Two agencies can quote the same number of hours and send you two different bills. The gap rarely comes from the hours themselves. It comes from who arrives, what training that person has, and what the agency counts as part of the visit.

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.

What pushes the line up

  • Training beyond the entry level, when the agency bills that training as a higher tier.
  • Experience with memory changes, when the agency treats that experience as a separate skill.
  • A second person needed for one task, which is often billed as a second line rather than a longer visit.
  • A language requirement, if the household needs staff who match it.
  • Short-notice booking, when a request has to be filled on a day the agency did not plan for.

What pulls the line down

  • Plain companionship or light household help, with a task list that matches the length of the visit.
  • A steady schedule with the same aide on the same hours, booked well ahead.
  • A short written task list, so the aide is not hired for skill the job never uses.

Ask each agency whether a steady schedule gets a lower line, and ask where that appears in writing. Do not assume a reduction. Ask for it.

Match the tier to the job

Write the tasks in one column and the tier you were quoted in the other. If the task list is light, a higher tier pays for skill you will not use. If the task list needs more training than the entry tier includes, the gap lands on your family, and the hours your family spends filling it never appear on any bill.

Questions for each agency

  • What does the entry tier include, and what training does it require?
  • What does the next tier add, and is that difference written into the quote?
  • Does a second person add a separate line, and when is that second person required?
  • What counts as a short-notice request, and does it change the line?
  • If the aide stays longer than planned, which line applies to the extra time?

What to write down

For each tier, record the name, what it includes, what it leaves out, and what the agency did not say. Silence is a finding. An unanswered tier question is a line you will end up paying for without knowing it was there.

To put the tiers into a yearly view, use Budgeting a Year of Home Care. To read each quote line by line, use how to read a home care quote.