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STUDY: Agency Home Care Aide Screening and Competency Measures Lacking

July 25, 2012

A study designed to assess the screening process that agencies use to hire home care workers and how agencies measure paid caregivers’ competencies found that practices — including training — varied widely and were often of “poor quality.”

Researchers at the Feinberg School of Medicine at Northwestern University — posing in telephone interviews as the children of elders who are in need of services and supports — asked 180 agencies in five states typical questions that families ask when hiring a caregiver.

The study, entitled “Hiring and Screening Practices of Agencies Supplying Paid Caregivers to Older Adults,” was published in the July 2012 Journal of the American Geriatrics Society.


The researchers asked questions about how agencies assessed their workers’ skills and fitness for employment; the tasks caregivers could perform; and required training. Among the findings are:

Assessment of Skill Competencies

  • Self-report (59 percent)
  • Perform a test (35 percent)
  • “Client feedback” (35 percent)
  • Shadowing or onsite training (15 percent)
  • Reference checks (11 percent)

Hiring Practices

  • Ask for references (64 percent)
  • Require prior experience as a caregiver (18 percent)
  • Require candidates to pass a test of “basic knowledge” that they administer (17 percent)


  • Perform criminal background checks (agencies only performed tests in the state where they operate) (92 percent)
  • Assess health literacy (none)
  • Perform no screening before hiring (13 percent)
  • Perform drug test (32 percent)

Responsibilities and Training

When asked what responsibilities that a caregiver could perform, most agencies said that they were able to manage:

  • Medication reminders (96 percent)
  • Scheduling physician appointments (99 percent)
  • Accompanying clients to a physician’s office (96 percent)
  • Following physician instructions (96 percent)
  • Assist with housekeeping, meal preparation, and personal care needs (100 percent)

The amount of time agencies devoted to training ranged from none to one week. Several agencies reported that they contract out their training program.

“Using an agency to hire paid caregivers may give older adults and their families a false sense of security regarding the background and skill set of the caregivers,” the study’s authors caution.

Informed Consumers Are Best Tools

The researchers suggest that “more stringent” state and federal regulations and sets of standards are needed.

Until there is more oversight in effect, they encourage clinicians to recommend to families that they ask prospective agencies questions from the survey, such as whether they:

  • conduct federal and state background checks and drug testing;
  • have a clear training protocol; and
  • routinely supervise employees in the home of the client.

“An informed consumer may be the best tool to improve the paid caregiver industry, by creating market pressure through the selection of caregivers from high-quality agencies,” the authors conclude.

— by Deane Beebe

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