Getting help for an elderly loved one at home starts with understanding what kind of care they need and which services, programs, and funding sources can provide it. The options range from a few hours of companionship per week to daily visits from licensed nurses, and costs vary just as widely, from free state-funded programs to private care at a national median of $35 per hour. Here’s how to figure out what your situation calls for and where to find it.
Figure Out What Level of Help Is Needed
Before you call an agency or apply for a program, take stock of where your loved one is struggling. Healthcare professionals use two categories to assess this: basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs). Basic ADLs are the physical essentials: bathing, dressing, grooming, using the bathroom, eating, and moving around the house (getting out of bed, walking to the kitchen). IADLs are the more complex tasks required to live independently: managing transportation, shopping for groceries, cooking meals, handling finances, and keeping up with housework.
Someone who needs help only with IADLs, like grocery shopping or laundry, is in a very different situation than someone who can’t bathe or get out of bed without assistance. Walking through both lists honestly will point you toward the right type of care and help you communicate clearly with agencies and insurance programs about what’s needed.
Two Main Types of Home Care
Skilled Home Health Care
This is medical care delivered at home by licensed professionals: nurses, physical therapists, occupational therapists. It covers things like wound care, pain management, mobility training, medication changes, and rehabilitation after a hospital stay. A licensed nurse can adjust prescriptions or modify a therapy plan that isn’t working. This type of care is often covered by insurance, including Medicare, though coverage comes with conditions (more on that below).
Non-Medical In-Home Care
This is the broader category most families are looking for. Non-medical caregivers help with the daily tasks that keep someone safe and comfortable at home: bathing, dressing, getting in and out of bed, meal preparation, medication reminders, light housekeeping, laundry, companionship, and transportation to appointments. These caregivers don’t hold medical licenses, and this type of care is typically not covered by insurance. It’s the kind of help that family members often provide until the workload becomes unsustainable.
How to Pay for Home Care
Medicare
Medicare covers home health services, but only under specific conditions. Your loved one must need part-time or intermittent skilled care (like nursing or physical therapy), and they must be considered “homebound,” meaning leaving home is a major effort that requires a wheelchair, walker, special transportation, or another person’s help. If the only care someone needs is personal assistance with bathing, dressing, or using the bathroom, Medicare will not cover it. That distinction trips up a lot of families. Medicare pays for the medical side, not the daily living side.
Medicaid and State Waiver Programs
Medicaid is often the most important funding source for non-medical home care. Most states offer Home and Community-Based Services (HCBS) waivers that pay for personal care, homemaking, and other support to help people stay out of nursing homes. Eligibility has two parts: financial (your loved one’s income must fall below a threshold, often called the “special income limit”) and functional (they must need a level of care that would otherwise require a facility). Every state runs its programs differently, with different names, waiting lists, and covered services. Your state’s Medicaid office or Area Agency on Aging can walk you through what’s available locally.
Veterans Benefits
If your loved one is a veteran receiving a VA pension, the Aid and Attendance benefit can provide additional monthly payments to cover home care costs. To qualify, at least one of the following must apply: they need help with daily activities like bathing, feeding, or dressing; they spend most of the day in bed due to illness; they’re in a nursing home because of a disability; or they have severely limited eyesight (5/200 or less in both eyes). A separate Housebound benefit exists for veterans who spend most of their time at home due to a permanent disability, though you can’t receive both Aid and Attendance and Housebound benefits simultaneously.
Paying Out of Pocket
The national median rate for non-medical home care is $35 per hour as of 2025, reflecting a 3% increase over the prior year. Rates vary significantly by state and metro area. At 20 hours per week, that works out to roughly $2,800 per month. Some families combine paid care with family caregiving to manage costs, hiring help for specific shifts or tasks while covering the rest themselves. Long-term care insurance, if your loved one purchased a policy years ago, may also reimburse some of these costs.
The PACE Program
The Program of All-Inclusive Care for the Elderly (PACE) is one of the most comprehensive options available, and one of the least well-known. PACE covers virtually everything: primary care, prescription drugs, hospital care, physical and occupational therapy, dental care, mental health counseling, home care, personal care, transportation, adult day programs with meals, and more. A dedicated care team coordinates all of it.
To join, your loved one must be at least 55, live in the service area of a PACE organization, need a nursing home level of care (as certified by the state), and be able to live safely in the community with PACE’s support. People who qualify for both Medicare and Medicaid typically pay nothing out of pocket. The catch is that PACE is only available in certain areas and in states that offer it through Medicaid, so availability is limited. You can search for nearby PACE programs through Medicare.gov.
Your Local Area Agency on Aging
If you’re not sure where to start, your local Area Agency on Aging (AAA) is the single best first call. These agencies exist specifically to help older adults and their families navigate the system. They coordinate in-home support services like help with bathing, dressing, and light housekeeping. They provide information and referral services to connect you with local resources tailored to your situation. Many also run meal delivery programs, transportation assistance, and caregiver support groups.
To find your local AAA, call the Eldercare Locator at 1-800-677-1116 or visit eldercare.acl.gov. A staff member can help you understand which programs your loved one might qualify for and how to apply.
How to Vet a Home Care Agency
Once you know what type of care you need, choosing the right provider matters enormously. The National Institute on Aging recommends asking these questions before hiring:
- Background checks: How does the agency screen its caregivers? Can they provide references?
- Training: What training do caregivers receive, and is it ongoing?
- Licensing: Is the agency licensed and accredited by the state or a professional association?
- Consistency: Will the same caregiver come each time, or will it rotate?
- Communication: How will the agency keep you informed about your loved one’s care?
- Emergencies: Is someone available around the clock? What types of emergency care can they provide?
- Problems: Who do you contact if something goes wrong?
Consistency matters more than families expect. Having the same caregiver builds trust and allows that person to notice subtle changes in your loved one’s health or behavior. Frequent rotation can be disorienting, especially for someone with cognitive decline.
Support for Family Caregivers
If you’re currently the primary caregiver, getting help for your loved one also means getting help for yourself. Respite care provides short-term relief so you can rest, handle your own appointments, or simply take a break. It can last anywhere from a few hours to several weeks.
Respite care takes several forms: an in-home aide who covers your usual shift, an adult day care center where your loved one spends supervised hours during the day, or a short-term stay at a residential facility. For someone receiving hospice care, Medicare covers up to five consecutive days of respite care in a hospital or skilled nursing facility. The ARCH National Respite Locator Service (archrespite.org) lets you search for programs in your area, including state-sponsored options and services for veterans.
Building respite into your routine, rather than waiting until you’re burned out, makes caregiving sustainable over the long term. Even a regular weekly visit from a volunteer or paid aide can make a significant difference.