The first sign is rarely a missed visit. It is a window that moves. The aide was scheduled to arrive between nine and eleven, and then the arrival becomes closer to eleven, and then the arrival time stops being a time at all. Each shift gets a little shorter from the front, and your morning gets a little longer. Nothing has been cancelled, so nothing looks like a problem.
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.
Slow drift is harder to see than a missed visit, and it moves the coverage you are counting on without anyone deciding to move it. This piece is about catching it while it is still small.
Write down the arrivals for two weeks
Keep a simple log beside the phone for two weeks. For each visit or aide shift, write the scheduled window, the actual arrival time, the actual departure time, and who was in the house before and after. Add a column for anything that changed: a new person, a swapped day, a short-notice call.
At the end of two weeks, read the log in order. You are looking for three things: arrivals that keep landing later than the window, shifts that end earlier than the schedule says, and visits that were moved without a clear reason written down.
Name where the drift starts
Drift usually starts in one of three places. The agency or caregiver service changed its staffing, so the person who arrives is covering a different route. The hospice team changed its visit rhythm, which can happen when the plan of care is reviewed. Or the family's own schedule changed, and the window was never updated to match. Your log should show which one it is, or at least narrow it down.
Call the scheduler who sets the window, not only the person who arrives. Ask them to explain the change and to confirm the new window in writing. If the change came from the hospice team, ask them to note it in the record and tell you when the next review is.
Check the shift you are paying for
When an arrival moves later, the hours you pay for may not be the hours you receive. Ask whether the shift length on the invoice matches the shift length on the agreement, whether travel time is counted in a way that shortens the shift, and whether a late start is credited. Ask in writing. The answer tells you whether the drift is a scheduling problem or a billing problem, and the two need different calls.
Decide before the gap opens
Set a line in advance. For example: if arrivals run later than the window for two weeks in a row, you call the scheduler and ask for the reason in writing. If the answer does not hold, you bring the log to the hospice team at the next visit. Choosing the line now means you are not deciding in the middle of a hard morning.
For local help with the next step if the schedule cannot be held, see Local Help for Hospice Families.