Getting in-home care starts with figuring out what kind of help you actually need, then finding a way to pay for it and choosing the right provider. The process can feel overwhelming, but it follows a logical sequence: assess what’s needed, explore funding, and hire carefully. Whether you’re arranging care for yourself or a family member, here’s how to move through each step.
Decide What Level of Care You Need
In-home care falls into two broad categories, and the distinction matters because it affects who provides the care, how you pay for it, and whether you need a doctor’s involvement.
Non-medical home care covers help with everyday tasks: bathing, dressing, grooming, cooking, cleaning, and transportation. Professional caregivers provide this type of support, and no doctor’s order is required. Because most people pay for it out of pocket, there are no medical eligibility requirements to meet.
Medical home health care involves skilled nursing and therapy provided by licensed nurses and therapists. This requires a doctor’s order, and patients must meet specific eligibility criteria, including having limited ability to leave home. Medicare and Medicaid can cover this type of care, which is why it comes with more paperwork and qualification steps.
To figure out where your situation falls, think about what the person receiving care can and can’t do on their own. Healthcare professionals use two categories of tasks to gauge this. Basic activities of daily living include bathing, dressing, eating, using the bathroom, and moving from one spot to another (bed to bathroom, couch to kitchen). Instrumental activities require more complex thinking: managing money, cooking meals, doing laundry, and keeping a household running. If someone needs help mostly with the second group, non-medical home care is likely enough. If they also need wound care, medication management through injections, or physical therapy, medical home health is the right fit.
Explore How to Pay for It
Cost is the biggest barrier for most families, and your options depend on whether you need medical or non-medical care. The median hourly wage for home health and personal care aides is about $16, but that’s what the worker earns. What you pay through an agency is higher, often $25 to $35 per hour depending on your location and the level of care. For someone needing 30 or 40 hours of help per week, those numbers add up fast. Here are the main funding paths.
Medicare
Medicare covers medical home health care but not non-medical help like cooking or housekeeping. To qualify, you must be considered “homebound,” meaning leaving your home isn’t recommended because of your condition or requires considerable effort using a wheelchair, walker, cane, or another person’s help. A healthcare provider must assess you face-to-face before certifying your need, and a Medicare-certified home health agency must deliver the services. One important limit: Medicare only covers part-time or intermittent skilled care. If you need round-the-clock nursing, Medicare won’t foot the bill.
Medicaid HCBS Waivers
Medicaid offers home and community-based services (HCBS) waivers designed specifically to help people receive long-term care at home instead of in a nursing facility. States have flexibility in how they design these programs, so what’s available varies by where you live. Some states target waivers toward elderly residents, others toward people with intellectual disabilities or specific medical conditions. To qualify, you generally need to demonstrate that you require a level of care that would otherwise land you in an institutional setting. The idea is that providing services at home shouldn’t cost more than a nursing home would. Contact your state Medicaid office or local Area Agency on Aging to find out which waivers exist in your area and how to apply.
Veterans Benefits
If you or the person needing care is a wartime veteran receiving a VA pension, the Aid and Attendance benefit can help cover in-home care costs. You may qualify if you need another person’s help with daily activities like bathing, feeding, and dressing, or if illness keeps you in bed for a large portion of the day, or if you’re in a nursing home due to disability-related loss of mental or physical abilities. A separate Housebound benefit exists for veterans who spend most of their time at home because of a permanent disability, though you can’t receive both Aid and Attendance and Housebound benefits simultaneously.
Long-Term Care Insurance
If you or your family member purchased a long-term care insurance policy, it may cover in-home services. Most policies trigger benefits when you need help with two or more of the six basic activities of daily living or when you have a cognitive impairment. Be aware of the elimination period: this is a waiting window (typically 30, 60, or 90 days, depending on what was chosen when the policy was purchased) during which you must cover care costs yourself before the insurance starts paying. Some policies require that you actually receive paid care during this period to satisfy the waiting requirement, so check your policy details carefully before assuming coverage will kick in automatically.
PACE Programs
The Program of All-Inclusive Care for the Elderly (PACE) is a lesser-known option that bundles medical care, home care, and social services into one program. To join, you must be 55 or older, live in the service area of a PACE organization, be eligible for nursing home-level care, and be able to live safely in the community at the time of enrollment. PACE is funded through Medicare and Medicaid for people who qualify for both. If you only have Medicare, you can still enroll but may need to pay a monthly premium for the long-term care portion.
Private Pay
Many families end up paying out of pocket for non-medical home care, since it doesn’t require a doctor’s order and has no eligibility hoops. This gives you the most flexibility in choosing a provider and setting a schedule, but it’s also the most expensive route over time.
Choose Between an Agency and a Private Caregiver
Once you know what you need and how you’ll pay, you have two main hiring paths: go through a licensed home care agency or hire an independent caregiver directly. Each has trade-offs.
Licensed home care agencies handle background checks, training, scheduling, and payroll. They carry liability insurance and workers’ compensation coverage, which protects you if a caregiver is injured in your home or if something goes wrong during care. If a caregiver calls in sick, the agency sends a replacement. The downside is cost: agencies charge more per hour because they’re covering overhead, insurance, and administrative staff.
Hiring an independent caregiver is typically cheaper, but the responsibility shifts to you. You become the employer, which means handling payroll taxes, verifying the caregiver’s background yourself, and carrying the liability risk if an injury occurs. Unlicensed providers and independent caregivers may not follow the same standards a licensed agency is required to meet. For families comfortable with the administrative work, this route can save significant money over months or years of care.
Vet Your Provider Thoroughly
Whether you hire through an agency or independently, ask pointed questions before committing. The National Institute on Aging recommends covering these areas:
- Licensing and accreditation: Is the agency licensed by the state? For medical home health, Medicare certification is a must.
- Background checks: How does the agency screen its caregivers? What does the process include, and how far back do checks go?
- Training: What training do caregivers receive, both before starting and on an ongoing basis? If your loved one has dementia or mobility challenges, ask about specialized training in those areas.
- Insurance: Does the agency carry both liability insurance and workers’ compensation? If you’re hiring independently, consider requiring proof of a personal liability policy.
- References: Ask for references from current or recent clients, and actually call them.
- Backup plans: What happens when a caregiver is unavailable? Agencies should have substitution protocols; independent caregivers generally don’t.
If possible, arrange a trial period before committing to a long-term arrangement. A few days of care will reveal whether the caregiver’s personality, communication style, and reliability are a good fit. The person receiving care should feel comfortable and respected. That matters as much as any credential.
Start the Process Step by Step
Putting it all together, here’s the practical sequence most families follow:
- List what help is needed. Write down every task the person struggles with, separating basic daily activities (bathing, dressing, eating) from household management tasks (cooking, bills, laundry). This list becomes your starting point for every conversation with agencies, insurers, and government programs.
- Talk to the doctor. If skilled medical care might be needed, the process begins with a physician or nurse practitioner. They can order a home health assessment, which is required for Medicare coverage. Even if you only need non-medical care, a doctor’s perspective can help clarify the right level of support.
- Check your funding options. Call Medicare (1-800-MEDICARE), your state Medicaid office, or the Eldercare Locator (1-800-677-1116) to find out what programs you qualify for. If you have long-term care insurance, call your insurer to understand your benefit triggers and elimination period. Veterans should contact their regional VA office.
- Interview at least three providers. Whether agencies or independent caregivers, compare them on training, background check procedures, insurance coverage, and cost. Ask each one how they’d handle your specific care needs.
- Set up a care plan. Once you’ve chosen a provider, establish a written care plan that spells out exactly what tasks the caregiver will perform, how many hours per week, and how communication with the family will work. For medical home health, this plan will be created in coordination with the prescribing doctor.
The whole process, from initial assessment to having a caregiver in the home, can take anywhere from a few days (for private-pay non-medical care) to several weeks (if you’re navigating Medicaid waivers or VA benefits). Starting the paperwork early, especially for government programs with waiting lists, gives you more options when the need becomes urgent.