How to compare home care agencies without a regulator to lean on

This is the fact families find most unsettling, so it is worth stating plainly: retirement homes in Ontario are licensed and inspected by the Retirement Homes Regulatory Authority, and long-term care homes are licensed and inspected by the province. Private home care agencies are neither. Any company can operate one. Individual nurses are regulated by their college, but personal support workers are not a regulated profession in Ontario.

That does not mean the sector is unsafe. It means the verification work falls to you, and that the ordinary signals, such as a polished website or a long list of services, carry almost no information.

Verify these four things yourself

1. 1

   Insurance and WSIB coverage

   Ask for proof of liability insurance and confirmation that workers are covered by WSIB. If workers are contractors rather than employees, ask who carries the liability if someone is injured in the home.

2. 2

   Employee or contractor

   Ask directly whether workers are employees or independent contractors. Employee models usually mean supervision, training and coverage when someone is sick. Contractor models are often cheaper and shift risk to you.

3. 3

   Screening

   Ask what checks are done, how recently, and whether they are repeated. A vulnerable sector police check is the baseline.

4. 4

   Registration of clinical staff

   If nursing is involved, look the nurse up on the College of Nurses of Ontario public register. It takes a minute and is free.

The questions that actually separate agencies

• Who supervises the worker in my home, and how often do they visit?
• What happens at 6am when the scheduled worker calls in sick? Do I get a replacement or a cancellation?
• How many different workers will come in a typical month?
• Can I meet the worker before the first shift, and can I ask for a different one?
• Who do I call at 11pm on a Sunday, and does a person answer?
• How do you record what happened on each visit, and can I see those notes?

Reasonable expectations of a first conversation

A good agency will ask more questions than it answers, will visit before quoting for anything complex, and will tell you when what you are describing is beyond what home care can safely deliver. An agency that quotes a rate over the phone without asking about transfers, cognition or medications is quoting for a different job than the one you have.