Quick Answer
For someone who needs help with daily activities but not round-the-clock nursing, in-home care is usually less expensive at part-time hours and lets them stay in familiar surroundings. At $25 an hour, 4 hours a day is about $3,000 a month and 8 hours a day about $6,000. Around-the-clock care at home generally costs more than a nursing home, which is the better fit for 24-hour skilled medical needs.
In This Guide
Key Takeaways
- →In-home care is usually less expensive at part-time hours; 24-hour care at home usually costs more than a nursing home.
- →Home is often the better fit for help with daily activities and early to moderate dementia.
- →A nursing home is the safer choice for 24-hour skilled nursing or when the home can't be made safe.
- →Medicare doesn't pay for long-term care in either setting. Long-term care insurance often covers both.
- →Include your loved one in the decision whenever they're able to take part.
Most families reach this decision under pressure: after a fall, a hospital stay or a doctor's warning. The two options differ in cost, in daily life, and in the kind of needs they handle well. This guide lays out the trade-offs so your family can decide with clearer information.
Monthly Costs Side by Side
In-home care is priced by the hour, so cost depends on how much help is needed. The figures below use BlueBonnet's base rate of $25 an hour; more complex care and overnight shifts cost more, and schedules of 30 or more hours a week get a volume discount.
| Level of help | In-home care (approx. monthly at $25/hr) | Compared with a nursing home |
|---|---|---|
| 4 hours a day | About $3,000 | Usually far less than a nursing home |
| 8 hours a day | About $6,000 | Often similar to or less than a nursing home |
| 12 hours a day | About $9,000 | Often more than a nursing home |
| 24 hours a day | About $18,000 | Usually much more than a nursing home |
Nursing home prices vary widely by facility and room type. Call the facilities you're considering for their current rates, and compare quality on Medicare's Care Compare tool at medicare.gov/care-compare. For a closer look at home care pricing, see what in-home care costs in Houston.
When In-Home Care Fits
- Your loved one needs help with some daily activities, such as bathing, dressing, meals and getting around, but not continuous nursing
- They want to stay home, and the home can be made safe with grab bars, a shower chair or other changes
- They have early to moderate dementia and do better with familiar routines and surroundings
- Family is nearby to share some of the care
- There's a way to pay for the hours needed, such as private funds or long-term care insurance
Home also keeps the things that matter most to many people: their own bed, their neighborhood, their pets, their routines. That carries real weight for quality of life.
When a Nursing Home Is the Safer Choice
- 24-hour skilled nursing needs, such as complex wound care or frequent IV medications
- Advanced dementia with behaviors that put the person or others at risk, and that can't be managed at home
- Short-term rehabilitation after a hospital stay, such as after a hip fracture or stroke, which Medicare may cover for a limited time when requirements are met
- A home that can't be made safe, or no reliable way to cover the hours of care needed
Mixing Options
It doesn't have to be all or nothing. Many families combine approaches: a short rehab stay followed by help at home, home care on weekdays plus an adult day program, or part-time care with family covering evenings. Plans can change as needs change.
How Each Is Paid For
| Payment source | In-home care | Nursing home |
|---|---|---|
| Private pay | Yes | Yes |
| Long-term care insurance | Usually, if the policy includes home care | Usually |
| Medicare | No, for ongoing non-medical care | Short-term skilled stays after a qualifying hospital stay only |
| Medicaid | Through STAR+PLUS for eligible Texans | Yes, for eligible residents of Medicaid-certified facilities |
| VA benefits | Aid and Attendance can help pay | Aid and Attendance and other VA programs may help |
BlueBonnet accepts private pay and long-term care insurance. For other funding options, see our guides to LTCI vs. Medicaid and VA Aid and Attendance.
Questions to Help You Decide
- What help does your loved one need, and at what times of day?
- Do any needs require a nurse rather than a caregiver?
- What does your loved one want, and are they able to take part in the decision?
- Can the home be made safe, and is anyone available nearby?
- How many hours of care can your family afford, and for how long?
- What would change your plan in six months, and what's the next step if it does?
Frequently Asked Questions
Is in-home care cheaper than a nursing home?
Usually at part-time hours. At $25 an hour, four hours a day of in-home care costs about $3,000 a month, which is typically well below nursing home prices. Around-the-clock care at home usually costs more than a nursing home.
Does Medicare pay for a nursing home or in-home care?
Medicare doesn't pay for long-term custodial care in either setting. It may cover a short skilled nursing facility stay after a qualifying hospital stay, and limited skilled home health services.
When is a nursing home the better choice?
A nursing home is usually the safer choice when someone needs 24-hour skilled nursing, has advanced dementia with behaviors that can't be safely managed at home, or lives in a home that can't be made safe.
Does long-term care insurance cover in-home care as well as nursing homes?
Most policies cover both settings, though some older policies cover only facility care or pay home care at a lower percentage. Check the policy's home care benefit.
How do I check the quality of a Houston nursing home?
Use Medicare's Care Compare tool at medicare.gov/care-compare to see star ratings, inspection results and staffing information for Medicare-certified nursing homes.
Related Reading
If you're weighing these options, our free in-home assessment can help you see what level of help is needed at home. Call (346) 689-2339.
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