Can I hire someone just to sit with my wife?

Can I hire someone just to sit with my wife is the sentence men type when they have an appointment and no spare person. The answer is yes. In-home dementia care in St. Louis, Missouri is often this job first: a person in the chair so you can leave. Chesterfield or Ballwin is the same job. Four hours, written down. It does not have to mean a nurse, and it does not have to mean all day.

Family Caregiver Alliance puts the scale on the table: about 50 percent of caregivers get no outside help at all. That is the default you are already living. This page is the other option, and the line where it stops.

Is sitting a real job under Missouri's three types of care?

Missouri's health department names three types of care in the home, and sitting lives in the third. Home Health is the skilled kind, with Medicare as the major payer, ordered by a physician, part-time or intermittent. In-Home Care is the Medicaid kind: homemaker and personal care, respite, adult day, requested through the DSDS Call Center at 866-835-3505. Private duty or private pay is funded by private money or insurance. No physician order is needed for an aide giving personal care, respite, or companion care, and no license is issued in Missouri for that type of company. Private-duty shifts, the state says, run four plus hours at a time. That is why the first hire on this desk is a four-hour block, not a drop-in.

This site does not enroll anyone in the Medicaid in-home program. Whether she qualifies is a question for DSDS. The private-pay door is the one that opens without a physician order when the job is companion sitting.

The National Institute on Aging describes the same work in plainer words. Home care services send an aide to help with personal care and/or company. Aides assist with bathing and dressing, and may help with light housekeeping, transportation, and errands. They do not provide skilled medical care. Sitting is the company half of that sentence. You are allowed to hire that half and leave the rest off the card.

What does a companion caregiver do, and what does that person not do?

Write the yes list first, then the stop line. Vague help is how you never call.

Yes, as companion and personal care. Sit in the chair you name. Keep her company. Make or set out lunch. Walk the hall if that is her loop. Help with bathing and dressing as personal care, not as nursing. Light housekeeping or a ride if you put it on the card. A reminder that it is time to take the tablets already in her labeled box. Presence in the hallway if she wanders. Overnight sitting is the same job at a different hour.

No, as a non-medical stop line. No skilled nursing, wound care, injections, or feeding tube. No deciding what a symptom means. No changing a dose. A reminder is prompting. A dose change is medicine. Wandering watch is presence, not a clinical intervention. If she needs the skilled list, that is home health, ordered through the physician. Ask the care team. Do not ask a companion to do it.

Medicare's own line is the other stop. Medicare does not pay for 24-hour-a-day care at your home, and it does not pay for custodial or personal care that helps with daily living activities when that is the only care you need. Sitting, by itself, is not a Medicare home health visit. This page is the job description, not the payer map.

The four-hour shift, written as a punch list

Do not hire "help." Hire a block. Here is one that matches a morning doctor visit. Copy it, change the times, keep the overlap.

1. 19:30 a.m. She arrives. Coat on the hook you name. You are still in the house.
2. 2Same chair. The one by the window, or the one across from the TV. Not a tour of the house. Sit where she already sits with you.
3. 310:00 a.m. You leave. Fifteen to thirty minutes of overlap is the handoff. Walk out while she is still looking at the other person. Do not linger in the doorway.
4. 4Lunch. What she already eats. Plate, cup, napkin. If a tablet falls in this hour, remind her from the labeled box. Never a dose change.
5. 5A walk in the hall. If that is her loop, it stays her loop. If she does not walk, she does not walk. No new exercise plan.
6. 62:00 p.m. You are back. Short overlap the other way. She (the caregiver) leaves. You are the person in the chair again.

Put bathing on a different card if that is the job that day. Bathing is personal care: help with the shower or the sink, the way you already do it, not a nursing task. Put wandering on the card as presence: be in the hallway, keep the door routine you already use. Do not write "prevent wandering" as if a person can guarantee it.

Medication, once more. The box is hers, labeled the way the clinic already set it. The companion says it is time. She takes what is in that slot. If a slot is empty, or she refuses, the companion calls you or follows the note you left. Nobody on that shift invents a substitute tablet.

What if my wife with dementia refuses the caregiver?

This is the usual first week, not a special failure. A wife with dementia refuses a caregiver for the same reason she will not let you leave: the house has one safe person, and it is you. Family Caregiver Alliance's hiring guide names it: families often face a loved one who does not want a stranger in the house. Tell the person you need help, and that accepting hired care is something they can do to help you, not a sign you are going to abandon them. Be present at first so the attendant and your wife can establish a relationship. If the person a company sends is not a fit, ask for someone else.

Script, short. "I have a doctor visit. This is [name]. She is going to sit with you. I need you to let her. I will be back at two." Do not argue the diagnosis. Stay for 9:30 to 10:00. Leave at 10:00. The shadowing article on this site is the longer version of the doorway problem.

If the refusal is still a hard no after two visits, change the label, not the job. Family Caregiver Alliance notes that some people will accept a "housekeeper" before they will accept a sitter. The punch list can still be the chair, lunch, and the hall. You are not tricking her about medicine or about where you went.