Twelve questions to ask a home care agency before you sign

Most families choose a home care provider once in their lives, under time pressure, from a list handed over by a hospital or a council. The brochures all say the same warm things. These are the questions that actually produce different answers, and what a good answer sounds like.

How do you check a provider is properly registered?

Search the Care Quality Commission register by provider name or postcode. Every organisation providing personal care in England must be registered, and the register is public and free. If a provider is not on it, they should not be delivering personal care at all.

Read the entry carefully, because there are two different things people confuse. A service can be registered but not yet inspected, which is normal for a newer provider and simply means CQC has not visited yet. That is not the same as a poor rating. If there is a rating, read the report rather than the headline, and check the date.

Also check what the provider is registered to do. Personal care, nursing care and support for particular groups are separate registrations. A provider registered for personal care is not registered to deliver nursing, and should not be offering it.

The twelve questions

Ask these of every provider you speak to, and write down the answers. The differences will be obvious when you compare them side by side a day later.

• How many different carers will visit in a typical month?
• Will we meet them before care starts?
• What happens when our regular carer is on holiday or off sick?
• Who writes the care plan, and how often is it reviewed?
• What is the minimum visit length you will agree to?
• What are your rates for weekends, bank holidays and nights, in writing?
• Who answers the phone at seven in the evening, and at the weekend?
• What training do carers have, and what happens in the first week?
• How will you tell us if something changes or goes wrong?
• What notice do we need to give to change or stop the care?
• How do you handle medication, and what is recorded?
• What would make you tell us we are not the right provider for you?

Which answers actually matter?

The first three. Consistency of carers is the difference families feel every single day, and it is the thing that varies most between providers. Small local teams tend to answer these questions precisely. Large rotas tend to answer them in generalities.

That last row matters more than it looks. A provider who says they can meet any need has either not understood the question or is not being straight with you. Every service has limits, and knowing where they are is a sign of a well-run one.

What should the paperwork contain?

Three documents, and you should have all of them before the first visit rather than after. A care plan describing what will be done and how, a written schedule of rates covering every variation, and a service agreement setting out notice periods and what happens if either side wants to stop.

• A care plan naming specific tasks, times and preferences, not "personal care as required"
• The rate for weekdays, weekends, bank holidays, nights and short-notice visits
• The minimum visit length and what happens if a carer arrives late or a visit is missed
• How medication is recorded, and who checks the records
• The complaints procedure, and who it goes to if the manager is the problem

Read the complaints procedure before you need it. Every provider has one because they must, and the ones worth using name a person and a timescale rather than an email address and a hope.

What should happen before care starts?

A visit, an unhurried assessment, a written care plan and a written quote. In that order, and without pressure. The assessment should look at the person and the house: how they transfer, where the bathroom is, what the routine has always been, what they would like to keep.

You should not be asked to sign anything on the day. Anyone creating urgency around a decision this large is doing it for their benefit, not yours. Take the paperwork away, read it, and ring back with questions.

What about reviews and word of mouth?

Useful, with caveats. Online reviews for care providers are sparse and skew towards the extremes. A recommendation from a district nurse, a GP surgery or a village community group is usually worth more, because those people see the aftermath rather than the sales visit.

• Ask the district nurses or the GP practice who they see doing good work locally
• Ask the provider for references from families in similar situations
• Check how recent the reviews are, not just how many stars
• Be sceptical of any testimonial that makes a specific medical claim

What about the carers themselves?

Ask directly how carers are recruited, checked and paid, because the answers predict how long they stay, and how long they stay predicts whether you get the same faces. Enhanced DBS checks, references taken up properly and full insurance are the floor, not a selling point.

The question few families think to ask is whether travel time between visits is paid. Where it is not, carers absorb the cost of a rural round themselves, which is precisely why turnover in this county can be high and why a fifteen minute call can arrive at ten past. It is a fair question and a reasonable provider will answer it plainly.

And afterwards?

Give it a fortnight, then review honestly. Is it the same faces? Do they arrive when they said? Does the person seem easier in themselves? Care that is not working rarely fixes itself, and changing provider early is far less disruptive than changing provider in six months.

We would rather you asked us all twelve of these than none. If our answers do not suit you, that is genuinely useful information, and we will happily point you towards someone else in the county who might fit better.