A ranking tells you how an agency is sorted, not how it fits your house. Before you read any list, settle the pattern your household needs. This guide sizes the choice between a worker who lives in the home and a worker who comes for set shifts. It does not name or recommend any provider.
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.
Two patterns, two different fits
A live-in arrangement puts a non-medical worker in the home for a stretch of days, with set rest and days off. A visiting arrangement brings a worker in for scheduled blocks and then leaves. Each one answers the house differently. Live-in asks about a room, a bathroom, a door, and quiet hours. Visiting asks about arrival times, block length, and what happens between blocks.
What it costs: The Missouri median for non-medical in-home care is $33 an hour, per the CareScout (Genworth) Cost of Care Survey 2025 state data tables, released March 2026. New Plan Care's standard rate is $34 an hour with a four-hour minimum, so a visit starts at $136 (newplancare.com/services).
Size the house before the list
Count the people who live in the home and who needs help, and note whether another adult shares the house and will also be present. Walk the rooms where the worker would be, and write down whether the worker would have a room with a door that closes, whether a bathroom would be shared, and where the kitchen and phones sit. Mark the hard hours, the stretches where help is most needed, such as the morning, the late evening, the nights, and the weekends. Those hours decide the pattern more than the total hours on a proposal.
What each pattern needs on paper
A live-in arrangement needs written days off, written quiet hours, and written rules for how the worker's rest is covered. A visiting arrangement needs written arrival and finish times, the shortest block the agency will book, and what the family does between blocks. Ask the agency to show how its pattern fits your house with a sketch, a room list, and a sample week, not with a sales summary.
What the rankings can and cannot show
From the file: the desk's St. Louis home care ranking page sorts agencies by review count and stars. Those signals describe how agencies are reviewed. They do not describe what hours an agency can cover in your house or whether its pattern suits your rooms.
Desk judgment: a high position is not a fit check. Use the ranking page only to build a shortlist, then size each agency against your house before you compare. The Medicare home health patient survey stars for the St. Louis metro measure a different category, and they should not stand in for the household check either.
Questions to ask
Can you run this pattern in a house like mine, and what does the worker's space look like? How are days off covered when the regular worker cannot come in? What changes when the household's hard hours move? Who decides when the pattern changes, and is that answer in the agreement?