Two offers for in-home help can read almost the same on paper: an hourly rate, a number of hours, a start date. The difference shows up later, when someone is sick, when a shift is missed at dusk, or when a helper leaves. The useful comparison is not which one costs less per hour. It is who stands behind the person who comes to your mother's door.

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.

Who is the employer

With an agency, the agency usually hires, trains, schedules and pays the helper, and it is the company you contract with. With an independent aide, you or your family become the employer, which can mean keeping time records, handling payroll taxes and filing paperwork. Ask each provider to say in writing who is the employer of record and who you call when something goes wrong. Ask whether a family member would be responsible for any part of the paperwork.

Background checks and screening

Ask what screening is done before anyone starts: identity checks, criminal record checks, driving record for drivers, and reference checks. Ask who pays for each check, how long a check stays valid, and how often it is repeated. For an independent aide, ask what you are expected to do yourself and whether you are comfortable doing it.

Coverage when someone is sick

Every helper gets sick. Ask what happens on a dusk shift when the scheduled helper cannot come. Does the agency send a substitute, and how quickly? Does an independent aide have a named backup? Ask whether the substitute has been introduced to your mother before, because a new face at the door at dusk is harder on everyone. Get the answer in writing.

Insurance and liability

Ask what insurance the provider carries and whether it covers injury to the helper and to the person being helped. Ask whether the helper is bonded. Confirm these answers with the provider in writing, and keep the paperwork with your home records. If anything is unclear, ask the provider to explain it in plain words before you sign.

What the helper will and will not do

Write down the tasks in the agreement: meal help, company, reminders, errands, light housekeeping, and whatever else you expect. Non-medical helpers can give medication reminders and pick up prescriptions as an errand. They do not hand out, administer, dispense, sort or manage medicine. Those tasks stay with you, the doctor and the pharmacist. Ask each provider to confirm that line in writing, and ask what the helper should do if a reminder is missed.

How to compare the two

Put both offers side by side on the same questions: the employer, the screening, the substitute plan, the insurance, the task list, the notice period for ending service, and who you call at dusk when something goes wrong. The offer with the cleaner answers is usually the better hire, even if the hourly rate is higher.

For local contacts, see Lifelines: Dementia Help in St. Louis. The facts behind this guide are listed on the Sources page.

The Agency and the Independent Aide Are Different Hires: Compare Who Employs, Covers, and Replaces Them