In-Home Care for Seniors

Types of In-Home Care Services

In-home care is not a single service — it is a spectrum. Understanding the differences helps families choose the right level of support.

Companion Care and Homemaker Services

Companion care provides social interaction, conversation and supervision. Homemaker services add light housekeeping, meal preparation, laundry and errands. Neither type involves hands-on personal care. These services are provided by non-medical aides and are not covered by Medicare.

Personal Care (Home Health Aide)

A home health aide (HHA) or personal care aide (PCA) helps with activities of daily living (ADLs) — bathing, dressing, grooming, toileting and mobility. This is hands-on, non-medical assistance. Home health aides are the most common type of in-home care worker.

Skilled Home Health Care

Skilled home health care is provided by licensed nurses, physical therapists, occupational therapists or speech therapists. It is ordered by a physician to treat a specific medical condition. Medicare may cover skilled home health care when strict eligibility conditions are met — including that the person is homebound and requires skilled care. This is not the same as ongoing custodial care.

Adult Day Services

Adult day programs provide structured activities, meals, health monitoring and social engagement at a community center during daytime hours. The person returns home each evening. These programs also give family caregivers essential respite time. The national median cost is approximately $85 per day (2023).

Home Safety Considerations

Before or alongside starting in-home care, a home safety assessment can identify hazards and reduce fall risk. Common modifications include:

• Grab bars in bathrooms and near the toilet
• Non-slip mats in the shower and tub
• Removal of loose rugs and clutter from walkways
• Improved lighting throughout the home, especially on stairs
• Stair railings on both sides
• Raised toilet seats and shower chairs
• Medical alert devices for emergencies
• Medication management systems to prevent errors

Caregiver Relief and Respite

Family caregivers provide the majority of in-home care in the United States — often without pay and at significant personal cost. Caregiver burnout is real and can affect the quality of care provided to the older adult.

Respite care gives family caregivers a planned break. Options include:

• In-home respite: a paid aide comes to the home so the family caregiver can rest or attend to other responsibilities
• Adult day services: the person attends a day program while the caregiver has time away
• Short-term residential respite: a brief stay in an assisted living or nursing facility
• Volunteer respite programs through local nonprofits and faith communities

The National Respite Locator (archrespite.org) and the Eldercare Locator can help families find local respite resources.

In-Home Care Costs

In-home care costs depend on the number of hours, the type of service and the local market. The following figures are national medians from the Genworth Cost of Care Survey 2023:

How In-Home Care Is Paid For

• Private pay (personal funds): the most common payment method for ongoing custodial care
• Medicaid Home and Community-Based Services (HCBS) waivers: may cover personal care and homemaker services for those who qualify financially and medically — eligibility and covered services vary by state
• Veterans benefits: the VA Aid and Attendance benefit and other programs may help eligible veterans pay for in-home care
• Long-term care insurance: policies vary widely — review your policy carefully for covered services and benefit triggers
• Medicare: covers only short-term skilled home health care ordered by a physician — does not cover ongoing custodial or personal care

For a full comparison of payment options, see our guide to paying for long-term care.