The 3pm to 7pm problem: after-school care and elder care at the same time

After school care and elder care at the same time is not a phrase anyone uses out loud, but it is the exact problem. Between 3pm and 7pm on a school day, two generations need a ride, a snack, company, dinner and a grown-up in the room, in two different houses, and you are one person with one car. If you have been solving it with speed, driving faster, leaving work earlier, eating in the car, you already know speed runs out. This page is about replacing speed with coverage.

Why this window breaks families

On the kids' side it is obvious. School lets out mid-afternoon. Practice starts at 4 or 5. Somebody has to be at the field, the game, the pickup line, and somebody has to make dinner appear. On Mom's side it is quieter and, for a lot of families, more worrying. Late afternoon is often the part of the day when an older parent is most tired and least steady. If she is living with dementia, the National Institute on Aging describes restlessness, agitation, irritability and confusion that happen as daylight begins to fade, which clinicians call sundowning, and notes that being overly tired can increase that late-afternoon and early-evening restlessness. Even without any diagnosis, the afternoon is when the phone calls come: she has not eaten, she cannot find something, she is upset and cannot say why.

So the two rows of the split week both fill up between 3 and 7, in different towns, and the yellow runs across the whole afternoon. Here is the same window laid out hour by hour for a family with a sophomore, a senior and a mother in Pacific.

Fix one: a neighbor or a sibling on a fixed day

Fixed is the word. A sibling who says call me if you need me has offered nothing, because you will not call. A sibling who owns Tuesdays 3 to 7, every Tuesday, has taken a yellow cell off the week. The Family Caregiver Alliance says family discord most often surfaces from the unequal division of caregiving duties, with one sibling taking the primary role because she lives closest. The fix for unequal is specific, and the Alliance's guide to holding a family meeting is how you get to specific: everyone who is part of the caregiving team, in one room, with the week on the table. A neighbor works the same way. Not could you look in on her, but could you sit with her Thursdays from 3 to 5 while I get the kids, and I will do your Saturday errands.

Fix two: shift the work day

If your employer will let you start at 7 and leave at 3 two days a week, those days go white. The federal leave law can also be taken as a reduced schedule when it is medically necessary for Mom's care, which is the version of FMLA that fits this window; the FMLA page has the eligibility rules and the sentence to say to HR. The Caregiver Action Network's page for sandwich caregivers says the same thing in four words: talk to your employer. The limit is that shifted days cover the kids' side of the window, not Mom's. You are still in Eureka at 4 when Mom is alone in Pacific.

Fix three: a caregiver from 2 to 6

This is the one that covers Mom's row so you can cover the kids'. A non-medical caregiver who comes to her house for the window does the things you would do there: drives her home from the 2pm appointment, makes a snack, keeps her company through the hard hour, starts dinner, reminds her that it is time for the tablets already in her labeled box, turns the lights on, and texts you at 6 that she is settled. The National Institute on Aging calls this respite and says it may last anywhere from a few hours to several weeks at a time, at home among other places. The Family Caregiver Alliance's guide to hiring in-home help anticipates the parent who does not want a stranger in the house, and suggests telling her that accepting the help is something she can do for you.

Who pays is the honest question, and the honest answer is usually you. Medicare says it does not pay for 24-hour-a-day care at home, homemaker services, or custodial or personal care that helps with daily living when that is the only care needed. Afternoon company and dinner are private pay or long-term care insurance for most families. Missouri's Medicaid program, MO HealthNet, is different from Medicare and can help with personal care services for people who qualify, and the Area Agency on Aging is the place to ask whether Mom does. No agency's hourly rate is printed on this site, including the one in the labelled box below, because none of it is public data. Call and ask.

Who stays with Mom while I do school pickup in Ballwin?

The same three answers, sized for a smaller gap. If the hole is an hour and a half between the Ballwin bell and your getting back to her, that is a neighbor or a sibling on a fixed day, or a caregiver who comes for a short afternoon block. The morning version of this, the 8am meeting in Chesterfield when Mom cannot be left alone, works the same way in reverse: a person in her house from 7:30 to 10 so you can log on. Whether she can be alone for ninety minutes at all is not a scheduling question. It is her doctor's, and it is in the box at the bottom of this page.

Does Medicare pay for someone to be with Mom in the afternoons?

Not for this. See the sentence above from Medicare's own home health page. Medicare home health is skilled, part-time care ordered as part of a plan. A person in the house for the afternoon window is not that, and pretending it is leads to a bill nobody expected. If a home health nurse or aide is already coming under Medicare, ask the care team how those visits fit around the window rather than assuming they fill it.