Hospice does not supply the hours between its visits, and families who go looking for a private companion often compare agencies on the hourly rate alone. The rate is only one line. The packet is where the agency makes its promises, and those promises are what you will live with on the day a shift falls through.

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.

Put the same five questions to every agency

Ask each agency the same questions in the same order, and write down the answers as given. Compare them after you have all of them, not one agency at a time.

First, who is the employer of the person who comes to the house? Ask whether the aide is an employee of the agency or an independent contractor, and who pays for that person's taxes, insurance, and injury coverage on the job. An agency that cannot answer plainly is telling you something about the rest of the packet.

Second, what is the substitute plan? Ask what happens when the regular aide is ill, on leave, or leaves the agency. Ask how fast a replacement arrives, whether the replacement has been through the same screening, and whether you can decline a particular person without losing your place.

Third, what is the sick-day rule for the agency itself? Ask whether a shift you have already paid for is refunded or rolled over when the agency cannot staff it. Get the answer in the packet, not in a phone call.

Fourth, what checks are run before anyone enters the house, and who sees the results? Ask what background and reference checks the agency performs, how often they repeat, and whether you will receive a copy of the result or only a yes. If the agency says it holds a state license for the services it sells, ask for the license number and confirm it with the Missouri Department of Health and Senior Services. Do not assume a general business license covers in-home care.

Fifth, who keeps the aide's notes? Ask whether the aide writes a log of each shift, where that log is kept, and whether you can read it. A log that stays in the agency's office helps the agency more than it helps you.

Read the medicine line closely

Ask in writing what the aide will do about medicine. A non-medical companion may give reminders and pick up prescriptions as an errand. The medicine itself stays with the family, the doctor, and the pharmacist. If a packet says the aide will give, sort, or manage medicine, the agency is describing a service you did not ask for, and you should treat the packet as unclear until it is corrected.

Cross-check the lines that move the total

Look at the cancellation notice period, the minimum hours per visit, and whether travel time is billed. Check whether weekend and holiday hours carry a different rate. Compare those lines across the packets the same way you compare the base rate. Get each answer as a figure on the paper, not a phrase.

Before you sign

Ask for a written copy of the care plan the agency will follow, the names of the people who supervise the aides, and the number to call when no one arrives. Leave the signing for the day the packets are side by side. A short wait costs less than a contract that promises something you did not ask about.

For local offices and programs in west St. Louis County, see Local Help for Hospice Families. The reasoning behind this checklist is on How We Write.