Getting in-home care for an elderly family member starts with understanding what kind of help they need, choosing between an agency and a private caregiver, and figuring out how to pay for it. The process can move quickly once you know the steps, but most families spend time upfront sorting through options they didn’t know existed. Here’s how to navigate it from start to finish.
Figure Out What Level of Care Is Needed
Before contacting any provider, take an honest look at what your loved one can and can’t do on their own. Care professionals evaluate this using two categories of daily tasks. The first covers basic self-care: bathing, dressing, using the toilet, eating, getting in and out of a bed or chair, and managing bladder and bowel control. These are the fundamental activities that determine whether someone can live independently.
The second category covers the more complex tasks of running a household: managing money, shopping for groceries, preparing meals, doing laundry, keeping up with housework, using a phone, getting transportation, and taking medications correctly. Someone might be perfectly able to dress and feed themselves but unable to manage their prescriptions or drive to the store. That distinction matters because it determines whether you need medical care, non-medical assistance, or both.
If your parent needs help with bathing, meals, and companionship but doesn’t require skilled nursing, you’re looking at personal care services. If they need wound care, physical therapy, injections, or monitoring of a chronic condition, that falls under home health care, which involves licensed nurses or therapists. Many families end up needing a combination.
Choose Between an Agency and a Private Caregiver
You have two main paths: hire through a home care agency or find an independent caregiver on your own. Each comes with real trade-offs.
An agency handles the logistics. They recruit, screen, and train caregivers. They manage scheduling, payroll, and taxes. If your regular caregiver calls in sick, the agency sends a replacement. Most states require agencies to carry insurance and meet licensing standards, which gives you a layer of protection.
Hiring a private caregiver is typically cheaper per hour, but you take on significant responsibilities. That person becomes your household employee, which means you’re on the hook for payroll taxes, background checks, and scheduling. If the caregiver is injured in your home, you could face liability. Some families purchase additional insurance to cover injury or theft. And if your caregiver quits or gets sick, you have no backup unless you’ve arranged one yourself.
For families who want more control over who provides the care and are comfortable with the administrative burden, private hiring can work well. For families who need reliability and don’t want to act as an employer, an agency is the simpler choice.
How to Vet an Agency
Not all agencies are equal. The National Institute on Aging recommends asking specific questions before signing any agreement. Start with these: How do you screen and check the backgrounds of your caregivers? Can you provide references? How are your caregivers trained? Will the same person come each time, or will the caregiver rotate? Are you available around the clock for emergencies, and what types of emergency care can you provide?
Pay attention to how the agency responds. A good agency will describe their training process in detail, explain their backup plan when a caregiver is unavailable, and be transparent about what their caregivers are and aren’t qualified to do. Ask whether caregivers are employees of the agency or independent contractors, because that affects accountability. Request a written care plan that spells out exactly which tasks the caregiver will perform, how many hours per week, and what happens if your needs change.
What It Costs
The national median rate for non-medical home care is $35 per hour as of 2025, according to the CareScout Cost of Care report. That represents a 3% increase from the prior year. At 44 hours per week, which is a common full-time arrangement, the annual cost comes to about $80,080.
Costs vary significantly by location. Urban areas and states with higher costs of living can run well above that median, while rural areas may be somewhat lower. Part-time care of 10 to 20 hours a week obviously costs far less, and many families start there before scaling up. If your loved one needs skilled nursing visits on top of personal care, expect higher rates for those hours.
Medicare Coverage for Home Health
Medicare covers home health services, but only under specific conditions. Your loved one must be considered “homebound,” meaning they have trouble leaving home without help from another person or a device like a walker, wheelchair, or crutches, or that leaving home requires a major effort due to their condition. They must also need part-time or intermittent skilled care from a nurse or therapist.
When those criteria are met, Medicare typically covers up to 8 hours per day of combined skilled nursing and home health aide services, with a maximum of 28 hours per week. In some cases, a doctor can authorize up to 35 hours per week for a short period. A doctor or other provider must order the services and a Medicare-certified agency must deliver them.
The critical limitation: Medicare does not cover long-term personal care. If your parent needs someone to help with bathing and meals indefinitely but doesn’t require skilled medical services, Medicare won’t pay for it. This catches many families off guard.
Medicaid and State Programs
Medicaid is the primary payer for long-term home care for people with limited income and assets. Most states offer Home and Community-Based Services (HCBS) waivers, which are specifically designed to help people stay in their homes instead of moving to a nursing facility. To qualify, your loved one must meet two tests: financial eligibility (income and asset limits that vary by state) and functional eligibility, meaning they need a level of care that would otherwise require placement in an institutional setting.
Each state runs its program differently. Some have long waiting lists for waiver slots. Others target specific populations by age or diagnosis. To find out what’s available in your state, contact your local Area Agency on Aging or apply through your state’s Medicaid office. The application process involves a financial review and a functional assessment, which usually includes an in-home visit from a case manager who evaluates your loved one’s ability to perform daily tasks.
Personal care services through Medicaid are specifically meant to help eligible people remain in their homes and communities rather than in nursing homes. If your family member qualifies, these programs can cover a significant number of weekly care hours at no cost.
The PACE Program
The Program of All-Inclusive Care for the Elderly (PACE) is a lesser-known option worth exploring. It bundles medical care, home care, and social services into a single program. To be eligible, a person must be 55 or older, live in the service area of a PACE organization, be certified as eligible for nursing home care, and be able to live safely in the community at the time of enrollment.
PACE participants receive a coordinated care team that manages everything from doctor visits to in-home aides to adult day programs. For those who qualify for both Medicare and Medicaid, there’s typically no monthly premium. PACE isn’t available everywhere, but it operates in over 30 states. You can search for a program near you through Medicare.gov.
Veterans Benefits
Veterans and their surviving spouses have access to the Aid and Attendance benefit, a pension supplement specifically for those who need help with daily activities. A veteran with no dependents can receive up to $29,093 per year. A veteran with one dependent can receive up to $34,488 per year. Two married veterans who both qualify can receive up to $46,143 per year, with an additional $2,984 added for each extra dependent.
To qualify, the veteran must have served at least 90 days of active duty with at least one day during a wartime period, and must meet income and net worth limits. The benefit can be used to pay for home care from any source, whether an agency or a private caregiver. Applications go through the VA and can take several months to process, so it’s worth starting early.
Long-Term Care Insurance
If your loved one purchased a long-term care insurance policy years ago, now is the time to pull it out and read the fine print. These policies typically start paying benefits when the policyholder can’t perform two or more of six basic daily activities (bathing, dressing, eating, toileting, transferring, and continence) or has a cognitive impairment like dementia.
Even after meeting that threshold, there’s a waiting period before payments begin. Most policies have an elimination period of 30, 60, or 90 days, chosen at the time of purchase. During that window, you pay out of pocket. Once benefits kick in, the policy pays a daily or monthly amount toward home care up to its coverage limits. Contact the insurance company to start a claim as soon as your loved one’s needs are clear, since the elimination period clock doesn’t start until you file.
Steps to Get Started
- Assess the need. Write down every task your loved one struggles with, both basic self-care and household management. This list becomes the foundation for every conversation with providers and insurers.
- Talk to their doctor. A physician’s order is required for Medicare-covered home health. Even if you’re arranging non-medical care, a doctor can provide documentation that supports Medicaid or insurance claims.
- Check financial programs first. Contact your local Area Agency on Aging (find yours at eldercare.acl.gov or call 211) to ask about Medicaid waivers, PACE, state-funded programs, and veteran benefits. Free or subsidized care may be available.
- Interview at least three agencies. Compare their caregiver screening processes, training standards, backup policies, and pricing. Ask for references and call them.
- Start with a trial period. Most agencies allow you to begin with a few hours per week and adjust. This lets your loved one get comfortable with a caregiver before committing to a full schedule.
The process of arranging home care can feel overwhelming at first, but it’s largely a matter of identifying needs, exploring payment options, and finding the right caregiver match. Many families find that even a few hours of weekly help makes an enormous difference in their loved one’s safety and quality of life.