Families worry about the wrong part. The question is almost never whether the aide will be competent. It is whether a stranger in the kitchen will make the house feel like somewhere else.

So here is exactly what the first week looks like with us, hour by hour, including the parts that usually go badly and what we do about them.

Before anything: the call

Fifteen minutes. We ask five things and we can quote on the call.

• What specifically is going wrong, in plain terms rather than clinical ones.
• Which parts of the day are hardest. Usually the morning block and the evening.
• Whether there are steps at the door, how many, and whether the flight turns. Send a photograph from the bottom of the stairs and we can answer straight away.
• Whether the person walks with help or uses a wheelchair.
• Who else is already helping. Family, neighbors, the Council on Aging.

No assessment fee, no membership fee, no minimum contract. If what you need is something your Council on Aging already provides free, we will say so. That happens most weeks.

Day one

Short, and deliberately not ambitious.

The aide arrives, is introduced, and does something practical and unintrusive. Making a cup of tea and putting a wash on beats a clipboard every time. We do not start with bathing on day one unless it is genuinely urgent, because personal care is where you end up rather than where you begin.

If you can be there for the first thirty minutes and then leave, do that. Your presence makes the introduction easier and your continued presence makes the visit about you.

Days two to four

The same person, the same time, the same order. Routine is doing most of the work here.

This is also when the plan changes, and it should. Almost every first plan is wrong in the same direction: the family has bought the wrong hours. The bad hour turns out to be six in the evening rather than eleven in the morning, or the shopping matters more than the cooking. Tell us in week one rather than month three. Changing it costs nothing.

The end of the first week

Three questions worth asking, in this order.

• Ask the person, not the family. Not did it go well, which gets a polite yes. Ask what she actually did, and listen for whether the answer is warm.
• Ask yourself what you stopped doing. If your week has not changed at all, the hours are in the wrong place.
• Ask us what we noticed. An aide in the house every day sees things a fortnightly visitor does not. Swelling, a new unsteadiness, food untouched, a bruise nobody mentioned.

That last one is the part families do not expect and rate highest later. A trained aide is an early warning system, which is exactly why we call it home health aide care rather than non-medical care.

What usually goes wrong, and what we do

• The person is cool about it for a fortnight. Normal. Accepting help means accepting that something has changed. It almost always thaws, and the thing that thaws it is the same face arriving at the same time.
• The family buys too many hours out of anxiety. Also normal. Cutting back is a correction, not a failure, and it is a good sign.
• The regular aide is sick. It will happen. Ask us how we handle it and we will describe an actual week rather than a policy.
• It is not the right match. Say so early and plainly. Nobody is offended and the fix is quick.

What it costs to start

One hour is a real booking. At $45 an hour , a single weekly visit is $45. A short daily visit covering medication, breakfast and a wash is $315 a week. Four hours every weekday is $900.

Start smaller than feels comfortable and add. Families who start high and step down often feel they got it wrong; they simply corrected, which is what a first week is for.

And if the difficulty is the building

Some of what looks like a need for more hours is really a set of front steps. We run stair assistance at $200 a visit with two trained staff and a motorized chair, and wheelchair transport at $115 each way, off the same number as the care. One agency, one invoice.

Where to go from here

Two different problems, two different places to start.

• If the difficulty is the week itself. Tell us what the week actually looks like and we will say what it would take and what it would cost, on the call, before you commit to anything. Home health aide care is $45 an hour.
• If the difficulty is getting out of the house. Book a ride and stair assistance here. Wheelchair transport is $115 each way or $230 round trip within five miles, and stair assistance is $200 a visit.

Questions we did not cover here are almost certainly in the home care FAQ, with the prices published.

Care Remedy Inc, 100 TradeCenter Suite G-700, Woburn, MA 01801. Call 781-957-8076 . Home health aide care, wheelchair transportation and stair assistance across Greater Boston, with offices in Woburn, Brockton and Springfield.

Sources: Mass.gov, Home Care Program. Our rates are current as of publication. This article is general information and is not medical advice.