What in-home care actually costs

The cost of in-home care starts at a national median of $35 an hour. That is the number nobody says out loud until you ask.

It sounds almost manageable, for an hour. Then you work out how many hours she actually needs, and the floor drops.

And 44 hours is not full coverage. It is not nights. It is not weekends. It is a person there for about six hours a day, on weekdays, and nobody there for the other 124 hours in the week.

This page is the cost of in-home care in full — the number, where it comes from, what pushes it up, and how families actually pay it — without the pretending that everyone else does.

If you’re not yet sure whether what she needs is skilled care or custodial care, start with home health vs. home care → — it changes who pays.

How much does home care cost — and where the number comes from

The figures on this page are from the CareScout Cost of Care Survey — the survey formerly run under the Genworth name, which has tracked long-term care prices for more than twenty years. The 2025 edition collected over 25,000 real rates from providers across the country. It is the most authoritative source that exists, and it is the one the insurance industry itself uses.

The national median for in-home care in 2025 was $35 an hour, up 3% on the year — a smaller rise than the steep increases of recent years, roughly in line with inflation. So when someone asks how much home care costs, that hourly figure is the honest starting point, before hours and location move it.

The change nobody’s told you: “homemaker” is no longer the cheap option

For years the standard advice was to hire “homemaker” help — hands-off support with cooking, cleaning, and errands — because it cost less than a “home health aide,” who does hands-on personal care like bathing and dressing.

That advice is now out of date, and it is worth knowing why.

In its 2025 survey, CareScout merged the two categories into one — “non-medical caregiver” — because their prices had converged. Two-thirds of agencies now charge the same rate whether the caregiver is folding laundry or helping someone out of the bath. The old home health aide cost advantage — or rather the homemaker discount beneath it — has largely disappeared.

So if an agency quotes you a lower rate for “just homemaker services,” that is a reason to ask questions, not a bargain to grab. The market has moved.

What actually drives your number up or down

The $35 median is a starting point. Four things move it, and some of them move it hard.

1. Where you live

This is the biggest single factor. In 2025 the non-medical caregiver rate ranged from about $24 an hour in Mississippi to about $46 an hour in Wyoming — nearly double, for the same job. Dense, high-wage regions cost more. Rural areas cost less, but often have far fewer caregivers available, which brings its own problem.

Look up your own state before you budget anything. The national median will mislead you in either direction.

2. How many hours — and the in-home care cost per hour, multiplied out

Here is the arithmetic families never do until they have to. At the $35 median in-home care cost per hour:

*The 24-hour figure is our own calculation — the $35 median hourly rate multiplied out to a full week. CareScout does not survey a 24-hour rate, and live-in care is often billed at a flat daily rate that works out lower than 24 times the hourly figure. Treat this row as the ceiling, not a quote.

Two things jump out of that table.

First: 24-hour home care costs a quarter to a third of a million dollars a year. That is not a typo, and it is the single most important fact on this page. It is why nobody keeps a person at home around the clock with hired help for very long, and why families who assume they will are in for a shock.

Second, and more useful: there is a threshold where a facility becomes cheaper than home. That brings us to the comparison nobody lays out honestly.

3. Home versus a facility — the comparison in one place

Here is what the same 2025 survey says the alternatives cost, next to in-home care:

Read down that column and the tipping point is obvious. At around 44 hours a week, home care and assisted living cost almost the same — and most people would rather be home. But push the hours up, and home care sails straight past a private nursing home and keeps going.

Somewhere around ten to twelve hours a day of paid help, staying home stops being the cheaper option and becomes a premium you are paying for a reason — usually a good one, but a premium all the same. Knowing where that line sits does not tell you what to choose. It tells you honestly what you are choosing between, which is more than most families are ever given.

4. Who you hire through

An agency charges more per hour, and the extra buys real things: they handle payroll and taxes, they carry insurance and bonding, they run background checks, and — critically — they send a replacement when your caregiver is sick or on vacation. You are not the employer.

Hiring privately — finding someone directly — can cost noticeably less per hour. But that lower rate is not the whole price. Hire someone directly and, in the eyes of the law, you have almost certainly become a household employer, with tax withholding, workers’ compensation, and liability that come with it. Pay privately and skip that, and the exposure is yours. And when your caregiver doesn’t show up, nobody is coming.

The per-hour saving is real. So is the reason for it.

The choice between an agency, a registry, and hiring directly changes both the price and who carries the risk. How to hire an in-home caregiver — three paths, and the tax trap in the cheapest one →

5. What she actually needs done

Standard personal care sits at the median. The number climbs for a caregiver trained in dementia behaviors, for two-person transfers, for overnight awake care, or for anything approaching a clinical task. And genuinely skilled nursing at home — a licensed nurse for wound care or IVs — is a different market entirely, with a national median around $90 an hour. That is rarely an all-day arrangement, and Medicare may cover it when it is truly skilled and doctor-ordered.

What Medicare pays toward all of this

For the custodial care this page is about — bathing, dressing, meals, supervision, company — when that is the only help she needs: nothing.

Not a reduced rate. Not a copay. Nothing. Medicare covers skilled, part-time, doctor-ordered home health care, and even that runs only a handful of hours a week and ends when the skilled need ends.

Every number on this page is a number your family pays, unless one of the routes below applies. Exactly what Medicare does and doesn’t cover at home, and the trapdoor in the middle of it →

How families actually pay for it

Nobody has $80,000 a year sitting in a drawer. Here is how it really gets paid, roughly in the order families reach for it. For the full picture of each path in one place, see how families pay for home care →

Out of pocket

Savings, pension, Social Security, and very often the adult children topping up the gap. This is the most common answer and the one that quietly drains a family’s own retirement. If you are paying out of pocket, the hours-versus-facility comparison above is the most important calculation you will do.

If the hard part isn’t the money but a sibling who insists none of it is necessary, that’s a different problem with a different fix: when your brother thinks she’s fine →

Long-term care insurance

If she bought a policy, this is the exact thing it was for — and most policies trigger when someone needs hands-on help with two or more activities of daily living. Find the policy before you spend a single dollar of your own. People pay out of pocket for months, sitting on a policy they forgot they had, because nobody went looking. The claim usually requires documentation of which activities of daily living she can no longer do on her own — which is exactly what a completed functional assessment gives you. How long-term care insurance works, and who it’s for →

Veterans’ benefits

If she or her late husband served during a wartime period, the VA’s Aid and Attendance benefit can add a meaningful monthly sum on top of a VA pension, specifically for people who need help with daily activities. It is underused because it is not well advertised. It is worth checking. How VA Aid and Attendance works, and how to apply for free →

Medicaid

This is the country’s real long-term care safety net — but it is income- and asset-tested, it varies enormously by state, and its home-care waiver programs often have waiting lists. It is not something you switch on in a crisis. And it carries a five-year look-back on asset transfers that makes last-minute maneuvering both ineffective and legally dangerous. If Medicaid is anywhere in your future, that is a conversation to have with an elder law attorney years early, not weeks late. How Medicaid pays for home care, and the five-year look-back →

The house

For many families the house is the only asset large enough to matter, and it gets used — through a sale, a reverse mortgage, or a home equity line. Each has serious tradeoffs, and each interacts with Medicaid’s rules in ways that can go badly if you move without advice. Do not touch the house to pay for care without talking to someone who knows both the tax and the Medicaid side.

And if all of this is landing on you because a hospital discharge is coming this week, start here: they’re sending her home Thursday →

Questions families ask about cost

How much does in-home care cost per hour?

The 2025 national median is $35 an hour for a non-medical caregiver, ranging from about $24 to $46 depending on the state. Skilled nursing at home is a separate, much higher market, around $90 an hour.

How much does home care cost per month and per year?

At the $35 national median, the cost of in-home care runs roughly $6,700 a month, or about $80,080 a year, for CareScout’s 44-hour-a-week benchmark. Fewer hours cost proportionally less, and daytime-every-day or around-the-clock coverage costs far more. Your state’s rate and the number of hours she needs are what actually set the figure.

How much does 24-hour home care cost?

At the national median hourly rate, 24-hour home care costs roughly $250,000 to $350,000 a year. Live-in arrangements are sometimes billed at a flat daily rate that comes in lower, but continuous hired care at home is expensive enough that most families compare it directly against a facility.

Is a homemaker cheaper than a home health aide?

Not anymore. As of 2025 the two rates have largely converged, and about two-thirds of agencies charge the same for both. CareScout now reports them as a single “non-medical caregiver” category, so there is no longer a reliable homemaker discount beneath the home health aide cost.

Does Medicare pay for any in-home care?

Not for custodial care — bathing, dressing, meals, supervision — when that is the only help needed. Medicare covers skilled, part-time, doctor-ordered home health care, which is a few hours a week and ends when the skilled need ends.

At what point is a facility cheaper than care at home?

Roughly above ten to twelve hours a day of paid in-home help, assisted living or even a nursing home often costs less than staying home. Below that, home is usually both cheaper and preferable.

Is agency care or private hire cheaper?

Private hire has a lower hourly rate, but it typically makes you a household employer, with the tax, insurance, and liability that follow — and no backup when your caregiver is unavailable. Agencies cost more per hour and absorb all of that.

Whichever way you hire, the person still has to be right for the job. How to vet and interview an in-home caregiver →

How do most families pay for home care?

Usually a combination: savings and family contributions first, then long-term care insurance if a policy exists, veterans’ benefits if she qualifies, Medicaid as the safety net, and often the house as the largest available asset. Each has tradeoffs worth professional advice.

Last verified: 15 July 2026 against the CareScout 2025 Cost of Care Survey · Next review: on publication of the 2026 survey (~March 2027)

This page is educational and is not medical, legal, financial, or tax advice. Mark Duda is not an attorney, a financial advisor, or a tax professional. Costs vary widely by location, provider, and need, and the figures here are medians, not quotes. Decisions about long-term care insurance, veterans’ benefits, Medicaid, and using home equity have significant financial and legal consequences — consult a qualified professional. See our disclaimers.