A home care agreement is usually more than the signed page. The front contract often names other documents and asks the family to accept them by reference: a rate schedule, a staff handbook, a client rights notice, a service area map, an incident policy, or an emergency plan. Each of those pages can change what the family actually agrees to, and each may sit in a different office folder or an online portal. Before anyone signs, the family should know which pages the contract points to, which version of each one applies, and whether anyone in the household has read them.

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.

Start with the words that point elsewhere

Read the signing page for phrases that send the reader somewhere else. Common examples include 'as amended,' 'as posted,' 'as described in the attached,' 'available upon request,' and 'in accordance with agency policy.' Each phrase is a pointer to a document that may not be in the packet. Mark every pointer on a printed copy of the contract, then match each mark to a named page.

Build the attachment list

For each referenced page, write down the title, any version or revision label printed on it, the name of the office that wrote it, and whether the family received a copy at signing. If a page has no version label, ask the agency to add one in writing. A page with no label cannot be compared with a later copy.

  • Title of each attachment, schedule, or policy named in the contract
  • Version or revision label, or a written note that none exists
  • Who wrote the page and who in the office maintains it
  • Whether the family holds a copy, and where it is filed

Ask whether a page can change after signing

Some agreements let the agency revise an attached page without a new signature. Ask the agency, in writing, the following: Can any attached page be revised without a new signature from the family? How will the family be told about a revision? Will the family receive the new version in writing before it takes effect? Is there a stated period in which the family can object or end service? A clear answer to each question is more useful than a general assurance that the agency is fair.

Treat brochures and website text as advertising unless the contract adopts them

Any written promise about replacement staff, arrival timing, or response after a missed visit should appear in the signed packet itself. Brochures, website pages, and sales sheets are not part of the agreement unless the contract says it includes them. Ask the agency to point to the page in the signed packet that contains each promise you heard during the tour. If the answer is that the promise lives only in the brochure, write that down as an open question.

Keep one packet and compare copies page by page

The family should keep one folder that holds the signed agreement, every attachment in the version it was signed with, and a note of the date each copy was received. Name the person in the household who receives any updated page. Ask the agency whether its office copy matches the family copy, and compare the two page by page on the day of signing and again whenever the office sends an update. Any difference between the copies is a question to resolve in writing before the difference takes effect.

Questions to bring to the office

  • Which pages does the contract incorporate, and where is each one kept?
  • Which version of each page applies to our household today?
  • Can any page change without a new signature from us?
  • How will we receive changes, and how much notice do we get?
  • Which written promises in your brochure appear in the signed packet?
  • Can you explain any clause in writing if we ask you to?

How to use this with a shortlist

When comparing agencies, put the attachment lists side by side. An agency that names few pages and keeps them in one place is easier to check than one that refers the family to several portals. Agencies that cannot produce a complete packet before signing have given the family a useful answer. For the method behind the agency rankings on this site, see How We Rate: Methodology. Ratings describe the agencies listed, not the paperwork in any one household, so the packet check remains the family's own task.

Anyone who does not understand a clause can ask the agency to explain it in writing and can ask a professional of their own choosing to read it. The county area agency on aging and the state consumer protection office can also answer general questions about how home care paperwork is usually handled.