10 Questions Before Hiring Homecare

10 Questions to ask when Selecting a Homecare Company Portrait of young nurse sitting with a senior man

It’s not just all about rates! 

When looking for a homecare company, it’s important to ask the right questions. Many people just focus on the rates when there are many other important factors to consider.

Below are 10 questions to ask before hiring a homecare company. Following are explanations and more details.

  1. What areas do you serve? 
  2. Are your caregivers employees or sub-contractors?  
  3. Do you provide Nurse Delegation?
  4. Will the caregiver transport the client?
  5. What types of personal care are allowed?
  6. What is your minimum number of hours?
  7. What is your cancellation policy?
  8. What happens if I have a concern after business hours?
  9. How do you handle customer complaints or caregiver conflicts?
  10. What are your rates? 

For more info about each of the questions- read on!

  1. What areas do you serve?

Make sure the home care company serves your town or community. Ask them if they currently have clients in your neighborhood. Some home care companies will say they serve an entire city or region but most specialize in a local area. Companies that serve your neighbors will be less likely to have problems providing back-up staff if your regular caregiver is unavailable.

  1. Are your caregivers employees or sub-contracted?

There are four types of home care companies; employers, registries, referral companies, and independent caregivers.

Employers – Home care companies hire and pay their employees directly. All employees are covered by the workers compensation and liability laws of your state. Employers are subject to federal tax, Social Security, and Medicare withholding and applicable state and local income taxes.

Registries – Registries are companies that coordinate the scheduling of caregivers, but pay their caregivers as independent contractors. In these cases the caregivers are independent and responsible for their own taxes. The registry charges you and then pays the individual caregivers without withholding taxes or insurance. In some cases, the registry will use a split fee model where you write two checks each week, one to the registry and another to the caregiver.

The registry typically provides scheduling services. This model is designed to reduce overall expenses by reducing liability, benefits, and workers compensation costs. While you may see savings, this also may increase your liability. You need to make sure that your caregivers have appropriate coverage if they are injured while working in your home.  In some cases the caregiver could be considered your employee and you would be liable for withholding taxes, including social security and Medicare taxes.

Referral Services – Some home care companies only provide referrals and background screenings. These companies recruit and screen caregivers and place them in your home for a fee. The fee is typically a one time fee, then you become the legal employer. If the caregivers working in your home are being paid directly by you, you are obligated to acquire a federal employer identification number (EIN) and pay federal withholding, Medicare, state and local taxes as well as employer matches. In some states you will also be obligated to provide workers compensation insurance, family medical leave, and meet other state labor industry practices.  Referral Services can generate significant savings over the long term. However, many families feel the additional paperwork, tax and bookkeeping expenditures, and management time is a substantial burden. We strongly recommend that you consult an attorney and an accountant if you decide to become an employer.

Independent Caregiver – There are many individuals who sell their services as caregivers.  They place an ad in the local paper and make individual arrangements with families to care for a loved one.  Although this may be the least expensive option there are a number of potential liabilities that you face as the employer of an independent caregiver, including tax withholding, workers compensation, and unemployment compensation.

Understanding how your caregivers are paid can be critical to your safety and your potential liability.

  1. Do you provide Nurse Delegation? 

Nurse Delegation is a great way to receive some skilled services, but without having to pay RN rates. To be eligible for nurse delegation, the homecare company will have their RN do an evaluation and assessment- then they will delegate a caregiver (Certified Nursing Assistant) to perform the tasks.

Tasks that can be delegated are: simple wound care, ostomy care (wafer changes), straight catheterization/ bladder irrigation, bowel programs, suctioning (not sterile), tube feeding, medication administration and blood glucose monitoring (BS checks, insulin injections). The client must be in a stable and predictable condition per delegating RN. Client must not require frequent RN monitoring. 

  1. Will your caregivers transport the client?

A big need for many families is to provide transportation for their loved one to doctors appointments, physical therapy sessions, church or temple, social events, entertainment and recreation. Some agencies will allow caregivers to drive their clients in the client’s vehicle. Some agencies will allow caregivers to transport their clients in the caregiver’s vehicle. Some agencies own vehicles and provide transportation services. Each of these methods carry a certain amount or risk and different companies have different policies regarding client transportation.

To avoid liability, many agencies do not permit caregivers to transport clients. However, some agencies will allow you to sign a waiver of liability. Finally, when using your family’s vehicle, make sure to verify appropriate coverage with your auto insurance provider.

  1. What types of personal care are allowed?

There are three levels of care provided by home care companies; companion care, personal care, and skilled care.

Companion care includes meal preparation, light housekeeping, assistance with daily activities such as letter writing, reading, and entertainment. This level of care is designed to provide peace of mind for the client and the family. At the companion level of care the caregiver generally does not touch the client.

Personal Care includes the basic Activities of Daily Living (ADLs) – eating, bathing, dressing, toileting, transferring, and continence. This level involves hands-on care and requires a higher level of training than companion care.  Many states have specific licensure laws and regulations that govern personal care.

Skilled Care see question #3 regarding Nurse Delegation

  1. What is your minimum number of hours? 

Some agencies will provide only 1 hour of service at a very high rate, a few will offer 2 hours of care, but most have a 4 hour minimum. 

  1. What is your cancellation policy?

Occasionally you’ll have to cancel services with your home care company.  When this happens, you need to determine their cancellation policy. Try to look for an agency that treats its customers fairly. Most clients will cancel a caregiver from time to time.

  1. What happens if I have an issue of concern after business hours?

The rule of thumb in home care is that the worst situations only occur nights, weekends, or on holidays. Home care is a 24/7/365 business. You want your agency to have a very clear process for managing problems outside of regular business hours.

Some agencies use answering services, others use pager systems, and a few larger agencies will staff their office 24 hours a day. With today’s technology there is absolutely no reason that you should expect to not be able to reach someone at your home care agency within a few minutes.  You need to know how to contact them after business hours and how they will respond.

  1. How do you handle customer complaints or caregiver conflicts?

Almost everyone who receives care will have problems from time to time. A caregiver becomes unreliable, or the client and caregivers personalities may clash. Many families find it difficult to report these problems because they don’t know how the agency will handle the complaint. They don’t want to make problems worse by having an agency discipline a caregiver. Conversely, sometimes companies will refuse to discipline a caregiver and simply move them to a new client.

Be up front with your agency. If you acknowledge that possible conflicts may arise you will find that your agency will be more likely to manage your complaint effectively. Have an open discussion about “what if” scenarios and see how the agency reacts. Ideally your agency will take complaints very seriously and act as a liaison to resolve conflict quickly and effectively.

  1. What are your rates?

Some agencies charge an hourly rate, while other agencies have packages of service. You’ll want to find an agency whose services and packages fit your needs and your budget. The more home care you buy, the better your hourly rate should be. Most of the expenses incurred by the agency are for the first hour of service.

When you compare hourly rates to the pay rate of your caregivers, it’s not unusual to see a 100% difference. Providing quality home care is expensive and high-quality agencies will charge you accordingly. When asking about rates be sure to evaluate total value, not lowest price.  Make sure you’re getting what you need and you are only paying for what you get.

You’ll also want to have a clear understanding of the home care company’s billing procedures and payment due dates. Many companies bill weekly or bi-weekly and expect to be paid before the next billing cycle. These are small companies who must pay their caregivers and make tax deposits. They need to receive regular payments in order to meet their payroll.  Many companies have a defined policy of how long they will continue to provide service after the due date of the bill.  Often, the company will discontinue services if they are not paid on a timely basis.


Capability Homecare wants to be your trusted homecare provider. For answers to any of the questions above, or for more info- please call us at

425 679 5770. 

A Christmas Memory I’ll Never Forget


The Christmas season is now behind us, but the memories of it linger on…

Reflecting on the holidays this year, what were some of your favorite moments? What is one thing you did that brought joy to someone’s face? I’d like to share one thing I did- and it not only brought joy to someone else, but it also made my day.

Our client- I’ll call her Mollie- desperately wanted to go to Tacoma to watch her niece’s school Christmas pageant.  Mollie’s niece isn’t a student at the school- she is the music teacher and responsible for the entire pageant. Directing and organizing 300 children under the age of 11… impressive stuff. Even more impressive, many of the children at this school have parents who have dedicated their lives to serving others by working on the Fort Lewis military base.

I had first heard about this musical performance one afternoon in early December when I was visiting with Mollie in her home. We were reminiscing about the holidays and she mentioned to me that she really wanted to attend the holiday pageant- but had no way of getting there. Although she has a full time caregiver that assists in her home on a daily basis, on this particular day her caregiver was unavailable. As Mollie told me about she had never missed a performance, and how her niece reserved VIP parking and special front row seating for her- her eyes welled up with tears and her voice faltered- I could tell this was very important to her.

 So I offered to take her. The minute the words were out of my mouth her expression changed to utter delight.

In the weeks leading up to the big event Mollie would call me often, running details by me, checking on what time I would pick her up, planning where we would go for lunch… this was a big outing for her and she wanted everything to be perfect.

Finally the day arrived, I picked her up at 10:00 and we headed to Tacoma. On the way down she shared stories of her life and her family, reminding me there is so much more to each and every one of our clients than what meets the eye.  When we arrived at the school her niece came running out to the parking lot to steer us to our VIP spot and then escorted us our reserved seats in the school gym.

The minute the show started I was captivated. Each and every child in that school was bursting with pride and excitement. They were singing their little hearts out- and it showed! My eyes filled with joyful tears- watching these sweet, innocent children have their moment to shine was thrilling.  Each song was better than the last- the kids danced, sang, and entertained the crowd for an hour and a half- and it was fabulous. Best of all, as I looked over at Mollie- the smile on her face confirmed that this was indeed the highlight of the holiday season for her.

Sometimes we forget that we can spread happiness by doing the simplest things for others. By taking time out of my busy schedule and driving my client to Tacoma I got to experience first hand the joy of  the season- and what it’s really about- and that’s a Christmas memory I will never forget.

Capability Homecare Acquires Peace of Mind Home Health

Capability Homecare Acquires Peace of Mind and Names New Director of Operations

Bellevue, WA

Locally owned Capability Homecare has made two strategic moves to further ensure their place as the premiere homecare agency in the Greater Seattle area.

Effective November 14th, 2014, Capability Homecare acquired Peace of Mind Home Health and will assume all of Peace of Mind’s current operations.

Additionally, Laura Henrichs has been named Director of Operations of Capability Homecare. Laura has over 14 years working in the homecare industry and joined Capability Homecare last February. The transition will be seamless, as Laura has been leading Capability Homecare’s client services efforts for the past nine months.

Capability Homecare was established by Daniel and Megan Bigbee in 2008. Since then, they have been committed to providing superior home care services for clients in the Greater Seattle/Bellevue area.

Capability Homecare’s screening methods exceed industry standards to ensure their caregivers meet the high expectations of their valued clients.

Capability Homecare is committed to maintaining the dignity, respect and independence of clients while creating peace of mind for their families.

Services include assistance with Activities of Daily Living, Personal Care, Medication Management, Meal preparation, Transportation, Companionship and Nurse Delegation. More information can be found at www.capabilityhomecare.com.


Observation Status

Did you know that you could go to the ER for chest pains, stay in the hospital for 2 nights- and Medicare Part A  might not cover your expenses? If you are not admitted the hospital (meaning you have been put on ‘observation status’) than your coverage is different than if you had been actually admitted as a patient.

This is an important distinction that many people need to be aware of! Whenever you go to the hospital, be sure to ask DAILY if you are considered inpatient or outpatient. Just because you have spent the night (or several nights) in the hospital DOES not mean you have been admitted as an inpatient.

Let’s say for example you go to the hospital for an outpatient procedure- while you are there, your blood pressure spikes and the doctor decides to keep you overnight to keep an eye on things. This does NOT mean you have been admitted to the hospital, and Medicare Part A will not pay for any of the expenses incurred during this hospital stay.

Even when your primary care doctor writes an order for you to be inpatient, don’t assume that you are admitted. The hospital can still make the decision to put you on observation (outpatient). In this type of situation, the hospital must inform you in writing of this change. Be alert for any paperwork that you receive while in the hospital.

There are a few reasons why inpatient versus outpatient is so important- namely because the cost of services while you are in the hospital will vary depending on your status. X Rays, Lab work, even prescription costs will be different depending on whether or not you are admitted or under observation.

Another very important reason to make sure you are actually admitted to the hospital is because if you need to go to a Skilled Nursing Facility after being in the hospital, medicare part A will only cover your expenses after a 3 day inpatient hospital stay. The daily rate at a SNF is

  • Days 1–20: $0 for each benefit period.

  • Days 21–100: $152 coinsurance per day of each benefit period.

  • Days 101 and beyond: all costs.*

*Keep in mind that you can receive custodial care in the privacy of  your own home for about the same price. Call Capability Homecare today to learn more. 425 679 5770.

For more information about Medicare and what is covered, click here!

Impacts of Hospice

Back CameraI was out with friends the other day and one of them recommended a fabulous Italian restaurant they had just eaten at. One of the other gals chimed in about how much she also loved that restaurant- and how it brought back so many memories because while her grandmother was at Evergreen Hospice, they would eat at this restaurant regularly since it was so close to the hospice house.

She then went on to describe her experience with hospice– and what an amazing service it is. She talked about how much it helped her family through a very difficult time. One thing she mentioned that I found to be very interesting was that originally her grandmother had been admitted to the hospital and the doctors were trying to run all sorts of tests, MRI’s and prescribe medication to treat her problem. When in reality, at age 97, all she really wanted to do was to die peacefully surrounded by loved ones and without any pain. Luckily, they were made aware of Evergreen Hospice House and advocated that her grandmother be transferred there. According to my friend, most doctors won’t mention hospice– it is a topic that you must bring up to them.

My friend spoke about how glad she was that the hospice staff educated the family on the stages of dying – so that when her grandmother started talking about taking an airplane ride- she knew that was a sign that the end was near. Because of the expertise of the hospice staff, they knew to not try to correct their grandmother and explain there were no airplanes… instead they encouraged her to get on the plane when she was ready. And when the time came, the family was there to experience and witness a beautiful death.

To have been a part of the process of dying in such a peaceful and safe environment was life changing for my friend. She could not say enough wonderful things about the Evergreen Hospice house and the experience she had.

After she finished sharing her story, my other friend spoke up about her personal experience with hospice. In her case it was her mother in law who was dying. My friend spoke about how rather than be in the hospital, they wanted to bring her home and let her make the most of the limited time she had left. My friend commented on how wonderful the hospice staff were- they arranged for a hospital bed to be delivered to the house, they took care of all pain medication, offered education and training to the family regarding what to expect as the illness progressed- and after she died- they took care of all the arrangements, making it much less stressful for the family.

Hearing my friends share their personal experiences with hospice makes me glad that more and more people are taking advantage of this service. Many people don’t realize that Hospice is covered by Medicare, and is often an under-utilized service.

According to Gentiva/ Odyssey Hospice, some possible indicators that hospice may be appropriate are:

  • Life expectancy of six months or less

  • Hospitalization or emergency room visit more than once in that past 6 months

  • Weight loss with a noticeable difference

  • Shortness of breath even while resting

  • Several falls over the last 6 months

  • Feeling weak or more tired than usual

  • Making frequent phone calls to physicians’ office

  • Spending most of the day in a chair or bed

Death and dying do not have to be a scary, lonely event. Allow experts to assist your family through this process. Capability Homecare works daily in conjunction with hospice teams. We can provide respite for families, help with housekeeping, companionship and assist with ADL’s. Our caregivers are experienced and trained in hospice care. We offer:

  • Increase communication with team members

  • Liaison between client, family and hospice

  • Increased awareness of pain management, communication

  • Tracking and communication of pain changes to hospice team

  • Increase staff during crisis management – during last 72 hours of life and as needed

  • Peace of mind for families who are looking for extra comfort and help

  • Caregivers are experienced working with hospice

  • Support hospice team managing disease

  • Provide 24/7 care so the patient is never left alone

  • Respite for family

For more information about hospice, click here, or call Capability Homecare at 425 679 5770

Education and Support for Adult Children of Seniors

At Capability Homecare we love to be a resource for events in our community.

Sara Shelton, MS Gerontology & Owner of Seattle Aging Solutions is offering a 6 week program to help educate the adult children of seniors.

The program will offer:

  • tools for coping with stress, guilt and feeling overwhelmed

  • Strategies for communicating effectively with your parents and other family members

  • Emotional support from others who are in a similar situation and understand

Workshop will be held at Ida Culver, Broadview starting Tuesday, Oct 15th from 6:30-8:30 pm and will run through November 19th.

Cost: $250 for one attendee and $400 for two attendees

For more information, call Sara at 206. 228. 2446 or email her at: sara@seattleaging.com

Mental Health & Care Management

Did you know the average time your doctor actually spends with you is only 7 minutes?*

Did you know that many doctors feel so rushed to get on to the next patient that they adopt strategies to avoid lengthy conversations (not sitting down, scanning notes, not actually touching the patient or interacting with family members in the room**).

In that brief period of time how can they possibly pick up on the signs of dementia- or any other changes in mood, behavior or health?

So what to do? One viable option is to hire a private counselor who can spend as much time as you need to do a mental health assessment or care management.

I recently met with John Ramsdell, who is a Licensed Mental Health Counselor, Geriatric Mental Health Specialist, a Certified Care Manager and PEARLS counselor. His areas of expertise are working with aging and disabled adults.  He is compassionate and knowledgable in the field of mental health.

According to his website– if you notice any of the problems listed below, a call to him might be just what you need.

  • Changes in mood or personality

  • No longer engaging in activities that were enjoyed in the past

  • Increasing forgetfulness or irritability

  • Time management problems

  • Difficulty making decisions

  • No longer maintaining relationships or becoming increasingly isolated.

  • Not accessing medical services or following treatment recommendations appropriately

  • Increasing sadness or anxiety

*http://www.nytimes.com/2006/03/22/opinion/22salgo.html ** http://www.naturalnews.com/040592_doctors_patients_doctor_visits.html