For many older adults, home care is an economical option for obtaining necessary care services. While monthly fees vary by location and the degree of service required, on average, rates for home-based care come in about 42% lower than nursing home rates.
Nursing home fees cover housing, utilities, meals, recreational activities, personal care and skilled nursing services. Home-based care, on the other hand, only includes the cost of services rendered. For those who have expenses, such as housing payments, meal delivery services and high utility bills, home care may not provide significant cost savings over nursing home care.
According to the Genworth 2020 Cost of Care Survey, the national average monthly rate for homemaker services is $4,481. This figure assumes 44 hours of weekly care at an hourly rate of $23.50. Services include assistance with daily living activities, such as grooming and toileting, light housekeeping, laundry, errands, medication reminders, help with physician-ordered exercise and meal planning and preparation.
Home health aide services, also called home health care, are similar. However, in addition to personal care, they include some skilled nursing services, such as speech, occupational or physical therapy, as well as medication administration and wound care. This specialized care has a higher price tag of $24 per hour or $4,576 per month.
Nursing home rates vary widely across the country, with monthly fees ranging from $37,000 in Alaska to as low as $5,019 in Texas. The national average is $7,756 for shared rooms and $8,821 for private rooms.
There are several options for paying for home care, depending on the individual’s income, assets and eligibility for certain programs.
Financial assistance options for home care under Medicaid vary by state. In Arizona, for example, services for those who qualify for Medicaid are covered under Long Term Care Services. New Mexico also has a managed care program called Centennial Care Community Benefit, which provides direct coverage for in-home services. In most other states, home care is covered under various Medicaid waivers. Eligibility criteria varies considerably throughout the country and may include the individual’s income, assets and level of need.
While Original Medicare doesn’t cover basic personal care services, it does cover home health care for qualifying individuals. Covered services include therapy, medical social services and part-time skilled nursing. Many Medicare Advantage Plans cover home care services, such as transportation for medical appointments and housekeeping services.
Veterans have several avenues for paying for home-based care, including Veteran-Directed HCBS, which enables the individual to choose their own caregivers for services, such as personal care and transportation, and the Aid and Attendance or Housebound Benefit, which provides a monthly cash benefit that can be used at the individual’s discretion for living expenses. Veterans may also reduce their home-based care expenses by obtaining services under the VA Respite Care program, which pays for short-term care in a VA community or the individual’s home.
Many states have state-funded programs for income-qualifying individuals who don’t meet Medicaid’s income or asset limits. The purpose of these programs is to help older adults obtain the care they need in their own homes, delaying or avoiding assisted living or nursing home placement. Programs vary, with some providing cash benefits that can be used to cover care costs, while others provide direct care for participants.