Most plans for keeping someone at home name a backup. It is a sister, a neighbor, a friend from church, or a paid helper on a few days. The name goes on the list, and everyone feels better. Whether the plan holds does not depend on whether the name is written down. It depends on whether that person has ever done the job alone, from start to finish, while you were out of the room.

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.

What usually goes wrong first

When the main caregiver falls ill, the backup is usually asked to step in on the least prepared shift: the night, the early morning, or the day a visit runs late. The backup has seen the routine. They have not carried it. They do not know where the phone list is kept, which drawer holds the supplies, what the person usually asks for at that hour, or who to call when something is not clear. The plan looks complete on paper, and the gaps show up in the first few hours.

How to tell the backup has never carried it

Check these honestly. The backup has never been left alone with the person for an hour or more. The backup has never done the bedside routine start to finish without you talking them through each step. The backup could not say, without looking, where the list of phone numbers is kept. The backup has no free time in the week that matches the hours you would need them to cover. The backup has said just call me but has not said when they could come, or how far away they live. And you have not been away from the house for a full night since the plan was set. If that last one is true, the plan has been talked about but never tested.

What to check, and in what order

Pick one real shift and give the backup a lead role for part of it, with you close enough to step in but not hovering. Watch what they ask. A good backup asks where things are, what the usual time is, and what to write down. A weak one waits to be told. Afterward, ask them what they would do differently.

Then write one page. It should say where the phone list is, the times the visits usually come, what the person usually needs at that hour, which person to call and in what order, and where the log or chart is kept. Keep it short enough that someone can read it in a minute at the door.

Where medicine stays

A backup who is not a clinician can usually be asked for two things: a reminder that a dose time has come, and a prescription pickup as an errand. Measuring, giving, sorting and managing the medicine stays with the family, the doctor and the pharmacist. The backup needs to know that boundary before the night it matters. The one page should name the family member to call about medicine questions, and the pharmacy and the doctor's office to call.

After the shift

When the backup has done a real shift, ask them to tell you what was hard. That is the most useful thing you will hear, and it will tell you whether the one page is enough or whether it needs another practice shift. If no one in the family can cover a shift at all, the hours between visits are the subject of the home page of this site, and West County options are on the Local Help page.