If you are wondering whether your widowed father needs help, you have probably already seen a sign or two. The mail is piling up. The refrigerator has the same three things in it. He is wearing yesterday's shirt. He used to call you and now you call him. In St. Louis families, as anywhere, the daughter is usually the first to notice, and the first to wonder whether she is overreacting. You are probably not.

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.

The plain answer: the common signs are small changes in the things your mother used to keep running. Meals that stop being meals. Showers that slip. Laundry that stops moving. Bills unopened. Fewer trips out. A house that is cleaner than it should be because nothing is being used, or messier than he would ever have allowed. Any one of those alone can be grief. Several together usually mean he would do better with a regular second person in the house, and non-medical in-home help is built for exactly that.

The signs worth writing down

Walk the house on your next visit and write down what you see, not what you fear. Food: is there real food, and is any of it being cooked? Clothes: is there clean laundry in the drawers? Bathroom: are the towels used, is the soap wet? Mail: is it opened? Car: has it moved? Calendar: is anything on it? Phone: does he answer? Keep the list plain. You will need it in a minute.

What non-medical help looks like

A companion or personal care aide comes on a schedule and fills the gaps you wrote down. That can mean cooking a supper and leaving another for tomorrow, folding a load of laundry, standing by during a shower, driving him to the barber, sitting with the mail, and giving a reminder about his pills. The caregiver does not take over his life or his medicine. The pills stay with him, the doctor and the pharmacist. The caregiver keeps the household moving and keeps him company while it does.

The assessment is paperwork, so read it

Most agencies start with a visit to the house, sometimes called an assessment or intake. Someone asks questions, looks around, and writes it up. That write-up becomes the basis for the care plan and the schedule, so it matters what it says. Ask for a copy and check it against your list.

Does it record the signs you actually saw, in plain words? If you told them he has not been cooking and the form only says assistance with meals as needed, ask them to write what you saw. The specific version is what tells the caregiver what to do on day one.

Does it reflect what your father said, too? He gets a voice in this. If he told the visitor he hates being fussed over in the morning, that should be written down, so the plan fits the man and not a checklist.

Does it list who to call, and for what? The form should name you, or whoever is closest, as the contact for changes, missed visits and anything that worries the caregiver.

Does it match the hours being proposed? If the assessment lists six things he needs help with and the schedule proposes one short visit a week, ask how that is supposed to work. The two pieces of paper should agree.

Does it say when it will be looked at again? Needs change, especially in the first year after a loss. A good agency says when they will come back and update the assessment, and what would make them do it sooner.

What to do tonight

Finish your list of signs and put the date of your next visit at the top. Call one or two agencies and ask how they do their first home visit and whether you can be there. The local help page has more on finding help in his part of the area.

When to ask the doctor

Some signs are not household signs. New confusion, falls, weight loss you can see, a sudden change in how he talks or walks, or talk of not wanting to be here all belong with his doctor, quickly. Tell the doctor what you saw. You do not need to have it figured out.

For the good-week card

Add one line: wrote down what I saw, and someone read it. That is the start of getting him the right help. If this is all very new, Start Here: The First Hundred Days walks through the first months in order.