Hiring help at home in New York: licensed agencies, certified agencies, private hires, and what an aide can do

Three ways to get help

New York law says an organization must be licensed or certified by the state Department of Health to provide or arrange home care. That gives you two kinds of agency, plus the option of hiring someone yourself.

• Licensed Home Care Services Agency (LHCSA): the everyday help most families mean. Home health aides and personal care aides for bathing, dressing, toileting, meals, and getting around, and sometimes nursing. Paid privately, by long-term care insurance, or by Medicaid through a managed long-term care plan.
• Certified Home Health Agency (CHHA): part-time, intermittent skilled care, meaning nurses and physical, occupational, and speech therapists, with some aide hours alongside. Ordered by a doctor, usually after an illness or hospital stay, and usually paid by Medicare or insurance for a period.
• A private hire: you find, pay, and supervise the worker yourself. Cheaper per hour, and you become the employer, with everything that means. Through Medicaid's CDPAP program, a person on Medicaid can hire their own assistant with the state handling payroll.

What an aide can and cannot do

A home health aide in New York completes a state-approved training program and can help with personal care, moving around, meals, light housekeeping tied to the care plan, and reminders to take medicines. A personal care aide has a shorter training and helps with the same daily tasks. Aides do not give injections, change sterile dressings, or decide on medicines; those are nursing tasks. The state has created an advanced home health aide role that can do some extra tasks under a nurse's supervision, but only through agencies that have set it up. Companions and homemakers are not aides and do not provide hands-on care.

Background checks and the registry

Agency workers in New York go through a fingerprint-based criminal history record check before they can be hired, and agencies may not hire someone the state has disapproved. The state's Home Care Registry lists home health and personal care aides who have completed approved training and whether they are approved for employment; families can look an aide up, or call the registry help desk at 1-877-877-1827. None of this applies to a private hire unless you arrange a check yourself.

Interviewing an agency

• Are you licensed or certified by New York State? What is the license number? Check it on NYS Health Profiles.
• Are aides your employees, and who supervises them? How often does a nurse visit the home?
• How do you match an aide to a client, and can we meet before the first shift? Can we ask for a change?
• What happens when the aide is sick or does not show? How fast do you tell us, and who comes?
• What is the hourly rate, the minimum shift, and what changes on nights, weekends, and holidays? Put it in writing.
• Do you take Medicaid managed long-term care, long-term care insurance, or VA programs?
• What is in the written care plan, and who updates it when needs change?
• How do we reach a person after hours, and how do we file a concern?
• Are aides trained in dementia care, transfers, and using a lift, if we need those?
• Can we see your most recent state survey results?

Interviewing a private hire

You are the employer. That means references, a background check you arrange, a written agreement, payroll taxes, workers' compensation, and a plan for when they are sick. Ask:

• What training do you have, and are you on the state Home Care Registry?
• Who have you cared for, and may I call two of them?
• What would you do if she fell? If she refused a shower? If you could not reach me?
• What hours can you commit to, and who covers when you cannot?
• Are you comfortable with lifting, incontinence care, and someone with memory loss?
• How do you want to be paid, and are you comfortable with payroll and taxes being done properly?

Red flags, either way

• Pressure to sign a long contract or pay a large deposit before you have met an aide.
• Vague answers about supervision or the license.
• Cash-only arrangements with an agency.
• A worker who asks to be paid off the books, wants to be added to accounts, or discourages you from visiting.
• No written care plan, or a plan that never changes.

In CarePair

The home care directory lists every licensed and certified agency, hospice, and adult day program in the counties we serve, from the state's list, so you can start from agencies that are real. Add the one you choose to the care team. A Cardinal advisor can tell you which ones families keep recommending.