Start with the rate and the minimum, because an agency that will not give you a number over the phone is telling you something. Then ask who shows up when your regular aide calls out, which is the question that separates agencies that work from agencies that sound good.

Here are the twelve we would ask, with the answers that should worry you. Ours are included so you can hold us to the same standard.

1. What is the hourly rate, exactly?

Worrying answer: it depends on the assessment, or we will discuss it after a home visit. Pricing that only appears after somebody has been in your living room for an hour is a sales technique.

Ours: $45 an hour for home health aide care, one to eight hours a day. Overnight is $540 for a 12 hour night and around the clock is $1,080 a day. The monthly math is published too.

2. What is the minimum visit and the minimum week?

Ask both, because they are different. Four hour visit minimums and twenty hour week minimums are standard in this industry, and they are the reason families get quoted $4,000 a month when they wanted help on Tuesdays.

Ours: none of either. One to eight hours a day, no minimum contract, no assessment fee.

3. Is there an assessment or sign up fee?

Some agencies charge a few hundred dollars before anybody does any work. Ask whether it is refundable if you do not proceed. Ours is nothing.

4. Who shows up when my aide calls out sick?

This is the most important question on the list and most families never ask it. Press for specifics: is there a named backup, how quickly, and what happens at 6 in the morning on a Sunday. Worrying answer: we will do our best.

5. How do I know the aide actually came, and for how long?

If you live an hour away, or three states away, this is what you are really buying. Ask whether visits are electronically logged and whether you can see it.

Ours: every visit is logged in MyCase, our own coordination platform, so arrival and departure are recorded as they happen and a missed shift is visible rather than discovered later.

6. Are aides employees or independent contractors?

It matters for your liability. If the agency treats caregivers as contractors, ask directly who carries workers compensation and what happens if somebody is injured in your mother's house. Ours are employees, background checked and insured.

7. What training do they have, and can they give medication?

Get a straight answer, because a vague one here is dangerous. Aides are not nurses. Ours are trained and CPR and First Aid prepared, and they cannot administer medication. They can be present while a client takes their own, help if something goes wrong, and call for help. If you need injections, wound care or medication administration, you need nursing, which is a separate service.

8. Can we meet the aide first, and can we change them?

Ask what happens if the match is wrong. A good agency replaces the aide without argument and without a penalty. Ask how many different people will be in the rotation, because an older person who gets a different stranger every visit will stop cooperating, and then you will be told she is refusing care.

9. How much notice do you need to cancel a visit?

Ask about the cancellation fee and the notice window in writing. Hospital stays and bad days happen, and a 24 hour cancellation policy you did not read about is a recurring annoyance.

10. What exactly will the aide not do?

Get the list before the first visit, not during it. Driving the client's car, heavy cleaning, lifting above a certain weight, pet care, caring for anybody else in the house. Mismatched expectations about what is in scope cause more complaints than anything else.

11. Who do I call at 9 on a Saturday night?

Ask for the after hours number and ask whether a human answers it. Then test it before you sign. Worrying answer: an answering service that takes a message for Monday.

12. How fast can you actually start?

If a discharge is coming Friday, a two week onboarding process is useless to you. Ask for a date, not a range.

What should I ask before I even call an agency?

Whether you need to pay at all, honestly. Call your local Aging Services Access Point if money is tight, since the state funded home care program is income based. Call your Council on Aging about rides, meals and respite. And if the person needs physical help with at least two daily activities and is on MassHealth Standard or CommonHealth, ask about PCA hours, which cost the family nothing.

Should we just hire somebody privately instead?

It is cheaper per hour and plenty of families do it well. Be clear about what you are taking on: you become the employer, which means payroll taxes, workers compensation, background checks including CORI and the sex offender registry, no backup when that person is sick, and no insurance if something goes wrong in the house. Also check your long term care policy first, because many will only reimburse care delivered by a licensed agency, and hiring privately can cost you the benefit.

What if we are not sure yet?

Then do not sign anything. Book one short visit and see how it goes. Three hours on one afternoon tells you more about an agency than any brochure, and with no minimum contract there is nothing to unwind if it is wrong.

Care Remedy serves eastern and central Massachusetts from offices in Woburn, Brockton and Springfield. Call 781-957-8076 and ask us all twelve.