How to Choose a Home Care Agency in Texas

Choosing a home care agency means deciding who will be in your parent's house, alone, regularly. The decision deserves a little paperwork and a few direct questions, whatever agency you are considering.

This guide covers five steps: check the license, ask a standard set of questions, understand what Texas rules require for background checks and training, get the arrangement in writing, and know where to report a concern. It is general information, not legal advice.

Step 1: Check the license

Texas Health and Human Services (HHSC) says plainly: “HCSSAs must be licensed to operate in Texas.” HCSSA stands for home and community support services agency. HHSC lists personal assistance services among the services these agencies provide “in a residence or independent living environment.” Under the state's rules, personal assistance services are routine ongoing care that helps a person with activities of daily living, and personal care includes services such as bathing, dressing, grooming, feeding, toileting and transfer or ambulation.

The rules also say that a person who is not licensed to provide personal assistance services “may not indicate or imply that the person is licensed to provide personal assistance services by using the words ‘personal assistance services’ or in any other manner.” (26 TAC §558.404)

HHSC publishes a downloadable directory of licensed agencies on its HCSSA page. For each agency it lists fields including license number, services provided, license status and license expiration date. Look for the agency's name and city, confirm that the services it provides match what you need, and read its license status.

Step 2: Ask every agency the same questions

The National Institute on Aging (NIA) advises: “Before signing an agreement for home health care or geriatric care management, get as much information as you can about the services, fees, terms, and restrictions.” Its worksheet, “Questions To Ask Before Hiring a Care Provider,” is a good template. These are its questions:

Step 3: What Texas rules require for background checks and training

Do not assume. Ask, and know what the rules say. In the Texas Administrative Code (26 TAC chapter 558), an agency must conduct a criminal history check for an unlicensed applicant or employee, and must search the nurse aide registry and the employee misconduct registry before an unlicensed employee's first face-to-face contact with a client. It must repeat the registry search at least every 12 months, and must discharge an employee who is designated unemployable or whose criminal history reveals a conviction that bars employment (26 TAC §558.247).

On training, the rules require orientation to the agency's policies and job-specific training, with demonstrated competency for tasks when competency cannot be determined through education, license, certification or experience (26 TAC §558.245).

These are minimums an agency must meet. They do not answer the questions that matter to your family: who exactly will come, how well they are matched to your parent, and how the agency handles it when something goes wrong. That is what the questions above are for.

Step 4: Get the arrangement in writing

Texas rules require an agency to give the client or family a written agreement for services that includes, at a minimum, notification of client rights, the services to be provided, supervision by the agency, the agency's charges if the client or family will pay, and a written statement of the procedure for filing a complaint (26 TAC §558.292). For personal assistance services, the individualized service plan must include the types of services, frequency and duration, planned start date, charges and plan of supervision (26 TAC §558.404).

Medicare.gov says it does not pay for custodial or personal care, such as help with bathing, dressing or using the bathroom, when that is the only care you need. Most families pay privately, so the fee terms matter. See our guide to what affects the cost of home care for the questions that get you an accurate quote.

Step 5: Check references and complaints, then know where to report

The NIA says: “It's always a good idea to check references before hiring a particular person or company. If possible, check for any complaints filed against a company with state and local agencies that regulate health services.”

• Complaints about a licensed home care or home health agency: HHSC says to call 800-458-9858 to report complaints about the care or treatment of someone served by a Regulatory Services provider. HHSC says the Texas Unified Licensure Information Portal “is the most direct way to file a complaint and is available 24/7.” Under the rules, an agency must give a client a written statement telling them how to reach this complaint line when services begin.
• Abuse, neglect or exploitation of an older adult: Texas Adult Protective Services says to call 1-800-252-5400. For emergencies, call 911.

Questions for Lilly's

Ask Lilly's the same questions you ask anyone else. Our how it works page explains what happens after you contact us, and our caregiver screening and training page describes our approach in our own words.