Most men in this spot start with a name: an agency, a neighbor's nephew, a card on the fridge. Start with a sheet instead. The useful question is not what an hour costs. It is how much of the month is already spoken for, and how much is left for the hours you cannot cover yourself.

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.

Write the income column first

Take one ordinary month and list every dollar that reaches the house for her: pension, Social Security, any annuity or retirement payment, rental income, and any money you draw from savings to cover the gap. Write the amount beside each source and the day it usually arrives. If a payment changes with her condition or her paperwork, mark it so you do not plan around the high number.

Write the care column second

Then list every cost of her care and the part of your household costs she drives. Use the bills you already have. Tag each line one of three ways: paid by a bill you already pay, paid by someone else, or not yet paid by anyone. Include the costs that never show up as a bill: the gas for the appointment drive, supplies she uses each month, and the take-out you buy because you cannot leave her long enough to cook. The sheet only works if the small lines are on it.

Find the gap and name it

Subtract the care column from the income column. If the result is positive, you have room. If it is negative, write the gap as one number at the top of the page. That number tells you how many hours, or which hours, you can afford to buy. It does not tell you what to do about her. Leave that question for her doctor and for you.

Check what someone else may already cover

Before you assume a line is unpaid, read the written terms. Check her health plan's summary of benefits for home care, the supplier's paperwork for equipment, and any long-term care policy she holds. Look for which kinds of help are covered and which are excluded, and whether coverage depends on a doctor's order, a waiting period, or a claim filed inside a set window. A phone call that gets the answer in writing is worth more than a guess from memory. The Local Help for Husband Caregivers page lists where to start asking.

Price the hired hours against the gap

Only now look at a hired helper. Write down the hours you want, the tasks in each block, and the total for a month at the rate the agency or person quotes. Write down every fee that can attach: travel, holiday or late-booking charges, minimum visit lengths, and any charge for a short shift. Then compare that total to the gap. If the hired hours fit inside it, you have a plan. If they do not, cut hours before you cut the lines that keep her safe, and say so in writing to the agency so the trade-off is on paper.

A hired non-medical helper can be booked for medication reminders and for picking up a prescription as an errand, so list those as errand lines. Medicine itself stays with the family, her doctor, and the pharmacist. Do not price it as a helper task.

Keep the sheet current

Recheck the sheet once a month, on the same day, against the bills that came in. When her needs change, the care column changes, and so does the gap. Move the new gap number to the top of the page and keep the old sheet in a folder so you can see what changed and when.

The Monthly Gap Is the Number to Find: Set Her Income Against Care Costs Before You Hire Anything