When an aging parent needs more help than family can provide, the range of options can feel overwhelming — and the way care is paid for in the US is genuinely confusing. This guide explains each main type of care in plain terms, what it typically costs, and, just as importantly, what Medicare, Medicaid and other programs do and don’t pay for.
Start here: The free Eldercare Locator (1-800-677-1116 or eldercare.acl.gov) connects you with your local Area Agency on Aging, which can explain the services and programs available where your parent lives.
The Main Care Options, From Least to Most Support
1. Help at Home From Family, With Equipment and Home Changes
Many older adults can stay safely at home longer with the right adjustments: grab bars, a shower chair, better lighting, a medical alert device, and a medication system. This is usually the least expensive option and the one most people prefer. Our home safety checklist is a practical starting point.
2. Non-Medical Home Care (Personal Care Aides)
Home care aides help with everyday tasks — bathing, dressing, meals, light housekeeping, errands and companionship — for a few hours a week up to around-the-clock. National cost-of-care surveys put typical rates at roughly $30–$35 per hour, though prices vary widely by state and city.
3. Home Health Care (Skilled, Medical)
Home health care is medical care at home ordered by a doctor: skilled nursing, physical, occupational or speech therapy, typically after a hospital stay or for a specific condition. This is different from home care above, and it’s the type Medicare may cover.
4. Adult Day Services
Adult day programs provide supervision, meals, activities and sometimes health services during daytime hours, while the person returns home in the evening. They’re often much cheaper than full-time home care and give family caregivers time to work or rest.
5. Assisted Living
Assisted living communities provide a private apartment or room, meals, help with daily activities, medication management and social activities, but not full-time nursing care. National median costs are commonly reported in the range of roughly $5,000–$6,000 per month, with large regional differences.
6. Memory Care
Memory care is specialized residential care for people with Alzheimer’s or other dementia, with secured environments, trained staff and structured routines. It usually costs more than standard assisted living.
7. Nursing Homes (Skilled Nursing Facilities)
Nursing homes provide 24-hour nursing care for people with significant medical needs or disability. They’re the most expensive option, with national medians often reported at roughly $8,500–$9,500 or more per month for a semi-private room.
Who Pays for What? Medicare vs Medicaid
Medicare
Medicare is health insurance for people 65 and older. The single most important thing to understand: Medicare does not pay for long-term custodial care — help with bathing, dressing and daily living, whether at home, in assisted living or in a nursing home.
Medicare may cover:
- Home health care when a doctor certifies it’s needed, the person is considered homebound, and they need part-time skilled care.
- Short-term skilled nursing facility care after a qualifying inpatient hospital stay, for rehabilitation, for a limited number of days, with cost-sharing after the first 20 days.
- Hospice care for people with a terminal illness.
- Some durable medical equipment, such as walkers, wheelchairs and hospital beds, when medically necessary.
Medicaid
Medicaid is a joint federal-state program for people with limited income and assets. It is the largest payer of long-term nursing home care in the US. Most states also offer Home and Community-Based Services (HCBS) waivers that can pay for home care or assisted living services so people can avoid moving to a nursing home. Rules and waiting lists vary by state.
Other Ways Care Is Paid For
- PACE (Programs of All-Inclusive Care for the Elderly): available in many areas, combining Medicare and Medicaid to provide comprehensive care so eligible older adults can live at home.
- VA benefits: eligible veterans and surviving spouses may qualify for programs including the Aid and Attendance pension benefit.
- Long-term care insurance, if your parent has a policy — check what triggers benefits and the elimination period.
- Medicare Advantage extras: some plans offer limited in-home support or safety benefits.
- Private savings and home equity, which fund a large share of assisted living.
How to Decide What’s Right
- Get an assessment. Ask your parent’s doctor about their needs, and consider an occupational therapy home evaluation. A professional geriatric care manager (Aging Life Care Professional) can also help.
- Be honest about safety. Falls, missed medications, wandering or an inability to manage alone at night are signs more support is needed. See signs your parent needs more support.
- Include your parent in the decision. Their preferences matter, and people cope better with changes they helped choose. Our guide on talking to aging parents about help may help.
- Check what they qualify for before assuming you’ll pay privately — contact the Area Agency on Aging and your state Medicaid office.
- Visit and compare. For residential care, tour more than one place, visit at different times of day, and check state inspection reports. For nursing homes, Medicare’s Care Compare tool at medicare.gov lists ratings.
Don’t Forget the Caregiver
If a family member is providing most of the care, their health matters too. Respite care, adult day programs and support groups can make home care sustainable. Read our guide to caregiver burnout.
This guide provides general information about US care options and is not legal, financial or medical advice. Medicare and Medicaid rules change and Medicaid varies by state — confirm details with Medicare (1-800-MEDICARE), your state Medicaid agency, or a qualified elder law attorney. Cost figures are approximate national ranges and vary widely by location.