An agency is a business you hire to send people into your parent's home. Before you sign, you are checking three things: what kind of agency it is, whether its license and published record hold up when you look them up yourself, and whether its promises appear in the written agreement. Each check takes an hour or less, and none of them requires the salesperson to be in the room.

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.

Confirm what kind of agency it is

Home care covers two different businesses, and a brochure does not always say which one you are dealing with. A Medicare-certified home health agency provides skilled services, such as nursing visits or therapy, that a doctor orders, and Medicare sets the conditions for covering those services (Medicare.gov). A private-pay or non-medical agency sends aides for personal care, companionship, and household help, and you pay its rate. Ask which category the agency holds. If it offers both, ask in writing which services are billed to Medicare or Medicaid and which are billed to you, and get the answer on the same page as the rate.

Check the license and the published record

Ask for the agency's state license number and the name printed on the license. Then look it up yourself through the Missouri Department of Health and Senior Services (DHSS) or the state office that handles the license type the agency names. Do not rely on a copy the agency hands you. If the agency says it needs no license for the services it offers, ask which rule it is relying on and write the answer down. If the answer is unclear, a Missouri Bar lawyer referral is the right next step, because that is a legal reading, not a care question.

For a Medicare-certified agency, search the agency on Medicare's Care Compare site, which lists certified home health agencies and their published quality measures. Compare the measures for the agencies you are weighing, one measure at a time. Do not pick the agency with the best overall summary and stop there. The individual measures show what the agency has reported about its own care, and they are the parts you can ask about.

Ask the insurance and complaint questions in writing

Ask whether the agency carries liability insurance and workers' compensation coverage for its aides, and whether its aides are its own employees or independent contractors. Those answers decide who pays if an aide is hurt in your home or damages property, so get them in writing and keep the answer. Ask how complaints are logged, who receives them, and how long a complaint usually takes to close. If the agency cannot name a person responsible for complaints, treat that as an answer about the agency.

Read the service agreement line by line

Mark each of the following in the agreement before you sign:

The rate and what it covers, including the minimum shift length, travel time, weekend and holiday rates, and any charge for a shift that is cut short.
How the rate can change, and how much written notice you receive before a change takes effect.
The task list. Name each task the aide will perform, such as bathing help, meal preparation, laundry, or errands. An aide may give medication reminders and pick up prescriptions as an errand. Giving, dispensing, sorting, or managing medicine stays with the family, the doctor, and the pharmacist, so if the task list says otherwise, correct it before you sign.
Cancellation terms, any deposit, and any fee for a missed or late shift on either side.
The replacement rule: what happens when the regular aide is out, how quickly a substitute is sent, and whether you can refuse a substitute.
Who files any claim the agency bills to a long-term care insurance policy or to VA benefits, and whether that filing is included in the rate.
The dispute clause. If the agreement requires arbitration or waives your right to go to court, have a lawyer read that clause before you sign.

The Consumer Financial Protection Bureau publishes general consumer guidance on contract terms and billing disputes, and the questions above apply those ideas to home care when the agency bills you directly.

Where free help fits

Missouri SHIP offers free Medicare counseling and can help you understand what a Medicare-billed home health plan covers and what it does not. Aging Ahead, the area agency on aging for the St. Louis region, can point you to in-home services and to local options you may not have seen in an agency search. The national Eldercare Locator, run by the Administration for Community Living, can connect you with the local office if you are outside that region. The Local Help With Paying for Care page lists these resources, and the Sources page lists the public references behind each claim in this guide.

Stop where the job passes to someone else

Questions about symptoms, treatment, or whether a particular service is medically necessary belong to the doctor and the nurse, not to the agency's sales staff. Questions about the meaning of a contract clause, an arbitration waiver, or a state licensing rule belong to a lawyer. If you are still building the full picture, start with Who Pays for Care at Home in St. Louis, and read the About This Desk page to see what this guide does and does not cover.

Judge the Agency Before You Sign: Check the License, the Published Measures, and the Service Agreement