In-Home Care Cost per Hour by State

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Across the United States, the median cost of an in-home non-medical caregiver is $35 per hour, according to CareScout's 2025 Cost of Care Survey, the dataset behind every number on this page. State medians in the survey's direct hourly table run from $24 in Mississippi to $46 in Wyoming. Rates were collected July through November 2025; the state values were first taken from the survey's data tables on July 20, 2026 and re-checked against the same tables on August 10, 2026, along with every other source below.

Treat those figures as the first line of a care budget, not the final price. An hourly median is a planning benchmark, not a local quote: billed hours, minimum shifts, evening and weekend pricing, the tasks involved, travel, who employs the caregiver, and state law can all move a real proposal above — or below — the state figure. The practical path is short: define the tasks and weekly schedule with your parent, use the median for the state where your parent lives, and request two or three written quotes for exactly the same scope.

Where should your family start?

  • Start small if your parent is managing most days well. A few defined hours of help, on the days and tasks that matter most, is the gentlest first change and the easiest to adjust.
  • Choose the agency path first if your family wants screening, scheduling, backup coverage, and payroll handled by the provider — and can accept a higher hourly bill rate in exchange.
  • Plan a direct hire only if someone in the family can realistically take on recruiting, backup planning, and household-employer duties, with professional payroll and tax advice from the start.
  • Choose neither yet if you haven't asked your parent which tasks and times would actually help. That conversation sets the schedule every quote will be priced from; if raising it feels difficult, our guide to talking with an aging parent about accepting help is a place to begin.
  • Talk with your parent's clinician or the hospital discharge team first if needs are urgent or changing quickly. The numbers on this page are planning math, not a care assessment.

Home caregiver and older woman cooking together in her kitchen

On this page

What kind of care do these numbers cover?

The benchmark on this page is what CareScout's survey methodology calls a non-medical caregiver: help with personal activities of daily living — bathing, dressing, moving safely around the home — and homemaker tasks such as meal preparation, light housekeeping, errands, and companionship. It does not price skilled care. CareScout reports skilled nursing delivered in the home separately, at a 2025 national median of $90 per hour, and Medicare-certified home health — nursing or therapy that a clinician orders after an illness or injury — is a separate clinical and coverage pathway addressed later on this page. If a proposal mixes task types, ask the provider to price the non-medical hours separately so you can compare them against the benchmark.

One more definitional point saves confusion later: the survey folds homemaker services and home health aide services into this single non-medical caregiver figure, while excluding skilled private-duty nursing. Providers, meanwhile, use their own labels — "companion care," "personal care," "aide services" — and the same label can mean different task lists at different companies. When you compare anything on this page to a quote, compare the written task list, not the label on the brochure.

Four terms recur in quotes, coverage rules, and care plans, and they are worth having straight before you read either:

  • Activities of daily living (ADLs) are the personal tasks a person does for themselves each day: bathing, dressing, using the toilet, moving from bed to chair, and eating. Most personal-care hours are priced around these.
  • Instrumental activities of daily living (IADLs) are the tasks that keep a household running: meals, laundry, shopping, transport, managing money, and managing medications. Homemaker and companion hours usually sit here.
  • Custodial care is the term Medicare and most insurers use for help with ADLs and IADLs that does not require a licensed clinician. It is the category this page prices, and the category most health coverage excludes.
  • Care level, or care tier, is a provider's own grading of how much support a person needs. It is not a clinical diagnosis, it is usually set by the provider's assessment, and it commonly determines which rate you are quoted.

Before you budget: this page is not a care assessment. If your parent has an immediate safety or medical concern, or needs are changing quickly after a hospital stay, work through their clinician or the hospital discharge team first. Set hours only once the care picture is stable enough to schedule.

At the national median, four common schedules look like this:

ScheduleWeeklyMonthly (weekly × 52 ÷ 12)Annual
10 hours/week$350$1,517$18,200
20 hours/week$700$3,033$36,400
40 hours/week$1,400$6,067$72,800
44 hours/week$1,540$6,673$80,080

All amounts use the $35 national median and are before premiums, fees, or direct-hire employer costs. The 44-hour schedule matches the assumption CareScout uses for its own annual figures.

The most useful first step costs nothing. Sit down with your parent and ask which tasks and times of day would make the biggest difference — and which routines, relationships, and privacy they want to keep exactly as they are. Turn that conversation into a specific list of tasks and a weekly schedule. Use the table row for the state where your parent lives; costs follow their address, not yours. Then request two or three written quotes for the same tasks, hours, and staffing pattern, with a reply-by date and a first rate-review date. If you want those paid hours to fit inside a broader stay-at-home plan, our aging-in-place checklist helps the whole household work before any single service does.

How much does in-home care cost per hour in your parent's state?

The rates below are 2025 median hourly costs for a non-medical caregiver from CareScout's Cost of Care Survey, collected July through November 2025 and re-checked against the source tables on August 10, 2026.

A median means half of the surveyed providers in that state reported a higher rate and half reported a lower one — it is not an average and not a quote. Three of the four money columns come straight from CareScout: the hourly rate, the monthly figure at 44 hours a week, and the annual figure behind it. The 20-hour column is Aging Parent HQ arithmetic — CareScout's annual figure × 20 ÷ 44 ÷ 12, rounded to the nearest dollar — because a part-time schedule is where most families actually start. All four are planning figures before minimums, premiums, fees, or direct-hire employer costs. Start from the row for the state where your parent lives.

LocationMedian hourly rate (2025)Est. monthly at 20 h/wkMonthly at 44 h/wkAnnual at 44 h/wk
U.S. national$35$3,033$6,673$80,080
What these figures are notNot an average; not a quoteAging Parent HQ arithmetic, not a CareScout figureExcludes minimums, premiums, and feesExcludes skilled nursing

States are grouped into the four U.S. Census regions and listed alphabetically within each: Northeast · Midwest · South and Washington DC · West.

Northeast in-home care rates by state

StateMedian hourly rate (2025)Est. monthly at 20 h/wkMonthly at 44 h/wkAnnual at 44 h/wk
Connecticut$36$3,120$6,864$82,368
Maine$45$3,857$8,485$101,816
Massachusetts$40$3,467$7,627$91,520
New Hampshire$40$3,467$7,627$91,520
New Jersey$38$3,293$7,245$86,944
New York$35$3,033$6,673$80,080
Pennsylvania$34$2,947$6,483$77,792
Rhode Island$40$3,467$7,627$91,520
Vermont$45$3,900$8,580$102,960

Midwest in-home care rates by state

StateMedian hourly rate (2025)Est. monthly at 20 h/wkMonthly at 44 h/wkAnnual at 44 h/wk
Illinois$36$3,120$6,864$82,368
Indiana$35$3,033$6,673$80,080
Iowa$41$3,562$7,836$94,037
Kansas$34$2,925$6,435$77,220
Michigan$35$3,012$6,626$79,508
Minnesota$44$3,813$8,389$100,672
Missouri$33$2,860$6,292$75,504
Nebraska$36$3,120$6,864$82,368
North Dakota$34$2,947$6,483$77,792
Ohio$34$2,947$6,483$77,792
South Dakota$44$3,835$8,437$101,244
Wisconsin$36$3,142$6,912$82,940

South in-home care rates by state, and Washington DC

StateMedian hourly rate (2025)Est. monthly at 20 h/wkMonthly at 44 h/wkAnnual at 44 h/wk
Alabama$27$2,340$5,148$61,776
Arkansas$25$2,167$4,767$57,200
Delaware$35$3,033$6,673$80,080
District of Columbia$38 (derived)$3,293$7,245$86,944
Florida$32$2,773$6,101$73,216
Georgia$32$2,773$6,101$73,216
Kentucky$33$2,817$6,197$74,360
Louisiana$26$2,253$4,957$59,488
Maryland$35$3,033$6,673$80,080
Mississippi$24$2,080$4,576$54,912
North Carolina$30$2,600$5,720$68,640
Oklahoma$33$2,860$6,292$75,504
South Carolina$31$2,719$5,982$71,786
Tennessee$31$2,687$5,911$70,928
Texas$30$2,600$5,720$68,640
Virginia$35$3,033$6,673$80,080
West Virginia$30$2,600$5,720$68,640

West in-home care rates by state

StateMedian hourly rate (2025)Est. monthly at 20 h/wkMonthly at 44 h/wkAnnual at 44 h/wk
Alaska$38$3,293$7,245$86,944
Arizona$38$3,293$7,245$86,944
California$40$3,467$7,627$91,520
Colorado$42$3,597$7,913$94,952
Hawaii$41$3,553$7,817$93,808
Idaho$39$3,337$7,341$88,088
Montana$38$3,293$7,245$86,944
Nevada$37$3,207$7,055$84,656
New Mexico$30$2,600$5,720$68,640
Oregon$40$3,467$7,627$91,520
Utah$39$3,402$7,484$89,804
Washington$45$3,900$8,580$102,960
Wyoming$46$3,987$8,771$105,248

Source: CareScout 2025 Cost of Care Survey median cost data tables; rates collected July–November 2025; tables re-checked August 10, 2026. The District of Columbia hourly value is derived from a separate CareScout publication — see below. The 20-hour column is arithmetic, not a provider quote.

A few notes on how these tables were built. The survey methodology covered 434 regions and drew on 6,014 home-care surveys; CareScout's own annual figures assume 44 hours per week for 52 weeks and exclude holiday rates. Every value above comes from the survey's direct median cost data tables, which are the controlling source for this page — not from rounded summary or ranking documents, and never from a different publisher's dataset.

One thing those tables reveal is worth knowing before you compare any two numbers on this page. CareScout rounds its hourly table to the nearest dollar, while its annual and monthly tables are calculated from unrounded medians — so in eleven states the two do not reconcile. Dividing each state's published annual figure by 2,288 hours shows the rate actually behind it:

StatePublished hourly rateHourly rate implied by the annual figure
Colorado$42$41.50
Idaho$39$38.50
Iowa$41$41.10
Kansas$34$33.75
Kentucky$33$32.50
Maine$45$44.50
Michigan$35$34.75
South Carolina$31$31.38
South Dakota$44$44.25
Utah$39$39.25
Wisconsin$36$36.25

Implied hourly = CareScout's published annual figure ÷ 2,288 hours (44 hours a week × 52 weeks), rounded to the nearest cent. The other thirty-nine states, the District of Columbia, and the national row reconcile exactly.

The difference is small — at most about $95 a month at 44 hours — but in these eleven states, multiplying the hourly column by your hours will not match the monthly column beside it. Where the two differ, the monthly and annual figures are the more precise numbers, and the rounded hourly rate is the better one to say out loud to a provider.

That distinction is worth naming for a second reason, because the same survey is published in more than one form. CareScout also releases a ranked state data document presenting most- and least-expensive states, and other publishers run entirely different cost surveys with their own samples and category definitions. Ranked and summary presentations can round, reorder, or group figures in ways that do not match the direct tables, and figures from separate surveys cannot be blended with these at all. Where a number elsewhere disagrees with a row above, the direct data tables are what this page follows.

The District of Columbia takes one extra step. CareScout's methodology reports that all 50 states and the District participated in the 2025 survey, but the downloadable hourly table publishes no D.C. value. CareScout does publish one separately: its 2025 cost of care data for Washington DC gives an annual non-medical caregiver cost of $86,944 on the survey's own 44-hour, 52-week basis. Divided out — $86,944 ÷ 2,288 hours — that is exactly $38.00 an hour, which is the figure in the D.C. row above and the reason it is labeled derived. It is CareScout's number and CareScout's assumption; the arithmetic is the only thing this page added. For a more local view anywhere, use the ZIP-code lookup on CareScout's cost-of-care page or collect written local quotes; rates within a state can vary meaningfully by area.

One question the tables do not answer on their face: are these rates still climbing? Nationally, yes, but gently. CareScout reports the non-medical caregiver median rose 3% in 2025, after several years of steeper increases. Translated into a household budget at the $35 national median, a 3% year is about $91 more a month on a 20-hour schedule and about $200 more on a 44-hour one — small enough to absorb, large enough to be worth seeing coming, and the reason to put a rate-review date in the agreement before the first visit rather than after the first increase. State-level movement was uneven; CareScout publishes a change-since-2024 figure for each state in its individual state releases, which this page does not yet carry.

A few habits make the tables more useful than a single glance. Because each figure is a median — the midpoint of surveyed provider rates — a local quote a few dollars to either side of your parent's state figure is ordinary, not a red flag. A quote far from the benchmark deserves a scope question before a verdict: a noticeably higher rate may include supervision, backup coverage, or heavier tasks, while a noticeably lower one may leave those out. Read the two monthly columns as brackets rather than predictions — 20 hours a week is a common part-time starting schedule, 44 hours approximates full-time coverage, and most families land somewhere between or start below both. And resist the temptation to budget from a lower-cost state nearby: the state where your parent lives sets the labor market their care is hired in, so that row — and eventually their ZIP code and written quotes — is the one that counts.

How do you turn an hourly rate into a weekly and monthly budget?

Three formulas turn any hourly rate into a budget. They are the arithmetic behind the 20-hour column above, and they will do the same for a rate on a real quote:

  1. Weekly cost = hourly rate × billed hours per week.
  2. Average monthly cost = weekly cost × 52 ÷ 12.
  3. Annual cost = weekly cost × 52.

Why 52 ÷ 12? A year has 52 weeks, so an average month contains about 4.33 weeks. Multiplying a weekly cost by 4 understates a typical month by roughly a third of a week — a gap that compounds quietly over a year of care.

To run your own estimate, take the rate from your parent's state row — or, better, the rate on an actual written quote once you have one — and multiply it by the hours you plan to schedule. As a worked example, 20 hours a week at Florida's $32 median is $640 a week, which is $640 × 52 ÷ 12, or about $2,773 in an average month — matching the Florida row above. Each added weekly hour raises the monthly total by about 4.33 times the hourly rate, which is why deciding hours with your parent matters more than shopping a dollar or two of rate. Any other schedule works the same way: 30 hours a week at that rate is $960 weekly and about $4,160 monthly.

Caregiver and adult daughter planning the weekly care schedule in the hallwayState cost figures checked August 2026

What the same schedule can cost under three different contracts

Two quotes can name the identical hourly rate and the identical weekly schedule and still land far apart, because the contract terms around the rate do the work. The three columns below hold the rate and the scheduled hours constant — 20 hours a week at the $35 national median — and vary only the terms.

LineLean structureTypical structureHeavier structure
Hours scheduled per week202020
Hours actually billed per week202224
Hours billed at a premium048
Weekly cost$700$790$880
Monthly cost of hours$3,033$3,423$3,813
Recurring monthly fees$0$0$75
Average monthly total$3,033$3,423$3,888
One-time charges in month one$0$150$250
First-month total$3,033$3,573$4,138

Illustrative contract structures, not surveyed data. Only the $35 rate is a published median. The lean column applies no minimum, no premium, and no fees. The typical column applies a four-hour visit minimum to two shorter visits and an assumed $5 weekend premium, plus an assumed $150 onboarding charge. The heavier column applies the minimum to four visits, an assumed $5 evening and weekend premium on eight hours, an assumed $75 monthly care-management fee, and an assumed $150 onboarding charge with a $100 deposit. Your quote will name its own figures; use these structures to see which questions to ask, not as market rates.

One line drives most of that spread, and it is not the rate and not the fees. Moving from 20 billed hours to 24 accounts for about $607 of the $855 monthly gap — roughly seven-tenths of it — while the premium hours account for about $173 and the care-management fee for $75. That is the practical reason to ask about minimum billed hours before you ask about anything else.

Once you have a written quote, the same structure extends cleanly. If some hours carry a quoted premium — evenings or weekends, say — split the weekly line: weekly cost = (regular hours × regular rate) + (premium hours × premium rate). Then add any fixed monthly fees from the quote to the monthly figure. Leave premium and fee fields blank until a proposal states them; a guessed premium is worse than none, because it looks like an answer.

The first month usually runs higher than the average month, and that is normal rather than a warning sign. One-time assessment or onboarding charges, any deposit, and the quirk of where the start date falls in the calendar all land in month one. Compute a first-month total separately from the average monthly figure so a front-loaded invoice doesn't read as the new normal.

Two cautions keep the math honest. First, budget on billed hours, not scheduled hours: minimums and per-visit rules, covered next, can make the invoice larger than the calendar. Second, never estimate round-the-clock coverage by multiplying one rate by 168 hours; continuous care is a staffing model with overtime and state wage rules, not a single line of arithmetic — see how overnight, live-in, and 24-hour care differ.

What changes the price on a real quote?

The distance between a state median and a first invoice usually comes from a handful of contract terms. The Aging Parent Cost Ladder is the order to check them in, because each rung can move the number more than the one before it:

RungWhat to askSize of the effectWhere it shows up
1. Benchmark rateWhat is the hourly rate for these exact tasks?Sets the base; state medians run $24 to $46The headline number on the quote
2. Billed hoursIs there a minimum per visit, per day, or per week, and how are shorter visits billed?The largest single mover in the worked model above — roughly seven-tenths of the spreadOften nowhere on the quote; you have to ask
3. Schedule premiumsWhich hours and dates are premium, and what is each premium worth?Second largest in that modelA rate schedule, sometimes on a separate page
4. Contract feesWhat is charged for assessment, onboarding, deposit, supplies, cancellation, and care management?Recurring fees compound; one-time charges land in month oneThe fees clause, and the first invoice
5. Employment overheadIf we hire directly, what do we owe as the employer?Social Security and Medicare alone add 7.65% of cash wages, before unemployment tax, workers' compensation, and insuranceNowhere on a caregiver's wage — see Publication 926 below
6. True monthly totalWhat does one average month cost, and what does the first month cost?The only figure worth comparing across quotesYour own arithmetic, not theirs

Does a minimum number of billed hours apply?

Many providers set a minimum per visit, per day, or per week, so a short errand can be billed at the minimum. Ask whether a minimum applies, at what level, and how visits shorter than it are billed. As the three-column table above shows, this single term moves a monthly total further than the hourly rate usually does.

Ask, too, whether the quoted rate depends on the specific tasks — help with transfers or mobility can carry a different rate than companionship. More visit days can also mean more travel and coordination inside the price.

What premiums and fees are added to the rate?

Ask which hours count as evening or overnight, which dates are premium days, and what each premium is. Confirm the actual figures in writing; there is no standard multiplier to assume. If driving to errands or appointments is part of the plan, ask whether mileage and travel time are included or billed separately. And ask what notice a schedule change requires and what a late cancellation costs — a real number for families juggling medical appointments.

Then ask about the charges that are not tied to hours at all: assessment or onboarding, deposits, supply charges, and any care-management fee. These shape the first-month total more than the hourly rate does, and a recurring monthly fee compounds quietly for as long as care continues.

Who sets the care level, and when can the rate change?

Ask when and how the rate can increase, whether supervision visits are included, and what happens when the regular caregiver is out. Included supervision and reliable backup can justify a higher rate; they are part of what you are buying.

Ask one more question that families often skip. The assessment that sets your parent's care level is usually performed by the same organization that will bill for the hours, and the care level commonly determines the rate. That is not a reason to distrust an assessment — providers need to know what the work involves — but it is a reason to ask what the assessment measures, what specifically would move your parent to a higher level, and how much notice you get before a level change takes effect. If the answer is vague or the proposed level surprises you, a clinician or a geriatric care manager who is not billing for the hours can give you a second read.

One number confuses many families: the caregiver's wage and the price you pay are different figures. An agency's bill rate also funds payroll taxes, insurance, screening, supervision, backup, and overhead. And a caregiver's wage is not a family's true cost of employing someone directly, either — employer obligations sit on top, which is exactly the next comparison.

The thread through all of these terms is the same: none of them has a national standard, so none of them can be assumed. Ask each one as a question, get the answer in writing before anything is signed, and notice how the provider responds — an organization comfortable putting its minimums, premiums, and fees on paper is telling you something useful about how it will handle everything else. The goal is not the lowest hourly rate; it is the lowest complete cost for care your parent actually accepts.

Should you use an agency or hire a caregiver directly?

Neither path is automatically cheaper or better. The honest comparison is between complete packages of cost, work, and risk — and it starts with one question.

Who actually employs the caregiver?

The answer determines who is accountable, what the hourly figure has to fund, and which duties land on your family. One rule before any comparison: get the employer of record in writing. Every other line on the quote depends on it.

What each path costs you

Four sourcing models cover almost every arrangement families actually use. Where a field cannot be answered at the category level — because it is set by the individual provider rather than by the model — the cell says so rather than guessing.

What to compareLicensed or registered home-care agencyRegistry or matching platformDirect hire by your householdMedicare-certified home health agency
Who employs and answers for the caregiverThe agency typically employs, schedules, and supervises its caregiversVaries by model — many only introduce families to caregivers who work independently; confirm in writingThe household is often the employer under federal tax rulesThe agency employs the licensed clinical staff who deliver ordered care
Cost basisHourly bill rateCaregiver's wage plus a platform, subscription, or placement fee — varies by provider, confirmCaregiver's wage plus employer taxes, insurance, and your own timeCovered by Medicare when the service and your parent both qualify; not an hourly non-medical arrangement
What the price has to fundWage, payroll taxes, insurance, screening, supervision, backup, overheadNot standardized — ask exactly what the fee covers and what it does notThe wage alone; employer costs and administrative time come on topClinician-ordered skilled services under the plan of care
Screening and trainingAsk how caregivers are screened, trained, and supervised, and confirm it in writingVaries by provider — confirm what was checked, by whom, and how recentlyThe family arranges background checks, references, and any trainingStaffing, licensure, and training standards apply to the certified agency
Backup when a caregiver is outAsk about substitute coverage and the call-out processVaries by provider — confirm whether any backup exists before you rely on itThe family finds relief coverage, or goes without help that dayCoverage continues under the ordered plan of care
Scheduling and oversightThe agency coordinates schedules and typically supervises the workUsually the family, using whatever tools the platform providesThe family manages the schedule and oversees qualityThe agency and the ordering clinician set and review the plan of care
Payroll, taxes, and recordsUsually handled by the agency as employer; confirmOften the household's duty when the caregiver works independently; confirmOften the household's duty when the caregiver is a household employeeHandled by the agency
Workers' compensation and liabilityAsk what coverage the agency carries for injuries and lossesVaries by provider — confirm whether any coverage reaches work in your parent's homeThe family may need its own coverage; ask an insurance professionalCarried by the agency
What it does not coverAnything outside the written task list; skilled nursing unless separately arrangedEmployer duties, supervision, and backup unless the agreement expressly says otherwiseNothing beyond the caregiver's hours — every other function is yoursNon-medical personal care and homemaker hours
Your family's ongoing timeLower day to day, though oversight is still neededHigher — in practice closer to a direct hire than to an agencyHighest: recruiting, managing, payroll, and contingency planningLow for the ordered services; separate for any private hours
Evidence statusTerms are set provider by provider — verify in the written agreementFee structures and employment status are not disclosed at category level — confirm per providerFederal employer duties verified against IRS Publication 926, reviewed August 10, 2026Coverage rules verified against Medicare.gov, reviewed August 10, 2026

The pattern to notice: a direct hire's lower visible rate often reflects work and risk moving onto the household rather than disappearing, and a registry sits closer to that end of the table than most families expect. For some families the trade is worth it — more control over who is in the home, continuity with one person your parent chooses, and a schedule built around their preferences. It is a real path, taken with eyes open.

When each path is the wrong fit

The table compares what each model provides. This is the other half: when each one is the wrong choice, and what to pin down before you commit to it.

Licensed or registered home-care agency. The agency employs the caregiver, so accountability for screening, supervision, and coverage sits with an organization rather than with your family. Not ideal when the schedule is short scattered visits that a minimum billed-hours rule makes uneconomic, or when your parent will not accept a rotating team. Confirm in writing: minimum billed hours, cancellation and late-change terms, and who employs the caregiver. Revisit when the care level is reassessed, the rate changes, or continuity breaks down.

Registry or matching platform. A registry usually introduces your family to caregivers who work independently, which means the household — not the platform — is typically the one accountable for the relationship. Not ideal when nobody in the family can absorb a call-out day, payroll cannot be set up before the first paycheck, or your parent needs continuity more than choice. Confirm in writing: who employs the worker, exactly what the fee covers, and what was screened, by whom, and how recently. Revisit when the caregiver leaves, weekly hours grow, or a second caregiver joins the schedule.

Direct hire by your household. Your family chooses, employs, and supervises the caregiver, and every duty an agency would otherwise carry comes with that. Not ideal when no one has the time to recruit and manage, no relief coverage exists for a sick day, or payroll and tax setup cannot be in place before the first paycheck. Confirm in writing: the employment classification as a professional has reviewed it, workers' compensation and liability coverage, and the backup plan. Revisit when wages approach either federal threshold below, duties change, or the caregiver's availability changes.

Medicare-certified home health agency. A clinician orders the care, the agency employs the licensed staff, and the plan of care — not your schedule — governs what is delivered. Not ideal when what your parent needs is personal care and household help rather than skilled services, or when the coverage rules are not met. Confirm in writing: which ordered services are covered and for how long, and which hours remain private-pay. Revisit when the ordered episode ends or your parent's clinical needs change.

When your family becomes the employer

Taken with professional advice, too. If your family controls what work is done and how it is done, the caregiver may be a household employee under federal tax rules. IRS Publication 926 explains the test and the duties that can follow — Social Security and Medicare taxes, possibly federal unemployment tax, and recordkeeping.

Two separate federal thresholds matter, and the lower one arrives sooner than families expect. Social Security and Medicare taxes apply once you pay one household employee cash wages of $3,000 or more during 2026. Federal unemployment tax works differently: it applies if you pay total cash wages of $1,000 or more to all household employees in any calendar quarter of 2025 or 2026. Twelve hours a week at a typical rate crosses that quarterly figure well inside the first three months. Both figures are from the 2026 edition of Publication 926, reviewed August 10, 2026; state tax, unemployment, and workers'-compensation rules are separate and can apply at different levels. Do not assume a caregiver can simply be treated as self-employed — classification depends on the actual working relationship, not the label. Talk with a payroll or tax professional before the first paycheck.

Three things only your parent's state can answer

Federal rules are the floor, not the whole picture. Three questions are decided where your parent lives, and each can move a real number.

QuestionWho decides itWhy it changes your number
Whether minimum wage, overtime, or live-in rules apply to your parent's caregiver, and on what termsYour parent's state labor or workforce agency; state law can be more protective than federal lawOvertime treatment can change a weekly total more than an hourly rate does
Whether a household employer must carry workers' compensation, and what state unemployment tax appliesThe state agency administering workers' compensation and unemployment insurance — often, but not always, the labor departmentThese are employer costs that never appear anywhere on a caregiver's wage
Whether a home-care agency or registry must be licensed or registered, and how to check a specific oneThe state health or professional-licensing agency; these requirements are set by the state, not federallyLicensure status is the cheapest verification you can run, and it is free

Start with the U.S. Department of Labor's directory of state labor offices, which lists the responsible agency, phone number, and website for every state, and with its state labor law topic pages comparing state rules against federal ones. Use the office for the state where your parent lives, not where you live.

Licensure is administered by a named agency in each state, and the three largest show the pattern: in Florida the Agency for Health Care Administration, whose facility locator lists licensed home health agencies; in Texas Health and Human Services, which licenses home and community support services agencies and runs a public provider search; and in California the Department of Social Services, which licenses Home Care Organizations and publishes a Home Care Aide Registry search. Those three are examples, not a directory. For every other state — and for local program routing anywhere — your parent's Area Agency on Aging, reachable through the Eldercare Locator, a public service of the U.S. Administration for Community Living, can name the agency that licenses home-care providers in their county. Enter your parent's ZIP code, not your own.

How do overnight, live-in, and 24-hour care differ?

A label is not a schedule. "Overnight," "live-in," and "24-hour" describe very different staffing and payment models, and they are not interchangeable pricing units. An overnight shift may be awake duty or may include expected sleep. A live-in arrangement means a caregiver stays in the home — it does not automatically mean one person is available, or paid, for every hour of the day. Continuous coverage usually involves more than one worker.

Before comparing any prices at this level, require each provider or candidate to put the actual model in writing: how many hours are awake duty and how many are expected sleep; how interruptions during sleep are handled and paid; when the caregiver is off duty and who covers those hours; who provides relief coverage and on what rotation; how many workers the plan involves; and how overtime is calculated and billed. A complete written model names each worker's hours and the total weekly billed hours — and once you have that total, the formulas above turn it into a monthly figure the same way as any other schedule.

This is also a decision to make with your parent, not just about them. Someone else present in the home at night — awake or asleep, familiar or new — changes privacy, routine, and the feel of the house more than any daytime visit does. Ask your parent what would make overnight help acceptable: which spaces stay theirs, who they would want it to be, and what the person should and shouldn't do while they sleep. An arrangement your parent has shaped is one they are far more likely to keep.

Do overtime rules apply to a live-in caregiver?

The legal backdrop is why written answers matter. The U.S. Department of Labor publishes a guide for families using in-home care workers covering employer structures, federal minimum wage, overtime, and recordkeeping, and separate sleep-time guidance on the specific conditions under which sleep time may be excluded from paid hours. Whether those conditions apply depends on the actual arrangement — and state law can be more protective than federal law.

That backdrop is also in motion, in two ways worth knowing before you compare live-in prices. As of the August 10, 2026 source review, the Department's direct-care guidance reflected an open federal rulemaking on how the Fair Labor Standards Act applies to domestic service, proposed in July 2025 and not final at that review. Separately, the Wage and Hour Division's Field Assistance Bulletin 2025-4, issued July 25, 2025, directs its investigators not to enforce the 2013 rule against third-party employers such as home care agencies that claim the companionship-services or live-in exemptions, and states that this position holds until any final rule takes effect. In practical terms, an agency may treat a live-in or companionship caregiver as exempt from federal overtime today. But non-enforcement is not repeal: the 2013 rule is still on the books, and the bulletin does not stop a caregiver from bringing a private claim, so a price built on that exemption can change if the rule survives. Ask each provider, in writing, how overtime is calculated for your parent's specific schedule and under which exemption, if any — and remember that a state may require overtime whether or not federal law does. Treat any live-in or continuous-care price as provisional until a payroll or employment-law professional has reviewed the written schedule against current federal and state rules.

Will Medicare pay for in-home care?

The two-part answer, straight from the official pages: Medicare generally does not pay for non-medical long-term care — the custodial care this page prices is usually paid out of pocket or through other programs. Separately, Medicare does cover qualifying home health services: part-time or intermittent skilled nursing or therapy that a clinician orders, under its own eligibility rules. So do not assume a caregiver is covered, and do not assume everything delivered at home is excluded — if your parent is leaving the hospital or has new clinical needs, ask the clinician or discharge planner whether ordered home health applies before you budget those hours as private-pay.

For the fuller funding picture, our guide to ways to pay for senior care covers Medicaid home- and community-based waivers, veterans' programs, long-term-care insurance, and other pathways.

What if the hours you need cost more than your family can pay?

This is the most common place a care plan stalls, and it is not a failure of planning. The schedule that would help most is frequently more than the household can pay for, and the useful response is to change the shape of the plan rather than to abandon it. Five moves, roughly in the order most families find them useful:

  • Buy fewer hours, better placed, before you buy none. Two well-chosen hours on the two hardest days of the week is a real plan. Ask your parent which moments are worst — mornings, bath days, the evening stretch — and cover those first. A smaller schedule you can sustain for a year beats a larger one you cancel in month two.
  • Combine paid hours with family and community coverage. Meal programs, volunteer visiting, faith-community help, adult day programs, and a rotation among relatives can carry hours that would otherwise be billed. Name who covers what, in writing, so the plan does not quietly land on one person.
  • Start any benefit application now, because the clock is the constraint. Medicaid home- and community-based waivers, veterans' programs, and long-term-care insurance each have their own eligibility rules, application steps, and — in some states — waiting lists that run months. Our guide to ways to pay for senior care walks through the pathways; starting an application early costs little and preserves an option you may need later.
  • Ask your parent's Area Agency on Aging what exists locally. Sliding-scale services, respite grants, and county programs vary enormously and are rarely advertised. The Eldercare Locator connects your family to the Area Agency on Aging for your parent's county — enter your parent's ZIP code, not your own.
  • Compare settings only after the four steps above, and only with your parent. At 2025 national medians, 44 hours a week of in-home care works out to about $6,673 a month, while the median monthly cost of an assisted living community is $6,200 — both from the same CareScout survey. Those figures are not equivalents: the assisted living median includes housing, meals, and on-site staffing, while the in-home figure buys hours of help in a home your parent already pays for. Read the comparison as a prompt to look at the whole picture, not as a threshold. Our comparison of in-home care and assisted living works through it without treating a move as inevitable, and if your family decides to explore residential options, see how to choose assisted living. One thing to know before that first call: most "free" placement and referral services are paid by the communities they send you to, which shapes which ones you are shown — ask any advisor who pays them before you hand over your parent's information.

No cost figure decides where a person should live. If the numbers and your parent's wishes point in different directions, that is a conversation to have with them and, where health is part of the picture, with their clinician — not a calculation to settle on a spreadsheet.

How do you compare quotes and choose a first schedule?

Two quotes are comparable only when they price the same thing: the same tasks, hours, staffing pattern, premiums, fees, cancellation terms, backup arrangements, supervision, and rate-change terms. Compare the same tasks, hours, and staffing pattern before you compare rates — otherwise the "cheaper" proposal may simply be the one that left more out.

The In-Home Care Quote Normalizer below is how to hold every proposal to the same specification. Send each provider or candidate your written task list and schedule, then record their answers side by side — print this section or copy the table into a document and add a column per quote.

Field groupRecord from every quote
Your parent's termsThe tasks they want help with; the times that fit their routine; the privacy, people, and habits that stay as they are
ScopeTasks included and excluded; level of supervision; confirmation that skilled services are excluded
ScheduleDays; start and end times; regular hours; minimum billed hours; how any overnight, awake-overnight, or live-in time is defined
RatesRegular hourly rate; evening or night rate; weekend rate; holiday rate; overtime handling; annual or contract rate increases
Fixed and variable feesAssessment or onboarding; deposit; transportation or mileage; cancellation; late schedule change; supplies; care-management fees
StaffingWho employs the caregiver; primary caregiver; backup coverage; continuity promise; call-out process; number of workers
Care levelHow the level is assessed and by whom; what triggers a level change; how much notice you get before a rate changes
Risk and administrationBackground checks; training; payroll and tax handling; workers' compensation; liability insurance; bonding; records
ContractStart date; review date; termination notice; refund or credit terms; complaint and escalation path; who may receive information about your parent's care and what written authorization is required; data and privacy practices
Calculated totalsWeekly total; average monthly total; first-month total; the implied hourly rate (average monthly total ÷ weekly hours ÷ 4.33) so proposals with different fee structures compare on one number; every excluded or unknown field, listed plainly

An unanswered field is not a saving — it is a cost you haven't seen yet. Keep every blank visible until the provider fills it in writing.

Who has the authority to arrange and sign?

Most of this page assumes your parent is deciding alongside you, and where they are, their agreement is what governs: a competent adult chooses their own care, signs their own agreements, and may decline help entirely. Two practical points follow from that.

First, a provider generally will not discuss your parent's care or bills with you without your parent's authorization. Ask each provider what written authorization it requires and have your parent sign it at the start, so a routine question three months in doesn't stall. Second, if your parent cannot take part in the decision, the family needs to know what authority already exists — a financial power of attorney, a health care proxy, or neither — before anyone signs a contract or sets up payroll. Our guide to power of attorney for an aging parent explains the difference between the documents; where nothing is in place and your parent can no longer grant it, an elder-law attorney is the right next call.

Where siblings share the decision, settle in writing who signs, who holds the schedule, and how the cost is divided before quotes come back. Disagreement about money and care level is ordinary in families, and it is far easier to work out before a start date than after the first invoice.

When completed quotes come back far apart, resist declaring a winner on price. Ask the higher quote what it includes that the others don't — supervision visits, guaranteed backup, a heavier task level — and ask the lower quote what is excluded or billed separately. Sometimes the gap closes; sometimes it reveals that the proposals were never for the same service. Either way, you learn which questions matter in your parent's market. And where the provider offers it, have your parent meet the proposed caregiver before the start date; fit is a real term of the deal even though it never appears on the invoice.

When one proposal fits, start deliberately. If the family and the provider agree, a defined pilot period — with a set end date and a scheduled conversation about what worked — beats an open-ended commitment; there is no universal "right" trial length, so set one together. Wherever possible, your parent should approve the goals of the arrangement, the days and times, the privacy boundaries, and who may enter the home. Put the start date, the review date, the rate-review date, and the backup plan in writing before the first visit. Care that begins with your parent's agreement tends to be care that lasts.

One last thing to know before anyone starts work. If you ever suspect that your parent is being mistreated, neglected, or financially exploited by a caregiver or anyone else, Adult Protective Services in your parent's state investigates those reports, and the Eldercare Locator will connect you to the right office. A licensing complaint to the state agency that regulates home-care providers is a separate route and can be used alongside it. Keeping the provider's written complaint and escalation path on file is the small step that makes either one easier to use.

Choosing in-home care at a glance

If you want the shortest possible version of this page's decision, it is this set of fits — in order of smallest reasonable change first:

  • Best when the care picture is still unclear: a conversation with your parent about tasks and timing — plus a professional assessment where health or mobility is changing — before any contract.
  • Best for a few defined hours a week with minimal family administration: a licensed or registered home-care agency that employs its own caregivers.
  • Best for families ready to act as the household employer: a directly hired caregiver, with payroll, tax, and insurance duties set up properly from the first paycheck.
  • Best for families who want help finding candidates but will manage the rest: a registry or matching platform — after written confirmation of who employs the worker and what the fee covers.
  • Best when a clinician has ordered skilled care after an illness or hospital stay: a Medicare-certified home health agency for the qualifying services, with any non-medical hours planned and priced separately.

Each of those fits has a situation it suits and a situation it doesn't:

Your parent's situationNext step and what to shortlistNot ideal whenConfirm before you sign or pay
Managing most days; wants help with a few tasks on set daysList tasks and times together, then request two or three home-care agency quotes at 10–20 hours a weekA minimum billed-hours rule makes short visits uneconomic, or your parent objects to rotating caregiversMinimum billed hours; cancellation terms; who employs the caregiver
Family can genuinely supply recruiting, backup, and payroll capacityConsider a direct hire with a written agreement and professional payroll setupNobody in the family can absorb a call-out day, or payroll cannot be set up before the first paycheckEmployment classification reviewed by a professional; workers' compensation and liability coverage; the backup plan
Family wants candidate access but will manage the relationshipConsider a registry or matching platform, priced as a direct hire rather than as an agencyThe household is not prepared to be the employer, or no backup coverage existsWho employs the worker; what the fee covers; screening depth and how recent it is
Needs changing after a hospital stay or a new diagnosisA professional assessment first — the clinician, discharge planner, or local Area Agency on Aging — before setting hoursNever skip this step to move faster; interim hours can run alongside it if your parent is not safe aloneWhich tasks are skilled versus non-medical; whether ordered home health is in place; when to reassess
Overnight or round-the-clock coverage is the questionGet each option's written staffing model and a payroll or employment-law review before comparing pricesAny time a price is quoted before the staffing model is written downAwake versus sleep hours; number of workers; overtime handling and under which exemption
The monthly figure is more than the household can payReduce and reposition hours, add community and family coverage, and start any benefit application nowReduced hours cannot meet a safety need — that is an assessment question, not a budget oneWaiver and veteran eligibility; sliding-scale programs in your parent's county; who covers the unpaid hours
You live in another state from your parentWeight backup coverage and supervision heavily; ask how the provider communicates with a family member at a distanceYour parent will not accept rotating staff, or a nearby relative is genuinely available and willingWho supervises and how often; how you are told about a missed visit; a named local contact
Care has started and your parent will not accept the caregiverAsk the provider for a different match before you change the type of care; separate a fit problem from a refusal firstThe objection is to paid help itself rather than to this person — that is a conversation, not a staffing changeTermination notice and what ending costs; what happens to any deposit; how quickly a replacement can start

Whichever path you shortlist, score every proposal against the same Quote Normalizer fields above — a proposal that leaves fields blank is not comparable to one that fills them.

When should you recalculate or reconsider the plan?

A care budget is a living document. Rerun the numbers — and revisit the plan with your parent — when the tasks or hours change, when an overnight need appears, when coverage gaps or caregiver call-outs keep repeating, when family members are stretched past what they can sustain, or when the monthly total and the budget stop matching.

Recalculating does not have to mean escalating. Often the right adjustment is a different mix of the same supports: rebalanced family help, community programs through the local Area Agency on Aging, and a modest change in paid hours. If relatives are carrying more than they can sustain, our guide to caregiver burnout and respite options is a practical place to start. And where coordination itself has become the problem — several providers, a complicated schedule, a family spread across states — a geriatric care manager is the professional who does that work for a fee, and an occupational therapist is the one to ask about whether the home itself can be adapted to reduce the hours needed. Whatever you decide, put the next review date on the calendar; a plan with a review date is a plan, and anything else is a hope.

When the arrangement isn't working

Sometimes care starts and does not settle. Before you change anything, separate three problems that look alike from the outside and have different fixes. A fit problem — your parent and this particular caregiver simply do not get on — is usually solved by asking the provider for a different match; most agencies will make one, so ask at the start how a change is requested and how long it takes. A care-level problem — the hours are in the wrong places, or the tasks are heavier than the plan assumed — is a scheduling conversation first and, if your parent's needs have changed, an assessment question second. A refusal — your parent does not want paid help in the house at all — is neither, and no new caregiver or cleverer schedule resolves it.

That last one is your parent's decision to make, if they are able to make it. Declining a specific person is not declining help, and declining help this month is not declining it forever. Before you unwind anything, read the termination notice in the agreement so you know what ending costs and what happens to any deposit, and ask the provider to confirm both in writing. Then go back to the conversation rather than around it; if it has become a hard one, our guide to talking with an aging parent about accepting help is written for exactly that point.

Frequently asked questions about in-home care costs

What does 20 hours a week of in-home care cost per month?

At 2025 state medians, 20 hours a week ranges from about $2,080 a month in Mississippi to about $3,987 in Wyoming. Find the row for your parent's state in the regional tables above for the figure that applies to them — and remember these are planning estimates before minimums, premiums, fees, or direct-hire employer costs; only a written quote gives the real number.

What does in-home care cost in Washington, D.C.?

CareScout's downloadable hourly table publishes no District of Columbia value, but CareScout publishes a D.C. annual figure separately: $86,944 for a non-medical caregiver at 44 hours a week for 52 weeks. That works out to exactly $38.00 an hour, which is the derived figure in the South and Washington DC table above — about $3,293 a month at 20 hours a week. It is CareScout's number on CareScout's own assumption; only the division is this page's.

How much does 24-hour or overnight in-home care cost?

There is no single reliable number. Continuous coverage is a staffing model — usually more than one worker — governed by overtime and state wage rules, so multiplying one hourly rate by 168 hours is not a valid estimate. Get a written staffing plan stating awake and sleep hours, the number of workers, and overtime handling, then have a professional review it before comparing prices.

Is hiring a caregiver directly cheaper than using an agency?

Not automatically. The visible hourly rate is usually lower, but employer taxes, workers'-compensation and liability coverage, backup when the caregiver is out, and the family's administrative time all sit on top of the wage. Compare the true monthly cost of each path for the same tasks and hours using the comparison table above, and get payroll and tax advice before deciding.

Will Medicare, Medicaid, or veterans' benefits pay for a caregiver at home?

Medicare generally does not pay for non-medical long-term care, though qualifying clinician-ordered home health services are covered under separate rules. Medicaid home- and community-based waivers, veterans' programs, and long-term-care insurance each have their own eligibility rules and application steps; our guide to ways to pay for senior care walks through those pathways.

How long does it take to set up in-home care?

It depends on the slowest step, not the fastest. Your parent's own readiness and decision timeline is a legitimate part of the schedule, not an obstacle to work around. Beyond that, the clock is set by quote turnaround, any professional assessment you schedule, and agency onboarding or caregiver matching — and if a benefits program is involved, applications and waitlists can add far more time. A reply-by date on quote requests keeps things moving without pressuring anyone.

Your next step

Write three things down with your parent this week: the tasks that would genuinely help, the days and hours that fit their routine, and the nonnegotiables — the privacy, people, and habits that stay as they are. Price that schedule against their state's row above, then send the same written specification to two or three providers with a reply-by date. When the quotes come back, hold them to the Quote Normalizer, choose together, and put the first review date on the calendar.

Caregiver and older man waving goodnight at his door as her visit ends

Sources and last verified date

Every figure on this page was checked against its source on August 10, 2026. The per-state values were first taken from CareScout's median cost data tables on July 20, 2026 and re-checked against the same tables on August 10, 2026. The page is rechecked when CareScout publishes its next Cost of Care Survey, or sooner if any source below changes.

Aging Parent HQ is an independent educational publisher. This guide is researched and written by the Aging Parent HQ editorial team from primary sources, and every figure on the page is traced to the document it came from. The household-employment tax passages and the federal wage-and-hour passages describe published federal rules and have not had licensed tax or employment-law review; when that review is completed, it will be credited here by name, role, and date. This page is general information for families planning care — not individualized medical, legal, tax, or benefits advice, not a care assessment, and no substitute for your parent's own clinician, an elder-law attorney, or a payroll or tax professional. Aging Parent HQ is not a home-care provider, a placement or referral service, a law firm, or a government agency. Nothing on this page is a paid placement. Corrections and source questions: hello@agingparenthq.com.

Last verified: August 10, 2026

Next review: February 10, 2027 (sooner if CareScout publishes its next Cost of Care Survey or any source above changes)

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