The laundry is waiting. There are dishes in the sink, groceries to put away and a bathroom that needs cleaning. You may be doing all of it while staying close enough to hear the person in the next 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.
You do not have to decide whether to hire help by asking whether the house is clean enough. Ask a narrower question: which work can leave your hands without leaving a gap in her care?
Start with the hospice. Medicare includes hospice aide and homemaker services in the hospice benefit. The federal hospice rule says an aide may perform household services needed to keep the areas used by the patient safe and sanitary. Examples in the rule include changing bed linens and doing light cleaning or laundry essential to the patient's comfort and cleanliness. That language does not promise whole-house cleaning, family laundry, meal service for everyone or yard work. The service also needs to be part of the hospice plan of care. (Sources: Medicare; Code of Federal Regulations, Title 42, Part 418.)
Ask what the hospice will actually do
Call the hospice office during ordinary hours and ask for the aide or homemaker duties in the current plan of care. Then ask these questions:
Is light cleaning included? Which rooms? Does laundry mean her sheets and clothing, or all household laundry? Can the worker prepare food for her? How often is the service scheduled? How long is the usual visit? Which duties will the worker not perform? If the work is needed but absent from the plan, who reviews that request?
Write down the answers. A benefit named in Medicare materials is not the same as a promise that every household task will be completed. The useful answer is the assignment attached to your mother's name, with its days, duties and limits.
Missouri describes homemaker work as light housekeeping and may include meal preparation, shopping and other household tasks. It describes chore service separately as heavier work such as yard work or heavy housework. Availability depends on the program and eligibility. A hospice social worker can help you ask whether an Area Agency on Aging or another public program should be checked before you hire privately. (Source: Missouri Department of Health and Senior Services.)
Make two lists before you hire anyone
On the first list, write work connected directly to her space: her bedding, her laundry, the dishes used for her meals and light cleaning around the bed or chair. Take that list to hospice first.
On the second list, write the work of keeping the household running: family laundry, full-house cleaning, grocery pickup, cooking for other people, trash, pet care, snow or leaf removal and errands. This is the clearer hiring list.
The National Institute on Aging recommends naming and dividing caregiving responsibilities instead of leaving one primary caregiver to absorb them. Use the same approach with household work. Give each recurring job an owner, even when that owner is a paid service. (Source: National Institute on Aging.)
Do not hire one vague person to “help with whatever comes up.” That phrase makes it hard to know whether you need a cleaner, an errand runner, a homemaker or a personal care worker.
Match the worker to the job
A house cleaner may be the right hire when the work is floors, bathrooms, the kitchen and ordinary household laundry. Give the cleaner a written list of rooms and tasks. Say whether the person on hospice will be resting in the home and which room should not be entered.
A homemaker may be a better fit when the work includes light housekeeping, simple meal preparation, shopping or laundry. Ask the agency to name the exact duties it allows. The word “homemaker” is not enough by itself.
A personal care worker is a different hire. If you expect help with bathing, dressing, toileting, eating, transfers or supervision, say so before anyone accepts the job. Do not assume a cleaner will take on personal care because she is already in the house.
For a Veteran, ask the VA social worker or caregiver support team whether Homemaker and Home Health Aide services, respite or another home and community service can be considered. VA services depend on eligibility, assessed need and local availability. They should be checked, not assumed. (Source: U.S. Department of Veterans Affairs.)
Compare the arrangement, not just the hourly work
When you speak with an agency, ask who employs the worker, who handles screening and payroll, whether a replacement is sent after a call-off, what happens if a visit runs late and how you end or change the service. Ask for the task list and cancellation terms in writing.
If you hire someone directly, ask who handles taxes, insurance and scheduling. Get references and confirm the duties before the first visit. The Family Caregiver Alliance advises families to prepare a job description and to understand whether an agency's workers are employees or contractors. (Source: Family Caregiver Alliance.)
For either arrangement, compare the minimum visit length with the work you actually need. A long minimum may not fit one load of laundry and a bathroom. A short visit may not cover shopping, cooking and cleaning. Ask what happens when the assigned list cannot be finished.
Keep the boundary around hospice care
A household worker should know where to find you and how to reach the hospice number, but should not be asked to decide what a change means. If the worker notices something different, the useful instruction is simple: tell you, or call the hospice according to the plan you have given.
Keep hospice medicines, paperwork and supplies together and out of the cleaner's work area unless a specific task requires access. Tell the worker what may be moved and what must stay where it is. Protect quiet rooms, family papers and any door or alarm instructions.
Choose the work that buys back your attention
If you can hire only a small amount of help, begin with the task that repeatedly pulls you away or leaves you depleted. It may be the bathrooms, grocery pickup, family meals or the weekly accumulation of laundry. The best task to hire out is often the one another person can complete without learning the intimate details of her care.
You are not hiring someone to take your place beside her. You are deciding that clean floors, folded towels or food in the refrigerator do not have to depend on the same pair of hands that answers the hospice phone.
For West St. Louis County contacts and public starting points, use Local Help for Hospice Families. The underlying federal, Missouri, VA, aging and caregiver references are collected on the Sources page.