You are comparing agencies because the daytime help is not reaching the bathroom trip at night, or because a hospital or doctor's office gave you a list of names. Either way, the first visit is where you learn what the agency actually does. Judge it on that visit, on the night phone line, and on what it will put in writing.
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.
Before you call anyone
Write down the falls you already know about: the date, the hour, and where she was on the walk from bed to toilet. Keep the walk stop by stop, from the edge of the mattress to the bathroom door to the toilet and back. An agency that takes the night seriously will ask for this. An agency that only asks for her name and insurance card is telling you how it will work.
Ask for the agency's state license number and look it up on the state's public licensing search before anyone comes to the house. If you need skilled visits, ask whether the agency is certified to bill Medicare. Write down the answer and the name of the person who gave it.
Questions to ask on the phone
Ask who would make the start-of-care visit and whether that same clinician returns for the next visits. Ask whether anyone is assigned to her case by name. Ask whether the agency does night visits at all. If it does not, say so plainly; a clear no is more useful than a vague yes.
Ask who answers the phone after hours, whether those people can see her chart, and whether they have ever been to a house like hers. Ask how a fall is reported to you and to her physician, and how quickly. Ask who covers when the usual person is out.
Whether she needs skilled nursing or therapy is a question for her physician, who signs the order. Do not let any agency decide that for you on the phone. Ask the agency what it needs from the doctor and what it will send back.
Ask how medicine is handled in the home. A non-medical worker may remind her to take her medicine and may pick up a prescription as an errand. The family, the doctor and the pharmacist keep the medicine itself. If an agency says its aides will hand out, sort or manage her medicine, ask who is responsible for that and get the answer in writing.
On the first visit
Watch whether the clinician walks the route with her or only sits in the kitchen. Look at the bed height, the lighting between the bed and the bathroom, the bathroom door, and the rug or cord at the edge of the path. A good first visit ends with a list of what was seen, not just a promise to follow up.
Ask for a copy of the written plan before the visit ends. Read it that night. Check that the night route is in it, that the falls are in it, and that the phone numbers are the ones you were told.
What to write down
Keep one page with the agency name, the license number you checked, the names of the people you spoke with, the night phone line, and who you call first if she falls. Write down every promise made by phone or in person, and mark which ones appear in the written plan. Anything not on paper is not yet a commitment.
When to walk away
Walk away if the agency will not put the night route in writing, cannot name who covers the off hours, says it will handle her medicine, or leaves costs as a verbal estimate only. Ask for the refusal in writing too. You can keep it and compare it with the next agency.
For agencies that serve the St. Louis area, the local help list is on the local help page. Use it to build your call list, then judge each agency by the same questions above.