Why an agency's rate is higher than the caregiver's wage

The gap is real. Only one slice of it has a public number. This desk will not invent the rest.

By the rate desk. Written September 11, 2026.

An agency rate is higher than a caregiver wage because they are not the same object. The wage is what the worker is paid. The rate is what the household is billed. Mixing them is how a family decides the difference must be "profit," and then shops as if every dollar above $14.28 were optional.

In the St. Louis metro the median wage for home health and personal care aides is $14.28 an hour, occupation 31-1120, area 41180, BLS OEWS May 2024. The mean on the same row is $15.72. The gap between mean and median is $1.44. When the mean sits above the median, a smaller number of higher wages is pulling the average up while the typical aide stays nearer the floor. The median is the honest one to read as the typical wage. It is still not the rate.

The one add-on with a published rate

On every dollar of wages an employer owes 6.2 percent for Social Security and 1.45 percent for Medicare. Combined, that is a 7.65 percent employer share, on top of what the caregiver takes home. The Social Security portion applies up to a wage base of $184,500 in 2026. A home care wage in this metro will not reach it. Source: IRS Tax Topic 751, the same citation already used on this site.

That 7.65 percent is the only slice of the gap this desk will print as a rate. State unemployment insurance is also owed. Those per-employer rates are not published in the files this site uses, so even the tax side of the stack stops being measurable after the federal share.

This desk will not multiply 7.65 percent by $14.28 and print the product as "the tax on an hour." The wage is a median across 42,390 aides, not the wage on a given shift. The tax is a statutory share of whatever wage is actually paid. Use the percentage. Do not ask this page for a dollar add-on per hour.

The add-ons with no published rate

Each of the following is a real cost of sending a caregiver to a house. None of them has a public dataset behind it in this metro. You will find articles that assign a percentage to each. They are estimates. This desk does not publish estimates.

• Workers compensation insurance on the caregiver.
• General and professional liability insurance on the business.
• Recruiting, background screening and training before a first shift.
• Scheduling, and the supervisor who covers a call-off at six in the morning.
• Paid time that is not billed, including travel between clients on some schedules, training time, and the extra hour at a shift change.
• Office overhead, software, and the phone somebody answers on a Sunday.
• Margin, without which the business stops existing.

An agency rate has to clear the wage, the published federal payroll tax, and this unpublished stack. How much of the stack any one company carries, and how much it prices into the household rate, is not a federal statistic. Anyone who tells you "agencies mark up X percent" is not citing the files on the sources page.

The wage itself is already a range

Even before the stack, the wage is not one number. The 10th percentile is $13.08. The 90th is $20.00. The spread is $6.92. Among the 25 largest metros that spread is the third widest. Two caregivers on the same roster can cost the agency very different wages and still be billed to you at one household rate. The rate is a company number. The wage is a person number. The gap between rate and wage will not be the same person to person, even inside one firm.

Aides are 14th of 16 healthcare support occupations in this metro by median wage, and 19th of 21 care occupations when the comparison set is expanded. Nursing assistants, a different occupation, sit at $18.66. Registered nurses sit at $39.69. Licensed practical nurses sit at $30.07. Those last two occupations do clinical work. Home care aides do not. The comparison is about pay, not about scope of practice. A household that wants a nurse is buying a different occupation and a different stack. A household that wants non-medical help in the house is buying occupation 31-1120, which is the large, cheap end of the local care labor market: 42,390 jobs, 1st of 21 by headcount.

Payroll records, same story, different door

The occupational survey estimates a wage for a job. The quarterly census counts what employers reported. In St. Louis County, private home health care services (NAICS 621610) reported an average weekly wage of $763 in 2024 Q4, across 5,023 jobs at 242 establishments. Source: BLS QCEW. That weekly figure is still a wage. It is the industry's payroll, not the household's invoice, and it is not a company rate for any named firm.

County payroll also shows why you should not read one local weekly wage as "what agencies charge around here." Jefferson County printed $1,482 a week at 3 establishments and 86 jobs. St. Louis city printed $699 at 77 establishments and 949 jobs. Small payrolls swing. The metro roll-up itself is withheld, at 409 establishments across the 15 counties fixed by the Census delineation. There is no metro average weekly wage to convert into a household rate, and this desk will not invent one.

What the gap is not

It is not proof that an agency is overcharging. This site has no agency prices to compare, and it will not rank companies on a number it does not have. It is not proof that hiring privately is cheaper. A private hire still has a wage, still has tax if you are the employer, still has a call-off problem, and still has no public dataset behind the number you were quoted in a text message. It is not a multiplier you can apply to $14.28 to produce a responsible budget. The methodology page refuses that shortcut in writing.

It is also not a reason to ignore the wage. The wage is the floor the stack sits on. In this metro the floor is low against peer markets: 20th of 25 large U.S. metros, 7th of 8 Missouri metros, 18th of 19 Midwest metros with 5,000 or more aides. A low wage floor does not mean a low household rate. It means the labor inside the rate is paid near the bottom of those lists. Read both facts. Do not let anyone offer you only one of them.

How to talk about the gap without inventing a percentage

Ask the agency to name the wage and the rate as two figures, even if it will only name the rate. Ask whether the assigned caregiver is an employee. Ask who covers workers compensation and a call-off. Ask whether the face rate includes nights and weekends. Write the answers on the quote. You still will not have a public breakdown. You will have a bid you can compare to a second bid on the same hour count.

If the conversation turns into "where does the rest of the money go," stop asking this desk to itemize it. The rest is the unpublished stack. For the question of which pocket pays the household rate, household cash or a policy or a program, use Paying for Care STL. For the question of which relative pays the private remainder, use Who Pays for Mom. Neither of those desks can print the missing percentages either. They can keep you from treating the gap as a sibling insult rather than as the cost of an employer standing between the household and the wage.

Home care as measured here is non-medical. Nothing on this page is a statement about anyone's health. Clinical work belongs with the physician who treats the person receiving care, and with whatever skilled service that physician puts on the plan.

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Next
What an hourly rate covers besides the wage
What families actually pay privately, and why the wage is not the rate
Sources, and the refusal to turn a wage into a price