Reference check questions for home health aides

A home health aide works in the patient’s home from written care instructions, supervised by a nurse or therapist who is rarely there during the visit. The agency needs to know whether the aide does the assigned tasks, stays within them, and tells the nurse when something about the patient changes. A certificate shows none of this, and an interview mostly shows what the candidate knows to say.

Medicare-certified agencies already supervise for these habits. Under 42 CFR 484.80, aide supervision covers following the patient’s plan of care, open communication with the patient and family, competency with assigned tasks, infection prevention and control, reporting changes in the patient’s condition and honoring patient rights. For every question below, ask a supervising reference for de-identified examples of the candidate’s work, excluding patient names and identifying details.

Who to ask

• The registered nurse who supervised the aide. When a patient also receives skilled services, 42 CFR 484.80 has a registered nurse or other skilled professional assess the aide’s services at least every 14 days, and observe the aide giving care if a concern comes up.
• A physical or occupational therapist who assigned the aide exercises or mobility tasks, for how carefully they were carried out between therapy visits.
• The agency’s scheduler or aide coordinator, for missed or shortened visits and how the aide managed a day of patients spread across a wide area.
• For a newly qualified aide, the instructor who ran their training and competency evaluation.

Questions to ask, by competency

Choose the competencies that matter most for the position and two or three questions from each. Ask every reference the same set, and when an answer is a rating, ask for the example behind it.

Working from the aide care plan

Each patient’s aide tasks are set out in writing. A good aide completes and records them, and checks with the nurse before doing anything not on the list.

1. When a patient or family asked the candidate to do something outside the written aide assignment, such as changing a dressing or adjusting oxygen, what did they do?
2. From 1 to 5, how accurately did the candidate complete the tasks assigned for each visit? Excluding patient names and identifying details, what de-identified example of their aide work supports that rating? (rating)

Reporting changes in condition

The aide may see the patient more often than any clinician. A new pressure area, an unreported fall or a lost appetite only helps if it reaches the nurse quickly.

1. Describe a time the candidate called the office or the case manager about a patient. What had they noticed, and what happened as a result?
2. If the candidate took vital signs or weights, how did they report a reading outside the patient’s usual range?

Infection control on the road

The aide carries supplies from home to home and cares for patients with wounds, catheters and infections. A lapse at one house can travel to the next.

1. When you made a visit with the candidate, how did they handle hand hygiene, gloves and their supply bag?
2. How did the candidate protect the next patient after caring for someone with a draining wound or a contagious infection?

Respect in the patient’s home

The patient is at home and the aide is a guest there. Honoring patient rights and keeping communication open with the family are part of what aide supervision checks.

1. How did the candidate respond when a patient declined part of the visit, such as a shower, on a given day?
2. How did the candidate work with a family caregiver who had firm views on how care should be done?

Keeping the visit schedule

An aide may see several patients a day across a wide area. A late or skipped visit can leave someone waiting in bed or miss care the plan requires.

1. How did the candidate plan a day with several patients far apart? Were visits ever cut short to make the route work?
2. When the candidate could not make a scheduled visit, how much notice did the office get, and did they help arrange cover?

Close the reference

End every reference the same way: ask whether they would hire or work with the candidate again and why, what support would help the candidate do their best work, and whether there is anything else you should know. The general question bank explains why the first of these matters most.

Checks a reference does not replace

• Qualifying training. Under 42 CFR 484.80, routes to qualify as an aide at a Medicare-certified agency include an approved training and competency evaluation program, and a state-approved nurse aide program with a listing in good standing on the state nurse aide registry.
• Recent paid aide work. The same rule says an aide who has gone 24 consecutive months without paid aide work must complete another qualifying program before giving care.
• The federal exclusion list. The HHS Office of Inspector General advises checking it before hiring and periodically afterward, since employing an excluded person can bring civil monetary penalties.
• The background check your state requires. CMS’s National Background Check Program has covered direct patient access employees of home health agencies in the states that joined it.

Warning signs to follow up

• A supervising nurse who remembers the candidate’s name but cannot give a de-identified example of their care.
• Visit notes the reference describes as copied from visit to visit, or tasks charted as done that patients disputed.
• Tasks outside the aide assignment, such as handling medications, presented as the candidate being helpful.
• A gap in paid aide work that the candidate did not mention, especially one close to 24 months.

One warning sign is a reason to ask another question, not a verdict. Reference check red flags covers how to check a concern fairly.

Questions to leave out

Ask only about the work. 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 candidate directly. Leave out health, medical leave, age, family plans and other protected characteristics. What to leave out has the full list.

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.