You’ve narrowed your list to three home care agencies. They all have professional websites. They all say they provide quality care. They all offer a complimentary consultation. And they all quote pricing in a similar range.
How do you choose?
The honest answer is that most of the difference between a great home care agency and an adequate one won’t show up in the marketing. It shows up in the answers you get when you ask specific, uncomfortable questions.
Here are ten questions worth asking before you sign anything.
1. Are your caregivers W-2 employees or 1099 contractors?
This is the first question because it determines almost everything else — training, accountability, insurance coverage, tax liability. In Maryland, personal care aides must be W-2 employees. Agencies using 1099 contractors are transferring legal and tax liability to you, the family. A good agency will answer immediately and clearly: W-2, always.
2. What licenses does your agency hold?
Maryland home care agencies fall under the Residential Service Agency (RSA) licensing framework administered by the Maryland Department of Health. There are three levels. Level 3 is the highest and permits the broadest scope of services, including skilled nursing. Ask which license the agency holds. Ask to see the certificate. A licensed agency will send it without hesitation.
3. Who writes my parent’s care plan?
The answer you want: a Registered Nurse. Not a scheduler. Not a case manager. Not the caregiver themselves. A licensed RN conducts an in-home clinical assessment, evaluates need across multiple domains, and writes a plan the caregiver executes. If the answer is “we build the plan based on the intake form your family filled out,” that’s not clinical — that’s administrative.
4. What certifications do your caregivers hold beyond CNA?
CNA (Certified Nursing Assistant) is the baseline. A CNA can help with bathing, dressing, mobility, and companion care. But a CNA cannot administer medications. For that, the caregiver needs to also be CMT-certified (Certified Medication Technician). If your parent takes daily medications, ask specifically: are your caregivers CNA + CMT? Or just CNA?
5. Who coordinates the care, and how will you keep me informed?
Care doesn’t end at the visit — someone has to manage scheduling, communicate with your family, and watch the whole picture. A well-designed agency gives you a single dedicated coordinator who knows your parent and their plan, plus a real communication rhythm — check-in calls and written summaries — so you’re never left guessing between visits. A poorly designed agency routes you to whoever answers the phone. Ask specifically: “Who is my point of contact, and how will I hear how my mother is doing?” The answer will tell you a lot.
6. How often does an RN review my parent’s care plan after care begins?
Under Maryland’s RSA framework, care plans require periodic RN review — but the minimum required and the standard of good care can be very different. A premium agency reviews plans at set intervals (every 60 days is a common cadence) and adjusts based on changes in condition. Ask what the review cadence is, who conducts it, and whether it’s included or extra.
7. Do you accept Medicare or Medicaid?
This isn’t a gotcha question — it’s a positioning question. Agencies serving primarily Medicaid and Medicare clients operate under insurance rules that shape everything: how caregivers are assigned, how quickly service starts, how long a visit is, whether you can request a specific caregiver. Private-pay agencies work differently. Neither is inherently better, but they’re different products. Know which one you’re buying.
8. Who is my single point of contact when I have a question?
The answer should be one person — a named coordinator — not “someone from the office.” If you’re calling a rotating dispatch line, you’re getting Medicaid-mill service dressed up. A concierge agency assigns you one coordinator who knows your parent by name, knows their care plan, and can make decisions on the spot.
9. How will you communicate with me between visits?
There should be a real answer here. A family portal. Weekly summaries. Post-visit notes. Some system that closes the loop between “here’s what happened today” and “here’s what I need to know as the adult child managing this.” “We’ll call you if something’s wrong” is not communication. It’s the absence of communication until there’s a crisis.
10. What is your minimum shift, and what happens on holidays?
Every agency has these numbers. What you want to check is whether they’ll say them clearly, whether the minimum works for your family, and whether holiday premiums are disclosed upfront or discovered on the invoice. Straightforward answers here signal an agency that treats families like adults.
Red flags to watch for
Beyond specific answers, listen for how questions are handled. Vague answers to specific questions (“we handle that on a case-by-case basis”) usually mean there’s no process. Reluctance to put anything in writing usually means the verbal promise won’t survive contact with reality. Pressure to sign before you’ve had time to review documents is a real warning sign.
The right agency wants you to ask these questions. They have practiced, clear answers because they’ve built their operation around delivering exactly what a thoughtful family would expect.
Where to start
If you’re evaluating home care agencies for a parent in Baltimore, we’d welcome the chance to answer these questions ourselves — in an in-home consultation with our care coordinator, at no cost. Schedule a free in-home assessment, or call (410) 753-4148.
Want more context on how we work? Read about the EagleWings approach or our Concierge Membership model.