When a family hires directly, the wage is only one line on the bill. The rest of the cost comes from the employer side of the job: taxes on each paycheck, insurance, paid time off, supplies, mileage, and the time it takes to keep the paperwork right. Agencies carry many of these costs inside their rate. A direct hire leaves them with you. Knowing which costs are yours before you compare is the only way to set a fair number next to an agency estimate.

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.

Step 1: Name the cost lines

Put these on one page before you ask anyone for a number:

  1. Hourly wage times the hours you plan each month.
  2. Any overtime the hours could trigger. Ask your accountant which rules apply to your plan.
  3. Employer payroll taxes on each paycheck. Get the rate from your accountant or your state labor office, not from a guess.
  4. Workers compensation or other insurance the hire may require or that you choose to carry.
  5. Paid sick or time-off days you agree to give.
  6. Mileage or fuel for errands and trips the caregiver makes.
  7. Supplies such as gloves, wipes, bags, and cleaning items.
  8. A replacement reserve for the cost and time of finding someone new if the hire leaves.

Step 2: Ask who carries each line

Ask the candidate or the agency these questions and write the answers beside each line:

  • Who files the payroll paperwork, and who pays the tax on each check?
  • Does the hourly rate include mileage, or is it billed separately?
  • Who buys the supplies, and how are receipts handled?
  • If the person leaves in the first month, what does it cost me to replace them?

Step 3: Build the monthly worksheet

Fill in every blank. Leave a blank as a blank and do not round it to zero.

Hours per month x hourly wage = ____________

Employer taxes (rate from accountant) = ____________

Insurance = ____________

Paid time off you agree to = ____________

Mileage or fuel = ____________

Supplies = ____________

Replacement reserve = ____________

Total monthly cost = ____________

What moves the number

The total goes up when hours go up, when a long gap in coverage forces you to pay for overtime or extra shifts, when the hire leaves and you must search again, and when the family picks up errands the caregiver should have done. The total goes down when the schedule is steady, when the hours are written in advance, and when the supply and mileage rules are set in writing before the first shift. Keep the medicine work with the family, the doctor, and the pharmacist; a caregiver's errands should cover the prescription pickups you agree on, not anything more.

For local contacts who can help you check the payroll side, see Local Help for Hiring a Caregiver. For the difference between agency and direct paths, see Hire a Caregiver in St. Louis: Agency or Direct.