Orientation is the stretch between the agency's yes and the first unsupervised visit. Most families rush it or skip it. Run it as a fixed sequence so that everyone knows what happens next and who signs off at each step.

Local option: New Plan Care gives families in the St. Louis area in-home help so a parent can stay home: companionship, help with bathing and dressing, meals, and overnight care. Call (314) 405-0887.

Step one: the written briefing

Before anyone enters the home, write the household routine on one page. Cover the daily order of tasks, the things that must not change, the things that can flex, and who makes the call when a plan breaks. Keep the page where the caregiver can see it during the shift. Ask the agency to confirm it has received the page and will give it to the caregiver before the first shadow shift.

Step two: the shadow shift

The first shift should be shadowed. A family member or a designated person from the agency stays in the home or nearby, watches the routine run, and corrects gaps on the spot. Ask the agency whether the shadow shift is billed as a normal visit, what hours it covers, and who is responsible for the caregiver during it.

Step three: the handover check

At the end of the shadow shift, ask the caregiver to walk through the next day's plan in their own words. Note what they got right and what they missed. Fix the gaps in the one-page routine before the next shift, not after.

Step four: the first solo visit and check-in

The first unsupervised visit should be followed by a call from the family to the agency's named contact the same day. Ask what the agency checks in that call, what it writes down, and how the family reports a problem. If the agency has no named contact for orientation, write that down. It is a finding.

Step five: the family steps back on a set date

Pick the day the family stops being present and say it out loud to the agency. Until that day, the family owns the routine. After it, the agency owns the visits and the caregiver owns the shift. Put the handoff date in writing so nobody has to guess.