Most families start by sizing home care to one person. That is the wrong first step. The house, the stairs, the other people living in it, and the animals all change the work an aide does. Size the help to the household first, then to the person who needs it.

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.

Start with the building

Walk the house the way an aide would walk it on an ordinary weekday. Write down every floor. Note where the bathroom sits compared to the bedroom. Count the entry steps, the stair runs, and any threshold that catches a foot. Check whether the front door sticks, whether there is a keypad or a lockbox, and where the trash and recycling go out. A two-floor house with one bathroom asks for a different plan than a single-level house with two.

Count the people under the same roof

List every person who lives there. Then list every person who depends on the same routine. That includes a spouse who needs a ride, a child who needs a breakfast on the table, or a roommate who shares the kitchen. Write down who cooks, who does laundry, and who fills the car. Each name you add is a block of the day that someone already covers or nobody covers.

Ask each agency to put its scope in writing. An aide is usually hired for the person named in the plan. Household duties that serve other people may fall outside that scope, or may be allowed only in limited ways. Get the answer in writing before the first shift.

Count the animals and the chores

Write down every animal in the house. Note who feeds it, who walks it, who cleans the litter, and who handles it when a visitor arrives. A dog that barks at every knock changes the first ten minutes of every visit. Tell the agency about the animal before anyone is booked, and ask how it handles pets.

Then list the chores by name. Dishes, groceries, pet food, mail, bins, bed linens, and the weekly clean-up each need an owner. Mark the ones that belong to the person needing help, the ones that belong to the family, and the ones that have no owner today. The unowned chores are where a plan quietly breaks.

Map the gaps in the week

Draw a grid with seven days across the top. Down the side, mark five blocks: early morning, late morning, afternoon, evening, and overnight. Fill each square with the name of the person who is home and able, or leave it blank. Blank squares are the real sizing question. They show where help is needed, and they show where scope questions will come up.

Do not size the plan to the busiest day alone. Size it to the blank squares that repeat every week. A single hard afternoon can be covered by a family member. A blank block that appears every Tuesday and Thursday needs a standing plan.

Questions to put to each agency

  • How do you size a plan for a house like mine, with my floors, my pets, and my other household members?
  • Which household chores are inside the plan, and which are outside it? Will you put that line in writing?
  • How do you handle animals, locked doors, and visitors during a shift?
  • If someone else in the house starts needing help, how do you change the plan, and how quickly?
  • Who builds the schedule, and who do I call when a block goes uncovered?
  • What do you not cover, and what will you tell me in writing that you do not cover?

Health questions go to the family's doctor. Keep the agency conversation on the house, the schedule, and the scope.

Compare every plan against the same house

Send each agency the same household inventory. Ask each one to mark the same blocks on the same grid. Then compare where each agency puts the aide, which chores it counts as inside the plan, and which it leaves out. A block that an agency will not mark is a finding. Write it down next to the others.

When the quotes arrive, read them against the grid, not against each other. For help reading the paperwork, see how to read a home care quote. For how this desk scores agencies on how plainly they talk about money, see How We Rate.

Local help that stays general

Several public and community sources in the St. Louis area can help you find in-home help and check your options. Start with your county's area agency on aging, the public information lines for the city and the county, and the senior centers and libraries that keep lists of local providers. Ask each one what it offers and what it does not, then write those answers beside your household inventory.