You have been told your parent cannot be alone. That does not tell you whether you can provide the care.

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.

Start with the hands-on tasks. Write each one on its own line. Do not accept a broad instruction such as “family will assist.” Ask what the assistance looks like at the bedside.

Your list might include helping your parent get dressed, use the toilet, move between surfaces, follow an exercise plan, use equipment, or complete a care procedure. MedlinePlus tells families to identify the personal care, household care, and health care help that will be needed after discharge. It also says the caregiver should read and understand the discharge instructions (MedlinePlus, “Leaving the Hospital: Your Discharge Plan”).

Day 0, while your parent is still in the bed

Ask the nurse, therapist, or discharge planner to name every task another person must do. For each task, write down four things:

What must be done. How often it must be done. What supplies or equipment it requires. What should make you stop and call for help.

Then ask to see the task performed. After that, have the person who would do it at home perform it while the appropriate staff member watches. A printed sheet or video may help later, but it does not show whether you can complete the task in the actual room, with your parent participating.

Federal discharge planning rules require the hospital process to involve the patient and caregivers or support people and to address the services needed after discharge (42 CFR 482.43). CMS guidance says initial implementation of the plan can include in-hospital education or training for the family or other support person who will provide care at home (CMS State Operations Manual, Appendix A, section 482.43). BJC’s public discharge information likewise describes discharge planning as including a decision about whether caregiver training or other support is needed (BJC HealthCare, “Patient Discharge Information”).

Use three marks beside each task:

I can do this. You have practiced it. You can repeat the steps. You know where the supplies will be.

I could do this after more training. Write the missing instruction beside the task. Ask who will provide it and whether it will happen before discharge or during a home visit.

This must be hired out. Use this when the task exceeds your physical ability, availability, comfort, or training. Say that plainly. Family Caregiver Alliance advises caregivers to tell discharge staff about physical, financial, work, and family limits and to ask who will provide needed training (Family Caregiver Alliance, “Hospital Discharge Planning: A Guide for Families and Caregivers”).

If hospital staff say you can learn later, get the later step into the written plan. Record the provider or agency, the task to be taught, the expected first contact, and the number to call if that contact does not happen.

Separate training from ongoing labor

A professional may teach you a task without becoming the person who performs it every time. Ask two separate questions:

Who will teach this task? Who will do this task at home?

Medicare Part B can cover caregiver training when a treating provider determines that it is appropriate for the patient’s treatment plan and other coverage conditions are met. The training may be individual or group instruction from an eligible Medicare provider (Medicare, “Caregiver Training Services”). Medicare-covered home health may also include patient and caregiver education when the patient qualifies for the benefit and the service is included in the ordered plan of care (Medicare, “Home Health Services”).

Neither benefit automatically supplies a worker whenever the task comes due. Medicare says it does not pay for round-the-clock care at home or personal care by itself when that is the only care needed (Medicare, “Home Health Services”). Ask what has actually been ordered, which agency accepted the referral, and which visits are intended for teaching versus performing care.

If you hire, buy the exact task

Do not ask an agency only whether it provides “personal care” or “home care.” Read your task list to the agency. Ask whether its worker may perform each task under agency policy and Missouri rules. Ask what training or competency check applies. Get the accepted tasks in writing.

Missouri requires a license for an entity operating as a home health agency, subject to the statute’s definitions and exemptions (Missouri Revised Statutes sections 197.400 and 197.405). The Missouri Department of Health and Senior Services maintains home health licensing information and directories. Its home care oversight includes checking agency compliance and verifying staff training and credentials (Missouri DHSS, “Home Care” and “Home Health Medicare and State Licensure”). Use the state directory to confirm the agency category and license information it gives you.

A license does not mean every worker can perform every task. Federal home health rules say an aide’s services must be ordered, included in the plan of care, permitted under state law, and consistent with the aide’s training. The aide also works from written patient care instructions prepared by the appropriate skilled professional (42 CFR 484.80). Ask who wrote those instructions and whether your parent’s exact task appears in them.

If the agency says the worker can “assist,” ask what that word excludes. Can the worker touch the equipment? Provide physical support? Handle supplies? Complete the task without you in the room? Call a supervisor if your parent cannot participate as expected? The answers determine whether you are hiring relief or hiring someone who still depends on you.

Day 1, when the car pulls in

Use the written list at the first real occurrence of each task. Do not add a new technique from memory. Follow the hospital or treating provider’s instructions.

If a hired worker is present, show the worker the written plan and ask the worker to confirm which tasks are assigned. If the worker declines a task, do not argue about the label on the service. Call the agency supervisor and ask whether a different worker, a revised assignment, or another service is required.

If you are doing the task, keep the phone number for questions beside the instructions. Mercy’s public rehabilitation information describes family participation in therapy sessions as a way to learn skills for the transition home, and Mercy Home Health describes teaching as one part of ordered home health care (Mercy Rehabilitation Hospital St. Louis, “Patient Information”; Mercy Home Health, Des Peres).

Day 2 to Day 3, use the real workload

Now count what happened, not what everyone expected.

For each task, record how many times it was needed, about how long the full sequence occupied, whether two people were needed, and whether the planned person was available. Also record any task that remained undone. Do not use this note to change clinical instructions. Use it to correct the staffing plan.

The National Institute on Aging recommends identifying the care needs and assigning responsibilities according to each person’s skills and circumstances (NIA, “Sharing Caregiving Responsibilities”). NCOA describes care transition programs as helping patients and caregivers learn self-management skills during the move from hospital to home (NCOA, “Programs for Advance Care Planning, Care Transitions, and Caregiver Support”). Your short record gives the hospital team, home health agency, or treating provider something specific to work from.

If the workload is larger than planned, ask one question: “Which of these tasks can be reassigned, taught differently, or covered by another service?” For St. Louis contacts that may help you find the right program or agency category, use Local Help After a Discharge.

Day 3 to Day 7, settle the division of work

Review the list with your parent if they can participate. Mark each task with one owner and one backup. The owner can be your parent, you, another family member, a privately hired worker, or staff from an ordered service. Do not write “family” or “agency.” Write a name or role that can be called.

Keep a task with yourself only if you can perform it as instructed and be present every time it is due. Hire it out only after the provider confirms that the worker may perform the exact task. If neither condition is met, take the gap back to the treating provider, discharge contact, or home health supervisor.

For a parent with dementia, Missouri has separate dementia-specific training requirements for certain paid workers, and DHSS describes a caregiver program that may provide customized instruction for eligible households (Missouri Revised Statutes section 192.2000; Missouri DHSS, “Missouri Caregiver Program”). Ask whether those rules or resources fit your parent’s situation. Do not assume that general caregiving experience includes dementia-specific training.

Keep the final page simple. Task. Instructions. Owner. Backup. Supply location. Number to call. That is enough to show what you are doing yourself, what you hired someone to do, and where the plan still has an empty line.

The point is not to prove that you can do everything. It is to make sure every required task belongs to someone who can actually do it.

Source titles and agencies used in this guide are collected on the site’s Sources page.

Learn the Hands-On Care Yourself or Hire It Out? Decide One Bedside Task at a Time