Hiring a caregiver on top of hospice: what they can do, what they never do, and the first week.

The jobs

Published September 11, 2026. Desk byline. Each claim on this page is linked to a public URL; the dated list lives on the sources page.

You typed hiring a caregiver on top of hospice because the aide left at eleven, the nurse is not due until Thursday, and the hours between those visits are yours. That is the design, not a shortfall. This page is what a hired person can do in a west county house, what they never do, who pays, and how the first week goes.

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Why families hire someone beside hospice

The Hospice Foundation of America says it without decoration: in most cases, hospice does not provide around-the-clock bedside care, and when services are provided at home, hospice generally requires one or more caregivers, who may be family, friends or paid caregivers. CaringInfo says the same from the other side of the door: the day-to-day care of a person receiving hospice care is provided by family, friends, the inner circle, or paid home health aides.

The benefit is a team that visits and a line that answers. The days, the nights, the chair at 2am: those belong to whoever is already in the house. In Ballwin or Chesterfield or Eureka that person is often you. Hiring is how some families share the blush squares, laid out in does hospice provide 24 hour care at home.

Will Medicare pay for a caregiver on top of hospice?

No. Medicare Part A pays the hospice team for the terminal illness. Extra hours of personal care in the house are a different thing. The home health page states that Medicare does not pay for 24-hour-a-day care at your home, and does not pay for custodial or personal care that helps with daily living when that is the only care needed. The long-term care page is shorter still: Medicare does not pay for long-term care.

So the extra hours, if you add them, are private pay, a long-term care policy if one exists, MO HealthNet personal care if she qualifies, or VA programs if he is a veteran. The local map of those doors is in hospice at home in west county.

Missouri private duty, which is not Medicare home health

Missouri's health department splits home care into three types on one page. The third type is the one families mean when they say they hired someone. It is commonly called private duty or private pay: personal care, respite, companion care, paid from private funds or insurance, no physician order needed for an aide giving those tasks, and no license issued in Missouri for that type of company. The family decides the hours.

The first type on the same page is home health, the Medicare one: skilled nursing, therapy, a home health aide, ordered by a physician, part-time or intermittent, a state home health license required. That is not the overnight chair, and it is not a companion so you can drive to the pharmacy in Valley Park. Missouri's senior and disability services door is on the health department site if Medicaid in-home care might apply.

Paid placement, labelled

The local private-pay row, for the hours hospice does not staff: New Plan Care is an independently owned non-medical in-home care company based in Chesterfield, Missouri, serving Ballwin, Chesterfield, Eureka, Glencoe, Grover, Pacific, Valley Park and St. Louis with personal care, meals, companionship and overnight presence beside hospice. It does not publish an hourly rate, and neither do we. Call (314) 405-0887.

New Plan Care pays for this spot. It is a client of OwnersFirm, which publishes this site, so read it as an advertisement with a phone number rather than as a result, a rank or a recommendation drawn from any of the articles on this page.

The line the hired person never crosses

Medicare's hospice booklet is the sentence to tape on the fridge: the hospice must give or arrange all care you get for your terminal illness. A hired caregiver is presence and hands. They are never a second hospice. Medicines, pain, breathing, restlessness, swallowing, skin, any change in her: the hospice line, every time. The booklet also says a hospice nurse and doctor are on call 24 hours a day, 7 days a week. On call. Reachable. The hired person may remind, may fetch the box, may write the time down, then they call you or the line, by the plan you wrote before the first shift.

Tell the hospice you are bringing someone in. Ask the nurse to meet them. The task-by-task split lives in between the visits. The shorter table below is the hired column, isolated, so the line is harder to miss.

What does the hired person do on the first week?

The first week is orientation. You already decided the hours were too many. The work now is to show the house so the person who sits them is not guessing.

• Tell the hospice before the first shift. Name the company or the person, the days, the hours. Ask who on the team should brief them.
• Ask the nurse to show turning, mouth care, and what to call about. The National Institute on Aging tells families to check with the person's health care team to make sure these suggestions are appropriate for the situation. That instruction applies to the hired person the same way it applied to you.
• Write fridge rules. What goes to the hospice line. Where the briefs are. How she likes the lamp. Your number, first.
• Overlap the first shift. Stay in the house. Walk the rooms. Let her hear you say this person is here so you can rest, not so you can leave her.
• Put the on-call number by the chair. Yours, and the hospice's.

After that, the week is ordinary work: a bath on an off day, meals, presence so you can sleep. The Family Caregiver Alliance's hiring page lists personal care, household care, health care, and emotional care. Health care stays with hospice. If the hired hours are overnight, read sleeping in shifts first.

If she refuses a stranger

This is common enough that the Family Caregiver Alliance wrote it down. Their wording, not a promise of how anyone in this house will feel: tell her that you need help and that accepting hired care is something they can do to help you, not a sign you are going to abandon them. Be present at the start. If personal care is the wall, start with the house.

If a sibling objects, the Alliance's sibling page says discord most often surfaces from the unequal division of caregiving duties. Their fact sheet on holding a family meeting is the one to print. Put the hours on the table so someone else can pick some up, or so the family can decide to hire.

Who pays for the hired hours

Mixing payers costs families weeks. Private pay is the Missouri third category above: you decide the hours. If a long-term care policy exists, find it tonight and read the in-home section; Medicare notes you may be eligible for long-term care through Medicaid, or you can choose to buy private long-term care insurance. MO HealthNet is different from Medicare; the state says it can help with benefits not normally covered through Medicare, like personal care services, for those who qualify. Ask the social worker.

If he is a veteran, the VA's Homemaker and Home Health Aide program sends a trained person, supervised by a registered nurse, to help with personal care and daily activities so a Veteran can remain at home. A wartime Veteran on a VA pension may qualify for Aid and Attendance. Ask the VA care team. This site will not guess eligibility. On taxes, the IRS describes medical expenses in Topic 502: they may be deductible to the extent they exceed 7.5 percent of adjusted gross income, only if they are not compensated by insurance. That is the IRS page, not advice. Ask a tax person. Aging Ahead has served St. Louis, St. Charles, Franklin and Jefferson counties since 1973. United Way's 211 line answers around the clock.

What they can do, and what they never do

Print this. Hand it to the hired person on day one. The longer three-column version is in between the visits.

The job	They can	They never
Being in the house so you are not	Yes. Presence, days or nights you hire.	A medical assessment of the night.
Turning and changing her	Yes, once the nurse has shown them.	A method they invent, or a skin treatment they decide.
Bath, hair, mouth, the bed	Yes, the way the nurse showed.	A substitute for the hospice aide visit.
Food, meals, laundry, the dog	Yes, if you put it on the fridge list.	Forcing her to eat, or interpreting a change.
Medicines	May remind, fetch the box, write the time.	Deciding, holding, or adding a dose.
Pain, breathing, any change	Calls you, then the hospice line.	Waiting until morning, treating, or saying it is nothing.

The hospice keeps the illness. The hired person keeps the hours.

What to do tonight

• Tell the hospice you are bringing someone in. Write the sentence so you do not soften it.
• Put the on-call number by the chair. Yours under it. Write four fridge rules.
• Overlap the first hired shift. Do not send a stranger in alone on night one.
• If a long-term care policy exists, find it. If he is a veteran, find the discharge papers. Ask the social worker about MO HealthNet.

When to ask the care team or the doctor

• Before a hired caregiver starts: what the nurse wants them to do, and never do.
• Any change in her: breathing, pain, restlessness, skin, swallowing, sleep. That is the nurse's row, always.
• Whether the aide can add a day, and whether volunteers can sit.
• The social worker, about MO HealthNet, the VA, and any benefit she may qualify for.
• Anything medical, including whether a change means a different level of care.

From the sources on this page

Not 24-hourIn most cases, hospice does not provide around-the-clock bedside care, per the Hospice Foundation of America.Not 24-hourMedicare does not pay for 24-hour-a-day care at your home, per Medicare.gov.Long-term careMedicare does not pay for long-term care, per Medicare.gov.No licenseNo license issued in Missouri for private duty or private pay companies, per Missouri DHSS.