Before hiring an in-home caregiver for yourself or a loved one, it’s essential to understand the different types of in-home care. What kind of care you or your loved one needs will influence the cost of care, regardless of whether you need one hour a day of assistance or 24 hours.
Read on for a brief overview of the three different care types and who can benefit from them. By the end of this section, you’ll have a clearer understanding of what type of in-home care is the best fit for you, which can help you plan for costs.
The most basic type of in-home care is companion care. Companion care aides, sometimes called elder companions, do not provide any medical services. They simply spend time with the seniors in the home, accompany them on outings, and keep a watchful eye to ensure the senior stays safe. They may also provide transportation for errands, medical appointments, or social engagements.
Who Can Benefit from Companion Care
This type of in-home care can be especially beneficial for seniors who live alone and may feel isolated. Companion care services are also helpful for seniors who live with family but are home alone most days during regular work hours. Ultimately, companion care can provide much-needed socialization and a second pair of eyes and hands to help keep seniors safe. This type of in-home care is not suitable for those who need regular hands-on assistance with ADLs or in-home medical care.
Next on the spectrum of in-home care is personal care assistance. In-home personal care aides help seniors with their activities of daily living (ADLs) such as eating, bathing, and toileting. Like companion care aides, they can also provide transportation, socialization, and help with household tasks like cleaning and cooking. The level of care is similar to what one would find in an assisted living community, though without the benefit of around-the-clock emergency assistance.
Who Can Benefit from Personal Care Assistance
In-home personal care assistance is appropriate for seniors who need regular help with their ADLs, mobility, or other non-medical needs. Typically, people who use personal care assistance have a higher level of need than those who use companion care. However, anyone who needs medical care should only consider home health care. Most personal care aides do not hold advanced nursing or medical credentials and are not licensed to offer medical services.
Home health care offers the most comprehensive in-home care services of the three types of care. It is the only type of in-home care that involves skilled nursing and medical services, and home health aides must hold a nursing certification or higher medical training. Home health care aides can provide skilled nursing care, medication administration including injections, physical and occupational therapy, assistance with oxygen tubes and catheters, and much more.
Who Can Benefit from Home Health Care
Seniors who need medical care, both routine and acute, are good candidates for home health care. Some choose to seek a home health care nurse’s help following release from a hospital or nursing facility to assist with the rehabilitation process. Others may opt for home health care as an alternative to residential nursing care or for routine, frequent services like dialysis or breathing treatments. Additionally, some seniors with chronic conditions work with a home health aide for monitoring and maintenance assistance.
When looking into the cost of in-home care, it’s important to consider both the type and amount of care you need. In-home care costs differ for non-medical in-home care and home health care. According to Genworth Financial, the average hourly cost of standard in-home care is $25, and home health care costs an average of $26. Though the difference may seem small, it adds up when someone needs frequent or around-the-clock in-home care.
Costs also can vary dramatically based on location. The figures quoted above are the U.S. national average, but certain states’ costs can be significantly higher or lower. Cost of living plays a role in this, and so does the availability of providers. Since home care aides visit you in your home, they have to factor transportation time into their costs. Additionally, in less densely populated areas, there may be fewer certified home care aides available for the job. For these reasons, seniors who live in rural areas may see high in-home care costs even if the overall cost of living in the town is low.
Hover over your state on the map below to view the state’s average home care costs. The figures represent the monthly cost for 20 hours of home care per week, so keep in mind that the cost for 24/7 care will be significantly higher.
Below, we present several in-home care scenarios and the estimated costs you would face in these situations. You may find a care scenario that resembles your own situation and get an idea of your care costs. Keep in mind that the figures below are rough estimates based on the national average cost. The only way to get a 100% accurate estimate of your home care costs is to contact several providers in your area for a quote. Don’t be alarmed by any large numbers you see in the monthly cost column; you may find that actual costs are lower with insurance or other financial assistance programs.
Approx. Hours of Care Needed per Week
Estimated Monthly Cost*
Covered by Medicare or Medicaid?
Dad lives alone and struggles with isolation and loneliness.
10-12 hours of companion care, spread out over several days
No. Companion care is not covered by Medicaid or Medicare.
Mom and Dad have chosen to age in place, but are having a hard time preparing their own meals and completing other ADLs.
10 hours of personal care assistance, split up into 2-3 hour intervals over several days
May be covered by a Medicaid waiver or PACE. Medicare does not cover non-medical home care.
Mom has a chronic medical condition and recently recovered from COVID-19. Her doctor recommends home health care for therapy and monitoring purposes while she fully recovers.
30 hours of home health care spread out over 5-6 days
Yes, both. Medicare and Medicaid offer coverage of home health care.
Dad lives with me and has dementia. I don’t like him to be left alone during the workday, and he needs help with ADLs.
45 hours of in-home care, 9 hours per day Monday-Friday
May be covered by a Medicaid waiver or PACE. Medicare does not cover custodial care.
Mom and Dad have chosen to age in place. Mom is in better health, but cannot complete all of her ADLs or assist Dad with managing his COPD. They need daily assistance and occasionally overnight care if Dad is sick.
Anywhere from 42 hours per week (6 hours per day) to 24/7 home health care, depending on the week.
$4,368 – $17,472
May be partially covered by Medicaid or Medicare. 24/7 care is never covered.
Mom requires a nursing home level of care but has chosen to age in place. She needs round-the-clock care at home.
24 hours a day, seven days a week of home health care
No. Neither program covers 24/7 in-home care.
*Based on national average costs of $25.46 per hour for non-medical care and $26 per hour for home health care. Prices in your area may differ.
If you or your loved one needs 24/7 care, in-home care is typically not the most economical option. While it certainly offers some unique benefits, most notably the ability to age in place, in some cases, it makes more financial sense to consider a residential care option. If you want the peace-of-mind and accessibility that around-the-clock care provides but are hoping to keep your care costs down, consider one of the following options.
Independent Living vs. In-Home Care
Independent living is a type of senior living where residents are expected to complete their ADLs without assistance. Some residents of independent living communities may drive or cook their own meals. Though assistance with ADLs isn’t part of independent living, the staff handles all interior and exterior maintenance and remains on-site around-the-clock to assist residents during an emergency. Some independent living communities may also have building-wide emergency alert systems. Seniors interested in companion care may find that independent living meets their socialization needs and eliminates some of the burdens associated with aging in place, like house cleaning and landscaping.
Assisted Living vs. In-Home Care
Assisted living communities are residential care facilities that assist with ADLs, prepared meals, housekeeping, and more. The level of care is similar to what one would receive from a personal care aide. Like home care, assisted living services can be scaled to each individual’s needs, allowing them to retain their independence but still have assistance when needed. Aides are available 24/7 to assist residents with personal care tasks or in the event of an emergency. At an average cost of $4,300 per month in the United States, it is significantly less expensive than around-the-clock in-home care.
Memory Care vs. In-Home Care
Dedicated memory care communities cater to seniors with cognitive impairment from Alzheimer’s disease or a related dementia. To meet residents’ unique needs, staff members must undergo additional training in working with people with memory loss. These communities have enhanced safety compared to assisted living, and activities and related programming are adjusted to benefit those with cognitive impairment. To account for the additional staff training, safety measures, and services, memory care communities typically cost approximately 20-30% more than comparable assisted living facilities. Still, it’s often less expensive than 24/7 in-home care.
Nursing Homes vs. In-Home Care
Nursing homes offer the highest level of care in the senior living spectrum. Residents of nursing homes typically have a serious or chronic illness or are recovering from an acute illness or injury. Whereas assisted living communities offer lifestyle services and amenities, the focus is on residents’ medical care in nursing homes. Nursing homes have a higher number of medically-trained professionals on staff in addition to care aides. It is the most expensive type of residential care, at an average cost of $8,821 for a private room. However, financial assistance programs like Medicaid and Medicare offer coverage of nursing home care.
Below are the estimated costs for one month of full-time care in independent living, assisted living, memory care, nursing care, and at-home. Keep in mind that the figures below represent the full price, and costs can often be lower with assistance from Medicaid, Medicare, or another program, especially for nursing home care. Additionally, these costs are estimated based on the national average, and may not represent costs in your area.
Some people pay for in-home care privately, using a combination of income, savings, and family contributions. Many seek other forms of financial assistance to help lessen the financial burden of in-home care. Unfortunately, financial assistance for in-home care is somewhat limited, especially for non-medical home care and around-the-clock care. It’s imperative to be aware that even when home care services are covered by insurance or another program, it typically excludes 24-hour care. Insurance may cover some hours of the day, but not all.
Medicare Coverage of In-Home Care
Most seniors qualify for Medicare, making it the first place many people turn for financial help when they need senior care. As a health insurance program, Medicare makes an important distinction between standard in-home care and home health care. Medicare does cover some in-home care services, but it does not cover companion or personal care, as these are considered custodial services rather than health services. However, if you need both personal care assistance and home health care, Medicare may cover the personal care services if you get them with the health services from the same provider.
Medicare covers most home health care services, including nursing care, physical and occupational therapy, and medication administration. However, there are limitations to Medicare’s coverage. Medicare will only cover intermittent skilled nursing care in the home. This means that the Medicare home health care benefit only applies to those who need part-time home health care, not 24/7 care. If you need more than intermittent care, which Medicare defines as “less than 7 days each week or less than 8 hours each day”, Medicare will not cover the cost of your in-home care.
Medicaid Coverage of In-Home Care
The federal government requires Medicaid to cover home health services for its beneficiaries in every state. Your “functional need” for home health care will need to be verified by a doctor, and there are time limits- 24/7 care is not covered.
Medicaid coverage of non-medical home care varies from state to state. It is not a required benefit under federal law, so each state can choose whether to offer coverage for this kind of care. If coverage of standard in-home care is available, it is typically via a Home and Community Based Services waiver program, which expands on Medicaid coverage in the state. Note that waivers may have additional eligibility requirements beyond regular Medicaid, and there are sometimes caps on how many people can receive the benefit, leading to waiver waiting lists.
PACE Coverage of In-Home Care
Programs of All-Inclusive Care for the Elderly (PACE) is a joint program between Medicare and Medicaid. It is intended for seniors who want to receive care in their home or community rather than a nursing home, making it a good option for seniors interested in in-home care. All services covered by Medicare and Medicaid are included in the PACE program, as are more benefits to give seniors more flexibility in their care. Importantly, PACE covers both non-medical in-home care and home health care services. Unfortunately, PACE is not available in every state. You can check what is and is not covered in your state on the official Medicaid website.
Covers Non-Medical In-Home Care?
Covers Home Health Care?
Sometimes, with waiver programs
Yes, but waiver programs are only available in certain states
No, only available in certain states
In addition to the public programs explained above, you may have one of the following financial assistance options available to you:
If you’d like more information on paying for in-home care, explore the resources below. These articles, guides, and search tools can help you understand 24/7 in-home care costs and your options for paying for in-home care.
How It Helps
This government-run website provides information about long-term care costs and how to pay for long-term care. It can be a good place to start the process of looking for long-term care for yourself or a loved one, and can help you better understand the marketplace and expected costs.
This guide explains your options for paying for in-home care. If you want an easy-to-understand, brief overview of what resources may be available to you and your family, this is a good place to start.
The National Council on Aging powers this useful search tool that connects users with benefit programs in their area. Simply enter your zip code to see all of the benefit programs in your area, including but not limited to paying for health care and medications.
The National Institute on Aging (part of the NIH) offers this overview on aging place, covering topics such as planning for long-term care and what to expect financially.
SHIP is a Medicare counseling program that offers free advice and guidance for seniors. SHIPs can help you navigate Medicare and answer questions about coverage, eligibility, and more so that you fully benefit from the program. The advisors can help you make educated care decisions that will best fit your budget. Use the website link to find your local SHIP.
How much does home health care cost?
Home health care costs an average of $26 per month in the United States. This comes out to $4,160 per month for 40 hours of care per week. Basic in-home care like companion care and personal care assistance is slightly less expensive than home health care, at an average of $25 an hour or $4,074 per month.
What is home care versus home health care?
Home care is a type of senior care in which aides provide personal care assistance and companion care, versus home health care which involves skilled medical care. The fundamental difference between home care and home health care is the medical component; companion and personal care aides are not certified to provide any medical services, while home health aides undergo more medical training.
Is home care cheaper than a nursing home?
Home care is sometimes cheaper than a nursing home. Which type of care costs more will depend on how much care you need and the financial assistance options available to you. For example, if you just need a few hours of home care per week, it will be less expensive than a nursing home. However, for 24/7 care, a nursing home is less expensive, especially when taking Medicaid and Medicare assistance into account.
Will Medicaid pay for in-home care?
Medicaid will pay for in-home health care for those who qualify for the program. In some states, standard in-home care such as personal care assistance is also covered by Medicaid through a waiver program. Additionally, the joint Medicare-Medicaid PACE program may cover some or all in-home care services, depending on the state.
Does Medicare pay for home care?
Medicare does not pay for standard home care such as companion and personal care assistance. However, in some cases, Medicare does pay for eligible home health care services such as skilled nursing care, physical and occupational therapy, and medication administration. If you receive home health care and personal care services from the same Medicare-approved provider, Medicare may cover all of your home care costs.