Issue 10 of 52Season 2: Building the Care Plan10 minute read
Building the care plan
Finding and Vetting In-Home Help
A weekly letter for the people who carry the most.
CBy Cherith
Hi friend,
You got as far as maybe.
Maybe you wrote a phone number on the back of an envelope. Maybe you got as far as the website and read the page about services twice without calling. Maybe you did call, and a very warm voice answered, and forty minutes later you hung up knowing less than when you started but somehow feeling like you had agreed to something.
That is the part nobody warns you about. The hard thing was never admitting you needed help. The hard thing is that once you decide to look, you are suddenly expected to evaluate an entire industry you have never touched, in a week, while exhausted, on behalf of someone whose safety depends on you getting it right.
You are not a purchasing department. You are a tired person with a phone.
So this week is the practical half. Who to call. What to ask. How to tell a real answer from a sales pitch. And the one question almost nobody thinks to ask, which is the one that decides whether this actually works.
Before the questions, the reason this is hard
The people you are trying to hire are the fastest-growing workforce in the country, and there are still not enough of them.
PHI reports that the home care workforce more than doubled in ten years, from nearly 1.4 million in 2014 to nearly 3.2 million in 2024. It projects over 6.1 million total job openings in home care between 2024 and 2034.
Now the number that explains everything else: in 2024, the median hourly wage for home care workers was $16.77.
The woman who will bathe your mother, notice that her ankle is swollen, and call you when something is wrong, is earning less per hour than most of the people who will tell you she is expensive.
The workforce, in three numbers
3.2M
home care workers in 2024
6.1M
projected openings, 2024–2034
$16.77
median hourly wage in 2024
Source: PHI, Direct Care Workers in the United States: Key Facts 2025.
First, the shortage is not your fault and it is not a reflection of your family. If the first agency cannot staff you for three weeks, that is a labor market, not a judgment. Call the next one.
Second, turnover is the real risk, not cost. Most families brace for the price and get blindsided by the churn. The plan falls apart when five different people come in five weeks and your mother stops opening the door.
Who to actually call
If the need is medical, look for a Medicare-certified home health agency. Medicare’s booklet sends families to Care Compare to find one, and says you have a say in which agency you use.
If the need is non-medical—bathing, dressing, meals, or someone in the house—look for a home care or personal care agency. Start with the Eldercare Locator at 800.677.1116. They know local providers, do not sell any of them, and will talk to you for free.
Call three. Not because two of them are bad, but because you cannot hear what a normal answer sounds like until you have heard three of them.
The questions that separate a real answer from a sales pitch
Ask “are your caregivers reliable” and every agency can say yes. Ask “what happens at seven in the morning when the aide calls out,” and you will get either a procedure or a pause. Both are information.
A sales pitch answers the feeling. A real answer has a number in it.
Print this. Keep it by the phone.
Six questions, asked in this order
1
“Are you Medicare-certified, and are you licensed in this state?” Medicare’s own checklist opens here. If the answer wanders, that is your answer.
2
“Will it be the same person every week, and what percentage of shifts does that usually hold?” You want a number. A feeling is not a number.
3
“What happens at seven in the morning when she calls out?” You want a procedure, and ideally a story about the last time it happened.
4
“What do you pay your aides?” It feels rude. It predicts everything. Turnover is the risk, and pay drives turnover.
5
“Can you put in writing, before the first shift, what this costs and what is not covered?” Medicare says agencies should give you the cost picture verbally and in writing.
6
“Can I talk to a family you have served for more than a year?” The length is the whole question. Anyone can produce a happy first month.
Same six questions. Three agencies. One page.
The one question almost nobody asks
“Will it be the same person every week, and what happens when she leaves?”
Not “do you have good caregivers.” Every agency has good caregivers. The question is whether your good caregiver will still be yours in November.
Listen for a number, a backup plan with a name in it, and what they pay. “Most clients see the same aide about eighty percent of shifts” is an answer. “We really try to keep it consistent” is a feeling.
Last week I told you the 2025 national median for non-medical caregiver help was $35 an hour. Put that beside the $16.77 the aide earns. Agencies carry payroll taxes, insurance, and scheduling costs, but knowing both numbers changes how you listen.
A timeline, not a deadline
What the first three weeks actually look like
Days 1 to 2
Two calls, not ten
One call to the Eldercare Locator for who covers your person’s county. One call to a doctor’s office if any part of this is medical. You are gathering names, not deciding anything.
Days 3 to 7
Three agencies, same questions
Ask each one the same things so you can actually compare. Take notes on paper. By the third call you will hear the difference yourself.
Days 8 to 14
The check, from anywhere
Confirm certification, use Medicare’s comparison tool for home health, ask for the written cost statement, and ask the continuity question. None of this requires being in the room.
Days 15 to 21
A short first shift
Start with two to four hours on a day that is not a crisis, with you in the house. First shifts are for meeting people, not for testing them.
Three weeks is normal. If it takes six, you have not failed. The delay is the market, not you.
Wherever you are standing in this
If you carry the daily care, you do not have to make the calls yourself. Comparing agencies is delegable work. Being there the first morning is not. Spend your hours on the part only you can do.
If you live nearby, say plainly before anything is signed whether you can actually get there in twenty minutes at seven in the morning. The plan will quietly assume you can.
If you are the one far away, this is the week your distance stops being a limitation. Certification checks, comparison calls, cost statements, and complaint routes can all be handled from your kitchen table.
Why this matters for the person you love
A checklist can feel like control, but the person whose house this is did not ask for a vendor comparison. She wants to know whether she will still decide things in her own kitchen.
Before the first shift, ask what she wants help with first and what she would rather do herself for as long as she can. Then tell the agency both answers.
Your endurance is not separate from her care plan. It is the load-bearing wall.
Your steady hand this week
Some of what you are shopping for is not for them. Part of what you are trying to buy back is a body that gets to see a doctor and a night that ends.
1 in 4
Nearly a quarter of family caregivers say they have difficulty caring for themselves. If your own appointments keep getting moved, you are not disorganized and you are not the only one.
Source: AARP and the National Alliance for Caregiving, Caregiving in the U.S. 2025
The small step
Find one place in your house that is not a work station, and sit in it for two minutes with nothing in your hands.
Not the chair where you sort pills. Somewhere your body does not already associate with a job. No phone, no list, no thinking ahead.
If you need somewhere to turn this week
Resources matched to today’s topic. You do not have to carry this alone.
I verify these before every issue. If a link or program has changed, I will let you know.
Before you go
You are not going to get this perfect, and perfect was never the standard. The standard is good enough to start, and reversible. You can change agencies. The first arrangement is a draft, not a verdict.
Call three. Ask the six questions. Write the answers on paper. Pick the one that gave you numbers instead of feelings, and start with a short shift on an ordinary day.
When you are sitting in the kitchen that first morning listening too hard, remember that the towel will be folded wrong, and that this is what the beginning of shared weight feels like.
You have been giving real answers for years. Now you get to ask for some.
With you in it,
C
Cherith
The Steady Hand
P.S. Next week we go smaller and more daily: medical supplies. The gloves, pads, wipes, thickener, and the things people quietly overpay for because nobody told them there was another way.
You are allowed to ask hard questions on behalf of someone you love. That is care with its eyes open.
