When a parent needs more help than family can give, in-home care fills the gap, but the choices and the costs can be confusing fast.
This guide cuts through it. There are two different things people mean by "in-home care," they cost different amounts and are paid for differently, and knowing which one your loved one needs is the first real decision. Here is how to tell them apart, what to expect to pay, how to find and vet help you can trust, and which programs may cover some of the cost.
Home Care vs. Home Health: Know the Difference
This is the distinction that trips up most families. The two services solve different problems:
- Home care (personal care). Most home-based care is personal care, meaning help with activities of daily living, bathing, dressing, eating, and taking medications, plus supervision to keep someone safe. Home care aides may also help with light housekeeping, transportation, and errands. They are usually not medical professionals and do not provide skilled medical care. This is the day-in, day-out help most older adults need to stay home.
- Home health. Home health care is short-term, skilled care, in-home nursing or therapy to help a person recover from surgery, an accident, or an illness. It is provided by professionals such as nurses and therapists, and it is usually time-limited.
Which one does your loved one need? If the need is ongoing help with everyday life, that is home care. If the need is skilled medical care after a hospital stay, that is home health. Many families end up using both.
What In-Home Care Costs
Home care generally charges by the hour, and some services charge a flat rate for overnight stays. Costs add up quickly for round-the-clock needs, which is why understanding who pays is so important.
- Medicare covers home health only in limited situations, short-term, medically necessary skilled care from a Medicare-certified agency. It does not pay for ongoing personal care or a caregiver's time.
- Medicaid is the largest payer of long-term home care, and many states will even pay a family member to provide it. See how to get paid as a family caregiver and consumer-directed services.
- VA benefits can help cover in-home care for eligible veterans.
- Out of pocket remains the reality for many families, often supplemented by long-term care insurance.
How to Find and Vet In-Home Help
Finding someone trustworthy to come into your parent's home is a high-stakes decision. The National Institute on Aging recommends a careful process:
- Ask for referrals. Start with your loved one's doctor or other health professionals, and ask friends and neighbors who they have used.
- Compare agencies. For home health, use Medicare's online tool to find and compare Medicare-certified home health agencies in your area.
- Gather information before you commit. Get as much detail as you can about a service before signing any agreement, what is included, the hourly rate, how scheduling and backup coverage work, and how aides are screened and supervised.
- Always check references. Before hiring a particular person or company, check references. This single step prevents many bad hires.
Agency or independent? Hiring through an agency usually costs more per hour but the agency handles screening, payroll, taxes, backup coverage, and supervision. Hiring an independent aide directly can cost less but puts those responsibilities, including being an employer, on you. Your local Area Agency on Aging can help you weigh the trade-off; find it through the Eldercare Locator at 1-800-677-1116.
Trying to arrange in-home care? Chat with Brevy's care navigator for help comparing home care and home health, understanding costs, and finding the programs that can pay for it in your state.
Frequently Asked Questions
Home care (personal care) is ongoing help with daily activities like bathing, dressing, meals, and light housekeeping, usually provided by non-medical aides. Home health is short-term skilled nursing or therapy, often after a hospital stay, provided by professionals like nurses and therapists.
Home care generally charges by the hour, and some agencies charge a flat rate for overnight care, so costs rise quickly for round-the-clock needs. Medicaid, the VA, and limited Medicare home health benefits can offset the cost.
Only in a limited way. Medicare covers short-term, medically necessary skilled home health from a Medicare-certified agency, not ongoing personal care or a caregiver's time.
Ask your doctor and trusted friends for referrals, compare Medicare-certified agencies using Medicare's online tool, gather full information before signing an agreement, and always check references before hiring.
Often, yes. Many state Medicaid programs and VA benefits let a family member be paid as the caregiver. See how to get paid as a family caregiver.
Learn More
- Signs Your Aging Parent Needs Help: What to Watch For
- How to Get Paid as a Family Caregiver: The 50-State Guide
- Medicaid Self-Direction and Consumer-Directed Services
- Caregiver Programs by State: The 50-State Directory
- Getting Started as a Family Caregiver: A First-Steps Guide
- Respite Care for Family Caregivers: The 50-State Guide
Find personalized help arranging in-home care at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.