Home Care Costs for Seniors: What You Need to Know

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.

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How are in-home care costs calculated?

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:

• More than 90% of home care agencies charge by the hour, though some offer discounted rates for monthly contracts.
  
• The median cost of home care in the U.S. is $23 an hour. This means half of home care agencies charge less than $23 an hour, while half charge more.
  
• In-home care costs vary based on geographic location, licensing requirements, and level of care required.
  
• The monthly median cost of in-home, full-time carefor seniors is$4,290. This is based on 44 hours of care a week.
  
• Home care costs haverisen more than 7% since 2018. “The home care industry is growing, and recent demand is surging,” says Buckheit. 

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.

Home care costs vary by need

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.

How are rates structured?

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.

Home care costs vary by state

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:

• Washington: $30/hr
• Alaska: $29.48/hr
• Minnesota: $29.00/hr
• South Dakota: $28.00/hr
• Wyoming: $28.00/hr
• California: $27.98/hr
• District of Columbia: $27.50/hr
• New Hampshire: $27.50/hr
• Vermont: $27.25/hr
• Massachusetts: $27.20/hr

The 10 least expensive states for home care:

• Louisiana: $16.88/hr
• Alabama: $17.80/hr
• Mississippi: $18.00/hr
• West Virginia: $18.00/hr
• Arkansas: $19.00/hr
• Georgia: $20.00/hr
• Kentucky: $20.00/hr
• North Carolina: $20.00/hr
• South Carolina: $20.00/hr
• Tennessee: $20.00/hr

How much does 24/7 in-home care cost?

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.

Cost of in-home care: A progression based on health

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.

Common home care cost plans

These price estimates, like the others cited throughout the article, are based on Genworth’s median home care cost of $23 an hour.

• 7 hours a week: $683 a month — Healthy, independent seniors may be able to get all the care they need from several short visits a week. Housework, companionship, meal preparation, and cleaning can be accomplished in this time frame for less than $1,000 a month. Seven hours a week is generally the minimum requirement for home care agencies, though some have higher or lower thresholds.
  
• 15 hours a week: $1,463 a month — A 2-3 hour daily check-in can benefit seniors who need more care but are independently mobile and cognitively sound. Several hours in the morning could provide assistance bathing, dressing, and preparing meals for the day.
  
• 30 hours a week: $2,925 a month — A 30-hour week may be ideal for seniors living with family caregivers who work, or who prefer more companionship and stimulation. Thirty hours a week equates to six hours a day, or much of the time a senior would be alone.
  
• 44 hours a week: $4,290 a month — Forty-four hours of care would provide coverage for a family caregiver who works full-time and doesn’t want their senior loved one to be alone. An aide could assist with all ADLs, including toileting, dining, and bathing. For aging loved ones experiencing cognitive decline, incontinence, or other chronic conditions that prevent them from being alone safely, 44 hours a week may be an ideal schedule — assuming a family member can cover nights and weekends.

Private vs. agency home care costs

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.

Private in-home caregiver costs

“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.”

• Private caregivers often have lower hourly costs since they set their own rates.
• You may have to pay extra to conduct background checks or have a lawyer review contracts.
• Private caregivers may not have worker’s comp insurance, making any accidents on the job costly to families.

Agency in-home caregiver costs

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.

• Families typically pay more for agency caregivers than private caregivers. Agencies pay salaries for multiple employees, workers’ compensation and liability insurance, and payroll.
• Agencies often provide continued training for care aides, or may require aides to be certified nursing assistants or companions.
• Contracts, insurance, and taxes are generally already included in home care agency costs.

Cost of home care vs. nursing homes and assisted living

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.

Cost of assisted living vs. in-home care

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:

• Assisted living includes restaurant-style meals and snacks. Home care aides help with meal prep but do not cover the cost of groceries.
• Assisted living communities have nighttime staff onsite in case of an emergency.
• Assisted living includes maintenance-free living, with costs of housing, utilities, repairs, and housekeeping included. While home care includes household tasks and chores, home mortgage or rent, taxes, and maintenance are paid by the homeowner.

Cost of in-home care vs. nursing homes

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. 

• Nursing homes offer round-the-clock care for one inclusive price, while home care costs are hourly.
• Nursing homes employ licensed medical professionals to assist with chronic conditions, wound care, and therapy, while home care aides are generally not qualified to provide medical assistance.
• Home care aides provide one-on-one assistance, while nursing homes often have a large, rotating staff.

Find in-home care for your family

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.

Sources:

Genworth. “Cost of Care Survey, 2019.” 
https://www.genworth.com/aging-and-you/finances/cost-of-care.html