Many older adults prefer to age at home without assistance. But sometimes it isn’t possible due to declining health or dementia. One option to help aging adults remain in their homes longer is in-home care — a type of nonmedical help with daily living provided by trained aides in the comfort of a senior’s own home. But what’s the cost of in-home care, and is it the right next step for your loved one?
The cost of in-home care depends on the number of hours a senior spends with a caregiver, as well as the services they need and the supplies necessary to support them. “Home care as a whole is a very individualized service,” says Joe Buckheit, founder of AgingCare.com. “Costs are not only specific to region and agency, but also to the services being provided.”
Learn more about how home care costs are calculated, the difference between private and agency in-home care costs, states with the highest and lowest rates, and how the cost of in-home care for seniors compares with nursing home and assisted living pricing.
Genworth Financial compiled more than 3,700 surveys from home care agencies to calculate in-home care costs across the United States in 2019. From this data, they discovered:
In-home care is generally paid for out-of-pocket, but your loved one may qualify for government programs such as Medicaid or VA benefits that help pay for home care. Medicare doesn’t pay for home care, though it typically covers short-term home health medical services prescribed by a physician.
How much will your family pay for home care based on the data above? The cost ultimately depends on a few factors, including what home care services they need and how often they need them.
Before beginning your search for in-home care, consider how much help your loved one requires. Do they live alone independently but want assistance with a few chores? Or do they require full-time help?
“Each agency should work with the family to perform a needs assessment,” says Buckheit. From there, the family and home care aide or agency will develop a plan that can range from simple companionship to hands-on personal care and help with activities of daily living (ADLs), like dressing and bathing. “Senior care services that require a higher level of training or experience may incur a slightly higher cost,” says Buckheit.
Most home care aides and agencies are priced by the hour. They often have a minimum number of contracted hours — generally two to four hours a day or seven hours a week — to cover transportation and staffing costs.
Some home care agencies will offer contracts for weekly or monthly care, generally if a family determines their elderly loved one needs significant assistance throughout the day.
If you live somewhere with a high cost of living, you can expect to pay above the national median for home care. However, if your city has a relatively low cost of living, you’ll probably pay less. State regulations impact the cost of care as well: Several states require special certifications, while others have capped costs for elder home care.
Find the hourly, monthly, and annual median cost of home care in your state here.
The 10 most expensive states for home care:
The 10 least expensive states for home care:
Agencies and private caregivers have different price structures for round-the-clock home care, depending on number of care aides, sleeping arrangements, and room and board. How much 24/7 in-home care costs varies by model, from most to least expensive:
Non-sleeping visits: 24/7 in-home care is generally covered by three caregivers working 8-hour shifts, or two caregivers working 12-hour shifts. For older adults who need round-the-clock care, aides should always be awake and available to monitor wandering, urinary incontinence, and restlessness, or to regularly move an immobile senior to prevent bedsores. Caregivers are generally paid the same hourly rate for waking shifts, day or night. The median rate for 720 hours, or 24/7 care for 30 days, of in-home care a month at an hourly rate is $16,560.
Sleeping visits: Seniors who need full-time supervision for peace of mind but can sleep through the night may not need an alert caregiver 24/7. If an elderly loved one just needs occasional help, an overnight caregiver may be able to sleep with a bell or alarm to wake them in case of an emergency or a trip to the restroom. For a 10- to 12-hour sleeping shift, you can expect to pay a flat rate of $120-$200. The median monthly cost of in-home care with a 12-hour sleeping shift of $150 is $12,780.
Live-in caregiver rates: A live-in caregiver may provide daily assistance as well as emergency support throughout the night. “A live-in caregiver receives the benefit of room and board, however it does not negate the need to pay for hourly care,” says Buckheit, though he notes there may be some reduction in in-home caregiver costs accounted for by living expenses. Before hiring a live-in caregiver, work out a care contract including responsibilities and fees, since they can vary greatly on a case-by-case basis.
Home care costs increase as a senior’s needs increase, requiring more hours of care. “Families that choose in-home care are acknowledging they need more assistance to keep their loved one home safely for as long as possible,” says Buckheit.
By starting home care early, seniors may be able to age in place longer without worrying about isolation, nutrition, or household responsibilities. Your home care agency will help you decide how many hours a week will benefit your family, but some common hours by care need are listed below.
These price estimates, like the others cited throughout the article, are based on Genworth’s median home care cost of $23 an hour.
Families looking for in-home caregivers have two options: Hiring a private, independent caregiver, or using a licensed home care agency. There are pros and cons to both private and agency caregivers.
“There is no payment structure for hiring a caregiver individually,” says Buckheit. “A private hire is contracted by the family and all fees, payments, and taxes are to be determined contractually between the caregiver and client.”
Though agency care is generally slightly more expensive, it removes scheduling and paperwork burdens from families and provides peace of mind. Also, if a caregiver is sick or otherwise unable to work, the agency will provide another aide to ensure there aren’t gaps in care.
Genworth’s survey cites the monthly median costs of assisted living and nursing homes at $4,051 and $8,517, respectively. Compare the costs and benefits of these care types.
At $4,051 a month, assisted living costs are similar to 44 hours of in-home care each week at $4,290 a month. These two types of care also offer similar services, from help with ADLs to housekeeping and transportation. Neither is designed for seniors who need extensive medical care.
A few differences between assisted living and home care pricing:
Nursing homes — sometimes called skilled nursing facilities — provide comprehensive medical care in addition to personal care services. That’s why they tend to be the most expensive senior care option at more than $8,500 a month for a private room.
If you think home care may be the right choice for your aging loved one, reach out to A Place for Mom’s Senior Living Advisors for a free consultation about home care options near you. They’ll be able to answer your questions about home care costs, benefits, and help you explore the next best steps.
Genworth. “Cost of Care Survey, 2019.”