Understanding the Cost of In Home Care

As we age, it's natural to need a little extra help and support to maintain our independence and quality of life. Indeed, a study by the AARP reports that 77% of older adults aged 50+ want to age "in place" - another term for staying in your home as long as possible.

And while that statistic may change as the senior living landscape evolves, there's also an equal level of innovation happening in the home care service market. Today, there are so many types of in home care services available, whether you need assistance with daily tasks, seek companionship, or require medical care.

So while the topic may seem daunting, we've done our best to break it down into key questions and answers that help you make the most informed and educated decision for you and your loved ones.

12 types of in-home care and support for older adults

• Personal Care Assistance: This type of in home care focuses on helping older adults with daily activities such as bathing, dressing, grooming, toileting, and mobility. This group of care needs is often referred to as "activities of daily living", or ADLs. When a family member needs daily support, it's common to consider both in-home care and assisted living communities. 
• Companion Care: Companion care is designed to provide emotional support, companionship, and socialization for older adults who may be isolated or lonely. The folks at Seniorly are so excited about the emergence of companion care services as we believe that social engagement and community are key to a positive aging experience. We love companies like Papa, which make it super easy to secure companion care.
• Homemaker Services: While many older adults are happy and healthy in their homes, some might find that keeping up with routine maintenance is more difficult as they age. Homemaker or housekeeping services (like a cleaning person, for example) help older adults maintain a clean, safe, and organized home. Household tasks may include light housekeeping, laundry, grocery shopping, or even meal preparation.
• Skilled Nursing Care: Some older adults may require in-home health care or medical services from a registered nurse or licensed practical nurse. Skilled nursing care includes services such as wound care, administering medications, and monitoring vital signs. For many patients who have experienced a health event, like a stroke or a fall, skilled nursing is an important part of the recovery process. For others who have more chronic health conditions, skilled nursing is vital to health maintenance.
• Therapy Services: Older adults may need in-home physical, occupational, or speech therapy to help them recover from injuries, manage chronic conditions, or improve their overall well-being. Routine therapy is so important to helping older adults stay active and to reducing mobility issues.
• Respite Care: Respite care provides temporary relief for primary caregivers, allowing them to take a break while a professional caregiver takes over their responsibilities. While respite care doesn't technically take place in the home, we wanted to include it as part of the care spectrum for in home care strategies. If you are managing or providing care for a loved one, it's important to consider respite care as a way to avoid caregiver burnout.
• Palliative Care: This type of care focuses on providing relief from the symptoms and stress of serious or terminal illnesses, improving quality of life for both the patient and their family. Services can range from pain management to emotional support and medical care coordination.
• Hospice Care: Hospice care is designed to provide comfort, support, and pain management for individuals with a terminal illness. Like palliative care, this type of skilled nursing care can range from pain management to counseling, but may also include spiritual care and practical advice for managing end-of-life arrangements.
• Live-in or 24-hour Care: For older adults who require constant supervision and assistance, live-in or 24-hour care may be necessary. Though expensive, around the clock care is a great option as it provides many of the categories of care outlined above, including companionship, housekeeping, support for ADLs, not to mention transportation or help in an emergency.
• Dementia and Alzheimer's Care: Specialized in-home care is available for older adults with dementia or Alzheimer's disease, focusing on managing symptoms and maintaining a safe environment. If you or a loved one is in the early stages of the disease, in home support may be a viable option. As the disease progresses, you may want to consider a more structured approach to care, like a memory care community. In both cases, the in home care costs for dementia patients may be higher and require individuals with specialized training in dementia care.
• Home Health Aide Services: Home health aides provide a range of services, including personal care, medication reminders, and light housekeeping, tailored to the needs of the older adult.
• Remote Care and Monitoring: With advancements in technology, some older adults who don't need direct care may benefit from the additional help of remote monitoring systems and tele-health services that allow healthcare professionals to monitor their health and provide support from a distance. This is a rapidly changing market, and we're excited to see where companies like Best Buy Health take us on the home care and technology journey.

How much does private home care cost?

The cost of in home care varies widely based on several factors; geography, complexity of care, the number of hours, and whether you are going through an in-home care agency or hiring someone directly.

Having said all that, Genworth reports show that the national median cost of care for part-time (20 hours a week) personal care aides is about $2200 a month, while the cost of a home health aide is about $2300 per month. Given the increased level of complexity involved for a home health aide, that's not a material difference. On the higher end of the spectrum, rates in New Hampshire are about $2730 per month for homemaker services and $2817 per month for home health aides, while in Louisiana those same monthly services are reported as $1640 and $1690 respectively.

How much does private home care cost per hour?

If you're looking at private in home care, you'll likely be paying an hourly rate. The national median hourly rate for in home care is between $26 and $27 per hour for homemaker or home health aide services. On the higher end, workers in California earn about $32 per hour while on the lower end, in home health care in West Virginia earn runs about $18.50 an hour.

Why is in home care so expensive?

In-home care costs largely depend on several key elements, most of them being driven by labor market conditions.

• First, the type of in home care required plays a significant role, as specialized medical care can be more costly than homemaker services. And this makes sense; the higher level of skill needed to administer care, the more likely it is that there is a smaller pool of qualified people who can perform the role, and the more those people are able to charge.
• Second, the your location can impact the cost, as areas that have a higher cost of living generally having higher in home care rates - that's why we see states with a high cost of living like Massachusetts or New Hampshire with the highest rates for in home care as well.
• Finally, how the home care service is delivered will impact the price. In general, working through an agency will cost more but also brings a host of benefits, like staff oversight and training, insurance, and planned coverage for caregiver sick days or holidays. If you choose to hire someone directly, you will likely pay a lower rate for in home care, but you'll be required to perform all the training, manage proper documentation regarding pay, and manage coverage for sick days.

Agency vs direct hire: which is best for in home care?

Cost of using an agency for in home care

Using an agency to provide in home care services can simplify the process of finding a qualified caregiver. However, it's important to be aware that agency-provided care can come with additional costs compared to hiring a caregiver independently. Agencies typically charge higher hourly rates, which can range from $25 to $50 or more, depending on the services and level of care needed. These higher rates often cover the agency's overhead costs, caregiver screening, training, and ongoing supervision, as well as insurance and bonding for their caregivers. While the cost might be higher, using an agency offers several advantages such as ensuring the caregiver is properly vetted, providing backup caregivers in case of emergencies or absences, and handling administrative tasks like payroll and taxes. When choosing an agency for in-home care, it's essential to research and compare multiple agencies in your area, taking into account their fees, services offered, and the quality of care provided.

If you're interested in working with an agency, Seniorly recommends the following:

• Home Instead
• The Key
• 24 Hour Home Care

Cost of hiring a caregiver directly to provide in home care

Hiring a caregiver directly for in-home care can be a more cost-effective option compared to using an agency - but it comes with its a unique set of responsibilities. When you hire a caregiver independently, you become the employer, which means you are responsible for negotiating salaries, managing payroll, and handling taxes. The hourly rate for a direct-hire caregiver can vary widely depending on factors such as experience, qualifications, and location, but it generally ranges from $15 to $30 or more. Although the rates may be lower than agency-provided care, keep in mind that there are additional responsibilities, such as conducting background checks, checking references, and ensuring proper training for medical services for the caregiver. You may also need to consider expenses related to workers' compensation, liability insurance, and backup care in case your primary caregiver is unavailable. If you're interested in hiring a caregiver directly, Care.com has a wide network of personal caregivers.

Assisted living vs in home care: which is more cost effective?

If care needs are limited to support for activities of daily living and medical needs are not complex, it's likely you're trying to figure out whether assisted living is the right way to go.

An assisted living facility is a residential care option that provides older adults with a private room or semi-private living space, assistance with daily activities, meals, and access to various services and amenities. The cost of assisted living varies based on factors like location, room size, and additional services, but in 2021 the national average monthly cost was around $4,500.

On the other hand, in-home care costs depend on the type and frequency of care services needed, and as we shared above, hourly rates can range from $15 to $50 or more. For some older adults, in-home care may be more affordable, especially if they only need part-time assistance or are living rent-free in their own homes.

However, as the number of hours of in home care increases and home health care aides approach the standard 40 hour work week, assisted living costs start to look a lot more attractive, providing better value to older adults than home health care services. Assisted living communities provide a more structured environment with built-in socialization opportunities, regular activities, and access to 24/7 support - and that's why we love them. Although when asked most older adults would say they want to age in place, that solution may not always be the best for their overall level of engagement. An assisted living community provides not only support for care needs, but stimulating activities, connection with other adults and physical fitness options.

Nursing home vs in-home care: which is more cost effective ?

When it comes to choosing between in-home care and moving to a nursing home (sometimes referred to as a skilled nursing facility), there's a lot to consider. In general, families contemplating this kind of choice are facing more complex medical and health issues so in both cases, the costs tend to be more expensive than simple support for activities of daily living.

In-home care allows the older adult to stay in the comfort of their own home and maintain a sense of independence. A medically-trained home health care aide might provide medical assistance for things that family caregivers don't feel qualified to do, like changing catheters or administering certain medications. Plus, in-home care can be tailored to the individual's specific needs and preferences.

On the flip side, a nursing home offers a higher level of medical care and supervision, making it a better fit for those with more complex health issues or who need constant monitoring. While a nursing home can be more expensive than in home care, there's no doubt that nursing homes also provide greater oversight, staff coverage and training.

Ultimately, it comes down to the individual's needs, financial resources, and personal preferences when deciding which option is best. Should you decide that in home care is the right solution, it may be beneficial to work through an agency for skilled nursing coverage, as they can provide the staff support and coverage needed for daily health related services that you might find in a nursing home.

How to pay for in home care services

Paying for in-home care services for older adults may seem daunting at first, but there are various options and resources available to help cover these costs:

• Personal savings, retirement accounts, and investments are often the primary sources of funding for in-home care.
• Medicare typically covers only short-term, skilled home health care services.
• Medicaid offers more extensive coverage for in-home care, but eligibility requirements vary by state. If your loved one meets the income requirements, they may be eligible for financial help with home care. This is usually through a state's Medicaid waives program. These programs typically allow family members to be paid to care for a loved one, so long as they pass a background check and complete a brief training.
• PACE program: If your loved one needs skilled nursing care but wishes to stay in their own home, they ma be eligible for the Program of All-Inclusive Care of the Elderly, or PACE. PACE is designed to keep more fragile seniors out of nursing homes. PACE isn't available in all regions, and generally seniors must qualify for both Medicare and Medicaid to be eligible.
• Veterans benefits are provided by the Department of Veterans Affairs and offer programs that can help cover the cost of in-home care for qualifying veterans and their spouses. Check out the Skilled Home Health Care Services, Homemaker and Home Health Aide Services, and Family Caregiver Programs to see if your loved one qualifies.
• Long-term care insurance: If your loved one has a long-term care insurance policy (LCTI) it should cover all the basic costs of home care. Review the policy carefully to look for any limitations or caps on benefits. 

In home care cost: is it worth it?

In-home care can be a viable and cost-effective alternative to nursing homes or assisted living facilities, especially for older adults who value their independence and wish to remain in the familiar surroundings of their own home. If you're considering in home care, it's important to evaluate the level of support you require, the associated costs, and the quality of care provided by the agency or caregiver. Ultimately, the decision will depend on your individual needs, preferences, and of course, your financial resources.