Home care vs assisted living: how families decide
Home care vs assisted living, plainly compared: what each costs at different hours of care, who each one fits, and the signs that it's time to decide.
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Home care vs assisted living is often the first comparison a family makes when a parent needs help every day. Home care brings a trained caregiver into your parent's own home, billed by the hour. Assisted living moves your parent into a residential community with an apartment, meals and staff help, billed by the month. Both serve people who need help with daily life but not skilled medical care.
We're a home care agency, so we'll say that up front. But the honest answer isn't always home care, and this guide says where it isn't.
At a glance
| Home care | Assisted living | |
|---|---|---|
| Where your parent lives | Their own home | An apartment in a residential community |
| Typical cost | $32 to $55 per hour, depending on where you live | A monthly fee, often with extra charges as care needs rise |
| Attention | One-on-one during each visit | Shared staff, on call |
| Company and activities | Depends on family, friends and outings | Built in |
| Skilled medical care | No | No |
| Medicare coverage | No | No |
Home care rates vary from state to state and even town to town, largely with caregiver availability and the local cost of living.
What home care is
Non-medical home care is a trained caregiver, often a certified home health aide, who helps with activities of daily living in your parent's home: bathing, dressing, toileting, moving from bed to chair, meals, light housekeeping, errands, medication reminders and company. It isn't skilled nursing. Wound care, injections and IV medicines come from a licensed home health agency, often covered by Medicare after a hospital stay.
Most families start with a set number of hours, such as mornings for a shower and breakfast or a few afternoons a week, and add more as needs grow. When someone needs help around the clock, there are two options: live-in care, where one caregiver lives in the home and gets time to sleep, and 24-hour home care, where caregivers work awake shifts.
The great strength of home care is continuity. Your parent keeps their bedroom, kitchen, neighbors, doctor, pharmacy and the walk they've taken for forty years. For someone with early memory loss, familiar surroundings are a real help.
What assisted living is
Assisted living is a licensed residential community for older adults who need help with daily activities but not skilled medical care. Residents usually have a studio or one-bedroom apartment, and the building has a dining room, activity spaces and outdoor areas. Meals, housekeeping, activities and help with bathing, dressing and medications are covered by a monthly fee, often with extra charges as care needs rise.
The trade is depth for breadth. A resident gets less one-on-one attention than with a home caregiver, but more company and a structured day. Assisted living isn't a nursing home, which provides skilled nursing around the clock, and it isn't memory care, the secured setting for people with dementia who can't safely come and go.
The cost, by hours of care
The fair way to compare is to price home care at the number of hours your parent actually needs. A typical range for a caregiver is $32 to $55 per hour, depending on where you live, because the cost of home care varies from state to state and even town to town, largely with caregiver availability and the local cost of living. Assisted living is one monthly fee, often with extra charges as care needs rise.
Because home care is billed by the hour, a few hours a day usually costs less than assisted living. As the hours grow toward a full day, every day, the two draw closer, and once your parent needs someone there day and night, assisted living usually costs less. To compare for your parent, multiply the hourly rate you're quoted by the hours they need each week, and set that beside the community's full monthly price at their level of care.
Your local rates matter most, and so do the extras: assisted living fees for higher care levels and medication management, and the cost of keeping up a house. Our guide to home care costs goes into hourly, live-in and 24-hour pricing.
Medicare pays for neither. Long-term care insurance usually covers both if your parent has a policy. Veterans and surviving spouses may qualify for VA pension benefits, including Aid and Attendance, that help with either. In New Jersey, the Medicaid program called MLTSS can cover home care or services in assisted living for people who qualify. Our payment options page explains what we accept: we're private pay, and if Medicaid is the right fit, we can refer you to one of our preferred providers that takes it.
Who each one fits
Home care fits best when your parent
- Is attached to the house and a move would feel like a loss
- Needs help for part of the day, on a predictable schedule
- Has family or friends nearby to fill gaps and keep them company
- Has early memory loss and does best in familiar surroundings
- Is recovering from surgery or an illness and expects to get stronger
Assisted living fits best when your parent
- Is lonely at home and would enjoy meals and activities with others
- Lives in a house that has become impractical: stairs, upkeep, a yard
- Has no family nearby to help manage care at home
- Needs light help but some supervision throughout the day
- Has been hinting that they'd like a community, or friends have moved to one
Some people fit neither. Dementia with constant wandering usually calls for memory care. Daily skilled medical needs call for a nursing home. A hospital stay with rehab needs often means short-term rehab first, then home care or assisted living depending on recovery.
What usually forces the decision
- A fall and a hospital stay. Hospital-to-home care often covers recovery. If the fall reveals a pattern, a move comes up.
- An exhausted spouse. A 78-year-old wife can't keep caring for her husband alone. Home care relieves her; assisted living for both is the other path.
- Loneliness. The parent who hosted every Sunday dinner now goes days without talking to anyone. Companion hours help; a community solves it more completely.
- Medication mix-ups. A missed or doubled dose. Home care can add reminder visits; assisted living builds medication help into the day.
- The house itself. The only bathroom is upstairs and the stairs are no longer safe. Some problems can be fixed with changes and help at home. Some can't.
It's easier to choose calmly before a crisis than in a hospital discharge meeting.
What each trades away
Home care trades away built-in company. A parent with 20 hours of help a week may still spend much of the day alone. Plan for it: adult day programs, senior center days, companion care, regular visits and phone calls.
Assisted living trades away home. A smaller apartment means fewer belongings, new routines and a building that doesn't smell like home. The first months are usually the hardest. Some people settle in happily; some never do. A lot of a parent's sense of self can live in the house.
Both beat doing nothing. The fall, the missed medication, the exhausted spouse in the hospital are real risks. Either kind of help reduces them.
Five steps to a decision
- Get a clinical opinion from your parent's doctor or the hospital social worker on whether the needs are non-medical or skilled.
- Get a free in-home assessment from a home care agency. A good one will tell you when home care can't meet the need.
- Tour a few assisted living communities, at a meal and again in the late afternoon. Get the full price list in writing.
- Price home care at the real hours needed, not an average.
- Talk with your parent. It's their home and their life, and the decision goes better when they help make it.
Always Responsive provides personal care and dementia care at home through offices in New Jersey, Pennsylvania and Florida. If you'd like an honest read on whether home care fits your situation, talk with our care team.
Common questions
Click or tap a question to see the answer.
Is it cheaper to have home care or assisted living?
It depends on how many hours of help are needed. A typical range for a caregiver is $32 to $55 per hour, depending on where you live, because the cost of home care varies from state to state and even town to town, largely with caregiver availability and the local cost of living. Part-time home care usually costs less than assisted living. Around-the-clock care at home usually costs more than assisted living.
Does Medicare pay for home care or assisted living?
Medicare doesn't pay for non-medical home care, such as help with bathing, meals and companionship, when that's the only care needed, and it doesn't pay for room and board or personal care in assisted living. Medicare home health covers part-time skilled nursing and therapy for people who are homebound and need it. Families usually pay privately or with long-term care insurance, VA benefits or, for those who qualify, Medicaid.
Who qualifies for non-medical home care?
Anyone who wants help can arrange private non-medical home care; there's no clinical requirement. An agency will assess your parent's needs and write a care plan. Medicare-covered home health care is different: it requires a doctor's order, homebound status and a need for skilled nursing or therapy.
What is the biggest drawback of assisted living?
For many people it's leaving home: a familiar house, neighbors, routines and belongings, traded for a smaller apartment with set mealtimes. Assisted living also gives less one-on-one attention than a home caregiver, and pricing often adds fees for higher levels of care. For people who are isolated at home, though, the built-in company can be a real benefit.
When should you switch from home care to assisted living?
Consider it when your parent needs supervision around the clock and the cost of care at home has passed the cost of a facility, when loneliness at home is hurting their mood or thinking, when the house itself has become unsafe or impractical, or when no family is nearby to help manage care. For dementia with constant wandering, memory care is usually the better fit.
