Getting home care for an elderly parent or family member starts with understanding what type of care they need, figuring out how to pay for it, and choosing between hiring through an agency or finding a caregiver independently. The process can feel overwhelming, but it breaks down into a series of manageable steps.
Determine What Kind of Care Is Needed
Home care falls into two broad categories, and the distinction matters because it affects cost, insurance coverage, and how you find a provider.
Home health care involves skilled medical professionals: nurses, physical therapists, occupational therapists, and case managers who work together on a care plan. This type of care is designed for people recovering from surgery, managing a serious illness, or needing wound care, injections, or medication management. It requires a doctor’s order, and most insurance plans, including Medicare, will cover it if specific medical criteria are met.
Personal care (sometimes called custodial care or non-medical home care) covers help with everyday tasks like bathing, grooming, cooking, housework, and running errands. A personal caregiver cannot provide medical care. You don’t need a doctor’s order to hire one, but insurance typically does not pay for it.
Many families need a combination of both, especially when someone is medically stable but can no longer manage daily life independently.
Assess Your Family Member’s Daily Abilities
Before contacting agencies or applying for benefits, take stock of what your family member can and cannot do on their own. Professionals use two categories to measure this: Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The ability to handle IADLs, the more complex tasks, typically declines first.
ADLs are the basics of self-care: moving around the home safely (including getting out of bed and navigating stairs), dressing, eating with utensils, and bathing. IADLs cover tasks that require more cognitive and organizational ability, like using a phone or computer, managing medications, handling finances, and preparing meals.
A formal functional assessment evaluates each of these areas and also identifies safety hazards in the home, such as fall risks on stairs or difficulty standing from a chair. This assessment becomes the foundation for any care plan and is often required when applying for Medicaid waivers or veterans’ benefits. Your family member’s doctor can perform one, or you can request an evaluation from a home health agency.
Understand What Medicare Covers
Medicare covers home health services, but the eligibility requirements are specific. Your family member must be considered “homebound,” meaning leaving the house isn’t recommended because of their condition, or doing so requires significant effort such as a wheelchair, walker, special transportation, or another person’s help. They must also need part-time or intermittent skilled care, not full-time assistance.
A health care provider must assess them face-to-face and certify the need, then order the care through a Medicare-certified home health agency. Covered services include skilled nursing (wound care, IV therapy, injections, monitoring of unstable conditions), physical and occupational therapy, speech therapy, medical social services, and durable medical equipment. Home health aides who help with bathing, grooming, walking, and feeding are covered only when the person is also receiving skilled nursing or therapy.
Medicare does not pay for 24-hour home care, meal delivery, housekeeping unrelated to the care plan, or personal care when that’s the only type of help needed. If your family member just needs someone to help with bathing and cooking but has no skilled medical needs, Medicare won’t cover it.
Explore Medicaid and Other Payment Options
For families who need non-medical home care and can’t afford to pay out of pocket, Medicaid’s Home and Community-Based Services (HCBS) waivers are one of the most important resources. These state-run programs fund care for people who would otherwise qualify for a nursing home but prefer to stay at home. Each state designs its own waiver program within federal guidelines, so eligibility rules, covered services, and wait times vary significantly by location.
To qualify, your family member generally must demonstrate a level of care need that would meet the state’s threshold for institutional (nursing home) placement. Income and asset limits apply, though states have some flexibility in how they calculate eligibility, particularly when a spouse is involved. Contact your state’s Medicaid office or Area Agency on Aging to learn the specific rules and apply.
Veterans and their surviving spouses have an additional option. The VA’s Aid and Attendance benefit provides a monthly pension supplement for veterans who need help with daily activities like bathing, feeding, and dressing, or who are largely bed-bound due to illness. Eligibility requires that the veteran already receives a VA pension and meets at least one medical necessity criterion. Apply through the VA directly.
The national median rate for non-medical home caregiving is $35 per hour as of 2025, reflecting a 3% increase from the prior year. For families paying privately, that adds up quickly. A caregiver coming for four hours a day, five days a week, costs roughly $700 per week or over $36,000 per year.
Decide: Agency or Independent Caregiver
You have two main paths for hiring non-medical caregivers, and each comes with trade-offs.
Home care agencies handle the logistics. They interview and vet caregivers, run background checks, verify certifications, manage scheduling, and take care of payroll and taxes. Many states require agencies to be licensed and insured. The convenience comes at a higher hourly rate, since the agency takes a portion. But if a caregiver calls in sick, the agency sends a replacement.
Hiring independently is less expensive per hour, but you take on the role of employer. That means running your own background checks, managing payroll, withholding and paying Social Security tax, Medicare tax, federal unemployment tax, and state employment taxes. The caregiver is considered your household employee. You may also want additional liability insurance in case of injury or disputes. Consulting an attorney or financial advisor before hiring independently is worth the upfront cost to avoid legal complications later.
Vet Any Provider Carefully
Whether you go through an agency or hire on your own, ask pointed questions before anyone enters your family member’s home. The National Institute on Aging recommends confirming whether the agency is licensed and accredited by state or local government. Ask specifically how they check caregiver backgrounds and experience, and what training their caregivers receive. For independent hires, run a criminal background check yourself and verify references by calling previous families they’ve worked for.
If you’re evaluating a home health agency for skilled medical care, check Medicare’s Home Health Compare tool, which rates agencies on quality measures and patient satisfaction. Ask whether the agency develops an individualized care plan, how often a supervisor checks in, and what happens if your family member’s needs change.
Consider a Geriatric Care Manager
If you’re coordinating care from a distance, juggling work and parenting, or simply feeling lost in the process, a geriatric care manager (sometimes called an aging life care professional) can serve as a private advocate. These professionals assess your family member’s needs in person, identify safety issues in the home like tripping hazards, coordinate services across providers, and adjust the care plan as conditions change. They’re particularly valuable for families where adult children live in different cities and no one person can manage everything locally.
Tax Deductions for Home Care Costs
If you’re paying for home care out of pocket, some of those costs may be tax-deductible as medical expenses. The IRS allows you to deduct wages paid for nursing-type services, even if the person providing them isn’t a licensed nurse, as long as the care involves tasks like giving medication, changing dressings, bathing, or grooming related to a medical condition. You can also deduct your share of Social Security, Medicare, and unemployment taxes you pay on the caregiver’s behalf.
If the caregiver splits time between medical tasks and household chores like cooking or cleaning, you can only deduct the portion of their wages attributable to medical care. You can even deduct a share of the caregiver’s meals and any extra rent or utility costs you incur to house them. The catch: you can only deduct the amount that exceeds 7.5% of your adjusted gross income, so this benefit mainly helps families with significant care expenses relative to their income.