Home Care vs. Nursing Homes

How Much Daily Help Does Your Loved One Need?

Before learning more about the differences between in-home care and nursing home care, it’s time to assess. Consider what kind of care and how much care you think your loved one requires. Begin by asking yourself these questions:

• Does your loved one need help with activities of daily living (ADLs), like bathing and dressing?
• Do they need help with medical tasks or medication reminders?
• Can grocery shopping and preparing meals for them make their life easier?
• Do they need assistance with bills or finances?
• Does your loved one need light help tidying and cleaning up around the house?
• Do they need someone to drive them to doctor’s appointments and to town?
• Will the help needed be part time or full time?
• Is the person in need of a senior companion — someone to play cards with or watch a movie with — to ensure they’re not lonely?
• Does your loved one require a good deal of medical assistance? Are they recovering from an injury or due to the onset of dementia?
• Would amenities like planned meals, on-site health care, and organized activities fit the bill?

Once you determine their needs, you may realize that hiring a local caregiver or companion might be enough. You may need a caregiver with a medical background (or to bring on a few people with specific skills). Lastly, you might realize that this special person in your life needs extensive services and would benefit from amenities that a nursing home can supply.

What Is In-Home Care?

Let’s begin by discussing in-home care, also sometimes called “home care” or “home health care “(the latter is usually medical in nature). Seniors looking to age in place greatly cherish the comfort of remaining in their own homes. For that reason, relatives often become their caregivers. In fact, more than 48 million family members currently help take care of their loved ones in their own homes and communities.1

If these caregivers work, however, or have their own families, they can quickly burn out. Our country’s loyal family caregivers provide a whopping $600 billion worth of unpaid labor each year!2

Maybe you’re exhausted from helping your aging relative and juggling your own challenges too. Perhaps you’d like to help, but you live across the country. Or maybe your loved one is declining and needs more care than you can give. For whatever reason, it’s understandable if you’re seeking in-home care solutions for your loved one.

Having home health care aides come regularly to the home can help you monitor your loved one and be sure they’re thriving. There are many types of home health care services to choose from. Does your loved one need a companion or a health aide to provide companion care? Or maybe you really need somebody to assist with ADLs? That includes helping them shower so they maintain hygiene, prepping meals so they don’t skip eating, transporting them to places so they get out and don’t sleep most of the day, reminding them to take their medications on schedule, and keeping up with general housekeeping.

If your relative has a more complicated medical situation, you might need skilled medical professionals. Nurses, physical therapists, occupational therapists, and others provide in-home care. Under the direction of a licensed physician, these professionals can assist with wound care, IV changes and insertions, feeding tubes, and medication administration. They also take care of physical needs beyond ADLs and basic mobility. Certified dementia and memory care health care providers, for example, offer care in homes. If your relative has mild to moderate stages of these conditions, you’ll benefit from choosing these specialized providers.

In-home care can range from a few hours per week to 24/7 care. Toward the end of life, care from a hospice or palliative care service is usually around the clock. In a typical situation involving hospice or palliative care treatment, a staff member is reachable by phone and members of their teams visit regularly.

What Are the Benefits of In-Home Care?

There are many advantages to having caregivers or companions come to the home. Here are some of them:

1. Many people choose in-home care over nursing home care because they enjoy the freedom of being in their own home. They prize feeling independent and retaining a sense of autonomy.  
2. Seniors feel safe and more comfortable in a familiar setting. They can sit in their favorite chair and are surrounded by their photographs and memories, which is psychologically soothing.
3. They also like receiving specific care in a home environment rather than institutional setting. Nurses, companions, therapists, and others help them in the ways they need on their home turf. 
4. Hiring a caregiver can be more affordable than living full time in a nursing home or assisted living facility. The costs of home care vary widely, however, depending on the level of assistance and time needed. 

When deciding on in-home care, families can choose to privately hire a caregiver like someone they know and trust from the neighborhood or church, or turn to an experienced agency. Agencies do much of the legwork, including finding qualified candidates; running background checks; confirming their credentials; handling the financial aspects, including caregiver payments; and calculating withholdings for taxes.

What Are the Drawbacks of In-Home Care?

While there are many benefits to in-home care, it might not be suitable for all older adults. Here are some drawbacks to consider:

1. It might be challenging to find caregivers in your area. They need to be reliable, able to work the schedule you need, and accept the pay you are offering.
2. That person must also be compatible with your loved one.
3. In-home safety measures might be costly. Besides buying a medical alert device, you might have to hire experts to add grab bars in the shower as well as install stair railings, ramps, and chairlifts to retrofit the entire home.
4. Compared to nursing home care, in-home care might not provide your loved one with the medical coverage they need. If their medical needs aren’t too complex, look for a senior home care provider who is also an RN or CNA (certified nursing assistant).

What Is Nursing Home Care?

Many families who think that full-time care is warranted opt for nursing home care. Nursing homes, though expensive, offer many services to residents and alleviate caregiver stress. Nursing homes are designed to provide 24/7 medical care and assistance for patients in a residential setting. Also referred to as convalescent homes, nursing home care is designed for those who need more than basic care that’s handled in a traditional home setting.

Some homes have age restrictions and most don’t allow on-site cooking or pets on the premises. Most facilities offer semiprivate and private rooms, with private rooms costing a bit more than shared spaces. Those with chronic health problems, severe mobility issues, or serious injuries may find that a nursing home is the ideal solution.

What Are the Benefits of Nursing Home Care?

Consider these benefits of living in a nursing home facility as you compare your options:

1. Caregivers assist residents with all of the ADLs, personal care, and mobility needs, as well as take care of their meals, cleaning, and laundry.
2. Nursing homes also provide skilled medical care and/or therapy whenever it’s needed.
3. Facilities may also offer advanced memory care services that are vital in the latter stages of conditions such as Alzheimer’s disease and Huntington’s disease.
4. Seniors like the social interaction and amenities nursing homes provide. Nursing homes often offer in-house activities, such as crafts, games, music programs, and fitness classes. In addition, they offer local trips, and transportation is provided for these shopping and entertainment outings.

What Are the Drawbacks of Nursing Home Care?

Now that we’ve looked at the benefits of nursing homes, let’s consider the potential drawbacks:

1. High-quality nursing home care is expensive.
2. Seniors feel a lack of freedom and independence when uprooted from their homes and forced to live according to rigid schedules.
3. Seniors lose their proximity to family and close friends.
4. There is a potential for subpar medical care and treatment.

Side-by-Side Comparison of In-Home Care and Nursing Homes

Cost of Home Care vs. Nursing Homes

The cost of nursing home care and in-home care will vary depending upon a number of factors: location, amount of care needed, and the level of care required. The average cost of care can vary greatly between states, with higher costs in regions where the cost of living is higher. One might think that home care is always the least expensive option, but depending on the aforementioned factors — particularly concerning those who have special needs or need 24-hour care — this may not be the case. Here are summaries of the national average costs of common care levels to give you an idea of what to expect.

In-Home Care Average Costs

The cost of in-home care will depend on the type of caregiver you are seeking and what qualifications you prefer them to have. Non-medical paraprofessionals, like home health care aides who assist with ADLs, housekeeping, and companionship services, average $33.99 per hour, $213 daily, $6,481 per month, and $77,769 per year in 2024.

Skilled medical care professionals provide similar services to health aides but can also perform more intensive services, such as medication administration, wound care, physical therapy, catheter care, and intravenous needs, due to their additional qualifications. If you are using an agency to hire in-home care, there may be a 10 to 15 percent increase in costs, but they are generally worthwhile for the convenience.

Nursing Home Average Costs

On average, a nursing home costs $294 daily for a semiprivate room and $330 daily for a private room. Monthly charges range from $8,929 to $10,025 for semiprivate and private rooms, respectively. Annual costs range from $107,146 to $120,304 for full-time nursing home care. Additional costs may be incurred if dementia, memory care, or other special services are required.

Paying for Senior Care

Now that you have an idea of how much in-home care and nursing homes cost, it’s time to consider how you’ll pay for it. There are several options when it comes to payment.

Some people need home health aides for only a few hours per week. Those who need intensive care or nursing home services full-time may need financial assistance from government, state, or local agencies. While their benefits and coverage vary substantially, the most popular ways to pay for in-home care and nursing homes include:

• Medicare
• Medicaid
• Veterans benefits and VA senior housing
• SSI/disability benefits
• Private grants — religious or community organizations
• Private insurance
• Long-term care insurance
• HUD senior housing benefits
• Leveraging a home
• Reverse mortgage
• Personal assets and resources

For home care, each state regulates the home care industry differently, so it’s important to check your state’s specifications and requirements. Medicare does pay for medically necessary home health care on a limited basis. Medicare Advantage plans might cover non-medical home care, as do several VA programs. According to AARP, if you don't have long-term care insurance or the financial resources to pay for in-home care (and these other options don’t work), search the federal government's Eldercare Locator and contact your local Area Agency on Aging.

When it comes to paying for nursing homes, keep in mind that Medicare may cover limited short-term stays in nursing homes and Medicare Advantage may cover certain expenses related to nursing home care in nationally and state licensed facilities. Long-term care insurance policies, which are often very expensive, do provide coverage for nursing home care, but check the details of your policy. Usually, people pay for the care themselves or until they deplete all their resources. At that point Medicaid, a public assistance program, covers costs. About 62 percent of nursing home residents have Medicaid.

Choosing What’s Right for You

Deciding on the best option and exploring what’s available near you may seem a bit overwhelming. The National Council on Aging's Benefits Checkup website can help older adults with programs that can help pay for health care, medicine, food, utilities, and more. Agencies and facilities also have specialists who can assist with financial questions. You can also see our convenient care directory or call one of our helpful associates on our hotline.