An agency quote tells you what an hour costs. It rarely tells you who watches the hour. The aide is in the house, but the person responsible for the care plan, the schedule, and the aide's conduct is often someone you never meet. Before you compare two offers, find out who that person is, how often they come to the house, and what they write down.

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.

Name the supervisor and what they answer for

Ask for the name and professional role of the person who supervises the aides assigned to your father. Find out whether that person is employed by the agency or contracted, and whether they hold the license type the agency advertises. Ask how many aides they oversee at the same time. A supervisor responsible for a few aides can give a different kind of attention than one responsible for a large caseload. Get the answers in writing, and check that the name on the agreement matches the name of the person who actually visits.

Pin down the visit schedule in the contract

A visit schedule that exists only in a sales call is not a schedule. Compare these points across providers:

  • How often the supervisor visits the home, and whether that frequency is stated in the service agreement.
  • Whether the first supervisory visit happens before the first shift, during it, or after it. Ask which.
  • Whether visits are announced or unannounced, and whether you can request one.
  • Whether the supervisor sees your father during the visit, and whether they will speak with you privately when you ask.
  • What triggers an extra visit without waiting for the schedule, such as a fall, a hospital stay, a new pattern of confusion, or a family complaint. Ask the provider to list them.

Ask to see what gets written down

Ask for a blank copy of the visit note, the care plan update form, and the incident report. You are checking whether the forms ask about the things you care about: whether your father got up safely, ate, was reminded about his medicines, and whether anything changed. Ask who can read these records, whether you can receive a copy, and how long the agency keeps them. A provider that will not show you a blank form has told you something useful.

Set the medicine boundary before the first shift

Medicine is the line most families get wrong. A hired or in-home non-medical aide may give medication reminders and pick up prescriptions as an errand. The aide does not hand out, administer, dispense, sort, or manage medicine. Those tasks stay with the family, your father's doctor, and the pharmacist. Ask each provider where medicine questions go, and look for that boundary written in the aide's job description, not only spoken on the phone. A supervisor who describes the aide as handling the pills is describing a task the aide should not take on.

Compare the answers, not the pitch

Put the same five questions to each provider and compare the answers side by side: who supervises, how often they visit, what they write down, how a concern gets logged and answered, and where medicine questions go. Two providers can charge the same hourly rate and offer very different supervision. The rate tells you what you pay. The supervision terms tell you who notices when something goes wrong.

Check whether supervision is inside the rate

Some quotes include supervision in the hourly rate. Others bill it on a separate line. Ask which model applies, and whether the supervision charge changes if the schedule changes. If you are paying privately while a VA claim is pending, a separate supervision line is one more recurring cost to plan around, so ask for it to appear in the first written estimate.

What supervision does not replace

A supervisor visit is not a medical assessment, and it does not decide whether your father qualifies for the Aid and Attendance add-on. That determination turns on what he cannot do alone and on the physician statement that describes it.1 Keep your own routine as well: a family member checks in on the days no one from the agency is in the house, and writes down what they see. Local help for the claim and the care plan is listed on the St. Louis offices page.

1 VA.gov, Aid and Attendance and Housebound benefits, and the Application for Pension (VA Form 21P-527EZ), with the physician's statement on VA Form 21-2680. See the Sources page for the full list.