The Four Hours Nobody Books: Find the Stretch of the Day No One Has Claimed

Day 0 is still in the bed, and what you need right now is a list of hours, not a list of tasks. Most families write down what their parent needs. Fewer write down when those things happen, and the hours with nothing written in them are where the gap lives.

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.

Draw the day as a grid

Take one sheet of paper and mark a row for each hour from waking to sleep, for each day your parent will be home. Fill in what is already fixed: the medicine times as the discharge paperwork lists them, meals, the bathroom routine, bathing, the daily walk, and any call the doctor's office has said it will make. Those hours are fixed because someone already owns them. Leave the rest blank.

Look for the blank stretch

The blank stretch usually repeats. It may be the mid-morning after breakfast, the long afternoon when the family has gone back to work, or the late evening when the one person who has been there all day heads home. Circle it. Then write the one thing that could happen in that stretch that your parent could not handle alone: a fall getting up from the chair, a dizzy spell at the sink, a bathroom trip that goes wrong, a phone that rings with no one to answer it.

Name the owner of each gap

For each circled stretch, write one name beside it. If you cannot write a name, you have found the problem. Do not write family or someone. Write the person who said yes and the hours they said yes for. Ask them to confirm it in writing, even if that is a text message. A helper you have not yet hired goes on the grid with a question mark, and the question mark stays there until you have a firm answer.

Check the grid against the hospital's words

Read the discharge instructions and look for any line about supervision, or about needing another adult present. Hospitals often describe the need in general terms. If the written plan does not say how many hours or what kind of watching is expected, ask the discharge nurse or case manager before you leave. Ask which hours they expect covered, whether they mean someone awake and in the room or simply someone in the home, and who you should call if the answer changes. Write down the name of the person you asked and the time you asked. Your parent's own Medicare discharge rights and the rules behind them are listed on the Sources page of this site if you want to read them before you call.

Keep one rule in mind while you fill the grid. A paid non-medical helper can remind your parent that a medicine time has come and can pick up a prescription as an errand. The medicine itself stays with the family, the doctor, and the pharmacist, so mark those medicine times with your own name, not a helper's.

Test the grid on the first night

When you get home, walk the grid against the actual evening. Note where the plan held, and where your parent reached for something, stood up on their own, or called out for help. The first night is the one you are checking, not the one you are proud of. Change one name or one time the next morning, and keep the sheet on the refrigerator where every helper can see it.

If a stretch still has no name after the first full day, the plan is not finished yet. Local Help After a Discharge lists the kinds of services to ask about for the hours you cannot cover yourself, and the questions to put to each one before you sign anything.