Caregiver reference checks for home care agencies

Home care is trust work. A caregiver spends hours alone with a client who may be frail, forgetful or dependent on them for meals, reminders and personal care, and nobody from the agency is in the room. References are the best evidence you have about how a candidate behaves when no one is watching.

This guide is for home care and home health agencies hiring caregivers, aides and companions. It covers what references show, what a few states require, who to ask, what to ask and how to finish quickly.

What references show that other checks do not

A background check searches records. A registry check confirms training or certification where the role requires it. Neither tells you whether a caregiver turns up for a six o’clock start in a snowstorm, how they speak to a client with dementia, or whether a family ever asked for them by name. References can.

What some states require

Reference rules for home care vary by state and by type of license. Three examples show the range. Check the current rule for your state and license type with your licensing agency or counsel, since these rules change.

• Pennsylvania. Under 28 Pa. Code § 611.51, a home care agency or registry must obtain at least two satisfactory references before hiring or rostering a direct care worker: positive, verifiable references, spoken or written, from a former employer or another person not related to the worker, that affirm their ability to provide home care. The worker’s file records when the references were obtained.
• New York. Under 10 NYCRR 766.11, a licensed home care services agency must verify an applicant’s employment history with previous employers before the worker has patient contact, or obtain recommendations from people unrelated to the applicant if they have no prior employment. A 2022 Department of Health letter adds that employers may not charge a fee to verify employment history, or refer other employers to outside vendors to do it.
• New Jersey. Under N.J.A.C. 13:45B-13.8, a health care service firm that sends an unlicensed, uncertified worker into a home must certify, among other things, that it verified the worker’s employment history or obtained two character references, and give that information to the client at least 24 hours before services begin.

Medicare-certified home health agencies also follow federal aide rules. Under 42 CFR 484.80, a home health aide must complete approved training and a competency evaluation, or be on the state nurse aide registry in good standing, among other routes.

Who to ask

• A scheduler or care coordinator at a previous agency, who knows the caregiver’s attendance and how often clients asked for them.
• A supervising nurse who reviewed the caregiver’s work or care notes.
• For private-duty caregivers, a family the caregiver worked for directly, once that job has ended.
• For a first caregiving job, a supervisor from other work, such as retail or food service, who can speak to reliability and honesty.

Questions that matter in home care

• How reliable was the caregiver about arriving on time and covering scheduled visits, including early starts, weekends and bad weather?
• Tell me about a time they noticed a change in a client’s condition or home. Who did they tell, and how quickly?
• How did they handle a client who was confused, upset or refusing care?
• Did any client or family ask for them by name, or ask not to have them again? Why?
• How did they handle a client’s money, belongings or medication reminders?
• Would you trust them with someone in your own family? What makes you say so?

For full question sets, see the questions for caregivers, home health aides and certified nursing assistants.

Move fast without skipping steps

Caregivers rarely wait on one agency. A candidate you interview on Monday may have another offer by Friday, so the reference stage has to finish in days.

• Ask for consent and references at the interview, not after it.
• Send every reference request the same day, and let references answer on their phone.
• Remind anyone who has not answered after a day or two, and call the day after that.
• If a reference cannot be reached, ask the candidate for another one from a recent job.
• Keep the questions short: six to eight is enough for most caregiver roles.

Questions to leave out

Caregiving is physical work, but references are not the place to ask about the candidate’s body. Before an offer, the EEOC’s guidance says an employer may not ask a third party, such as a former employer, any question it could not ask the applicant directly. Ask how the caregiver performed the job, including transfers and other physical tasks as the reference saw them, not about their health, injuries or medical leave.

Keep a complete worker file

Record the date each reference was obtained, who gave it and what they said, alongside the interview, registry and background check results. Pennsylvania’s rule, for example, requires the worker’s file to show when references were obtained, and a complete file is easier to show an inspector than a stack of notes.

This article is general information, not legal advice. Confirm the requirements that apply to your organization, and in your state, with your counsel or HR policy office.