The Approved Hours Ran Out Before the Month Did. Catch the Gap Before the Aide Stops Coming
Paid home care usually breaks in the calendar before it breaks on the bill, so count the approved hours against the schedule every week.
A paid home care plan rarely fails with a dramatic phone call. It fails in the calendar first. An aide comes two days less than approved, a week passes with no replacement, and the next invoice shows hours nobody wrote down. Your job is to count the hours against the approval every week, so the gap shows up on a Tuesday instead of at the end of the month.
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 approval letter
Find the notice that authorized the service. It should name the service, the amount (hours, or units under the program's own measure), the start date, and the end date. Write those four things on one card and keep it where the person who keeps the schedule can see it. If any of the four is missing from the letter, call the agency or program and ask for the missing part in writing before the next period begins.
Count the hours every week
Set a simple weekly check. Add up the hours on the caregiver's timesheet or visit log, subtract that from the approved amount for the period, and write down the remainder. Do this on the same day each week. A remainder that shrinks faster than the calendar suggests is the first sign that visits are being shortened, moved, or logged differently than planned.
The signs that show up first
Watch for visits that stop without a call, a caregiver who asks for payment outside the agency's billing, invoices for hours you did not authorize, and a reauthorization date that passes with no paperwork in your hand. A change in the case manager or the aide is not wrongdoing by itself, but it is the moment when hours most often slip through, so ask what was handed over.
What to ask the case manager
Ask five questions and get the answers in writing. What happens on the day the approved hours run out? Who files the reauthorization, and by what date? If the hours are cut, what written notice will I receive? Which payer is paying for each service on the invoice? Who do I call on a weekend? Medicare does not pay for ongoing non-medical help at home, so if a Medicare notice is mixed in with this care, check which payer is behind each line before you assume it is covered. Missouri SHIP offers free Medicare counseling. Aging Ahead can help you find the local aging programs that may be involved. Missouri DSS administers the state programs that pay for many in-home services.
For a starting list of local contacts, see Local Help With Paying for Care. The sources behind these program names are listed on the Sources page.
Where this stops
If the question becomes whether a notice was issued properly, whether to challenge a cut in hours, or what a document means for your rights, that belongs to a Missouri lawyer, and the Missouri Bar's lawyer referral service is the place to start. If the question is about the person's health or whether the level of care still fits their needs, the physician decides that, not the schedule.