Finding home care for a senior starts with understanding what kind of help they actually need, then choosing the right hiring model, checking credentials, and figuring out how to pay for it. The process can feel overwhelming, but breaking it into clear steps makes it manageable. Here’s how to work through each one.
Figure Out What Level of Care Is Needed
Before you contact a single agency, spend a few days observing your loved one’s daily routine. Healthcare professionals assess seniors using two categories of tasks: basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Knowing where your family member struggles tells you exactly what type of caregiver to look for.
Basic ADLs are the physical essentials: bathing, grooming, brushing teeth, getting dressed, and moving from one spot to another (bed to bathroom, couch to kitchen). If your loved one needs hands-on help with these tasks, they need a personal care aide at minimum.
IADLs are more complex tasks that require planning and organization: managing money, cooking meals, doing laundry, handling medications, grocery shopping, and keeping the house clean. A senior who can still bathe and dress independently but struggles with meal prep and bill-paying may only need a homemaker or companion-level caregiver for now. Someone who needs help with both categories likely needs more hours and a higher level of care.
If your loved one also has medical needs, like wound care after surgery, injections, physical therapy, or monitoring a chronic condition, that crosses into skilled home health territory. Skilled care is provided by licensed nurses or therapists and is a separate service from personal care, though some agencies offer both.
Know the Two Main Types of Home Care
Non-medical personal care covers help with daily tasks: bathing, dressing, meal preparation, light housekeeping, transportation to appointments, and companionship. Caregivers providing this level of service don’t need nursing licenses, though many hold certifications.
Skilled home health involves medical services delivered at home by registered nurses, physical therapists, occupational therapists, or speech therapists. Medicare covers skilled home health if your loved one meets the “homebound” criteria, meaning they have trouble leaving home without assistance due to illness or injury, or leaving home requires a major effort. A doctor must also certify that skilled services are needed. Medicare does not cover non-medical personal care on its own.
Many families end up using both: a visiting nurse for medical tasks a few times a week and a personal care aide for daily help with meals, hygiene, and mobility.
Agency vs. Hiring Independently
You have two basic paths for finding a caregiver: going through a home care agency or hiring someone directly. Each has real trade-offs in cost, convenience, and risk.
Hiring an independent caregiver saves roughly 20% to 30% compared to agency rates. Independent caregivers typically earn $15 to $17 per hour, while agencies charge around $21 per hour or more. But those savings come with significant strings. When you hire directly, you become the employer. The IRS requires that caregivers be classified as household employees, not independent contractors. If you pay a caregiver $2,100 or more in a calendar year, you’re responsible for withholding and paying Social Security and Medicare taxes (7.65% from each side). You’ll also need to file Schedule H with your tax return. If you paid more than $1,000 in any calendar quarter, federal unemployment tax applies too. Many families pay caregivers under the table to avoid the paperwork, but this carries legal and financial risk for both parties.
Agencies handle all of that. They manage payroll, taxes, scheduling, and substitutes when your regular caregiver is sick. They carry professional liability insurance, which independent caregivers almost never have. For families who need skilled medical care at home, agencies are the more practical choice because of the added liability involved in clinical tasks. The higher hourly rate is essentially the price of not being an employer.
How to Search for and Vet an Agency
Start with Medicare’s Care Compare website (medicare.gov/care-compare). It rates home health agencies on measurable quality indicators: how much patients improve in mobility and daily functioning, how often patients end up in the emergency room or hospital, whether care starts promptly after a referral, and how patients rate their experience in surveys. You can search by zip code and compare agencies side by side. Look at patient survey results in particular, which cover quality of care, communication between providers and patients, and whether patients would recommend the agency to family and friends.
Care Compare only lists Medicare-certified home health agencies (skilled care). For non-medical personal care agencies, check your state’s licensing board or department of health. Not all states require licensure for personal care agencies, so standards vary.
When you contact an agency, ask these questions early:
- Background checks: What screening do you run on caregivers? At minimum, you want a criminal history check through fingerprinting. Some states, like California, require checks through the state Department of Justice and issue formal clearance notices. Ask whether the agency checks abuse registries as well.
- Training and certification: What credentials do your caregivers hold? Are they certified nursing assistants, home health aides, or companion-level staff?
- Supervision: How often does a nurse or care manager visit to oversee the caregiver’s work?
- Backup staffing: What happens if our regular caregiver calls out?
- Communication: How frequently will the family receive updates? Who is the point of contact for questions or concerns?
Interviewing Individual Caregivers
Whether you’re hiring independently or choosing between caregivers an agency sends, the interview matters. Focus on situational questions that reveal how someone handles real-world challenges, not just what’s on their resume.
Ask about their training and certifications, but also ask them to describe a time they dealt with a difficult situation with a patient or family member. How do they handle a senior who refuses to take medication or gets agitated? Can they walk you through their approach to communication when something goes wrong? Ask them to describe a memorable situation where they positively impacted someone’s life. The answers tell you more about temperament and problem-solving than credentials alone. If your loved one has specific needs like dementia care, mobility limitations, or diabetes management, ask for concrete examples of experience with those conditions.
Pay attention to how the caregiver interacts with your loved one during the meeting. Warmth, patience, and genuine interest matter as much as technical skill for someone who will be in your family member’s home every day.
Understanding the Costs
Home care costs vary widely depending on where you live and the level of care needed. For non-medical personal care, rates paid to individual providers in 2025 range from $12 to $36 per hour across states, with a national median around $19 per hour. Agencies charge more, with personal care agency rates ranging from $14 to $44 per hour.
Skilled care costs significantly more. Home health aide rates through agencies range from $25 to $159 per hour depending on the state, with a median of $41. Registered nurse visits run from $25 to $190 per hour, with a median of $70. Most families don’t pay these skilled rates out of pocket because Medicare or Medicaid typically covers them.
For a senior needing 30 hours per week of personal care at $20 per hour, you’re looking at roughly $2,400 per month. At 40 hours a week, that climbs to about $3,200. Full-time, around-the-clock care can easily exceed $8,000 to $10,000 monthly.
Paying for Home Care
Medicare covers skilled home health services (nursing, therapy) when a doctor orders them and the patient is homebound. It does not cover ongoing personal care like help with bathing, cooking, or companionship.
Medicaid is the primary public payer for non-medical home care, but eligibility and services depend heavily on your state. Most states operate Home and Community-Based Services (HCBS) waivers, which allow Medicaid to fund personal care, homemaker services, home health aides, adult day programs, and respite care for seniors who would otherwise need a nursing home. Each state designs its own program, so the services available, income limits, and wait times differ. Some states have long waiting lists for these waivers. Contact your state Medicaid office or local Area Agency on Aging to find out what’s available and how to apply.
Long-term care insurance, if your loved one purchased a policy years ago, often covers home care services. Check the policy for daily or monthly benefit limits and any waiting periods. Veterans may qualify for home care benefits through the VA’s Aid and Attendance program. Beyond these, some families use a combination of personal savings, reverse mortgages, or life insurance policy conversions to cover costs.
Setting Up a Care Plan
Once you’ve hired a caregiver or agency, put a written care plan in place before care begins. This protects your loved one and gives the caregiver clear expectations. A good care plan covers the daily and weekly schedule of tasks, specific instructions for medication management (including reminders and any assistance with administering), dietary needs or restrictions, and mobility or fall-prevention protocols.
Include a section for emergencies: a list of emergency contacts (family members, primary doctor, specialists, local emergency services), the senior’s medical history summary, current medications, and any advance directives like a healthcare proxy or do-not-resuscitate order. Every caregiver working in the home should know where this information is kept.
Set up a system for ongoing communication. A shared digital calendar or care log where the caregiver records daily activities, meals, mood changes, and any concerns gives family members visibility even when they’re not present. Agree on a regular check-in schedule, whether that’s a weekly phone call, a daily text update, or notes left in a binder. Small changes in appetite, sleep, confusion, or mobility often signal bigger issues. A caregiver who documents consistently helps you catch those patterns early.
Monitoring Quality Over Time
Finding good home care isn’t a one-time decision. Needs change, sometimes gradually and sometimes fast. A senior recovering from hip surgery may start with skilled nursing and physical therapy, then transition to personal care only, then eventually need just a companion for a few hours a week. Or needs may escalate as a condition like dementia progresses.
Check in with your loved one privately and regularly. Ask how they feel about their caregiver, whether they’re comfortable, and if anything feels off. If they have cognitive decline, watch for indirect signs of problems: unexplained bruises, weight loss, increased anxiety, or reluctance around the caregiver. Drop by unannounced occasionally if you live nearby.
If you’re using a Medicare-certified agency, their quality scores on Care Compare update periodically. Revisit those ratings and compare them to other agencies in your area. If satisfaction drops or problems emerge, switching agencies is always an option. The goal is a care arrangement that keeps your loved one safe, comfortable, and as independent as possible for as long as possible.