Deciding that a parent, spouse, or loved one needs help at home is hard enough. Choosing who provides that help can feel even harder. In Maryland, dozens of agencies offer personal care services, and from the outside their websites and brochures can look nearly identical.
The good news: a handful of direct questions will quickly reveal how an agency actually operates. Here are ten we believe every family should ask — along with what a strong answer sounds like.
1. Are you licensed as a Residential Service Agency (RSA)?
In Maryland, agencies that provide personal care services in the home must be licensed as a Residential Service Agency (RSA) by the Maryland Department of Health's Office of Health Care Quality (OHCQ). Licensing means the agency has met state standards for staffing, supervision, and operations — and that a regulator is watching.
Ask to see the license, or verify it yourself through the OHCQ. An agency that hesitates to discuss licensing is telling you something important. (We hold ourselves to the same standard: Zoe's is transparent that our own RSA license is currently pending approval, and our in-home personal care services begin only once it's granted.)
2. Who supervises the caregivers — and how often?
This may be the single most revealing question. Many agencies employ dedicated aides but provide only distant administrative supervision. Ask specifically: Is a Registered Nurse involved in overseeing care? How often does a supervisor review the care plan or visit the home?
RN oversight matters because a nurse is trained to notice what others might miss — a change in skin condition, new confusion, swelling, or medication issues — and to escalate to the family and physician before a small issue becomes a hospitalization.
3. How is the care plan created, and who writes it?
A strong agency starts with an in-home assessment and builds a written, individualized plan of care — not a generic checklist. Ask who conducts the assessment, whether the family participates, and how often the plan is reviewed and updated as needs change.
4. How do you screen and train your caregivers?
Ask about background checks, reference verification, and what initial and ongoing training caregivers receive. If your loved one has specific needs — dementia, Parkinson's, or recovery after surgery — ask whether caregivers are trained for those situations specifically.
5. What happens if our regular caregiver is sick or unavailable?
Continuity of care matters, but so does reliability. A good agency has a plan for coverage and will tell you how backup caregivers are briefed on your loved one's routine and preferences.
6. How do you communicate with families?
Will you get updates after visits? Who do you call with a concern — and will a real person answer? Ask how the agency loops in family members who live out of town, and how quickly it responds when something changes.
7. Do you coordinate with doctors and discharge planners?
If your loved one is leaving a hospital or rehab facility, coordination is everything. Ask whether the agency communicates with physicians, case managers, and discharge planners — and whether it has experience supporting post-hospital transitions.
8. What services are — and aren't — included?
Personal care (bathing, dressing, mobility), companion care, meal preparation, and errands are typical non-medical services. Be clear about what's covered, what costs extra, and what the agency is not licensed to do. An honest agency will tell you plainly where its role ends.
9. How does billing work?
Ask for rates in writing, including minimum visit lengths, cancellation policies, and holiday or overnight pricing. Note that Medicare generally does not pay for non-medical personal care at home, so ask what payment options the agency accepts and whether it can point you toward resources for exploring coverage questions.
10. Can we start small?
Many families do best beginning with a few hours a week and adjusting as trust builds. An agency confident in its caregivers won't pressure you into a large commitment on day one.
Trust what you observe, too
Beyond the answers, pay attention to how the conversation feels. Did they ask thoughtful questions about your loved one — their routines, preferences, and personality — or only about scheduling and payment? The agencies worth trusting treat the first phone call the way they intend to treat the care itself: personally.
If you're beginning this process in Baltimore County or the surrounding communities, we're glad to be one of the conversations you have. We'll answer every one of these questions about ourselves — including the honest ones.