Your parent cannot be alone after discharge. Two in-home care agencies say they can send an aide.

Do not compare them by the sales call alone. Compare the worker screening, the supervision, and the backup plan. Those are three different things.

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.

Keep one page for each agency. Write the same answers in the same order.

Day 0, still in the bed: define the job first

Ask the hospital team to write down what another person must do. Use tasks, not a general phrase such as “needs supervision.”

Does someone need to stay within hearing distance? Help with toileting? Prepare food? Remind your parent to use a walker? Watch for a problem named in the discharge instructions? Call a clinician if a stated condition appears?

Ask which tasks require a licensed clinician. A private-duty aide is not a substitute for ordered nursing or therapy. Medicare says personal care by itself is generally not a covered home health service. Medicare-covered aide care is tied to qualifying skilled services and other coverage conditions. That distinction changes what you are comparing and who is expected to pay (Medicare, “Home Health Services Coverage”; 42 CFR Part 409, Subpart E).

Give both agencies the same written task list. Ask each one to mark:

1. Tasks its aides may perform.
2. Tasks its aides may not perform.
3. Tasks that require a nurse or another licensed professional.
4. Tasks that require training specific to your parent.
5. Tasks the agency expects family to handle.

If an agency answers only with “companionship” or “personal care,” ask again. You need the boundary around the actual job.

Compare the screening, one check at a time

Ask, “What checks were completed on the aide you plan to send?” Do not stop at “background checked.”

In Missouri, the Family Care Safety Registry collects information from specified state sources. DHSS explains that regulated providers may also have duties involving criminal history records, the Employee Disqualification List, the child abuse and neglect registry, and the Department of Mental Health Employee Disqualification Registry. A registry check is not the same as every possible local, federal, or out-of-state search (Missouri DHSS, “Family Care Safety Registry”; Missouri Revised Statutes Sections 192.2495 and 210.900 through 210.936).

Ask each agency to name the checks it performs. Then ask:

Was the planned aide checked before being assigned? Does the agency repeat any checks? Does it check names used previously? What does it check when a worker has lived outside Missouri? Who reviews a result that needs explanation? Can the agency confirm that the aide is eligible for this assignment without giving you private personnel records?

Ask whether the agency verifies identity, work authorization, employment history, references, driving status when driving is part of the job, and any credential it advertises. A long list is useful only if the agency can tell you which checks apply to this worker and this task.

If you hire a worker directly instead of through an agency, you may become the person responsible for screening, references, scheduling, payroll questions, and replacement coverage. Missouri DHSS says a person contemplating the placement of a care worker may qualify to request certain Family Care Safety Registry information for employment purposes. Ask DHSS what access applies to your arrangement before assuming an agency’s screening will follow a worker into a private hire (Missouri DHSS, “Providers: Family Care Safety Registry”; Family Caregiver Alliance, “Hiring In-Home Help”).

Day 1, the car pulls in: verify the person and the assignment

Before opening the door, know the aide’s name and expected arrival window. Ask the agency how its workers identify themselves. Keep the agency’s main number beside you and call it if the person or timing does not match.

Ask the aide to review the task list with you. Check that the agency gave the aide the correct address, schedule, mobility instructions, communication needs, emergency contacts, and limits of the job.

Do not assume “trained” means trained for your parent. Ask what the aide was shown about the specific transfer method, equipment, food instructions, toileting routine, or behavior plan in the discharge papers. If a clinician must teach a task, arrange that teaching before the aide attempts it.

Federal home health rules set qualification and supervision requirements for aides employed by Medicare-certified home health agencies. Those rules do not turn every privately paid companion service into Medicare-certified home health care. Ask each company which kind of provider it is and which rules apply to the service you are buying (42 CFR 484.80).

Day 2 to Day 3, the first full days: test supervision

Ask who supervises the aide. Get a name, role, and working phone number.

Then ask what the supervisor actually does. Does the supervisor review care notes? Observe the aide in the home? Call you or your parent? Update the task list? Retrain the aide after a problem? Decide whether a task is outside the aide’s role?

Ask how you report a missed task, late arrival, rough handling, unsafe conduct, missing property, or a change in your parent’s condition. Find out who answers during the shift and after normal office hours.

Write down the escalation order:

Aide, then supervisor, then agency manager, then the appropriate outside contact if the agency does not resolve a safety or service problem.

Missouri DHSS maintains the Employee Disqualification List for findings involving abuse, neglect, misappropriation, or falsified service records in covered settings. That list is one part of screening. It does not replace your own record of what happened in the home (Missouri DHSS, “Additional HCBS Resources”).

Keep factual notes. Record the scheduled time, arrival time, task involved, who you called, and what response you received. Do not wait for the end of the week if the missed task leaves your parent without the help required by the discharge plan.

Day 3 to Day 7, the week: make the backup plan prove itself

Ask both agencies the same absence questions before choosing:

Who notices when an aide has not clocked in? How soon does the agency call you? Who searches for a replacement? Is replacement coverage promised or only attempted? Can the substitute perform the same tasks? What happens if no qualified substitute is available? Are you charged for time no one worked?

Ask for these answers in the service agreement. A scheduler’s verbal promise is hard to use during a missed shift.

Build your own short backup list too. Name the person who can stay temporarily, the tasks that cannot wait, and the number to call if your parent’s condition changes. The National Institute on Aging advises planning around the help a person needs to remain at home, while the Family Caregiver Alliance recommends defining duties and backup arrangements when hiring in-home help (NIA, “Aging in Place: Growing Older at Home”; Family Caregiver Alliance, “Hiring In-Home Help”).

If neither agency can cover the tasks or hours the hospital says are necessary, take that answer back to the discharge planner. Say which hours remain uncovered. Ask for a plan that does not depend on help that has not been secured.

Choose from the written answers

Put the two pages side by side. Compare five lines:

The exact tasks accepted.
The checks completed on the assigned worker.
The supervisor responsible for the shift.
The response to a missed or unsafe task.
The replacement process when the aide cannot come.

A polished intake call does not answer those questions. A lower hourly charge does not fill an uncovered shift. Choose the agency whose written process fits the work your parent actually needs.

If you still need local starting points after the task list is clear, use Local Help After a Discharge. Keep the same comparison sheet for every agency you call.

The Agency Says Its Aides Are Screened. Compare the Checks, Supervision, and Backup Before You Hire