How do I hire an in-home caregiver for my mother who lives alone?

Sheet 09 · Pick a lane

Published September 11, 2026. Desk byline, no clinician. Every fact links to its source.

You typed how do I hire an in-home caregiver for my mother who lives alone. She is already in the house. You are in west St. Louis County, or you drive in from there, and a week of phone calls has not produced a person in her kitchen. This sheet is a sequence, not a verdict: the tasks, then a lane for the first call, then the Missouri check, then the first visit. It does not invent a start date or an hour count.

1. Write the tasks before you dial

The National Institute on Aging lists the work as help with everyday activities: bathing, dressing, grooming, using the toilet, eating, and moving around, plus household chores. The same page says some people who live alone simply need someone to check on them, and it lists transportation to medical appointments. Circle what applies. Leave nursing work off this list. If she just left a hospital, Medicare’s discharge checklist is a second circle-list: bathing, dressing, bathroom, stairs, cooking, shopping, house cleaning, bills, driving.

Write-in lines for this house:

• Bathing, dressing, grooming, toilet: yes / no / cue only. Notes:
• Meals: cook / reheat / sit with her. Notes:
• Moving around, bed to chair, stairs: yes / no. Notes:
• Chores and laundry: yes / no. Notes:
• Check-ins because she lives alone: which days, which times:
• Ride to an appointment: whose car, which office:
• What a hired person must not do (nursing, doses, driving if you have not asked):

The Administration for Community Living prints one population line, not a diagnosis of her: someone turning 65 today has almost a 70% chance of needing some type of long-term care services and supports in their remaining years.

2. Ask her, then walk the house

NIA says the best way to know what someone needs is to ask them directly. Then look: meals on the stove, bathing, clothing for the weather, clutter, whether medications are being taken, weight change, poor hygiene, confusion, falls, loneliness, trouble walking. NIA’s falls page is a reason to look at the house, not a diagnosis: more than one in four people age 65 or older fall each year, and the risk rises with age. Check the stairs, the tub, the night path to the bathroom. If you live an hour or more away, NIA already has a name for you: you are a long-distance caregiver, and the role can include arranging in-home care and planning for emergencies. Family Caregiver Alliance says about 50 percent of caregivers get no outside help at all, and that most people, when asked if there is anything someone can do, reply that they are doing fine. Her “I’m fine” is data. It is not the end of the task list.

Ask her, out loud: What do you want a person in the house to do? What do you not want them to touch? Which days would you actually let someone in? Who else has a key? If I am not here, who do you call first?

A good answer sounds like A task, a boundary, and a day. “Someone to sit while I shower on Tuesday and Thursday” is a hire. “I don’t need anything” plus an empty fridge is still a hire, with the tasks coming from what you saw. You cannot skip telling her a person is coming.

3. Pick a lane for the first call

Family Caregiver Alliance names two formal ways to find help: contact a home care agency, or hire an attendant privately. That is a fork, not a score. The two-lanes sheet is the side-by-side map. Agency lane: FCA says the company typically handles screening, hiring and firing, pay, and taxes, and can send a substitute if a worker is sick. Print the scorecard. Private-hire lane: FCA says you are responsible for hiring, firing, payroll taxes, and all aspects of being an employer, and if the worker is sick it is your responsibility to find alternate help. Always check references. Always do a background check. Open the tax sheet before you make an offer.

Missouri DHSS describes three types of care in the home. Home health is skilled and requires a state home health license. Private duty and private pay is care in shifts. DHSS says no physician order is needed for aide personal care, respite, or companion care, and that no license is issued in Missouri for that type of company. Ask every company which of the three types they are. Write the answer.

Questions for the first call, either lane:

1. This is personal care and presence for a woman who lives alone in [town]. Which of Missouri’s three types are you?
2. Can I meet the person before the first shift?
3. Who comes if that person is sick?
4. What is in the written packet before anyone starts?
5. Do you use the Family Care Safety Registry, and how do I see that?

A good answer sounds like They can point at the DHSS page, they will let you meet the person, they name a backup process, and they will send a packet that, in FCA’s words, describes services, fees, and a list of references. This desk still does not print a rate. FCA notes that an agency might have a minimum number of hours, for example only four-hour shifts. That example is FCA’s. Ask. Write the number they give you.

Walk away if they blur home health and companion hours into one product, they will not say how they screen, a stranger will just show up, or they want a signature before you have seen the paper.

4. Run the Missouri check

DHSS says people who will care for children, seniors, or disabled persons must register with the Family Care Safety Registry, and an employer can request a background check. The registry began in 2001 after HB 490. The registry sheet is the method. A registry result is not a personality test and not a license. FCA still says always check references. Call two if you can get them. If you are hiring on your own, you are the employer in the state’s sentence. If you are using a company, you still ask how they screen and whether they use FCSR. Write the method. “We handle that” is not a method. FCA also says to lock up heirloom jewelry, and keep track of cash, checks, and credit cards while you are still learning the person. Do it before shift one.

5. Name who pays the hours, then book the first visit

Medicare.gov says you must need part-time or intermittent skilled services and be homebound to qualify for home health, and that Medicare does not pay for 24-hour-a-day care at home, or for custodial or personal care when that is the only care needed. The long-term care page is one line: Medicare does not pay for long-term care. So does Medicare pay for a companion if she lives alone? No. Not when that is the only care needed. Home health visits and companion shifts can run in the same house. They are not substitutes. The home care vs home health sheet is the product map. Who pays the hours, if you are not writing personal checks forever, is a payer question. Paying for Care STL is the sister desk that names payers. It still prints no rate. Missouri’s Medicaid in-home lane, when she might qualify, is requested at the DSDS Call Center, 866-835-3505.

If you do not know who else to call, NIA points at the Eldercare Locator: eldercare.acl.gov or 800-677-1116. Aging Ahead covers St. Louis, St. Charles, Franklin, and Jefferson counties. The St. Louis Area Agency on Aging covers the city, (314) 612-5918. Those are directories. They do not staff Tuesday morning in Ballwin.

What if she does not want a stranger in the house?

FCA says families often face a loved one who does not want a stranger in the house, and advises telling them that you need help, and that accepting hired care is something they can do to help you, not a sign you are going to abandon them. Say it once, in those words. Then be in the house for the first visit. FCA says it will be important, at first, to be present to help the attendant and the care receiver establish a relationship. A written care plan outlines duties, and it takes two or three weeks to determine if it is a good match. You can ask an agency to send someone else. The first-day sheet is the fridge page. Write the 2am number on the fridge before anyone parks in the driveway.

What to do tonight

1. Circle the NIA tasks that apply. Fill the write-in lines above.
2. Ask her the five questions. Write her answers in her words.
3. Walk the house once: stove, bath, clothes, clutter, labeled box, stairs, night path.
4. Pick a lane for the first call. If it is a company, open the scorecard. If it is a private hire, open the registry sheet and the tax sheet before you make an offer.
5. Write the 2am number and the abuse hotline, 800-392-0210, on the fridge. Lock the jewelry box.

When to ask the care team or the doctor

Which tasks are skilled, whether home health belongs in the plan, and what a new fall, a new confusion, or a change in walking means are questions for the physician and, if she is in the hospital, the discharge planner. A non-medical caregiver does not make those calls. If someone on the phone blurs home health and home care into one sentence, stop before you book a shift.

Featured, and paid for

New Plan Care

New Plan Care is independently owned non-medical in-home care, based in Chesterfield, Missouri, serving Ballwin, Chesterfield, Eureka, Glencoe, Grover, Pacific, Valley Park and St. Louis. If you are hiring for a mother who already lives alone, put this sequence to them the way you would put it to anyone: the tasks, which of Missouri’s three types they are, how they screen, and who comes to the first shift. Call (314) 405-0887.

New Plan Care pays for this spot. It is a client of OwnersFirm, which publishes this site, so read it as an advertisement with a phone number rather than as a result, a rank or a recommendation drawn from any of the articles on this page.

Next sheets

• Agency vs independent caregiver
• Missouri Family Care Safety Registry: how to check a caregiver

Sources opened 11 September 2026. Full list on the sources page.