for a comprehensive background check. It’s a small investment for the protection it provides.
How Much Does a Home Health Aide Cost?
The national average for home health aide services is approximately $33 to $37 per hour based on recent Genworth Cost of Care data. Full-time care (40 hours per week) can run $60,000 or more per year — and costs have been increasing by roughly 4% or more annually, driven in large part by a persistent nationwide caregiver shortage.
State-by-state variation is significant. Rates in lower-cost states may start in the mid-$20s per hour, while higher-cost states like California and Massachusetts can exceed $35 per hour.
Medicare will cover a home health aide only when the care is prescribed by a physician as part of a plan that includes skilled nursing or therapy. It does not cover custodial-only aide services. Other funding options include Medicaid waivers, long-term care insurance, veteran benefits, and reverse mortgages.
Moving Forward
Hiring the right home health aide can genuinely transform daily life for your loved one — and for you. A good match provides not just care but companionship, dignity, and peace of mind. Taking the time to choose carefully is the most meaningful investment you can make in this process.
You don’t have to do this alone. Your loved one’s doctor, local Area Agency on Aging, and reputable home care agencies are all resources that can guide you through the process.