Families usually judge an agency by the coordinator who answers the phone and the aide who sat in the kitchen during the tour. Once care starts, the question changes to a simpler one: who actually walks through the door on a given day, and did the family know that before it happened?

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.

First check: get the names in writing. Ask the agency to name a lead aide and one backup for the household, and to put both names in the service paperwork. Desk note: a name on paper is an agency statement, not a file record. Treat it as the starting point for the checks below.

Second check: count the faces in the first two weeks. Write down the first name of each person who arrives and the date. Some change early on is common while an agency settles its schedule, so a new face in week one is not automatically a failure. What matters is the trend. If the list is still growing by the third week, the schedule is not holding.

Third check: ask who is coming before the day. A workable arrangement lets the family learn the name of the next visitor before the visit starts. Ask the coordinator to confirm the next day's name by a set time, and note whether that confirmation actually arrives.

Early signs to write down

  • The agency says the aide will be 'whoever is free' rather than naming someone.
  • Visit times move, and nobody calls to say so.
  • A new aide arrives without a short introduction or without the care plan the family wrote.
  • The aide cannot describe the household routine the family gave at intake.
  • The coordinator stops returning the call that asks who is coming next.

Desk note: none of these signs proves bad intent. Each one is a question the agency should be able to answer in a sentence. When the answer takes a week, the family is already losing its schedule.

Questions to put to the agency now

  • How many different aides are normally assigned to one household in a month, and what triggers a change?
  • How much notice does the family get before a new name is assigned?
  • Who is the single contact who confirms the next visitor, and by what hour?

Editorial note: a household that wants the same face every day may treat this as a deal breaker, while a household that is comfortable with a small rotating team may not. Decide which before the first visit, so the pattern has a standard to be measured against.

Before the first visit, the agency's public files are worth a look too. See how to check any home health agency in five federal lookups: how to check any home health agency in five federal lookups.