Nobody in Melrose wakes up and decides to arrange home care. Something happens first.

She has stopped washing properly and will not say why. He has lost weight and there is nothing in the fridge worth eating. There was a fall in February that only came out in June. A daughter has been coming every morning before work for a year and has run out of road.

This is the plain version of what home care here costs, what a caregiver actually does in the house, and how few hours it usually takes.

What does home care cost in Melrose?

$45 an hour for home health aide care, from one to eight hours a day. No membership fee, no assessment fee, no minimum contract.

What that buys in practice:

• One hour every morning for medication, breakfast and a wash: $315 a week.
• Three mornings a week, three hours each: $405 a week.
• Four hours every weekday: $900 a week, about $3,900 a month.
• A single weekly visit for the shopping and the laundry: $45.

We publish the rate because almost nobody in this state does. Ask every agency you call for three things in this order: the hourly rate, the minimum visit length, and the weekend rate. Four hour minimums are common and they quietly double the cost of a plan you thought was two hours a day.

What does a home health aide actually do?

The practical, physical parts of the day that have stopped being manageable. Not medical treatment.

• Personal care. Bathing, showering, dressing, grooming, toileting and continence care. Usually the reason a family finally picks up the phone.
• Getting up and moving safely. Transfers, help on and off the bed and the toilet, a steadying arm around the house.
• Meals and fluids. Cooking, and whether the food is actually being eaten, which are two different problems.
• Medication reminders, and noticing when the pills are not going down.
• The house. Laundry, bedding, tidying, the shopping.
• Company. Ranked last by families when they call and first when we ask them six months later.

We call it home health aide care rather than non-medical care, because the phrase non-medical undersells what a trained caregiver notices. She is in the house every day. She sees the swelling, the new confusion and the untouched food in the fridge before anyone at a clinic does.

What an aide does not do is skilled nursing. Wound care, injections, IV therapy and monitoring an unstable condition need a nurse through a Medicare certified agency, and if that is what you need we will say so and point you at it.

How many hours do we actually need?

Fewer than most families assume, and in a different shape.

The hard parts of a day are not spread evenly across it. They sit in two blocks: the morning from about seven to eleven, which is washing, dressing, medication and breakfast, and the early evening, which is supper, settling and the hour when confusion is worst. The middle of the day is usually fine alone.

Shape the hours around those two blocks and you will spend a fraction of what a full day costs. Start smaller than feels comfortable and add. Families who start high and cut back often feel they got it wrong; they simply corrected, and that is a good sign.

Will it be the same caregiver every time?

That is the goal, and it is the most important question you can ask any agency.

Continuity is most of what makes home care work. For somebody with memory problems, a rota of strangers is worse than no help at all, because every visit starts from nothing and each new face is an intrusion rather than a relief.

Every agency will tell you continuity matters. The useful follow up is: what happened the last time the regular aide called in sick? A real answer describes an actual Tuesday. A policy answer describes a policy.

Call these before you pay anybody

A fair number of our first calls end with us saying you do not need us yet, or that something free already covers it.

• The Melrose Council on Aging. The right first call for what the city itself runs, and for benefits help.
• Mystic Valley Elder Services, the Aging Services Access Point covering Melrose along with Malden, Medford, Everett, Stoneham, Wakefield, Reading, North Reading, Chelsea, Revere and Winthrop. The ASAP is the gateway to the state Home Care Program, which funds homemaker and personal care hours for people who meet the age, functional and income tests.
• A SHINE counselor, free, for anything to do with Medicare and supplemental coverage.

If those cover it, that is the right answer and it costs you nothing. Private hours are for the gap they leave, and for people who do not qualify or cannot wait for an assessment.

Should we just hire somebody privately?

A fair question. Hiring directly is cheaper per hour and you become an employer: payroll taxes, workers compensation, liability if somebody is hurt in the house, and no cover at all when your caregiver is sick, on holiday or leaves.

Plenty of families here do it well, usually when they found somebody through a neighbor and the need is stable. What an agency buys you is the backup, the insurance and somebody to call at seven in the evening.

Starting care after a hospital stay

Melrose is better placed than most. MelroseWakefield Hospital, part of Tufts Medicine, is in the city with a full emergency department, so most discharges are a short ride.

One local detail worth putting in your phone now rather than on the night: the hospital's street address is 585 Lebanon Street, but the emergency department entrance is a different address, 70 Rowe Street .

A discharge planner handles the medical handover well and is not resourced to check whether your house works. If a date is already set, call before the day rather than on it, and read what to do when the hospital says the bed is needed, which covers the Massachusetts appeal deadline most families miss by a few hours.

Care in an older Melrose house

About 54% of housing here was built before 1940, which is the high end even for this part of the state. Victorian and early twentieth century houses were built beautifully and were not built for somebody with a walker.

In practice that means a narrow staircase that turns, the only full bathroom on the second floor, and a kitchen laid out for somebody who could reach the back of a high cupboard. Care here is built around that: the morning visit covers washing upstairs so the rest of the day can happen on one level, and the aide keeps an eye on the things that a person living alone has quietly stopped doing because they are too awkward.

If the house itself has become the problem rather than the person, it is worth asking whether a bed can come downstairs and whether a ground floor lavatory can become a shower room, before anyone starts talking about moving.

Which towns do you cover?

Our Woburn office covers Melrose, Wakefield, Stoneham, Malden, Medford, Saugus, Reading, Woburn and Winchester. We also run offices in Brockton for the South Shore and Springfield for the Pioneer Valley.

How to start

One call, about fifteen minutes. Tell us what specifically is going wrong and which parts of the day are hardest, and we will say what it would take and what it would cost, on the call, before you commit to anything.

Tell us what the week actually looks like , or call 781-957-8076 . Home health aide care is $45 an hour, one to eight hours a day, and there is no contract to sign.

Not sure it is time yet? Read the signs worth looking for, or the full FAQ with prices.

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

Sources: Tufts Medicine, MelroseWakefield Hospital · Mass.gov, Home Care Program. Our rates are current as of publication. This article is general information and is not medical or legal advice.