Help Paying for Senior Home Care
Most people pay for senior care using a variety of payment methods, such as Medicare, private insurance, and savings.
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If you're like most older adults, you want to stay in your home as long as possible. That’s where you are most comfortable, and many seniors want to maintain their independence. Senior experts call this aging in place. Home care allows you to do this. It's less expensive than institutional care, such as assisted living and nursing homes.
What is home care? This type of care includes home health care and non-medical care at home, such as assistance with activities of daily living (ADLs) and domestic chores. Below, you'll find information on how to pay for elderly home care through Medicare, Medicaid, and other federal, state, and local programs.
Table of Contents
A Rising Need for Home Care
The market for home care is exploding thanks to the wave of baby boomers reaching their golden years. Right now, 76.4 million Americans are baby boomers. By 2030, all baby boomers will reach age 65 or older, according to the U.S. Census Bureau. 1
As these boomers and their families realize how expensive institutional care is, there’s a big need for lower-priced alternatives. Typically, relatives will step up to the plate and help loved ones as they age. It’s hard to believe, but AARP says that currently, about 48 million relatives are caregiving for senior loved ones. 2
If, let’s say, the senior’s condition worsens, these wives and daughters (most family caregivers are women) often have to cut back on work hours at their jobs in order to help their loved ones. Respite care gives your exhausted relative the breaks they need to work, decompress, or run errands.
A friend or someone from a home health agency can provide respite care services. Depending on the needs of the older adult and the primary caregiver, respite workers can assist here and there, overnight, or during the week while the main caregiver works.
It’s easy to see why home care is skyrocketing. According to the Bureau of Labor Statistics, the employment of home health and personal care aides is expected to expand 21 percent from 2023 to 2033. 3
Pro Tip: Learn more about home care vs. nursing homes to compare the types of care provided and the up-to-date costs.
Our free housing and care finder uses your unique needs to curate a list of the best options in your area.
What Do Home Care Workers Do?
Home care aides and homemakers provide non-medical assistance. They usually help with activities of daily living (ADLs) such as bathing, dressing, toileting, and grooming. They assist with housekeeping, meal prep, laundry, and transportation, too. Some states require agencies that employ them to be licensed and meet minimum standards established by the state.
Home health care aides can also help clients with ADLs, but they can do more health or medical-related tasks. They monitor a patient’s physical and mental condition, report changes, remind clients about their medications, change bandages, and help with some medical equipment. They can check the patient’s vital signs (depending on the state’s regulations) and sometimes work under the direction of a nurse. Home health care aides need certification or a license in some states.
Other professionals who provide home health care include:
- Certified nursing assistants (CNAs)
- Registered nurses (RNs)
- Licensed practical nurses (LPNs)
- Physical therapists (PTs)
- Speech-language pathologists (SLPs)
- Occupational therapists (OTs)
- Registered dieticians (RDs)
- Respiratory therapists (RTs)
- Wound care specialists
- Social workers (MSWs)
Home Care Costs
It's no wonder seniors choose home health care over stays in a hospital if they can. The average cost of a hospital stay is thousands of dollars each day, while the median cost of home care would set you back only $200 each day in 2024.
Let’s delve further into this. The median cost of hiring a homemaker is $195 per day and a home health aide is $213 per day. If you needed their help all year, it would cost $70,699 and $77,769 per year, respectively. 4
Compare that to the median yearly cost of a nursing home semi-private room at $107,146 or a nursing home private room at $120,304. You can see why getting assistance in the home is so attractive financially to older adults.
How to Pay for Home Health Care
The following is how recipients of home health care pay for services, according to the Centers for Medicare and Medicaid Services:
- Medicare 41%
- Medicaid 24%
- State/local governments 15%
- Out-of-pocket 10%
- Private insurance 8%
- Other 2%
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Qualifying for Medicare Home Health Care
If you are enrolled in Original Medicare, you may be eligible for home health benefits. All of the following conditions must be met:
- You must be under a plan of care that is established and regularly reviewed by your doctor.
- Your doctor must certify that you require one or more of the following services: skilled nursing care, physical therapy, occupational therapy, or speech-language therapy.
- The home health agency providing services must be Medicare-certified.
- Your doctor must confirm that you are homebound. That means your condition prevents you from leaving the house without assistance (e.g., a wheelchair, walker, or help from another person), and that leaving would require a “considerable and taxing effort.”
- You can only receive Medicare-covered home health care for skilled nursing on a part-time basis, which is generally defined as less than 8 hours a day or fewer than 7 days a week for 21 days or less.
- You can get skilled nursing care on an intermittent basis. That usually means less than 8 hours a day or fewer than 7 days a week. The length of care will depend on the senior’s needs and the doctor's plan of care.
What Medicare Covers
- Skilled nursing care provided by a registered nurse (RN) or licensed practical nurse (LPN), including medically necessary services like shots, tube feedings, IV drugs, changing dressings, administering prescription drugs, and diabetes care teaching.
- Physical therapy, occupational therapy, and speech-language services when medically necessary, as prescribed by a doctor.
- Medical social services, including counseling and help finding community services
- Medical supplies used in your care which can include durable medical equipment (DME)
What Medicare Does Not Cover
- Personal care such as bathing, dressing, and other activities of daily living. (Medicare will, however, cover it when it’s part of a doctor-ordered home health care plan and medically necessary treatment for recovery from illness or injury.)
- Homemaker services such as cleaning, laundry, shopping, and preparing meals
- 24-hour-a-day care
- Home-delivered meals
- Medical alert devices
Did You Know? Medical alert systems are not covered by original Medicare, but are by some Medicare Advantage plans. They include select AARP Medicare Advantage (HMO) plans by UnitedHealthcare under their Healthy Benefit programs and some Aetna Medicare Advantage Value Plus PPO plans that include personal emergency response systems (PERS) as part of wellness benefits. You might check Humana Medicare Advantage plans, as some offer discounts on medical alert systems through their Value-Added Items and Services (VAIS) program.
Medicaid and Home Care
As states have flexibility in administering the program, Medicaid coverage for home care varies by state. Federal guidelines, however, require Medicaid to cover part-time nursing, medical supplies, and some home care aide (HCA) services.
Additional services, such as physical, occupational, and speech therapy, may also be covered if they’re prescribed by a physician. Coverage details depend on the senior in question and the state.
Home Care for Veterans
If you are a Veteran and eligible for a VA pension, you may be entitled to the Housebound benefit. It is a payment to those receiving care in-home or in a family member’s home.
Veterans may be eligible for the Housebound benefits if:
- The Veteran has a single permanent disability evaluated as 100 percent disabling is permanently and substantially confined to their home OR,
- The Veteran has a 100 percent disabling permanent disability AND another disability evaluated as 60 percent or more disabling.
In addition, your income limit to receive the housebound benefit is $20,732 without dependents or $25,982 with dependents. Contact your regional VA office. You can view listings by state on the VA’s website. You can also apply online using the VA's VONAPP (Veterans On-Line Application) website.
Other services vets may be eligible for:
- Homemaker and home health aide care, which can assist with everyday activities.
- Skilled home health care provides coverage for nursing care, physical, occupational and speech therapy, and social work.
- Telehealth care allows remote monitoring and consults.
- Home-based primary care provides in-home medical care.
Veterans must meet specific qualifications and can apply by contacting their VA social worker or case manager. Or they can complete the Application for Extended Care Benefits (VA Form 10-10EC). You can also call the VA toll-free at 877-222-VETS (8387).
Program of All-inclusive Care for the Elderly (PACE)
PACE is a comprehensive Medicare and Medicaid program that provides care to seniors so they don’t have to go to a nursing home or other care facility. They live in their homes and receive help from the community.
To be eligible, you must be 55 or older, live in a PACE service area, need nursing home-level of care (according to their individual state’s Medicaid guidelines), and live safely in their community. The program provides meals, transportation, and social services, as well as other major services.
According to the National Council on Aging, 5Â PACE programs offer the following for older adults who live at home (or attend adult day health centers):
- Primary care nurses and doctors
- Specialty care
- Emergency services
- Hospital care
- Laboratory work
- X-rays
- Prescription drugs
- Dental care
- Nutrition counseling
- Occupational therapy
- Physical therapy
- Recreational therapy
There are no deductibles or copays for drugs, services, or care provided by the PACE program. With Medicare, you will pay a monthly premium for Medicare Part D, which covers prescription drugs under PACE. If you have Medicaid, you have no monthly premium for the long-term care portion of the PACE program.
Other Helpful Resources
Area Agencies on Aging (AAA) are local organizations, funded by the Administration for Community Living, that provide seniors with valuable information about local, state, and regional resources that expressly help seniors get services in their homes. Reach out to your local AAA by visiting the Eldercare Locator.
Pro Tip: Â If you contact the folks at Area Agencies on Aging and tell them what you need, they try to match you with a company in your area that offers home care to seniors. Typical care services offered might include house cleaning and yard work, bathing, cooking, meal assistance, caregiver support, and nursing care.
The National Association for Home Care & Hospice (NAHC) gives guidance on finding licensed home care agencies and offers resources on the home care system. Get tips on financing and also about your eligibility for different programs.
State and Local Services
In addition to the above federal resources, each state has an elder affairs/aging department with programs to support seniors, including home health and home care. For example, New Hampshire's ServiceLink is a comprehensive community-based resource for seniors looking for home care, housing, financial support, food assistance, and many more services.
To find home health and home care in your area, click on your state's link below.
Alabama – Department of Senior Services
Alaska – Division of Senior and Disabilities Services
Arizona – Aging and Adult Administration
Arkansas – Division of Aging, Adult, and Behavioral Health Services
California – Department of Aging
Colorado – Office of Adult, Aging and Disability Services
Connecticut – Aging Services Division
Delaware – Division of Services for Aging and Adults with Physical Disabilities
District of Columbia – Office on Aging
Florida – Department of Elder Affairs
Georgia – Division of Aging Services
Hawaii – Executive Office on Aging
Illinois – Department on Aging
Kansas – Department for Aging and Disability Services
Kentucky – Department For Aging & Independent Living
Louisiana – Governor's Office of Elderly Affairs
Maine – Office of Aging and Disability Services
Maryland – Department of Aging
Massachusetts – Executive Office of Elder Affairs
Mississippi – Division of Aging
Missouri – Division of Health and Senior Services
Nebraska – Health and Human Services – State Unit on Aging
Nevada – Aging and Disability Services
New Hampshire – Bureau of Elderly and Adult Services
New Jersey – Department of Health and Senior Services
New Mexico – Aging Network Division
New York – Office for the Aging
North Carolina – Division of Aging and Adult Services
North Dakota – Aging Services Division
Oklahoma – Department of Human Services
Oregon – Aging and Disability Services
Pennsylvania – Department of Aging
Rhode Island – Department of Elderly Affairs
South Carolina – Lieutenant Governor's Office on Aging
South Dakota – Dakota at Home
Tennessee – Department of Disability and Aging
Texas – Department of Aging and Disability Services
Utah – Division of Aging & Adult Services
Vermont Department of Disabilities, Aging, and Independent Living
Virginia – The Division for Aging Services
Washington – Aging and Long-Term Support Administration
West Virginia – Bureau of Senior Services
United States Census Bureau. (2019). 2020 Census Will Help Policymakers Prepare for the Incoming Wave of Aging Boomers.
AARP. (2024). Care for America’s Caregivers.
U.S. Bureau of Labor Statistics. (2024). Home Health and Personal Care Aides.
Genworth. (2024). Cost of Care Survey.
National Council on Aging. (2024). What Is the Program of All-Inclusive Care for the Elderly (PACE)?
