Getting home care for an elderly parent or family member starts with figuring out what level of help they actually need, then matching that to the right type of service and finding a way to pay for it. The process can feel overwhelming, but it breaks down into a few clear steps: assessing your loved one’s needs, choosing between medical and non-medical care, exploring payment options, and vetting the people who will be in their home.
Figure Out What Kind of Help They Need
Before you call an agency or start comparing costs, take an honest look at where your family member is struggling. Healthcare professionals use two categories to evaluate this. The first covers basic daily activities: bathing, dressing, getting in and out of a bed or chair, using the toilet, eating, and maintaining continence. The second covers more complex tasks that let someone live independently: managing money, keeping up the house, grocery shopping, making phone calls, preparing meals, doing laundry, getting transportation, and taking medications correctly.
Walk through both lists. If your parent needs help with cooking, cleaning, and errands but is otherwise healthy, they likely need a personal caregiver rather than a medical professional. If they’re recovering from surgery, need wound care, require physical therapy, or can’t manage medications safely, they need skilled home health services. Many families eventually use both.
Home Health vs. Personal Care
These two types of home care are fundamentally different, and mixing them up can cost you time and money.
Home health care involves licensed medical professionals: nurses, physical and occupational therapists, nursing assistants, and case managers. It’s appropriate for people recovering from hip or knee replacements, managing conditions after cardiac surgery, needing IV antibiotics, or requiring ongoing medication management. You need a doctor’s order to start home health services, and most insurance (including Medicare) will only cover it if specific medical criteria are met.
Personal care is non-medical. A personal caregiver helps with grooming, meal prep, housework, errands, and companionship. You don’t need a doctor’s order, and insurance typically does not cover it. This is the right fit for someone who is generally healthy but needs a hand with daily life, whether that’s a few hours a week or full-time support.
Check Whether Medicare Covers It
Medicare covers home health services, but only under specific conditions. Your family member must be considered “homebound,” meaning leaving the house requires significant effort due to illness or injury, such as needing a wheelchair, walker, cane, special transportation, or another person’s help. They must also need part-time or intermittent skilled care ordered by a physician.
“Part-time or intermittent” generally means up to 8 hours per day of combined skilled nursing and aide services, capped at 28 hours per week. In some cases, a provider can authorize up to 35 hours weekly for a short period. If your loved one needs more than that, they won’t qualify for Medicare home health coverage. And Medicare does not pay for non-medical personal care services like housekeeping, meal prep, or companionship on their own.
Explore Medicaid and State Programs
Medicaid is often the most important funding source for families who need ongoing home care but can’t afford to pay out of pocket. Most states run Home and Community-Based Services (HCBS) waiver programs that pay for care at home as an alternative to a nursing home. These waivers can cover personal care, homemaker services, and other supports that Medicare won’t touch.
Eligibility requires demonstrating that your family member needs a level of care that would otherwise qualify them for a nursing facility. Each state sets its own rules for income limits, asset thresholds, and the number of people it will serve. Waiting lists are common. To apply, contact your state’s Medicaid office or your local Area Agency on Aging, which can walk you through the process and connect you with other community resources like home-delivered meals and homemaker assistance. You can find your local agency through the Eldercare Locator at eldercare.acl.gov or by calling 1-800-677-1116.
Veterans Have Additional Options
If your family member is a veteran receiving a VA pension, they may qualify for Aid and Attendance benefits, which provide additional monthly payments specifically to help cover the cost of home care. 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 is available for veterans who spend most of their time at home because of a permanent disability. Both supplements can make a meaningful dent in home care costs.
What Home Care Actually Costs
The national median cost for non-medical home care in 2024 was $33 per hour. What that translates to monthly depends entirely on how many hours of help your family member needs:
- 7 hours per week (a daily check-in): about $1,000 per month
- 15 hours per week (a few hours most days): about $2,145 per month
- 30 hours per week (substantial daily help): about $4,290 per month
- 44 hours per week (near full-time): about $6,292 per month
Costs vary significantly by state and metro area. Rural areas tend to be cheaper, while cities in the Northeast and West Coast run well above the median. When budgeting, factor in that needs often increase over time. What starts as a few hours a week for meal prep and errands can grow into daily assistance with bathing and mobility within a year or two.
Agency vs. Independent Caregiver
You have two main hiring paths, and each comes with real trade-offs.
A home care agency handles the logistics: they recruit and screen caregivers, run background checks, manage payroll and taxes, carry professional liability insurance, and provide a replacement if your regular caregiver calls in sick. You pay a higher hourly rate for this convenience, but you’re not on the hook as an employer.
Hiring an independent caregiver directly is typically cheaper per hour, but it shifts all the administrative and legal responsibility to your family. You’ll need to run your own background checks, verify references, and handle payroll. The IRS classifies home caregivers as household employees, not independent contractors, which means you’re responsible for withholding taxes and paying employer contributions. Paying someone “under the table” creates legal risk. If this sounds daunting, affordable third-party payroll services exist specifically for families employing household workers.
Independent caregivers also typically don’t carry liability insurance. If a caregiver is injured in your parent’s home, your family could be financially responsible. For families choosing this route, a household employer insurance policy is worth looking into.
How to Vet a Home Care Provider
Whether you’re hiring through an agency or on your own, ask pointed questions before anyone sets foot in your loved one’s home. The National Institute on Aging recommends covering three areas in particular:
- Licensing and accreditation: Is the agency licensed by the state? Are they accredited by a professional association? Requirements vary by state, but you want to confirm they meet at least the minimum standards.
- Background checks and experience: How does the agency screen its workers? Can they share references from other families? For independent hires, run a criminal background check yourself through your state’s online system or a reputable screening service.
- Training and supervision: What training do caregivers receive, both initially and on an ongoing basis? Who supervises them, and how often? For someone with dementia or mobility challenges, specialized training matters.
Beyond these basics, ask about their process for handling emergencies, how they communicate with families, and whether they create a written care plan. A good provider will welcome these questions. One that deflects or rushes past them is telling you something.
Getting Started Step by Step
Once you’ve assessed your family member’s needs and understand the financial picture, the practical steps are straightforward. If they need skilled medical care, ask their primary care doctor for a home health referral and check whether Medicare or their insurance will cover it. If they need non-medical help, contact your local Area Agency on Aging for referrals to vetted agencies in your area and to learn about any state-funded programs they might qualify for. Apply for Medicaid HCBS waivers early, since wait times can stretch months in some states. If your loved one is a veteran, contact the VA about pension-based benefits before assuming you’ll need to pay entirely out of pocket.
Start with fewer hours than you think you’ll need. This gives your family member time to adjust to having someone in their home, lets you evaluate the caregiver’s fit, and keeps costs manageable while you figure out the right long-term arrangement. You can always increase hours as needs change.