Verify the agency is licensed and insured in California, confirm caregivers are employees (not contractors) with background checks and workers’ comp, ask specifically what happens when a caregiver calls out, get pricing in writing including all premiums and minimums, and find out who supervises the care and how often. The backup-coverage question separates good agencies from bad ones faster than any other.
Most families choose an agency under time pressure, during a crisis, from a list a discharge planner handed them. Here’s how to make a decent decision quickly.
First: registry or agency?
This is the most consequential distinction and the one least often explained.
A registry (or referral service) matches you with independent contractors. You are often the employer of record. That can mean you’re responsible for payroll taxes, liability if the caregiver is injured in your home, and finding a replacement yourself when nobody shows up.
An agency employs its caregivers. The agency handles payroll, taxes, workers’ compensation, liability insurance, supervision, training, and backup coverage.
Registries are usually cheaper per hour. The savings is real, and so is the risk transfer. Ask directly: “Are your caregivers your W-2 employees, and do you carry workers’ compensation?” A vague answer is an answer.
Licensing and insurance
- Are you licensed by the California Department of Social Services as a Home Care Organization? California licenses home care organizations, and caregivers must be registered in the state’s Home Care Aide Registry with a background check. Verify it yourself rather than taking a website’s word for it.
- Are you bonded and insured, and can I see the certificate? General liability, professional liability, workers’ comp. Ask for the certificate. Real agencies produce it without friction.
- If you provide home health, are you Medicare-certified and accredited? Home health is a separate license from home care. Joint Commission or ACHC accreditation is a meaningful signal of process discipline.
Caregivers
- What’s your screening process? Listen for: DOJ/FBI background check, registry verification, reference checks, TB clearance, and I-9 verification.
- What training do caregivers receive — initially and ongoing? Ask specifically about dementia, transfers and fall prevention, and infection control. “They’re all experienced” is not a training program.
- What’s your caregiver turnover rate? Industry turnover in home care is high — often cited well above 60% annually. An agency that knows its own number and will say it out loud is telling you something. One that deflects is also telling you something.
- How do you match caregivers to clients? You want a process — skills, personality, language, schedule — not “we send whoever’s available.”
- Can we meet the caregiver first, and can we request a change? Both answers should be yes, without drama.
Coverage and reliability
- What happens when the caregiver calls out sick? ← the single best question The right answer is specific: an on-call staffer, a bench of trained backups, a named notification timeline. If the answer is a version of “we’d try to find someone,” you’ve learned what happens at 6 a.m. on a Sunday.
- Is someone reachable 24/7 — and is it a human at your agency? An answering service that takes a message is not 24/7 support.
- What’s the same-day and holiday coverage plan?
Supervision and care planning
- Who writes the care plan, and who supervises the caregiver? Look for an RN or qualified supervisor conducting an in-home assessment and periodic supervisory visits — not a scheduler with a form.
- How do you communicate with the family, and how often? Ask about care notes, a family portal, and who calls when something changes.
- What happens if needs increase? This is where scope matters. An agency that only does non-medical home care has to hand you off — to a home health agency, then maybe a placement advisor. Each handoff loses information. An organization that spans home care, home health, private nursing, and placement can escalate without restarting.
Money
- Get all of it in writing:
- Hourly rate by shift type; live-in and 24/7 rates
- Minimum shift and minimum weekly hours
- Nights, weekends, holiday premiums
- Mileage and transportation
- Assessment or start-of-care fees
- Rate change notice terms
- Cancellation policy and notice to terminate
- Whether they bill long-term care insurance directly
On LTC insurance: direct billing matters more than families expect. Fronting $5,000/month and waiting on reimbursement is a real cash-flow burden.
Red flags
- Can’t or won’t produce a license number and insurance certificate
- Pressure to sign today
- Rates that are dramatically below every other quote (usually a registry, or misclassified workers)
- No in-home assessment before a quote
- No answer on backup coverage
- Reviews that only ever mention the office staff and never a caregiver
- Long-term contracts with penalties
Green flags
- In-home assessment before pricing
- Written care plan you actually receive a copy of
- A named supervisor and a real 24/7 line
- Straight answers on turnover and backup
- Clinical leadership you can look up
- Reviews from both families and employees — how an agency treats caregivers predicts caregiver retention, and caregiver retention predicts your experience
About 1st Meridian Care Services
1st Meridian provides home care, home health, concierge private nursing, and placement services across San Diego, Los Angeles, Orange County, Riverside, and Palm Desert — with a leadership team you can look up by name and reviews from families and employees.
Take this list to us and to whoever else you’re considering. A good agency won’t mind the questions. Contact us.
FAQ
What’s the difference between a home care registry and an agency? A registry refers independent contractors and often makes the family the employer of record, responsible for taxes and liability. An agency employs caregivers directly and carries payroll, workers’ compensation, liability insurance, supervision, and backup coverage.
What’s the most important question to ask a home care agency? “What happens when the caregiver calls out?” A specific answer — on-call staff, trained backups, a notification timeline — indicates real operational capacity. A vague one predicts the mornings when nobody arrives.
Are home care agencies licensed in California? Yes. Home care organizations are licensed by the California Department of Social Services, and individual caregivers must be registered on the state’s Home Care Aide Registry with a completed background check.
Should I use an agency that only does home care, or one that does home health too? An organization that provides both can escalate from personal care to skilled nursing without a handoff to a new company, which preserves continuity when needs change.
