Staffing

• Smaller agencies tend to use only staff that they have hand-picked and hired. Larger agencies, with bigger caseloads to cover, are more likely to use outside help from staffing agencies. While the staff provided by these agencies may be highly skilled, they have no familiarity with the agency's procedures or with its patients. Additionally, it can be upsetting for some patients, especially those with cognitive difficulties, to have to adjust to an unfamiliar caregiver with each visit.
  
  

Plan of Care Development

• A plan of care is a written "map" of the patient's abilities, needs, and treatment goals. Small agencies know all their patients well and generally pride themselves on writing individual care plans to address each client's unique needs. Larger agencies often use generic care plans developed with the "general" client in mind.
  
  

Visit Length

• The staff from the home health agency you select should not rush through their visits with you or your loved one so they can get on to their next client. In many large agencies, however, staff are expected to see a large number of patients each day. This means each visit must be brief and to the point with no additional time built in for observation or conversation. A smaller agency, on the other hand, may have fewer visits scheduled each day, so its staff members can take time to truly interact with the patient. In doing so, they may discover issues or concerns that would have gone unaddressed had they been in a rush to finish and leave.
  
  

Familiarity with Area

• Most guides to choosing a home health agency suggest that you ask how long the agency has been in business as an indication of stability. If you are dealing with a large chain agency, it's also wise to ask how long it has been in business in your area. A chain that is new to the area might be unfamiliar with resources that a smaller, local agency would know about instantly.
  
  

For Profit vs. Not for Profit

• Not all large agencies exist "for profit" and many "for profit" agencies provide excellent care. The difference is that the bottom line of an agency that exists for-profit isn't necessarily patient care--it's making money for its owner or shareholders; whereas the bottom line of a not-for-profit is using resources to see that the patient gets the best services possible. If this distinction is important to you, consider going with a small, community, not-for-profit home health agency.