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How to set up in-home care for a parent from another state: the out-of-state daughter's St. Louis folder
If you are trying to work out how to set up in home care for a parent from another state, the thing you are missing is not a phone number. It is a folder. One physical folder in her house and one shared document on your phone, holding the same things: the papers, the numbers, the names, and who has a key. Everything you arrange from Denver or Dallas runs through it, so build it first.
The National Institute on Aging's checklist for getting affairs in order says to put important papers and copies of legal documents in one place, whether a file, a drawer, or a notebook that lists where everything is, and then to tell someone you know and trust where to find them. On its long-distance page it adds the digital half: create a list of important phone numbers and email addresses, keep it in a shared document or spreadsheet online, and update it regularly. Folder in the house, document in the cloud, same contents.
Tab one: the papers
The NIA's affairs-in-order checklist sorts what belongs in the folder into personal, financial and health information, and it names the legal documents that matter most: a will, a durable power of attorney for finances, and the advance directives, which it says are legal documents that provide instructions for medical care and only go into effect if you cannot communicate your own wishes. In Missouri those advance directives have local names. Missouri Legal Services explains that the most common types are a Durable Power of Attorney for Health Care, which appoints an agent to make health care decisions when you are unable to, and a Health Care Choices Directive similar to a living will. The Missouri Bar publishes the form free and says you do not need a lawyer to complete it, though you may want one if it does not fit.
One item on the NIA list is easy to miss and matters most to a daughter in another state. The checklist says to give permission in advance for a doctor or lawyer to talk with your caregiver as needed, notes that you may need to sign and return a form, and points out that this differs from naming a health care proxy: a proxy decides only when she cannot communicate, while permission lets the office talk to you on an ordinary Tuesday. Ask her physician's office which form they use and file the signed copy here.
- Personal: full legal name, Social Security number, date and place of birth, where the birth and marriage certificates live.
- Financial: income sources, insurance policies with agents' names, banks and account numbers, the latest tax return, where the signed will is.
- Health: the Missouri durable power of attorney for health care, the health care directive, the permission-to-talk form, every doctor's name.
- Review: the NIA says at least once each year and after any major life event. Put a date on the front of the folder.
Tab two: her money, and your authority to touch it
You will end up paying a bill from another state. Before you do, know what the paper you hold allows. The Consumer Financial Protection Bureau publishes free guides for managing someone else's money, one for each of four roles: an agent under a power of attorney, a court-appointed guardian, a trustee under a revocable living trust, and a government-appointed fiduciary for Social Security or VA benefits. Print the one that matches your role and file it behind the document that gives you the role. If you have none of those papers, you are a daughter with a login, and the guide explains why that is worth fixing before anything goes wrong.
Tab three: the numbers
The same list is on the home page; this copy lives in the folder. The Eldercare Locator, 1-800-677-1116, a public service of the Administration for Community Living, routes you by her ZIP to whichever agency covers her address. For St. Louis County that is Aging Ahead, the Area Agency on Aging for St. Louis, St. Charles, Franklin and Jefferson counties since 1973, with Meals on Wheels, caregiving services and community options consulting; its home page lists (800) 243-6060 as the main line. Add her doctor, her pharmacy, the neighbor with a key, the nearest hospital, and 211, which answers 24 hours a day in Greater St. Louis. Then add yourself, with your time zone next to your number, so the neighbor calls anyway.
Tab four: the three kinds of help at home in Missouri
"In-home care" means three different things in Missouri, and knowing which you are setting up saves a week of wrong calls. The state's health department describes three types of care in the home:
| Type | Who mostly pays | What it is | How you start it |
|---|---|---|---|
| Home health | Medicare | Skilled, part-time or intermittent | Through her doctor; it is ordered, not hired |
| In-home care | Medicaid (MO HealthNet) | Homemaker and personal care | Request services at the state's DSDS Call Center, 866-835-3505 |
| Private duty or private pay | Private funds or insurance | Aide personal care, respite, companion care | No physician order needed; Missouri issues no license for this type of company |
The first row is medical and not yours to arrange; ask the care team whether it is in the plan, and know that Medicare does not pay for 24-hour-a-day care at home or for custodial or personal care that helps with daily living when that is the only care you need. The second row depends on whether she qualifies; the call center will tell you. The third row is the one a daughter can set up from another state this week, and because the state issues no license for it, there is no directory to check. What you can ask for is answers.
Tab five: what to ask any company before anyone is in the house
Not a ranking; this site names and scores no one. These are what an out-of-state daughter needs answered before a stranger has a key.
- Who, exactly, comes? One person or a rotation, and what happens when they are sick.
- Will you call me after every visit? The single most important question on this page. If the answer is "we can do a weekly summary," ask again.
- How do I authorize and pay from another state? Who signs, who is billed, and whether you can change hours by phone.
- What can the caregiver not do? A good answer names the line: no nursing tasks, no deciding what a symptom means, no changing what is in the pill box. Reminding her to take what is in the labeled box is prompting; deciding what should be in it is medicine, and her doctor's.
- What happens if she refuses the visit? Because she will, at least once.
- What if the caregiver arrives and something is wrong? Who they call first, and whether you are second.
The paid placement on this site belongs at the end of that list, not the top. New Plan Care is an independently owned non-medical in-home care company based in Chesterfield, Missouri. Its caregivers work the west-county towns a daughter in another time zone actually needs covered: Ballwin, Chesterfield, Eureka, Glencoe, Grover, Pacific, Valley Park, and the rest of St. Louis. They help with meals, bathing and dressing as personal care, rides, companionship, overnight presence and a regular routine, and they will take a call from another time zone. It is a client of OwnersFirm, which publishes this site, and pays to be named here. Ask what a week costs on the phone; this desk will not invent a number the company has not printed. Ask it the six questions above. Call (314) 405-0887, or read what it does before you do.
Tab six: who has a key
Access is what stops an out-of-state plan cold, and it is the tab families forget. Decide, with her, who holds a physical key and write the names down: the neighbor, one sibling, and, once you hire anyone, how they get in on the first morning. A lockbox with a code you can change from your phone lets a caregiver in without waking the neighbor, and lets you change the code the day a caregiver stops coming. Ask any company how its caregivers expect to get in. Write the code in the folder in the house, not in the shared document, and tell her where it is. The folder is hers.
What to do tonight
- Create the shared document with six headings: papers, money, numbers, the three kinds of help, questions, keys. Blanks are the to-do list.
- Send a folder and six tabs to her house, addressed to her, with a note that you will fill it together on the next visit.
- Download the Missouri Bar's free durable power of attorney for health care form and read it once before the visit.
- Text your number, with your time zone, to the neighbor with the key.
When to ask the care team or the doctor
Row one, home health, is ordered by a physician and belongs to one. Whether she needs it, for how long, and what skilled care means for her are not questions this folder can answer. The permission-to-talk form in tab one exists so you can ask her doctor yourself, from another state, with her blessing. And if the reason you are setting up help is a change you noticed, a fall, weight loss, confusion, a story that will not line up: the help is the logistics. The change is the doctor's.