Hourly, live-in, or 24-hour care: how the monthly cost is built
A month is hours, shift type, minimums and the unpublished rate. Only the wage underneath those hours is measured.
The monthly number you will actually pay is not on this site. It is built from a billing structure the agency already uses and a week of hours the household has not yet written down. Get those two things on paper before you try to annualize anything.
What this desk can put under that month is the wage floor for the occupation you are buying. In the St. Louis metro the median hourly wage for home health and personal care aides is $14.28, from the BLS OEWS May 2024 metropolitan file, area 41180, occupation 31-1120. The bottom tenth of that occupation sits at $13.08. The top tenth sits at $20.00. The annual median the same row prints is $29,700. That annual figure is a wage for the worker, not a household budget for a year of care.
Three structures, not three prices
Hourly, live-in and 24-hour coverage are billing structures. They are not three published rates this desk can rank. No public file in the sources list records any of them as a household price. Treat a website that prints "typical live-in" or "typical 24-hour" dollar figures as an estimate. This desk does not publish estimates.
Hourly coverage bills the clock. You buy a block of hours on named days. The quote should state the hourly number, the shortest shift it will staff, and whether unused hours inside a weekly minimum still bill. Nights, weekends and holidays often bill on a different line. Until those lines are written, two hourly quotes with the same face number can produce different months.
Live-in coverage bills a presence, not a stack of waking hours. The caregiver sleeps in the house. The quote may be a daily rate, a shift rate, or an hourly rate with a cap. It may distinguish waking hours from sleeping hours. It may require a private room and a meal. None of those terms is in the occupational survey. Ask for them. Write them down. A live-in month is not "24 times the hourly wage," and it is not "24 times the hourly quote." Both of those multiplications are inventions. This desk will not do them.
Twenty-four-hour coverage is a staffing plan. The house is not left empty. That plan may be successive hourly shifts. It may be a live-in plus relief hours. It may change between weekdays and weekends. The month is the sum of whatever the plan actually bills, including the overlap at shift change and the extra cost of a call-off. Do not let anyone collapse that plan into a single hourly figure and a guess at days in the month.
The pieces that turn a week into a month
Once the structure is named, the month is arithmetic the household can do. This desk will not do it for you, because the rate is unpublished. You can still list the inputs so the arithmetic is honest.
- The hour count you actually want in a normal week, written as days and start and stop times, not as "someone there in the evenings."
- The minimum shift, and any weekly hour minimum that bills even if you cancel inside it.
- The quoted number for weekday hours, and the quoted number for nights, weekends and holidays if those differ.
- Whether live-in or overnight is a different unit: a day, a shift, or a capped hourly block.
- What happens when a caregiver calls off and a substitute covers. Some invoices stay flat. Some add a line.
- Mileage, errands and waiting at an appointment: billed, included, or refused.
- Cancellation notice. A month with two skipped days is not a month minus two days if the notice rule bills them anyway.
- How the invoice is produced, and whether it arrives weekly or monthly.
Every one of those is already known to the agency. None of them is in the wage file. The companion questions on what an hourly rate covers are the same list from the cost side. Use both. Two quotes that match on the hourly line and diverge on minimums will not match at the end of the month.
Why the wage still belongs in this conversation
The wage does not tell you the monthly total. It tells you what the labor inside that total is paid, and how uneven that pay is. The spread between the 10th and 90th percentile in this metro is $6.92, third widest among the 25 largest U.S. metros. A live-in week and an hourly week can be staffed by people sitting at very different points on that spread. The invoice will not show you which point. Ask who is assigned, what they are paid only if the agency will say, and what happens when the assigned person is off. You are buying continuity as much as you are buying hours.
The occupation is large here. The survey counts 42,390 aides in the metro. It is also cheap here. St. Louis is 20th of the 25 largest metros on the median wage, 7th of the 8 metros the survey files under Missouri, and 18th of the 19 Midwest metros with 5,000 or more aides. Those ranks are on the tables. They describe the labor pool a scheduler is drawing from when the plan is hourly, live-in or round-the-clock. They do not describe your invoice.
Payroll in St. Louis County, industry NAICS 621610, printed an average weekly wage of $763 in the fourth quarter of 2024, across 5,023 jobs at 242 establishments. Source: BLS QCEW. That weekly figure is still a wage paid to workers in the industry, not a household's weekly invoice for a live-in week. Do not convert it into a live-in rate. The conversion would be a guess.
The one published add-on, and the ones that are not
Whatever structure you buy, the employer still owes payroll tax on wages. The published employer share is 6.2 percent for Social Security and 1.45 percent for Medicare, combined 7.65 percent, with the Social Security portion applying up to $184,500 in 2026. Source: IRS Tax Topic 751. A home care wage in this metro will not reach that base. State unemployment insurance is also owed, at a per-employer rate this desk cannot print. Workers compensation, liability insurance, recruiting and the supervisor who covers a 6 a.m. call-off have no public rate. They sit inside every structure. They are why a live-in quote is not "the wage times the hours the person is in the house."
Who pays for which hours
A month of mixed coverage often has more than one payer even when the agency is the same. Daytime hours might be a private check. A few skilled visits in the same week, if they exist, belong to a home health agency and a different bill. Overnight sitting might be the household. A long-term-care policy might reimburse some hours and refuse others. This desk's files do not sort those pockets. Paying for Care STL is the place to walk which hours a program or a policy will actually touch.
Inside the family, the fight is usually about which days each sibling covers with their own time, and which days get hired. That is not a billing-structure question, but it changes the hour count you hand the agency, and the hour count is the main lever on the month. Who Pays for Mom is built for that split. Settle the hour count first. Then ask for quotes on that exact count, in each structure you are considering, on the same week of the calendar.
What not to do with a calculator
Do not multiply $14.28 by the hours in a month and call it a budget. That product would be a wage bill for a full-time aide, not your invoice, and this desk will not print it. Do not multiply an unpublished quote by 24 and call it a 24-hour rate. Do not take the annual median wage of $29,700 and treat it as what a year of in-home help costs the household. That is the worker's median annual wage in the survey, for the hours the survey is measuring, not a household's year.
Do this instead. Write one sample week. Get two written quotes for that week, one hourly and one live-in or overnight if you need presence rather than a short block. Ask each quote to show the month as four of those weeks, plus how holidays and fifth weeks are billed. Compare the months. Keep the wage tables open so you remember what the labor underneath is paid. Then pick a structure you can actually staff and actually pay, not a structure that looks cheaper because someone multiplied the wrong unit.
The 15 counties of this metro are fixed by the Census Bureau delineation for area 41180. Payroll is disclosed in only 7 of them. If you live in a county where the wage cell is withheld, you still have the metro occupational figure. Do not invent a local monthly rate to fill the gap.
Featured, and paid for
New Plan Care
New Plan Care is an independently owned non-medical in-home care company based in Chesterfield, Missouri, serving Ballwin, Chesterfield, Eureka, Glencoe, Grover, Pacific, Valley Park and St. Louis. It does not publish an hourly rate, and neither do we. Ask it how hourly, live-in and overnight shifts are billed, including minimums. Call (314) 405-0887.
Disclosed feature. New Plan Care is a client of OwnersFirm, which publishes this site, and pays for this placement. It was not ranked against anything on this page, and no wage figure on this site was influenced by that relationship.