Home care cost is built from hours, and those hours can come from more than one source. The same week may be paid by the family, by an insurance policy, by a public program, or by no one at all. Before comparing any agency's billing terms, sort each hour by who is responsible for it.

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.

Build the hour grid

Draw the seven days across the top and the waking day down the side. Shade every hour the family expects help. Then mark the funding source for each shaded block. Blocks with no funding source are the gap, and the gap is the question the family must answer before the agreement is signed.

Name the possible payers

  • The family's own funds, paid on an agreed schedule.
  • A long-term care insurance policy, if one exists. Read which hours and settings it covers.
  • A public program for older adults, reached through the area agency on aging serving the St. Louis region or the county senior services office.
  • The state Medicaid home-based program, which has its own eligibility rules and its own approved provider list.
  • A Veterans Affairs benefit, if the older adult served in the armed forces. Ask the benefits office which hours, if any, it recognizes.

Ask each payer four questions in writing

  • Which hours does this source cover, by day and by time of day?
  • Does it pay the agency, a worker directly, or a care manager's plan?
  • What is the approval process, and how long does it take?
  • What happens to unused or capped hours at the end of a period?

Compare agencies on the grid, not the brochure

Ask each agency how it bills: by the hour, by the shift, or by a day rate for live-in coverage. Ask whether nights, weekends, and holidays are billed differently, and whether a visit that runs long or starts late is adjusted. Then match each shaded block of the grid to the billing unit that would apply to it. Two agencies that look alike on a brochure may divide the same week very differently.

Watch the changes after the start

Changes made after the plan begins often move the total more than the starting terms do. Common examples are hours added mid-plan, nights and weekends booked late, and a shift in the care plan that requires a second worker. Ask each agency to state in writing how each of those changes is priced and approved.

Close the gap before the first shift

Any block still unfunded needs an owner: the family, a named helper, or a smaller schedule the family can carry. Write that decision on the grid and keep a copy with the agreement, so the week is covered on paper before anyone starts work.