Home care is paid, non-medical help at home. A caregiver comes to the house to help with bathing, dressing, meals, getting around and company, so that an older adult can stay at home safely. Medicare does not pay for it on its own, so most families pay privately or use Medicaid, VA or long-term care insurance when they qualify.
This guide explains what home care is, who it suits, what caregivers do and do not do, how it is paid for, what drives the cost and how to choose an agency. Carevo is a directory. It does not provide care, employ caregivers or vouch for any agency, so the choice and the checking stay with you.
What home care is and what it is not
Home care means a caregiver, usually sent by an agency, spends time in your home or a loved one's home. The Alzheimer's Association groups in-home care into companion services (supervision, recreation, visiting), personal care (bathing, dressing, toileting, eating and exercise), homemaker services (housekeeping, shopping, meal preparation) and skilled care (wound care, injections, therapy by licensed professionals). The first three are what people usually mean by home care. The fourth is medical care and is covered in home health care.
Medicare.gov describes long-term care as mostly non-medical help with daily personal tasks like dressing, bathing and using the bathroom, and says it can be received at home, in the community, in an assisted living facility or in a nursing home. Home care is the version delivered at home.
Home care is usually booked by the hour or by the shift, from a couple of hours a week to round the clock. The more hours, the more it costs, which is why the number of hours is the first thing to settle. Our home care hours cost calculator lets you test different schedules.
Who home care helps
Home care suits people who want to stay in their own home but need regular help with daily life. Common situations:
- An older adult who is steady on most days but needs help showering, dressing or getting in and out of bed.
- Someone recovering from a hospital stay who needs a few weeks of extra help after skilled nursing visits end.
- A person who lives alone and has trouble shopping, cooking or keeping track of medications.
- A person with memory loss whose family needs a trained person in the home. See dementia care at home.
- A family caregiver who needs regular time off. See respite care.
It is a poor fit when the main need is medical, such as injections, wound care or monitoring an unstable illness. That is skilled care, ordered by a doctor. It is also a poor fit when safety needs have outgrown what a visiting caregiver can cover, and a community with staff on site, such as assisted living or a nursing home, is a better setting. A doctor, hospital discharge planner or social worker can help you judge that.
What a home caregiver does and does not do
Caregivers commonly help with:
- Bathing, grooming, dressing and using the toilet
- Getting out of bed or a chair, walking and moving safely around the house
- Preparing and serving meals and helping with eating
- Light housekeeping, laundry and changing linens
- Reminders to take medications that the person manages themselves
- Errands, rides to appointments and company
The Medicare.gov description of home health aide tasks, such as help walking, bathing or grooming, changing linens and feeding, is a good picture of the hands-on side.
What a non-medical caregiver does not do is medical care. Wound care, injections, IV therapy and monitoring a serious illness are skilled nursing, which Medicare.gov lists under home health. Agencies set their own limits on what their caregivers may do, and they differ. Before you sign, ask for the list of tasks in writing, and ask what happens if a need comes up that is not on it.
Home care compared with similar services
- Personal care is the hands-on part of home care: bathing, dressing, toileting, eating and moving.
- Companion care is company, supervision and light help, with little or no hands-on care.
- Home health care is skilled nursing and therapy ordered by a doctor. Medicare can pay for it when you meet its rules.
- Private duty nursing is longer shifts of nursing care at home for complex medical needs.
- 24-hour home care and live-in care are ways of scheduling home care around the clock.
- Adult day care is a daytime program outside the home.
Some households combine them, for example a Medicare-certified agency for nursing and therapy after a hospital stay, and a separate home care agency for daily help.
How home care is paid for
Medicare, Medicaid, the VA and insurance each pay for part of the picture, and none pays for everything. The coverage lines on this page are a starting point. The rules that apply to you depend on your state, your plan and your situation.
Medicare. Medicare.gov says Medicare does not pay for long-term care, and that Medicare and most health insurance, including Medigap, do not pay for long-term care services in a nursing home or in the community. Medicare can pay for part-time or intermittent home health aide help, but only while you also get skilled nursing or therapy. Custodial or personal care is not covered when it is the only care you need. The Medicare funding guide explains the rules, and the Medicare home health checker helps you prepare questions for a doctor.
Medicaid. Medicaid home and community-based services (HCBS) let people who qualify get long-term care at home instead of in an institution. According to Medicaid.gov, 1915(c) waiver programs can include homemaker services, home health aide, personal care, adult day health and respite, and states choose the maximum number of people a waiver serves. That means eligibility, services and waiting times differ by state and by program. Medicaid.gov says some states let participants self-direct, which means recruiting, hiring and supervising their own workers and deciding how a budget is spent. See Medicaid and long-term care, the state programs and how family members can be paid.
VA. VA lists Homemaker and Home Health Aide care, home-based primary care, adult day health care and respite care among its home-based services. All enrolled Veterans may be eligible if VA decides they need the service and it is available near them, and some services carry a copay. See VA benefits and VA Aid and Attendance for VA programs that can help with costs.
Long-term care insurance. If there is a policy, it may pay toward home care once its conditions are met. The policy sets what it pays and when. Read the long-term care insurance guide and ask the insurer to explain the claim process before you book care.
Private pay. Many families pay out of pocket from income and savings. See private pay for ways to plan and ask agencies about it.
What drives the cost of home care
There is no single national price, and Carevo does not publish one. These are the things that move the bill:
- Hours. The more hours you book, the higher the bill. Ask whether the agency has a minimum visit length.
- Level of help. Hands-on personal care and care for someone with memory loss can be priced differently from company and errands.
- Time of day. Nights, weekends and holidays may be priced higher. Ask.
- Where you live. Wages and agency costs differ across states and cities.
- Agency or independent caregiver. An agency's rate has to cover the caregiver's pay and the agency's own costs, including management, scheduling and back-up. The Bureau of Labor Statistics reports a national median wage of $17.21 an hour for home health and personal care aides in May 2025. That is what aides are paid, not what an agency charges.
- Minimums and contracts. Ask about weekly minimums, cancellation rules and how long the rate is fixed.
The Department of Labor says third-party employers such as home care agencies cannot claim the companionship or live-in exemptions, and must pay at least minimum wage and overtime for covered hours. That is one reason agency rates can differ from what a household pays a person it hires directly. If you hire directly, the Department says the household typically acts as the employer.
How to choose a home care agency
- Write down the need before you call. The Alzheimer's Association suggests listing the person's care needs and your expectations first. Include hours, tasks, language, pets, and anything about the person's history and preferences.
- Build a short list. Ask the doctor, a hospital discharge planner, friends and your Area Agency on Aging. The Eldercare Locator (1-800-677-1116) connects you to local agencies on aging. Then browse home care agencies on Carevo by state and city and compare.
- Call at least three. Ask the same questions each time and write down the answers.
- Interview at home. The Alzheimer's Association suggests interviewing in the home, with a third person present if possible.
- Check references. Ask for them, call them, and ask whether criminal background checks are done.
- Get the terms in writing. Rate, minimum hours, cancellation, what tasks are included and how complaints are handled.
For a longer checklist, read how to choose a home care agency.
Questions to ask every agency
- Are your caregivers your employees, or do you refer independent contractors?
- Which state license or registration do you hold, and can I see it?
- How do you screen caregivers, including background checks?
- What training do caregivers have, and is there training in dementia care if that applies?
- Are caregivers trained in first aid and CPR?
- Are caregivers bonded and insured?
- Will the same caregiver come each time? Who covers if they are sick?
- Who supervises the caregivers, and how often does someone visit the home?
- What is your rate, your minimum visit length and your cancellation policy?
- Do you accept Medicaid, VA or long-term care insurance payments, and do you bill them directly?
- How do I reach someone after hours?
- What happens if my needs change?
Red flags
- The agency will not say whether caregivers are employees or contractors.
- No written service agreement, or pressure to sign on the first call.
- Vague answers on screening, training or insurance.
- A different person arrives every visit with no hand-over.
- The agency promises Medicare will pay for ongoing personal care. Medicare.gov says it does not.
- Requests for large prepayments or for cash.
- No way to reach a person after hours.
Next steps
- Decide the hours and tasks you need, and use the care cost comparison if you are weighing home care against a facility.
- Check what any coverage you have will pay for, before care starts.
- Tell us what you need and we will show agencies that serve your area. You decide who to call.
If a caregiver is exhausted too, the caregiver burnout quiz is a short check on how you are doing.