Questions You Might Ask Potential Service Providers


Agency Management Structure and Financial Stability

  • What is your agency’s management structure?
  • How long has the Executive Director/CEO been with your agency?
  • How long have other senior managers been with your agency?
  • Does your agency produce an annual report?  May I review it?
  • Does your agency have a board of directors? If so, how large is the board? How many board members are guardians or family members of people who receive services? How many board members are people who receive services from your agency? How often does the board of directors meet?
  • Has your agency’s license, certification or accreditation ever been in less than “full license” status? If so, when did this occur and how long were you in less than “full license” status? What were the reasons?
  • Has your agency had a recent financial audit? May I review it?
  • Does your agency have adequate financial reserves to ensure its stability? 
  • Does your agency have a strategic plan? What are some of the agency’s major goals and challenges as outlined in the strategic plan? Which stakeholders were involved in developing this plan?
  • Explain your agency’s fee structure. What is covered and not covered?
  • Does your agency have difficulty paying bills?  Does your agency pay bills on time?
  • Does your agency have any difficulty paying taxes?  Has your agency ever not been able to make your employer tax payment on time?

People Supported by the Agency

  • What is the age range of the people supported by your agency?
  • How many people who use wheelchairs or who have other significant mobility issues does your agency support?
  • How many individuals who are unable to speak does your agency support?
  • How many people who are unable to eat by mouth or who have significant swallowing difficulties does your agency support?
  • How many people does your agency support who have significant behavior support needs?
  • What experience does your agency have in supporting people with specific needs similar to those of my loved one?
  • How many people does your agency support who face any of the following issues? (complex medical needs, mobility issues, g-tubes, tracheotomies, hypothermia, seizures, dual diagnosis, special dietary needs, incontinence, aging issues or dementia, history of skin breakdown, etc.)
  • How many people does your agency support who previously lived in a state-operated facility?
  • Have any people who previously lived in a state-operated facility gone back to that facility? If so, why?

Direct Support Staff

  • How many staff does your agency employ?
  • How many of these are direct support staff?
  • What are the minimum requirements for direct support professionals at the time they are hired?
  • What is the starting rate of pay for direct support professionals?
  • What is the average rate of pay for direct support professionals?
  • What benefits do direct support professionals receive?
  • Describe your pre-employment screening procedures. (Examples of specific procedures such as abuse/neglect registry checks, drug testing, state or national criminal background checks, driving record checks, employment reference checks, personal reference checks and other checks.)
  • What types of issues make a potential employee ineligible to be hired?
  • Do you hire people who have had felony convictions?
  • How frequently are background and/ or drug checks repeated after employees are hired to ensure new issues have not occurred?
  • Do individuals supported participate in hiring and evaluating staff?  How?
  • What is the rate of turnover among your direct support professionals?
  • What is the average length of employment for current direct support staff?
  • What type of supervisory support is provided for direct support professionals?
  • What types of schedules do direct support staff work?
  • Is there an overlap between shifts to ensure good communication?
  • If not, what strategies are used to ensure good communication between shifts and between residential and day support staff?
  • What strategies or incentives does the agency utilize to promote retention of direct support staff (advanced training, monetary compensation, recognition, etc.)?
  • What are your practices regarding informing guardians about staff changes?
  • How does your agency ensure direct support staff are committed to providing person-centered supports?
  • Does your agency use volunteers?  In what way?

Staff Training

  • What amount and type of training do staff members complete before administering medications?
  • Who provides this training? 
  • What sorts of training do direct support staff receive regarding other specific health/behavioral issues? (Possible issues include caring for g-tubes or j-tubes, lifting and transferring, helping people who have swallowing difficulties eat, providing positive behavioral support, preventing negative behavior, responding to negative behavior, using and caring for assistive technology devices, etc.)
  • Who provides this training?
  • What types of competency checks do staff members complete?
  • What training do staff members receive on providing basic health care services?
  • How many hours of training is provided on meeting health care needs of people with disabilities?
  • What training do staff members receive on responding to medical emergencies?
  • Who monitors the performance of staff in completing duties related to providing health care?
  • What training do staff members receive in preventing/reporting abuse, neglect and exploitation?
  • How often do training updates occur? What skills are covered in training updates?
  • What training do staff members receive related to providing person-centered supports? (For example, person-centered planning, promoting choice, promoting personal relationships, identifying and supporting personal goals and dreams)
  • What types of training are required on an ongoing basis after employees have completed their initial training?

Frontline Supervision and Administrative Support Structures

  • Who provides supervision to the direct support staff?
  • How many staff members/residential sites are supervised by each frontline supervisor?
  • What are the requirements to be a frontline supervisor (how much experience, education, etc.)?
  • What are the general responsibilities of frontline supervisors? 
  • What are the training requirements and expectations for frontline supervisors?
  • What is the rate of turnover among frontline supervisors?
  • What type of support is provided to residential staff in the evening? Overnight? On weekends? On holidays?
  • What happens if a residential staff member doesn’t come to work as scheduled?
  • If an emergency or other unexpected event occurs after regular business hours, who do direct support staff call for assistance?

Residential Services

  • How many residential settings does your agency operate?
  • How many people typically live together?
  • Would your agency be willing to develop a new home or service for my loved one?  If your answer is yes, how long would it take before my loved one could begin receiving services?
  • What is the level of staffing in each of your current homes?
  • Is “awake overnight” staff provided?
  • Where are the homes located?
  • What is the cost for residential services?
  • Does this cost include other potential costs? (Examples include utilities, food, telephone, cable, lawn care, home maintenance and repairs.)
  • If an individual receives residential services from your agency can (s)he obtain services from another provider for day support? for targeted case management?
  • What is your agency’s track record of providing services to people with special needs such as requiring one to one supervision, presenting a significant history of aggressive, destructive or self-injurious behavior, presenting significant health challenges, requiring consistency in staffing, not fitting into workshops or other traditional day services programs, etc.?
  • Do the homes have appropriate accessibility features? (Depending on individual needs this might include widened doorways/hallways, ramps, grab bars, roll-in shower, lift system, single level construction, automatic doors, special construction to prevent property damage, or a wide variety of other features.)
  • What kind of transportation is available? At what cost?
  • Does each home have a vehicle available at all times?
  • How frequently are individuals served supported to participate in community activities and events?
  • What types of community events can individuals supported expect to be involved in?
  • Are individuals supported to be able to participate in community events with 1-1 staffing, or will involvement in the community usually be as part of a group? If part of a group, how large will the group be?
  • What types of structured recreational activities are available?
  • Who monitors to assure the expected level of community involvement occurs?
  • Describe a typical morning at the home.
  • Describe a typical evening at the home. 
  • Describe a typical weekend at the home.
  • Are individuals able to choose his/her housemates?
  • What opportunities for choices do individuals have with regard to what to eat, what to wear, how to spend free time, etc.?
  • May family members and friends visit whenever they wish?
  • May individuals visit their family members and friends when they wish to do so?
  • How are individuals supported in keeping in touch with friends and family?

Health Care and Assistive Technology Supports and Services

  • What arrangements are made to ensure people supported by your agency receive the health care services they need? (This would likely include primary care, dental care, eye care and pharmacy services. For some this would also include services from specialists such as neurologists, gastroenterologists, psychiatrists, physical therapists, occupational therapists, psychologists, podiatrists, orthopedists, etc.)
  • When people have medical appointments, who schedules the appointments and who takes people to the appointments?
  • How are people transported to medical appointments?
  • What procedures are followed if a medical emergency occurs?
  • What provisions does your agency make to provide necessary nursing services?
  • How many RNs and LPNs does your agency employ? If so, are these nurses employed full-time or part-time?
  • What are the duties of your nursing staff?
  • How long have these nurses worked for your agency?
  • How long have these nurses worked with people with developmental disabilities?
  • If I or a direct support staff believes my family member needs medical attention, what is the process to obtain nursing or other medical attention?
  • If an individual is unable to leave the home during the day because of illness (or for another reason) will he/she be able to stay home? If not, where will he/she go?
  • What health care services will be covered by insurance and what out of pocket expenses will individuals be expected to pay for health care services? (Examples of out of pocket expenses might be: dental services, pharmacy co-pays, fees to specialists who do not accept Medicaid reimbursement, cost of over-the-counter medications, etc.)
  • How will the following items, if needed, be paid for: medical equipment, assistive technology devices, nutritional formula, adult disposable briefs, communication devices, etc.?
  • What are your expectations with regard to communicating with families/guardians regarding the health care issues of their loved ones?
  • Who would take care of assuring assistive technology needs are met? (Wheelchair fitting and repair, alternative positioning devices, communication devices, environmental controls, lift maintenance and repair, lift van maintenance and repair, etc.)
  • Who would provide physical and occupational therapy services (if needed)?
  • How are weight, nutritional status and diet/menus monitored?

Day and Employment Services

  • What types of day and employment services are operated by the agency?
  • Where are these located?
  • How many people participate in different types of day services programs? What are typical activities in the day services program?
  • What kind of work is available?
  • If an individual is employed, how much will he/she be paid?
  • How many people are involved in supported employment?
  • What types of supported employment jobs do people have?
  • On average, how much do people who are paid by piece rate earn? How much do people with significant disabilities earn?
  • If an individual is not be working, or is working only part of the day, what will he/she do the rest of the day?
  • What is your agency’s track record of providing services to people who are unable or not interested in participating in a workshop program, require one to one supervision, present a significant history of aggressive, destructive or self-injurious behavior, present significant health challenges, require consistency in staffing, etc.)
  • What staffing ratios are provided in your day services and work programs?
  • Will transportation be provided to work or day services on a consistent basis? What kind of transportation will be provided? Will there be an additional fee for this transportation?

Rights, Advocacy, Personal Information and Satisfaction:

  • What are the rights of a guardian of a person who receives services from your agency?
  • To what extent will the guardian be involved in transition planning for an individual if he/she seeks services from your agency?
  • If an individual and/or guardian has a concern or grievance, what process should be followed?
  • How are people informed/trained on their rights and grievance procedures?
  • How many complaints or grievances have guardians or people supported by your agency filed in the past year?
  • How are responses to complaints, concerns or grievances monitored for effectiveness?
  • If an individual or guardian is not satisfied with your response, what should they do?
  • Do you have a consumer run advisory board?  How often do they meet?
  • How are individual’s funds managed?
  • Who will serve as representative payee?
  • If your agency is the designated payee do you charge a fee?
  • If your agency is the designated payee what reports will you provide to the individual and/or guardian?
  • What records will be kept about individual supported by your agency? Who has access to these records? What types of safeguards are in place to ensure the confidentiality of one’s private information?
  • How do you assess the satisfaction of the people who receive your services?
  • How do you assess the satisfaction of the parents and guardians of people who receive your services?
  • If satisfaction surveys are used, when was the last one done? What were the results? May I receive a copy of the results?
  • What opportunities are provided for guardians to provide input to the agency?
  • Is there a family/guardian group? If so, how often does this group meet?
  • How many people supported by your organization have left your services during the past year? Why did these people leave?

Safety, Emergency Preparedness and Freedom from Abuse/Neglect

  • What policies are in place regarding the reporting of possible abuse or neglect?
  • How many incidents of suspected abuse/neglect were reported in the past year for the people you support? How many incidents of abuse/neglect were substantiated?
  • What policies are in place regarding issues such as medical emergencies, power outages, weather emergencies, and missing persons?
  • What training do staff members receive regarding these policies?
  • If direct support staff need additional support during an emergency who do they call?
  • Who monitors the condition of the homes/facilities to ensure they are safe?
  • What process is in place to correct safety issues or other safety concerns?
  • What process is in place to ensure that medications are stored safely?