You have a quoted hourly rate written on a pad by the phone. Before you treat that number as the price, find out whether it belongs to a care level. Some providers set one rate for every client. Others start with an intake assessment, give your parent a level, tier, or category, and price the hour by that label. If the label moves, the rate moves, even if the schedule stays the same.

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.

This sheet does not tell you which pricing model is better. It tells you how to find out which one you are being offered, what will push the number up or down, and what to write down so a later change does not surprise you. If you have not yet decided between an agency and hiring a caregiver yourself, start with Hire a Caregiver in St. Louis: Agency or Direct. For the full sequence, see Start Here: Five Steps to Hiring.

Step 1. Ask whether the rate has a level attached

Ask it plainly: "Is the hourly rate you quoted the same for every client, or does it depend on an assessment of my parent?"

Answers to listen for: "One rate for all non-medical care, and it changes only when our rate sheet changes" is a clear answer. "It depends on the level we assign after the home visit" is also clear, and it means you need Steps 2 through 5. "It depends" with nothing after it is not an answer. Ask again: "Depends on what, exactly?"

Write down:

Flat rate or level-based: ____________________
Name of the level my parent would start at: ____________________
Rate at that level, per hour: ____________________
Person who told me: ____________________

Step 2. Get each level defined by tasks, not adjectives

Labels such as "light," "moderate," and "heavy" tell you nothing until they are tied to specific work. Ask for the written definition of every level, not only the one your parent starts at. You are looking for a task list. Examples: help standing from a chair, help in the shower, help with toileting, supervision for someone who wanders, medication reminders, meal preparation, rides to appointments.

Ask: "Which tasks on this list would move my parent from the level you assigned to the next one?"

Answers to listen for: A specific task named in a written document. Walk-away sign: "Our care manager uses judgment" with no document behind it. Judgment can play a part, but it should be applied against something written down that you can read too.

Write down the one or two tasks that sit right at the edge of the next level. Those are the tasks most likely to raise the bill.

Task that would move the level up: ____________________
Task that would move the level up: ____________________

Step 3. Ask who decides the level, and from what

A level is only as fair as the process that sets it. Ask three questions and write down each answer.

  1. "Who does the assessment, and what is that person's role?" Get a job title, not only a first name.
  2. "What triggers a reassessment?" Common triggers include a scheduled review, a hospital stay, a fall, or a caregiver reporting that a task takes longer than it used to. Ask which of these apply here, and whether you can request a reassessment yourself.
  3. "Can the level go down as well as up?" If your parent gets stronger after a rough stretch, you want the same process to work in that direction.

Walk-away sign: The level can be raised based on a single caregiver's note, with no visit and no conversation with you.

Assessor's role: ____________________
Triggers for reassessment: ____________________
Can I request one: yes / no
Can the level go down: yes / no

Step 4. Ask how you will be told, and when the new rate starts

This question protects your money most directly. Ask: "If the level changes, how do I hear about it, how far ahead, and which shift is the first one billed at the new rate?"

Answers to listen for: Written notice delivered a set number of days ahead, a named effective date, and the new rate applied only to shifts after that date. Walk-away sign: A higher rate applied to shifts that were already worked, or a change that first shows up on the invoice.

Then ask: "If I disagree with the new level, what happens next?" A good answer names a person, a second look, and what you will be billed while the question is open.

Notice period before a level change: ____________________
How notice arrives (letter, email, portal): ____________________
Who I call to dispute it: ____________________
Rate billed while a dispute is open: ____________________

Step 5. Ask what a level change does to the caregiver

Sometimes a higher level means more than a higher price. It can mean a different worker, because the provider assigns certain tasks only to staff with particular training. That matters if your parent has finally settled in with one person.

Ask: "If my parent moves up a level, does the same caregiver stay, or would you have to send someone else?"

Write down the answer word for word. If the answer is "someone else," also ask how long a replacement would take and whether the old caregiver could work alongside the new one for a shift or two.

Step 6. If you hire directly, the same question shows up as a raise request

A caregiver you hire yourself will not use a tier label. The same pressure still arrives when the work grows. A job that starts with meals and companionship can turn into help in the shower and help at night. The caregiver may fairly ask to be paid more. You will be better off if the starting duties were written down before that conversation.

Before the first shift, write a one-page duty list. Keep a copy, give one to the caregiver, and agree on how you will talk about added duties: who raises it, how often you review the list, and that pay is discussed before new duties begin, not after. This sheet does not give employment or tax advice. For public offices that can explain your obligations as a household employer, see Local Help for Hiring a Caregiver.

Signs to walk away

  • The provider will not show you the definitions for levels other than your parent's starting level.
  • The level can change without a home visit or a call to you.
  • No written notice period exists before a new rate takes effect.
  • A higher rate can apply to shifts already worked.
  • The quote is described as "starting at" with no statement of what would raise it.

The one line to compare across providers

After every call, fill in one line. When you compare providers, compare these lines, not the opening rates.

Provider: ____________ | Flat or level: ______ | Starting level: ______ | Task that moves it up: ____________ | Notice period: ______ | Same caregiver if level rises: yes / no

A lower opening rate attached to a level your parent may soon outgrow can cost more than a higher flat rate. You cannot know which applies until these blanks are filled.

Every claim on this desk is meant to point back to a public page. See Sources for the public pages we work from, and How We Write the Sheets for why we do not publish prices or rank companies.