Choosing help at home: aides, home health, and how to pick an agency

Three kinds of help, often mixed up

• Home health: nurses and therapists (physical, occupational, speech) for a period after an illness or hospital stay. A doctor orders it. In New York it comes from a Certified Home Health Agency, and Medicare usually pays when the rules are met.
• Home care aides: help with bathing, dressing, toileting, meals, and getting around. This is the day-to-day help most families mean. In New York it comes from a Licensed Home Care Services Agency (LHCSA), paid privately, by Medicaid, or by long-term care insurance.
• Companions and homemakers: company, light housekeeping, errands, rides. No hands-on care. Often private pay, sometimes through the county Office for the Aging.

How much help is enough

Start by writing down a normal day and marking the hard parts: mornings, showers, meals, evenings, nights. Many families begin with a few hours on the hardest days and adjust. Two warnings: agencies often have a minimum visit length, and round-the-clock care at home costs more than most families expect, often more than assisted living. If nights are the problem, say so early.

Questions to ask any agency

• Are you licensed by New York State, and what is your license number? You can look it up on NYS Health Profiles.
• Are aides your employees, trained and supervised by a nurse, or independent contractors?
• What happens when the aide calls in sick? Who covers, and how fast will you tell us?
• Can we meet the aide first, and ask for a different one if it is not a fit?
• What is the hourly rate, the minimum visit, and what costs extra (weekends, holidays, overnight)?
• Do you accept Medicaid, a managed long-term care plan, long-term care insurance, or VA benefits?
• How do we reach someone after hours?

Red flags

Pressure to sign a long contract, vague answers about who supervises the aides, cash-only arrangements, or no written care plan. Private hires outside an agency can work, but then you are the employer: taxes, backup coverage, and checking references are yours.

In CarePair

The home care directory lists every licensed agency, home health agency, hospice, and adult day program in the counties we serve, from the state directory. Add the one you choose to your care team so everyone knows who to call. An advisor can tell you which ones families recommend.