Finding in-home care for an elderly parent or loved one starts with understanding what level of help they need, then choosing between an agency and a private caregiver, and finally vetting your options carefully. The process can feel overwhelming, but breaking it into clear steps makes it manageable. Most families can narrow down their options within a few weeks once they know what to look for.
Figure Out What Level of Care You Need
Before you contact a single agency, spend time observing what your loved one can and can’t do independently. Healthcare professionals typically evaluate two categories of daily function. The first is basic activities of daily living: bathing, dressing, using the toilet, eating, getting in and out of bed, and maintaining continence. The second is what’s called instrumental activities, the more complex tasks that let someone live independently: managing finances, housekeeping, grocery shopping, preparing meals, doing laundry, using transportation, making phone calls, and handling their own medications.
Someone who struggles mainly with instrumental tasks like cooking and housekeeping may only need a few hours of help per week. Someone who needs hands-on assistance with bathing, dressing, or transferring from a bed to a chair typically needs more frequent visits or even full-time support. Writing down exactly which tasks your loved one needs help with gives you a concrete list to share with potential care providers and prevents you from paying for services you don’t actually need.
Home Care vs. Home Health Care
These two terms sound interchangeable, but they cover very different services. Home care is nonmedical. It includes companionship, help with bathing and dressing, meal preparation, light housekeeping, laundry, medication reminders, and transportation to appointments. Home health care is medically focused and prescribed by a doctor. It involves skilled nursing, wound care, medication administration, injections, rehabilitative therapies, pain management, and health monitoring.
Most families searching for “in-home care” need the nonmedical kind. If your loved one also has medical needs like wound dressing changes or physical therapy after a hospital stay, you’ll likely need both types, sometimes from different providers. A home care aide can remind your loved one to take their pills, but only a home health provider can actually administer medications, run medical tests, or provide rehab services.
Where to Start Your Search
The federal government runs a free service called the Eldercare Locator, operated by the Administration for Community Living. You can reach it at eldercare.acl.gov or by calling 1-800-677-1116. It connects you to your local Area Agency on Aging, which maintains lists of vetted care providers in your community and can point you toward financial assistance programs.
For home health agencies specifically (the medical kind), Medicare’s Care Compare tool at medicare.gov lets you search by zip code and see star ratings for agencies in your area. Agencies receive two types of ratings: one for quality of patient care, based on measures like how quickly care begins, whether patients improve in mobility and bathing ability, and how often patients avoid unnecessary hospitalizations. The second rating comes from patient satisfaction surveys covering communication, specific care issues, and overall experience. Look for agencies with strong scores in both categories, and be cautious of any agency without enough data to generate a rating.
For nonmedical home care, your Area Agency on Aging is the best starting point. You can also ask your loved one’s doctor, hospital discharge planner, or friends who’ve been through the process. Online directories exist, but they often function as paid referral services, so treat them as a starting point rather than a vetted recommendation.
Agency vs. Private Hire
You have two main paths: hiring through an agency or hiring a caregiver directly.
Agencies handle recruiting, background checks, training, scheduling, payroll, taxes, and insurance. If your loved one’s regular caregiver calls in sick, the agency sends a replacement. You pay a higher hourly rate for this convenience. The national median rate for a home health aide through an agency is $34 per hour as of 2024, according to the CareScout Cost of Care Survey. That works out to roughly $5,400 per month for 40 hours of weekly care.
Hiring privately costs less per hour, but you take on significant responsibilities. You become a household employer. The IRS requires you to withhold and pay Social Security and Medicare taxes if you pay a household employee $3,000 or more in cash wages in a calendar year. If you pay all household employees a combined $1,000 or more in any calendar quarter, you also owe federal unemployment tax on the first $7,000 of each employee’s wages. You’ll need to file Schedule H with your tax return and issue a W-2 to the caregiver. Many states have additional requirements, including workers’ compensation insurance. Skipping these obligations can result in penalties and leaves both you and the caregiver unprotected.
Questions to Ask a Home Care Agency
When you’ve identified a few agencies, schedule calls or in-person meetings. Three questions matter most. First: what screenings do you perform before hiring caregivers? You want to hear about both federal and state criminal background checks, and ideally drug testing. Second: are your caregivers insured and bonded through the agency? This protects you if a caregiver is injured in your loved one’s home or if property is damaged or stolen. Third: what happens if my loved one’s regular caregiver can’t make it? A reliable agency has a clear backup plan and won’t leave you scrambling.
Beyond those essentials, ask how the agency supervises its caregivers, whether a care coordinator will visit the home periodically, how they handle complaints, and whether they create a written care plan. Ask about minimum hour requirements per visit, as many agencies require three- or four-hour minimums. Request references from current clients in similar care situations.
Writing a Care Agreement
Whether you hire through an agency or privately, get everything in writing. A personal care agreement is especially important when hiring a family member or independent caregiver. According to the Family Caregiver Alliance, the agreement has three basic requirements: it must be in writing, it must cover care to be provided in the future (not retroactive payment for past help), and compensation must be reasonable, meaning it shouldn’t exceed what a third-party caregiver in your area would charge for the same services.
Your agreement should clearly define the caregiver’s role with specific tasks listed, the duration of the arrangement, how compensation will be paid (weekly, biweekly, or monthly), and what happens if either party wants to end the agreement. Consider including provisions for vacation time to reduce caregiver burnout, annual raises, reimbursement for out-of-pocket expenses like gas or supplies, and whether you’ll provide any benefits like health insurance. Being specific upfront prevents misunderstandings that can damage both the care relationship and family dynamics.
Paying for In-Home Care
Medicare covers home health care (the medical kind) only under specific conditions. Your loved one must be considered “homebound,” meaning they have trouble leaving home without help from a device or another person, leaving isn’t recommended because of their condition, or getting out of the house requires a major effort. They must also need part-time or intermittent skilled nursing care. In most cases, that means up to 8 hours of combined skilled nursing and aide services per day, with a cap of 28 hours per week. Short-term needs may qualify for up to 35 hours weekly. Medicare does not cover nonmedical home care like companionship, housekeeping, or meal preparation.
Medicaid offers more help for nonmedical care through Home and Community-Based Services (HCBS) waivers, but eligibility varies significantly by state. Generally, you must meet your state’s income and asset limits and demonstrate a level of functional need. Some states set income eligibility at 150% of the federal poverty level. Under certain waivers, states can cover people who wouldn’t normally qualify for Medicaid, specifically to help them avoid moving to a nursing facility. Contact your state Medicaid office or local Area Agency on Aging to find out what’s available where you live.
Long-term care insurance, if your loved one purchased a policy years ago, often covers in-home care. Veterans may qualify for home care benefits through the VA’s Aid and Attendance program. For everyone else, in-home care is typically an out-of-pocket expense, which is why accurately assessing the level of care needed matters so much financially. Starting with fewer hours and adjusting upward as needs change is a practical way to manage costs over time.