Before you sign anything, decide which kind of help you are comparing. A skilled home health agency sends nurses, therapists, and home health aides on a doctor's written plan of care, usually after a hospital stay. A private non-medical agency sends companions or personal care aides you pay for directly. This article is about the first kind. If the discharge plan includes home health, the hospital is required to give you a list of agencies that serve your area and to respect your choice among them (eCFR, 42 CFR 482.43). If your parent has a Medicare Advantage plan, check whether the plan limits which agencies are in network before you choose.

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.

Step 1: Check the Medicare certification

Look up the agency by name and address on the Medicare Care Compare site (CMS). An agency that bills Medicare for home health has to meet the federal conditions of participation (eCFR, 42 CFR Part 484). If the agency does not show up at all, or the listing shows a different address than the one on your paper, stop and ask why before you go further. Write down the agency's listed phone number and the date you checked. Do not build your own ranking from the star or measure pages. Read what is posted, note what you see, and compare it with the same fields for the other agencies on your list.

Step 2: Check the Missouri license

Home health agencies that operate in Missouri are licensed through the Missouri Department of Health and Senior Services (DHSS). Look up the agency in the DHSS listing and confirm three things: the license is current, the legal name matches the name on your discharge paper, and the address is the office that will actually send staff to your parent's home. Agencies sometimes use a trade name that is different from the licensed name. The name on the bill and the name on the license should be the same company.

Step 3: Ask about the service area and the visit windows

Ask whether the agency serves your parent's exact street and ZIP code, not just the city. Then ask how visit times are set. Most agencies give a window, not an exact time, such as "sometime between 9 and noon." Ask how far ahead they call to confirm, and whether a nurse visit can be moved if your parent has a therapy appointment that day. Write down the window they give you so you can hold them to it.

Step 4: Ask who supervises the staff

Ask for the name of the registered nurse who runs the case and supervises the aides. Ask how often that nurse visits the home, and how to reach that nurse during the day and after hours. You are asking who is accountable when something in the plan changes, so the answer should be a person with a role, not just a main office number.

Step 5: Ask what happens when a visit is missed

This is the question that separates agencies more than the brochure does. Ask three things. How will they tell you that a visit will not happen? How fast can they send a replacement? Who answers the phone at night and on weekends, and does that person have the authority to send someone? Ask whether a missed visit is written into the record and whether you can get a copy. If the answers are vague, ask the same question again in a different way and see whether the answer changes.

Step 6: Get the plan of care in writing

The doctor orders the plan of care, and the agency carries it out. Ask for a copy of the plan before the first visit, and check that it lists the services, how often each one comes, and the goals written in it. Ask who reviews the medicine list with your parent during the visits. That review belongs to the nurse on the case, and the family, the doctor, and the pharmacist keep responsibility for the medicine itself. Home health aides support the daily care in the plan, but they do not take over the medicine. Keep the plan with the other discharge papers where you can find it fast.

Step 7: Know what the agency will not cover

Home health services are tied to the doctor's plan and to Medicare's rules about being homebound, so they come in visits, not as all-day coverage. If your parent needs someone in the house for hours every day, that is a separate private arrangement, and it is usually paid by the family. Ask the agency what it does not provide, and write that down next to what it does provide. The gap is where families usually get surprised.

A short comparison sheet

Use one page for each agency on your list, with the same lines on every page: Medicare certified (yes or no, and where you checked), Missouri license (number, name match, address match), service area confirmed for your exact address, visit window they offer, supervising nurse and how to reach that nurse after hours, missed visit rule and replacement time, plan of care copy received (yes or no), and what is not included. Fill in every line before you call the agency you prefer. If one agency leaves a line blank, ask the question again before you move on.

For the rest of the first week, the Local Help After a Discharge page lists the next calls to make, and the Sources page shows where each rule in this article comes from.

The Agency Badge Is Checkable: Confirm Medicare Certification, the Missouri License, and Who Covers a Missed Visit