This sheet is a working tool. Each point below is either taken from a public file or marked as editorial judgment. Nothing here is a rating of any named provider.

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.

Why the backup question comes first

A family that does the work itself usually depends on one helper, often a relative or neighbor. A family that hires out depends on an agency's promise of a schedule. Both plans are tested on the same kind of day, when the helper is sick, away, or has a conflict. Editorial: in this desk's view, the gap is where a plan gets tested, not the regular week, so the gap should be settled before any split is written.

Build the gap list

Write each recurring task on its own line. Beside each line, write the usual person. Then write a second name for that line, or the word none. A line marked none is a single point of failure. Editorial: the family should decide every none line before any agency is called, because an agency will fill a gap only as well as the family has described it.

What the agency paper can and cannot show

Ask the agency for its written plan for a missed or late visit. The public federal files the desk checks list registration and certification status for an agency. They do not list how an agency will staff a particular day. For the steps to confirm that status yourself, see how to check any home health agency in five federal lookups. Editorial: treat a verbal promise of cover as no promise until it appears on paper.

Mark the split on one sheet

Make three columns: what the family keeps, what the agency takes, and a shared line with a named backup on each side. Editorial: the shared column is where most disagreements start, so it deserves the most detail. Write the hours each backup can actually give, not the hours they hope to give.

Questions to put to the agency

  • If the assigned aide cannot come, what is the replacement window, and who calls the family to say so?
  • Who is on call when the office is closed, and what is that person's direct line?
  • Will the same aide return after a substitute visit, or will the family be told in advance who is coming?
  • What does the agency put in writing about a missed visit, and where is that page kept?
  • If the family must step in on a line, which task is it, and does the agency expect that step to be taken?

When the family holds the gap

If a backup is a family member or friend, write that person's name and the hours they can cover. Editorial: a backup who has never been told is not a backup. Confirm each backup in writing, a text message is enough, and do it again whenever the routine changes.

Keep the sheet current

Review the split whenever the household's routine changes or an agency's paperwork changes hands. Compare the agency's written plan to the sheet line by line, and mark any line that no longer has a name beside it. Health questions go to the family's doctor.