Key Takeaways
- In-home care lets your loved one stay in their own home while receiving personal support — from help with bathing and meals to skilled nursing and therapy.
- There are two distinct types: non-medical home care (a home health aide or companion) and skilled home health care (a nurse or therapist). They are paid for very differently.
- The national median cost of non-medical in-home care is $80,080/year ($6,673/month), or $35/hour, based on 44 hours per week (2025). CareScout now reports home health aides and homemakers as a single category because their prices have converged.
- Medicare covers skilled home health care — but only when it’s medically necessary, ordered by a doctor, and provided by a Medicare-certified agency. It does not cover non-medical personal care or homemaker services.
- 75% of seniors prefer to stay in their own homes as they age. In-home care is often how that preference becomes reality.
Most families don’t start planning for in-home care calmly, with time to research. They start planning after something happens — a fall, a hospital discharge, a moment when it becomes clear that a loved one needs more help than anyone realized. If that’s where you are right now, you’re not alone, and you’re in the right place.
In-home care covers a wide range of services that help older adults remain safely in their own homes rather than moving to a facility. It can be as simple as a few hours of help with cooking and cleaning each week, or as intensive as round-the-clock nursing support. This guide explains what in-home care actually is, what different types of care cost based on the most recent available data, how Medicare and Medicaid factor in, and how to find and evaluate a provider you can trust. No jargon, no sales pitches — just what you need to know.
What Is In-Home Care?
In-home care is any professional support service delivered in a person’s home rather than in a hospital, nursing home, or assisted living facility. The goal is almost always the same: help an older adult maintain their independence, safety, and quality of life while staying in familiar surroundings.
The term covers two fundamentally different types of care, and understanding the distinction matters — because they are paid for differently, staffed differently, and serve different needs.
Non-medical home care (also called personal care, companion care, or custodial care) provides help with daily tasks. This is assistance with bathing, dressing, grooming, meal preparation, light housekeeping, transportation to appointments, medication reminders, and companionship. The caregiver is typically a home health aide (HHA) or homemaker — not a licensed nurse or therapist. This type of care is what most families picture when they first consider in-home care.
Skilled home health care provides medically necessary services in the home — wound care, IV medication administration, physical therapy, speech therapy, occupational therapy, injections, and monitoring of complex conditions like heart failure or diabetes. These services are delivered by registered nurses, licensed practical nurses, or licensed therapists. Skilled home health care is almost always tied to a specific medical need or recovery from illness or surgery, and it’s typically ordered by a physician.
Both types can be used at the same time — a senior recovering from a hip replacement might have a physical therapist visit three times a week (skilled care) while a home health aide helps with bathing and meals every day (non-medical care).
Who Needs In-Home Care?
In-home care is not only for people with severe disabilities or terminal illness. Many people use it for relatively modest needs, and start earlier than you might expect.
Common reasons families arrange in-home care:
- An older adult has difficulty with one or more activities of daily living (bathing, dressing, eating, toileting, mobility)
- Recovery after a hospitalization, surgery, or serious illness
- A diagnosis of dementia or Alzheimer’s disease, where someone needs supervision and reminders
- Family caregivers who need regular breaks (this is sometimes called respite care)
- Isolation and loneliness — a companion aide provides social connection as well as practical help
- A physician has ordered physical, occupational, or speech therapy to be delivered at home
Three-quarters of American adults 50 and older prefer to stay in their own homes as they age, according to AARP’s 2024 Home and Community Preferences Survey. In-home care is often the direct service that makes that preference possible.
Types of In-Home Care Explained
Companion Care and Homemaker Services
This is the lightest level of in-home support. A companion or homemaker helps with:
- Light housekeeping and laundry
- Grocery shopping and errand running
- Meal preparation
- Transportation (to medical appointments, errands, social activities)
- Social engagement and companionship
- Medication reminders (but not administration)
Companion care is well-suited for seniors who are largely independent but benefit from a few hours of help each week. It does not require a medically trained caregiver.
Personal Care (Home Health Aide Services)
Personal care involves hands-on assistance with activities of daily living — bathing, dressing, grooming, toileting, mobility, and eating. A home health aide (HHA) provides this level of care. HHAs typically have more formal training than homemakers, though requirements vary by state.
Personal care aides spend more time with the person they’re caring for, and are often central to the daily routine of seniors with moderate to significant physical limitations.
Skilled Home Health Care
Skilled home health care requires a licensed professional — a registered nurse, licensed practical nurse, or licensed therapist. Services include:
- Wound care and post-surgical monitoring
- IV therapy and injectable medications
- Physical therapy (PT) for mobility and strength
- Occupational therapy (OT) for daily functioning after illness or injury
- Speech-language therapy for swallowing or communication issues
- Monitoring and management of chronic conditions
- Teaching patients and family caregivers how to manage a condition at home
Skilled care is almost always time-limited and tied to a recovery or treatment goal. It’s different from the ongoing personal support that non-medical home care provides.
Specialized and Dementia Care
Some home care aides and agencies have specific training in dementia care — supporting people with Alzheimer’s or other cognitive conditions who may resist care, become confused, or need structured routines. If your loved one has dementia, ask specifically about caregiver training in this area. The Alzheimer’s Association recommends verifying training before hiring.
Live-In and 24-Hour Care
Some seniors need someone present at all times — either due to fall risk, late-stage dementia, or complex medical needs. Live-in care means a caregiver stays in the home overnight but has designated sleep hours. 24-hour care involves rotating shifts to ensure someone is actively awake and available at all times. These are the most intensive and expensive in-home care arrangements. The 2025 Cost of Care Survey does not publish a separate national median for live-in or 24-hour care; costs are typically calculated by multiplying an agency’s hourly rate by the hours of coverage required, and should be requested directly from local agencies.
In-Home Care Costs in 2025
In-home care costs significantly less than nursing home care, and for many families, that gap is what makes staying at home financially viable. The 2025 Cost of Care Survey by CareScout (Genworth) — which collected more than 25,000 rates from long-term care providers nationwide between July and November 2025 — provides the most authoritative current data:
| Service Type | Annual Median Cost | Monthly Median | Change vs. 2024 |
|---|---|---|---|
| Non-medical caregiver (44 hrs/week, $35/hour) | $80,080 | $6,673 | +3% |
| Adult day health care (5 days/week, $95/day) | $24,700 | $2,058 | -5% |
| Assisted living (for comparison) | $74,400 | $6,200 | +5% |
| Nursing home semi-private (for comparison) | $114,975 | $9,581 | +2% |
The 2025 survey also added a new category: skilled nursing in the home (private duty nurse), with a national median of $90 per hour or $160 per visit. Unlike the non-medical caregiver rate, this covers licensed nursing care ordered by a physician.
A few important notes on these numbers:
The annual figures assume 44 hours of care per week — roughly one full-time caregiver working standard business hours. If your loved one needs only 10–15 hours of help per week, the actual cost is proportionally lower. At the same time, if 24-hour coverage is needed, costs rise sharply above these medians.
Costs vary enormously by state. In the 2025 survey, Wyoming had the highest non-medical caregiver costs at an annual median of $105,248 ($46/hour), while Mississippi had the lowest at $54,912 ($24/hour) — roughly half as much. See in-home care costs for every state. Always use the CareScout interactive tool at carescout.com/cost-of-care to look up median costs for your specific state and county.
Home care costs rose another 3% from 2024 to 2025. Labor costs are a major factor, since agencies compete for direct care workers and minimum wage increases in many states raise hourly rates.
How Medicare Covers In-Home Care
Medicare’s coverage of in-home care is more limited than most families expect — and the distinction between what it does and doesn’t cover is critically important.
Medicare covers skilled home health care — but only when specific conditions are met. To qualify, your loved one must:
- Be under the care of a doctor or authorized health care provider who certifies the need for skilled home health services.
- Be homebound — meaning leaving home requires considerable effort due to illness or injury.
- Need intermittent skilled nursing care, physical therapy, speech-language therapy, or occupational therapy (OT can continue but not begin coverage).
- Receive care from a Medicare-certified home health agency.
When these conditions are met, Medicare covers skilled nursing visits, physical/occupational/speech therapy, home health aide visits when provided alongside skilled care, and certain medical supplies used in the home. The patient pays nothing for covered home health services.
What Medicare does not cover:
- Non-medical personal care or homemaker services when that’s the only care needed
- 24-hour-a-day care at home
- Meal delivery services
- Custodial care not connected to a skilled care need
This means that the kind of care most families actually need the most — daily help with bathing, meals, and getting around — is generally not covered by original Medicare. Medicare Advantage (Part C) plans sometimes offer supplemental home care benefits, so always check your loved one’s specific plan.
How Medicaid Covers In-Home Care
For families with limited income and assets, Medicaid is the most significant source of funding for ongoing personal in-home care. Nearly all states run Home and Community-Based Services (HCBS) waiver programs under Section 1915(c) of the Social Security Act that allow Medicaid to pay for personal care, homemaker services, home health aide services, adult day health, and respite care delivered at home.
About 257 HCBS waiver programs are currently active nationwide. Services and eligibility vary significantly by state. To qualify, most people must:
- Meet financial eligibility requirements (income and asset limits similar to nursing home Medicaid)
- Demonstrate a nursing home level of care need — meaning without in-home support, the person would require institutional care
- Be a state resident and U.S. citizen or qualified immigrant
Critical caveat: Even if your loved one meets all eligibility criteria, many states operate waiting lists for HCBS waiver programs because enrollment is capped. In some states, the wait can be months to years. Contact your local Area Agency on Aging or state Medicaid office immediately if you think your loved one might qualify — getting on the waitlist early matters.
To find what your state offers, visit Eldercare.acl.gov or call the Eldercare Locator at 1-800-677-1116. The ACL’s Eldercare Locator connects families to local Area Agencies on Aging and other community resources, including in-home care services.
Other Ways to Pay for In-Home Care
Out of pocket: Many families start by paying privately. For part-time care (10–20 hours per week), this is often manageable. As needs increase, costs can escalate quickly.
Long-term care insurance: Policies vary widely, but most long-term care insurance plans cover in-home care as well as facility-based care. If your loved one has a policy, review it carefully — there are typically benefit triggers (usually inability to perform 2 of 6 activities of daily living) and an elimination period before coverage begins.
Veterans benefits (VA Aid & Attendance): Wartime veterans and their surviving spouses may qualify for the VA’s Aid & Attendance pension benefit, which pays tax-free monthly amounts that can be applied to in-home care costs. In 2026, the maximum is $2,424/month for a single veteran and $2,874/month for a married veteran (rates effective December 1, 2025). Veterans who already receive Medicaid for their care will have this amount reduced. Apply through VA.gov.
State-funded programs: Many states have their own programs that go beyond Medicaid to support in-home care — especially for seniors who don’t yet qualify for Medicaid but have limited resources. These can include state-funded personal care programs, caregiver support programs, and home modification assistance. Your local Area Agency on Aging is the best starting point for identifying what exists in your state.
How to Choose an In-Home Care Provider
Finding the right provider takes more than a quick internet search. Here’s a practical process.
Step 1: Define What You Actually Need
Before you call a single agency, be specific about what help is needed. Write it down:
- Which activities of daily living does your loved one need help with, and how often?
- Are there medical needs (wound care, medication management, therapy) that require a licensed professional?
- How many hours per week of care are realistically needed?
- Are there dementia, mobility, or behavioral factors that require specialized training?
The clearer you are about the actual need, the easier it is to match an agency’s capabilities to that need.
Step 2: Find and Compare Agencies
For skilled home health care agencies, use Medicare’s Care Compare tool at medicare.gov/care-compare (select “Home health agencies”). This shows quality ratings and patient satisfaction scores for every Medicare-certified home health agency in the country.
For non-medical personal care agencies, Care Compare doesn’t apply — these agencies are not Medicare-certified. Instead:
- Ask your loved one’s physician or hospital discharge planner for recommendations
- Contact your local Area Agency on Aging via eldercare.acl.gov — they maintain lists of vetted local providers
- Ask other families in your area for direct recommendations
The Alzheimer’s Association recommends starting with referrals from trusted healthcare providers and verifying credentials directly with each agency before committing.
Step 3: Interview Agencies — and Ask the Hard Questions
When you contact a shortlist of agencies, ask directly:
- Are you licensed in this state? (Requirements vary — some states require licensure for personal care agencies, others don’t)
- Are caregivers your W-2 employees, or independent contractors? (Employees mean the agency handles taxes, insurance, and workers’ comp — less risk for your family)
- What training do your aides receive, and is it ongoing?
- How do you handle it when a caregiver can’t show up? Is backup available the same day?
- Do you conduct background checks on all caregivers?
- Are your services covered by long-term care insurance, and will you help with paperwork?
- Can you provide references from current or recent clients with similar care needs?
The agency-vs-caregiver-registry distinction matters. A home care agency employs the caregivers, handles scheduling and backup, and carries liability insurance. A caregiver registry connects you with independent caregivers, but the legal and financial responsibility shifts significantly to your family. Most families are better served by a licensed agency.
Step 4: Start and Evaluate
Most agencies will conduct an initial in-home assessment to understand your loved one’s needs before starting. This is a good opportunity to observe how the agency communicates and whether the care coordinator listens carefully.
Once care begins, plan to check in actively for the first few weeks. Ask your loved one directly — and separately — how it’s going. A good match between caregiver and senior makes an enormous difference in consistency and quality.
Frequently Asked Questions
What is in-home care for seniors?
In-home care refers to any professional support provided in a person’s home rather than in a care facility. It ranges from companion care and help with daily tasks (cooking, bathing, errands) to skilled medical services like nursing, physical therapy, and wound care. The two main types — non-medical personal care and skilled home health care — are paid for very differently.
How much does in-home care cost per hour in 2025?
Based on 44 hours of care per week, the 2025 national median for a non-medical caregiver is $35/hour (about $80,080 per year). CareScout no longer reports home health aides and homemakers separately. Rates vary significantly by state — from $24/hour in Mississippi to $46/hour in Wyoming. Use CareScout’s interactive tool at carescout.com/cost-of-care to find costs in your area.
Does Medicare pay for in-home care?
Medicare covers skilled home health care — nursing visits, physical/occupational/speech therapy, and home health aide services when they accompany skilled care — but only if your loved one is homebound and a doctor certifies the need. Medicare does not cover non-medical personal care, homemaker services, or 24-hour home care. When Medicare coverage applies, the patient pays nothing for covered services.
Does Medicaid pay for in-home care?
Yes, in most states. Medicaid’s Home and Community-Based Services (HCBS) waiver programs cover personal care, home health aide services, homemaker support, and adult day care for qualifying low-income seniors. Eligibility typically requires both financial need and a nursing home level of care. Many states have waiting lists. Contact your state Medicaid office or local Area Agency on Aging to apply.
How do I find a good in-home care agency?
For skilled home health care, use Medicare’s Care Compare tool at medicare.gov/care-compare to check quality ratings. For personal care agencies, contact your local Area Agency on Aging via eldercare.acl.gov, ask your loved one’s physician for referrals, and interview at least two or three agencies before deciding. Ask specifically about caregiver training, backup availability, and whether aides are employees or independent contractors.
What’s the difference between in-home care and home health care?
The terms are often used interchangeably, but they’re not the same thing. In-home care (or personal care) is non-medical — a caregiver helps with bathing, meals, and daily tasks. Home health care (or skilled home care) is medically necessary — a licensed nurse or therapist provides clinical services. Medicare covers home health care but not general personal in-home care. The type your loved one needs determines how it’s paid for.
Sources
- Medicare.gov. “Home Health Services.” https://www.medicare.gov/coverage/home-health-services. Accessed: 2026-10-04.
- Medicare.gov. “Care Compare — Home Health Agencies.” https://www.medicare.gov/care-compare/?redirect=true&providerType=HomeHealth. Accessed: 2026-10-04.
- Medicaid.gov. “Home & Community-Based Services 1915(c).” https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c. Accessed: 2026-10-04.
- Administration for Community Living (ACL). “Connecting People to Services.” https://www.acl.gov/node/601. Accessed: 2026-10-04.
- Eldercare Locator / ACL. “Find Local Help.” https://eldercare.acl.gov/Public/Index.aspx. Accessed: 2026-10-04.
- CareScout (Genworth). “CareScout Releases 2025 Cost of Care Survey Results.” https://investor.genworth.com/news-events/press-releases/detail/1054/carescout-releases-2025-cost-of-care-survey-results. Published: March 2, 2026 (surveyed July–November 2025).
- AARP. “2024 Home and Community Preferences Survey.” https://www.aarp.org/home-family/your-home/info-2021/home-and-community-preferences-survey.html. Published: 2024.
- AARP. “Does Medicare Cover Home Health Care?” https://www.aarp.org/medicare/does-medicare-cover-home-healthcare/. Accessed: 2026-10-04.
- Alzheimer’s Association. “Choosing an In-Home Care Professional.” https://www.alz.org/media/Documents/alzheimers-dementia-choosing-in-home-care-professional-ts.pdf. Accessed: 2026-10-04.
- U.S. Department of Veterans Affairs. “Aid & Attendance and Housebound Benefits.” https://www.va.gov/pension/aid-attendance-housebound/. Accessed: 2026-10-04. (2026 rates effective December 1, 2025.)
