Choosing a home care agency: what to ask before you sign

Every agency page on this site links to its CQC inspection report. The overall rating is the headline, but the five key questions underneath are where the detail is: safe, effective, caring, responsive and well-led. For a home care agency the ones to read are safe (medication errors, missed visits, staffing) and well-led (whether the office knows what is happening on the ground). An agency rated Good overall with Requires improvement for well-led is an agency whose problems will reach you eventually.

Check the date. Ratings can be years old and the agency may have changed hands. A newly registered agency will be unrated, which is normal; ask when it expects its first inspection.

Agencies work an area around their office and it is rarely a neat circle. The agency page on this site shows the area each says it covers, or our estimate where it does not say. Either way, ring and give your postcode. Then ask the question that matters: is there a regular carer near me, or would I get whoever is free? An agency at the edge of its area tends to fill your slot last and cancel it first.

• Do you cover my postcode, and how many clients do you have nearby?
• Is there a travel charge for my address?
• How soon could care start?
• What is the shortest visit you will do?

The answer to “how many different carers will we see in a fortnight” separates agencies more than anything else. Two or three is good. Eight is normal at a large agency and hard for someone with dementia. Ask whether the carers are employed by the agency or self-employed and introduced (the agency or your own carer guide explains why it matters), whether you can meet the main carer before the first visit, and whether you can ask for a male or female carer.

• How many different carers would we see in a typical fortnight?
• Are the carers employed by you or self-employed?
• Can we meet the main carer first, and change carers if it does not work?
• What training do they have in dementia, moving and handling, medication?
• Do carers drive, and can they take my relative to appointments?
• Do you offer a male or female carer on request, and carers who speak our language?

Visits run late; that is home care. What you are buying from an agency is what happens next. Ask what the window is around a visit time (fifteen minutes either side is good, an hour is not), whether you are told when a carer is running late, and what counts as a missed visit and what is done about it. Ask who answers the phone at 7am on a Sunday. Many agencies now give families an app showing when the carer arrived and what they did; the agency page on this site notes it where the website says.

The question is not whether a visit will ever be missed. It is whether anyone will notice, and ring you.

• The weekday rate, the weekend rate and the bank holiday rate.
• The price of a 30 and a 45 minute call, not just the hourly rate.
• Travel or mileage charges, and the mileage rate for outings.
• Whether the assessment is free.
• The notice for cancelling a visit, a holiday, and the whole arrangement.
• What happens to the bill during a hospital stay.
• When rates were last raised and by how much.
• Whether they take direct payments and NHS Continuing Healthcare, if relevant.

Put the answers into the estimate for your hours, and read what the rate includes for the things that usually get missed.

A good agency writes a care plan with you before care starts and reviews it after a few weeks and then regularly. Ask to see a blank one. Ask how you raise a concern and how quickly it is answered, and whether there is a named person rather than an office number. Ask what happened the last time something went wrong; an agency that can describe a real complaint and what it changed is one that handles them.