The Companion Agency Sends a Name. Check the Scope Sheet, Insurance, and Swap Rule Before the First Shift

You have a name from the agency and maybe a first name for the caregiver who will come. Before you sign anything, ask the agency for its written scope sheet. Read it for three things: what the caregiver does, what the caregiver does not do, and who owns each task when the shift ends.

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.

Day 0: Read the scope sheet line by line

A non-medical caregiver may give medication reminders and pick up prescriptions as an errand. A non-medical caregiver does not hand out, administer, dispense, sort, or manage medicine. Those tasks stay with the family, the doctor, and the pharmacist. If the sheet describes any of those tasks, ask the agency to correct the document in writing before you sign. A verbal promise will not help you on the night it matters.

Check the sheet for these lines: meals, bathing help, transfers, walking supervision, overnight presence, transport to appointments, and errands. For each one, write down who decides when the task changes. You want the answer to be a named person at the agency, not a general office number.

Day 1: Ask about insurance and employment

Ask whether the caregiver is the agency's employee or an independent contractor. The answer changes who carries responsibility if something goes wrong in your parent's home. Ask for the name of the liability insurer and for proof that workers' compensation coverage is in force. If the agency will not name the insurer, ask for it in writing and call the insurer yourself to confirm the policy is active.

Ask what the background check covers, how far back it reaches, and whether it is repeated. Ask whether the caregiver is bonded and what the bond covers. Ask whether the agency holds a Missouri DHSS license for the services it offers. If it says it does not need one, ask which rule it relies on, and keep that answer in writing. Your questions are reasonable, and a sound agency will answer them without fuss.

Day 2 to Day 3: Test the swap rule

Most families plan for the caregiver who shows up. Plan for the one who does not. Ask what happens when the regular caregiver calls out sick. Ask how many hours of notice the agency gives you, who calls you, whether you can refuse a substitute, and whether the substitute gets the same scope sheet. Ask what the replacement policy is if the match does not work after the first week. Then ask who you call at nine on a Sunday night when no one answers the office line.

Medicare generally does not pay for custodial companion care, so this cost usually comes from the family's own budget. Ask the agency to state in writing which services are billed as hours and which are billed as errands, and whether errands carry a minimum time block.

Day 3 to Day 7: Compare the bill against the scope

Put the invoice next to the scope sheet. Every billed item should match a line on the sheet. If the invoice shows a trip to the pharmacy but the sheet does not list errands, ask for the difference to be explained. If the caregiver is asked to stay late because a ride is delayed, ask whether that time is billed, and whether the agency requires your approval first.

Read the cancellation rule before the first shift. Ask how much notice is needed to pause or end service, whether a hospital readmission pauses billing, and whether any deposit is refunded. Do not compare hourly rates alone. Compare the scope, the insurance, the swap rule, and the cancellation rule, because those four decide what you actually get.

For background on choosing in-home help, the National Institute on Aging publishes plain guidance on questions to ask a home care provider. Use it as a checklist next to the sheet, not in place of it. The desk's list of local help is on the Local Help After a Discharge page, and the sources behind this guide are on the Sources page.