They are unorganized,at least in the tri cities wa, they don't keep updated in their clients living conditions, I had a client that chain smoked and had a homeless alchoholic living with them. Pay was constantly messed up. Never sent other caregivers when I was sick or snowed in to my clients. Oh and did I mention they didn't train me at all. They wanted me to work the max time allowed before you have to get your certs to make sure I was dedicated to the job but then were sending me to clients houses alone that needed total care. I had clients teach me how to change catheter bags and how to turn people. I was ultimately a glorified underpaid house maid most of the time.