I agree with others that if there is a risk of physical harm, that is the time to take action. For three years I managed 5-7 aides who stayed with my mother from 7a to 7p. I found it better to hire them directly than use an agency. It was both less expensive and meant the same people provided care. One great source was the local college that trained physical and occupational therapists. These students had lots of fresh knowledge and liked the first-hand life experience of caring for my mother, who loved them all.