The discharge planner hands you a list this afternoon.

You will be asked to pick an agency before supper, for a parent who is coming home on Thursday, and nobody has explained what any of it costs. This page is the next 72 hours, in order.

A sunlit front room with an empty armchair, a folded quilt over the arm and a wheeled walker parked beside it. — The room most of our work happens in. Getting out of that chair safely is the whole job.

The first 72 hours

Hour 0

You call, and we ask seven questions.

Not an intake packet. Seven questions, about four minutes, and at the end of them we tell you plainly whether we are the right kind of help or whether you want somebody else.

Who is coming home, and from where
What they cannot do alone right now
Whether anyone stays overnight in the house
Stairs, and where the bathroom is relative to the bed
Whether there is a Medicare home health order in place
Whether there is long term care insurance or a VA benefit
What day and what hour you need somebody there

Hour 4

A nurse walks the house, and it is free.

Same day when we can, next morning at the latest. She is not there to sell an assessment. She is there because most of what sends someone back to the hospital in the first month is in the house, not in the diagnosis.

The path from bed to toilet, at night, in the dark
Throw rugs, cords, and the height of the bed
Grab bar anchoring, which is usually into nothing
Every bottle in the cabinet, written down and compared to the discharge sheet
Who else is in and out of the house, and on which days

A kitchen counter in an older home with a seven day pill organiser part filled, an open spiral notebook, a landline phone and a coffee mug. — The counter is where the nurse spends most of the visit. Every bottle in the house gets written down and compared against the sheet the hospital sent home, and the two lists disagree more often than they agree.

Hour 24

The first shift, and the same aide on the second.

We staff the first week with two people and no more, so your mother is not meeting a stranger every morning during the week she is least able to handle one. If the fit is wrong, say so and we change it. There is no charge for a shift you send home in the first hour.

Bathing, dressing, transfers, toileting
Meals cooked in your kitchen, and the dishes after
Medication reminders, from the box you filled
Laundry, bed linens, and the trash out on the right day
Rides to the follow up appointment, in her car

Hour 48

What the aide is not allowed to do.

This is the part agencies leave off the website, and it is the part that causes the argument in week three. An aide is not a nurse. In Missouri an unlicensed aide may not do any of the following, and ours will tell you no.

Push medication, including putting a pill in someone's hand
Wound care past a clean dry dressing
Injections, including insulin
Catheter or feeding tube work
Lift a person alone who cannot bear any weight

Hour 72

The schedule settles, and you see the number.

By the third day we know what the week actually takes, which is almost never what the hospital estimated. You get a written schedule and the weekly figure before the first invoice, not after it. Change it with 24 hours notice and there is no fee.

Four different things get called home care, and only one of them is us.

They are paid for in completely different ways, which is why the answer to "does insurance cover it" is genuinely different for each. Read the one that matches your situation and ignore the rest.

Home care

Paid privately, by the hour

Bathing, meals, housekeeping, transport, company. No licence required to receive it, no doctor's order, no diagnosis. This is what we do.

Home health

Medicare Part A, if you qualify

Skilled nursing and therapy, ordered by a physician, for a limited number of weeks after an event. Excelsior Springs Hospital runs one. It ends when the goal is met.

Hospice

Medicare hospice benefit

Comfort care with a six month prognosis. Covers the nurse, the equipment and the medication for the terminal condition. It does not cover somebody sitting with her all night.

Assisted living

Private, monthly, plus a move

She leaves the house. Around $4,000 a month in this part of Missouri, and the waiting lists in Clay County run long. Worth pricing against 30 hours a week at home.

What an hour costs

Effective January 2026. Four hour minimum on any single visit. No registration fee, no assessment fee, no annual fee.
Shift	Per hour
Weekday, 7am to 7pm	$34
Evening and weekend	$37
Overnight, awake, 10pm to 6am	$39
Live in, 24 hours, per day	$385
Six named holidays	$51

A common week here is three mornings and a Saturday, which is 16 hours and comes to $556. Long term care policies reimburse most of that; we bill them directly and you pay the difference. Missouri Medicaid consumer directed hours are billed to the state, not to you, but the waiting period is real and we will tell you how long it is running this month.

Where we actually drive

Excelsior Springs, Lawson, Kearney, Holt, Richmond, Orrick, Camden, Hardin, Polo, Braymer, Plattsburg, Lathrop, Smithville and Liberty. Anything past a 35 minute drive from Broadway and we will say so on the phone rather than take the case and staff it badly.

The front porch of a white clapboard house on a small town street, with a wooden ramp built over the front steps.

If you are reading this at eleven at night, call anyway.

Somebody picks up. Not a service that takes a message, and not a menu. The overnight phone is on a person who can schedule a shift for the morning.

(816) 555‑0142

If it is an emergency, hang up and dial 911 first. We will still be here after.