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 day-to-day life provided by trained aides in the comfort of a senior’s own home. But how much is in-home care, and is it the right next step for your loved one?
The cost of in-home care for the elderly 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.
In July and August of 2020, CareScout, a Genworth Financial company, contacted 57,981 providers to complete 14,326 surveys of nursing homes, assisted living facilities, adult day health facilities, and home care providers.
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 your relative needs 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. “Senior care services that require a higher level of training or experience may incur a slightly higher cost.”
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.
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 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.
Genworth Financial compiled a list of hourly, monthly, and annual median costs of home care in each state.
Agencies and private caregivers have different price structures for round-the-clock home care, depending on the 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 fecal and urinary incontinence, 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 $17,280.
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 $24 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.”
Our advisors help 300,000 families each year find the right senior care for their loved ones.
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 $4,300 a month, assisted living costs are similar to the $4,481 a month cost of 44 hours a week of in-home care. 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.
There are 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 about $8,821 a month for a private room.
For some families, determining how to pay for home care is stressful. However, there are several little-known funding sources, including VA programs, reverse mortgages, and — for low-income seniors — Medicaid.
Original Medicare doesn’t cover home care or non-medical services by home care aides. It does, however, cover select home health care services. In short, home medical services prescribed by a doctor and carried out by a skilled medical professional are covered by Medicare. Home health is generally intended to provide short-term care for seniors choosing to recover at home versus a hospital.
“Medicare covers medically necessary, in-home care, also called home health or skilled nursing,” says Kim Barnett, content manager at AgingCare.com. “It must be ordered by a doctor, and it is authorized only for short-term purposes.”
(Learn more about the differences between home care and home health.)
However, Medicare Advantage, a type of health care plan offered by private companies, may cover non-medical or home care aides depending on the plan. In these cases, the home care agency must be part of Medicare’s network.
For low-income seniors, Medicaid may cover some home care services depending on your state. In response to a desire to reduce or delay institutional care for the aging population, almost every state now offers Medicaid eligibility for medical and non-medical in-home care, says Barnett.
“However, as with all Medicaid-funded services, there are strict eligibility guidelines,” she says. “Each state determines its own programs and requirements.”
Medicaid’s home and community-based service waivers (HCBS waivers) program may be used to cover non-medical services such as help with activities of daily living (ADLs). Family caregivers may also receive payment through the Medicaid Cash and Counseling program. Contact your state Medicaid office for more information on programs, benefits, and eligibility.
The U.S. Department of Veterans Affairs (VA) offers programs to help pay for home care to assist veterans and their families. Qualifications and services covered are different for each program, so it’s best to speak with a social worker in the VA to determine which program is most beneficial or applicable to your situation.
Discover three possible VA programs to help offset home care costs:
A reverse mortgage enables a home owner to take out a loan which converts part of the home’s value into liquid assets. The owner can then obtain funds in a lump sum or as needed to supplement income. This option enables seniors to stay at home while creating consistent cash for care by tapping into their home’s equity.
The only federally-insured form of a reverse mortgage is called a Home Equity Conversion Mortgage (HECM). These mortgages are backed by the U.S. Department of Housing and Urban Development (HUD).
Seniors interested in this type of reverse mortgage must meet certain requirements:
The Federal Trade Commission offers tips for shopping for reverse mortgages.
Families often pay out-of-pocket for home care services through several means including:
Did you purchase a long-term care insurance policy? There’s a good chance — depending on your policy and coverage — you can receive funds through long-term care insurance for in-home care. Typically, benefits begin when you need help with at least two ADLs, such as bathing or dressing.
Sometimes private health insurance pays benefits for home care services. Flexible spending accounts may also be used to pay for home care.
Understanding various funding sources for home care can be complex. Consider speaking to someone directly if you’re still unsure about how to cover home care costs.
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, 2020.”