When support at home is new to a family, the first phone call can feel like the whole decision. It is not. The real work happens before the first visit and in the week after it. This guide walks through the steps in order so you can see what to check at each one.

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 day you have now

Before you call anyone, write down what a normal day looks like in the house right now. Note when the person you care for gets up, eats, bathes, goes outside, and goes to bed. Note the hours that have become hard, which are often late afternoon and the middle of the night. Note what they still do well and what they have stopped doing on their own.

This list is for you, not for an agency. It lets the first conversation start from facts instead of worry. It also helps you ask for the help you need instead of signing up for a bundle you will not use. If you want a picture of what a helper's day can look like, read A Day of Support at Home.

Name the hard hours before you book

Most families find that the trouble is not the whole day. It is a few stretches, and those are the hours to plan for first. If the evenings are the problem, think about exactly which part of the evening you want covered, and at what point in the day it starts to get difficult. The guide Evenings and Nights at Home can help you think that through.

Take health questions to the right place

If you notice a change in how the person you care for thinks, speaks, or moves, bring that to the family's doctor. Nothing in this guide is medical advice, and the agencies named on this site do not decide what a change means. A helper in the home can keep a simple log, notice what happened during the day, and pass it on to you. Deciding what it means belongs with the doctor.

The first phone call

Ask the agency to walk you through the basics on the phone, and write down the answers.

  • Which services they provide, in plain terms, and which they do not. Ask them to name the things they will not do, too.
  • Whether their workers are employees or independent contractors, and how each worker is checked before a first visit.
  • What happens when the usual worker is sick or away, and who covers the house.
  • Who you call in the evening and at night, and whether a person actually answers.
  • How changes are reported to the family, and how often.
  • What the written agreement says about ending service, and what happens to any money paid ahead.

Read the written agreement

Read the agreement before anyone signs it. Look for the schedule, how changes to hours are made, what the agency does when it cannot cover a visit, and what counts as the end of service. Ask the agency to explain any line you do not understand. A fair agency will not mind the question. Ask someone you trust to read it with you, and if you need more help, the senior services office in your county or in the City of St. Louis can point you to local resources for reading documents like this.

The in-person meeting or home visit

Ask to meet the person who would actually come to the house, not only the office staff. Watch how they listen. Ask them to describe a usual day for someone in a similar situation, and notice whether they ask you questions about the person you care for before they answer. Ask to see a blank copy of the care plan form, and ask how it is updated and who reads it.

Pay attention to how the person you care for responds, too. Some people settle with a new face within a few minutes, and others need several visits. If the person you care for is unsettled by a stranger, plan a short first visit and a longer second one, and tell the agency that ahead of time.

Plan the first week, not the first month

A first month can feel abstract. A first week is concrete. Write out who will be in the house on the first morning, the first afternoon, the first evening, and the first night. Name the family contact for each part. Arrange keys and entry codes before the first visit, and decide who keeps a spare set.

Decide ahead of time which tasks belong to the family and which belong to the helper, and write the list where everyone can see it. A helper can keep the household running, help with meals, keep a simple log, and remind the person you care for about appointments. Keeping the list written down means no one has to guess on the first hard evening.

After the first full week

At the end of the first full week, sit down with your notes. Compare what you planned with what actually happened. Note the hours that went smoothly and the ones that did not. Ask the agency for a short review call, and bring your list of questions. If the schedule needs to change, change it early, while the details are still fresh.

For the hours that still feel hard, Planning the Hard Hours at Night offers more ideas for the late part of the day. If you are still comparing agencies, How We Rate Memory Support explains the criteria used on this site, which may help you decide what to ask about next.

Caregiver support groups and respite options are also worth asking about. Local senior services offices and area agencies on aging can tell you what public help is available in your part of the region, and they can be a steady place to start when the phone calls feel like too many.