In-home care for seniors is paid help that comes to an older person’s home so they can continue to live there safely and comfortably. It ranges from a few hours a week of companionship and housework, to daily help with bathing and dressing, to skilled nursing and therapy ordered by a doctor. The national median for non-medical in-home care services is about $35 an hour, and most families pay for it themselves.
The right kind of senior home care depends on what your parent or loved one actually needs help with. Most older adults want to keep living at home as long as they can, and the right care services can make that possible. Below you will find the main types of in-home senior care, what each one does, what it costs, who pays, the signs that it is time, and how to get started.
Types of in-home care services for seniors
People use many names for the same services: elder care, senior care, home care, home help. These are the five main care options you will run into.
Companion and homemaker care
Companion services are non-medical help around the house and company for an elderly loved one who is lonely or a bit forgetful. It covers conversation, light housekeeping, laundry, cooking, grocery shopping, errands, rides to appointments, and medication reminders. Companions and homemakers do not provide hands-on personal care in most states.
Personal care
Personal care aides and home health aides assist with the activities of daily living: bathing, dressing, grooming, toileting, eating, and moving from bed to chair. They often do homemaker tasks as well. This is what most families mean when they talk about elderly home care. Our guide to what a home health aide does lists the typical tasks and the limits.
Home health care
This is where many families get confused. In-home care usually means non-medical help. Home health care is medical care at home, ordered by a doctor and given by a licensed agency. It includes skilled nursing, physical therapy, occupational therapy and speech therapy, often after a hospital stay, a fall or a new diagnosis. Visits are short and usually for a limited time, with the goal of recovery or stability.
Private duty nursing
A registered nurse or licensed practical nurse provides longer blocks of specialized care at home, such as for tube feeding, ventilators, complex wound care or other ongoing medical needs. This is the most expensive kind of in-home care.
Hospice and palliative care at home
Hospice care is for people with a terminal illness who are expected to live six months or less and have chosen comfort over treatment aimed at a cure. A hospice team visits the home, manages symptoms and supports the family. Palliative care focuses on comfort and quality of life at any stage of a serious illness and can go along with regular treatment.
Signs a senior needs help at home
The need for help often creeps up slowly, and an aging loved one may hide it. Watch for these signs when you visit or call:
- falls, near-falls, or new bruises they cannot explain
- weight loss, spoiled food in the fridge, or skipped meals
- missed or doubled medicines
- unpaid bills or piles of unopened mail
- wearing the same clothes for days, or signs they are not bathing
- a house that is much messier than usual
- getting lost, forgetting appointments, or repeating questions
- trouble getting up from a chair or climbing stairs
- pulling away from friends and hobbies
- a family caregiver who is exhausted, or a senior who can no longer bathe safely alone
One sign alone may not mean much. Several signs together usually mean it is time to bring in help. Chronic conditions like diabetes, heart failure or Parkinson’s often make the need grow over time.
What is the 40-70 rule?
The 40-70 rule is a simple idea from a home care company’s public education campaign: when you are close to 40 and your parents are close to 70, it is time to start talking about aging. That means living arrangements, driving, money, health care wishes and who would help if something happened. Talking early, before a fall or hospital stay forces quick decisions, gives everyone time to think.
How much does in-home senior care cost?
Cost is the question most families ask first, and the answer depends on the type of care and your loved one’s care needs.
The CareScout Cost of Care Survey, a large yearly survey of care providers, reports these national medians:
- Non-medical in-home caregiver (homemaker and home health aide services): about $35 an hour. At 44 hours a week, that comes to about $80,000 a year.
- Private duty nursing: about $90 an hour.
- Adult day health care: about $95 a day.
- Assisted living: about $6,200 a month, for comparison.
Prices vary a lot by state and city. You can check your area with the CareScout cost of care tool. Many agencies also have a minimum visit length, often a few hours, so a quick 30-minute check-in may not be possible.
A simple way to estimate: multiply your local hourly rate by the hours you need each week. For example, 20 hours a week at $35 is $700 a week, or roughly $3,000 a month. If your loved one needs someone there day and night, read our guide to 24-hour home care.
Who pays for elderly home care?
Medicare
Medicare pays for home health care, not for ongoing personal care. To qualify, the senior must be homebound, a doctor must certify the need, and they must need part-time or intermittent skilled care like nursing or therapy. When those rules are met, Medicare can also cover some home health aide visits. It does not pay for companion care, homemaker services or personal care when that is the only help needed, and it does not pay for 24-hour care. Medicare also does not pay family caregivers, though some state Medicaid programs do. Details are on Medicare.gov’s home health page and in our guide on whether Medicare covers a home health aide. Medicare does cover hospice care at home for people who qualify.
Medicaid
Medicaid is the largest payer for long-term personal care at home. Every state offers home and community-based services, often through waiver programs, for seniors with limited income and assets who need a high level of care. Rules, hours and waiting lists differ by state. Many states also have self-directed programs that let the senior hire a family member, often an adult child, as a paid caregiver.
Long-term care insurance
Many policies pay for in-home care once the person needs help with a certain number of daily activities or has dementia. Look at the daily benefit, the waiting period, and whether the policy requires an agency or allows a family member or independent caregiver.
VA benefits
Veterans may qualify for the VA Homemaker and Home Health Aide program or the Aid and Attendance pension. Ask the social worker at the local VA medical center.
Private pay and local programs
Most families pay out of pocket, at least in part. Your local Area Agency on Aging may offer low-cost help such as meals, rides, or a few hours of homemaker services. Find it through the Eldercare Locator at 1-800-677-1116.
Specialized elder care: dementia, veterans and respite
If your loved one has Alzheimer’s or another dementia, ask for caregivers with dementia care training and a steady schedule with the same faces. For veterans, ask the VA about its home care programs before you pay privately. If a family caregiver needs a break, short-term respite care can cover a few hours, a weekend or a week. See respite care for the elderly.
Hiring senior care services: agency, independent caregiver or registry
You have three main ways to hire help. Whichever you choose, the care provided should come with a written care plan and respect the dignity of the senior, including their say in how things are done.
- Home care agency. The agency hires, screens, trains, pays and insures its care professionals. It sends a backup when someone is sick. It costs more per hour, but it takes most of the work and risk off your plate.
- Independent caregiver. You hire someone directly, often at a lower hourly rate. You handle screening, scheduling, backup, and usually taxes and insurance as the employer.
- Registry. A registry matches you with independent caregivers for a fee. It may do background checks, but the caregiver usually works for you, not the registry, so the employer duties often land on you.
Our guide to finding a home care provider goes through the pros and cons in detail, and our list of questions for interviewing home care providers helps you compare them.
First steps to get in-home care started
- Talk with your loved one. Ask what is hard for them and what help they would accept. People accept help more easily when they have a say.
- List the needs. Write down tasks, times of day, and how many hours a week you think are needed.
- Talk to the doctor. Ask whether skilled home health care is needed and whether Medicare would cover it.
- Check the money. Look at savings, insurance policies, Medicaid eligibility and VA benefits.
- Contact two or three providers. Ask for an in-home assessment, a written care plan and written rates. Ask how soon they can start.
- Start small. A few hours a week lets your loved one get used to a caregiver. You can add hours later.
- Stay involved. Visit, call, and ask both your loved one and the caregiver how it is going.
Checklist: in-home care for seniors
- Note which signs of needing help you have seen.
- Decide which type of care fits: companion, personal care, home health, nursing or hospice. Compare it honestly with senior living options like assisted living.
- Estimate hours per week and multiply by your local hourly rate.
- Check Medicare, Medicaid, long-term care insurance and VA options.
- Choose between an agency, an independent caregiver or a registry for your in-home care services.
- Interview providers and get rates in writing.
- Start with a trial period and review it after a few weeks.
