You do not need a live-in. You do not need forty hours. You need somebody there from seven to nine in the morning, because that is when the shower happens and that is where the falls happen.

So you call an agency, and you get told there is a four hour minimum per visit. And a twenty hour minimum per week. Which means the two hours you actually want costs the same as four, and the eight hours a week you actually want is not available at all.

Here is what is going on, and what your options are.

Why do agencies have minimums?

It is not arbitrary and it is not greed. It is the caregiver's paycheck.

Think about the two hour shift from the aide's side. She drives twenty five minutes to your mother's house, works two hours, and drives twenty five minutes to the next one. She has spent nearly three hours to get paid for two. Do that three times a day and she is working an eleven hour day for six hours of pay. Very few good aides will accept that, so agencies that have to fill shifts with reliable people set a four hour floor and stop having the conversation.

The weekly minimum is a different thing again. That one is about the cost of carrying a client at all: intake, care plan, scheduling, supervision, payroll, insurance. A client at eight hours a week costs an agency nearly the same in overhead as a client at forty. Franchise models in particular are built around a certain hours-per-client number, and eight hours a week does not clear it.

So the minimum is real, and understanding it helps you get around it.

What does Care Remedy actually require?

We schedule from one to eight hours a day, at $45 an hour , with no minimum contract and no assessment fee .

That is the differentiator, so we should be honest about what makes it possible rather than pretending it is magic. Two things: we are not a franchise, so we are not managing to somebody else's hours-per-client target, and we run our own scheduling platform, so the cost of carrying a small client is genuinely lower for us than it is for an agency doing it on paper and phone calls.

What we will tell you honestly: short shifts are easier to staff in some towns than others, and easier at some times than others. A two hour morning shift in Woburn is straightforward. A two hour morning shift forty minutes from any of our offices, at the exact time every other client wants a morning shift, is harder. We will tell you which one yours is on the first call.

What can an aide actually do in two hours?

More than families expect, if the two hours are pointed at the right thing.

A well used morning block looks like this: get her up, shower with somebody steadying her, dressed, medications taken and actually swallowed, breakfast eaten rather than made and abandoned, the bed made, a load of laundry started, a look in the fridge for what is running out, and a few minutes of ordinary conversation.

An evening block is usually different and often more valuable: a real dinner, evening medications, a shower if mornings are a fight, teeth, into night clothes, and into bed safely, with the walker where she can reach it and the path to the bathroom clear and lit.

What two hours cannot be is vague. If the aide arrives and nobody has decided what the two hours are for, they get spent on whatever comes up, and you will not feel like you got anything.

Which two hours should you buy?

Almost every family gets this wrong at first, because they pick the time that is convenient for them rather than the time that is risky for their parent.

If bathing is the problem, buy the morning. The bathroom is where people fall, and a shower nobody supervises is the single largest risk in most of these houses. Skipped showers are also the earliest honest signal that someone is not managing.

If eating is the problem, buy the late afternoon. People who live alone skip dinner more than any other meal, because cooking for one at six o'clock is the point in the day where it stops feeling worth it. Weight loss in an older person is not a small thing.

If confusion is the problem, buy the evening. Confusion reliably worsens as the light goes. If your mother is fine on the phone at two o'clock and strange at seven, the seven o'clock hours are the ones that matter.

If loneliness is the problem, buy the same time every day. The regularity is doing more work than the length. Two hours on Monday, Wednesday and Friday at eleven becomes something to be up and dressed for.

What does a small schedule cost?

At $45 an hour, with no package to buy into:

• 2 hours, three days a week. 6 hours. $270 a week, about $1,170 a month.
• 2 hours, every day. 14 hours. $630 a week, about $2,730 a month.
• 3 hours, every day. 21 hours. $945 a week, about $4,095 a month.
• 4 hours, every day. 28 hours. $1,260 a week, about $5,460 a month.

Worth holding next to the alternative. Assisted living in eastern Massachusetts commonly runs six to eight thousand dollars a month, before the levels of care charges get added, and it involves selling or emptying the house. Two hours a day at home is a different order of decision, and it is reversible.

Is a few hours a day enough?

Sometimes, and sometimes not, and you deserve a straight answer rather than a reassuring one.

A short daily schedule works well when the person is safe alone between visits. That means she can get herself to the bathroom, she is not wandering, she would pick up the phone if something happened, and she is not leaving the stove on.

A short daily schedule is not enough when any of those stop being true. If she has fallen twice this year, if she has gone out at night, if she has forgotten a pot on the stove, then two good hours in the morning does not address what happens at two in the afternoon, and stretching a small schedule to cover a big risk is how families end up in an emergency room wondering how it happened.

We would rather tell you that on the phone than take the booking. If your situation needs more hours than you are asking for, you will hear so.

What about hiring privately instead?

Plenty of families do, and for a small number of hours it can be cheaper per hour. Go in knowing what you are taking on.

When you hire someone directly to work in your parent's home, you are generally the household employer. That means payroll taxes, and it means workers compensation coverage, which Massachusetts requires for a domestic worker in a private home at sixteen hours a week or more. Massachusetts also has a Domestic Workers Bill of Rights, which sets out rules on written agreements, rest breaks, notice before termination and record keeping.

And there is the practical problem underneath all of that, which is coverage. When your private aide has the flu, or her car breaks down, or she takes a two week holiday, there is nobody. Agencies exist substantially to solve that one problem.

None of that makes private hire wrong. It makes it a real decision rather than a cheaper version of the same thing.

Starting small in Massachusetts

Care Remedy provides home health aide care across eastern and central Massachusetts, with offices in Woburn, Springfield and Brockton. One to eight hours a day at $45 an hour. No minimum contract. No assessment fee. Start at two hours, add hours if you need them, stop when you do not.

Call 781-957-8076 and tell us the town and the two hours you want. We will tell you on that call whether we can staff it.

Starting small is not a lesser version of getting help. For most families it is the right first move, and it is a far easier conversation to have with a parent than any of the alternatives.