Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without

prior written permission.

Private Home Care Agency Interview Questions This form structures your interview with each agency, giving you examples of the most important information to obtain. This form also gives you a place to take notes from each interview so you can easily review the content of each interview, avoiding any confusion later. Name of Agency: ________________________________________________ Date: __________________________________________________________ Contact: _______________________________________________________ Phone number: _________________________________________________

1. What is the level of staff training? _____ Nurse’s aide/support worker/home health aide _____ Registered nurse’s assistant _____ Registered nurse _____ Social worker _____ Other: _____________________________________________

2. Is the agency accredited or certified? _____ yes _____ no __________________ regulating agency

3. What is the minimum number of hours for a shift?

________________________________________________________

4. What is the cancellation policy? ________________________________________________________

5. Hourly rate? Weekly rate? Is the rate negotiable?

________________________________________________________

6. What is the emergency procedure? ________________________________________________________

7. What are the types of care provided?

_____ housekeeping _____ medication management _____ bathing _____ meal preparation _____ shopping _____ escort to appointments _____ companionship _____ post-operative care _____ palliative/hospice care _____ driving _____ toileting _____ grooming

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Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without

prior written permission.

8. What is the consistency of staff who will come to the home? _________________________________________________________

9. How is the staff trained and supervised?

_________________________________________________________________________________________________________________________________________________________________________________

10. What is your agency’s approach with seniors? _________________________________________________________________________________________________________________________________________________________________________________

11. What do you do if my loved one is resistant to help?

___________________________________________________________ ______________________________________________________________________________________________________________________

12. Can I meet the caregiver before hiring him/her?

_________________________________________________________________________________________________________________________________________________________________________________

13. Do you provide a receipt for tax purposes?

_________________________________________________________

14. Reference names and phone numbers: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

15. Share the following information with the agency regarding your loved one’s needs:

a. Health status and medical diagnoses b. Medication type and dosing c. Behavioral problems or concerns, mood problems or concerns,

personality characteristics (social, quiet, private, etc.), d. Personality type of caregiver you’re requesting (talkative, patient,

firm, etc.)

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Erickson Resource Group – stephanie@ericksonresource.com / www.ericksonresource.com t: 514-795-7377 EST ©2009 Erickson Resource Group - All rights reserved. No content contained within this document may be reused without

prior written permission.

e. Interests (cards, reading, television, outings) f. Personality type of caregiver you are requesting (outgoing,

sociable, firm, quiet, etc.) g. Family support h. Services required i. Legal information (Durable power of attorney, Mandate, etc.) j. Other:

_______________________________________________________________________________________________________________________________________________________________

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