What’s an In-Home Caregiver?

Hiring an in-home caregiver for your loved one is a great way to combat loneliness, get basic chores done, and ensure medication compliance as they age. Even more skilled care—like tending to catheters, feeding tubes, and tracheostomies—can be provided by in-home nurses. 

But it can get a little confusing to figure out what type of in-home caregiver your loved one needs. They go by many different names and have different skills. In fact, your loved one might need more than one type of in-home caregiver.

We’ll introduce you to the different types of in-home caregivers and help you decide which one’s right for you or your loved one—or if they might need an alternative type of care.

Let’s start by talking about the two main types of in-home caregivers: those who give either personal care or health care.

Personal care covers anything non-medical. Think of the things you do for your loved one during your visits:

• Cooking or prepping meals
• Transferring your loved one from the bed to a wheelchair or vice versa
• Assisting with dressing, grooming, bathing, and using the toilet
• Doing laundry, washing dishes, and tending to other basic household chores
• Shopping for groceries and running other errands
• Driving your loved one to appointments
• Providing companionship and helping your loved one stay socially active
• Keeping an eye on someone at risk of wandering or falling
• Reminding your loved one to take their medication on time

Personal caregivers typically don’t perform any medical treatments or administer medication—at least not without extra training or licensure. They usually only help with “activities of daily living.”

A personal caregiver is also called a Personal Care Aide (PCA). Here are some other synonyms for a Personal Care Aide or personal caregiving:

• Personal Attendant
• Non-medical care
• Assistive care
• Companion care

Not quite. Home Health Aides have extra training to provide a few health services, like checking vital signs, administering medications, or changing bandages. Each state governs what a Home Health Aide is allowed to do and how much training they’re required to have.

Otherwise, Home Health Aides perform the same duties as Personal Care Aides.

They can be. It all depends on what your loved one needs. If they need help getting out of bed to go to the bathroom each night or need nightly medications brought to them, a live-in caregiver makes sense.

However, it’s possible to get nighttime care without providing a bedroom for the caregiver. You can hire multiple caregivers to work in shifts, allowing your loved one to get 24/7 care.

You’ll need to hire a second caregiver even if you go the live-in route since live-in caregivers require breaks and days off. 

Not necessarily. According to our health advisor Sally Russell, “respite caregivers allow the usual caregivers to have some of their own normal life, while personal caregivers often do things the family cannot do.”

So respite caregivers are like substitute caregivers, and personal caregivers are long-term hires.

One of the easiest ways to hire a personal caregiver is through a staffing agency. These groups do background checks on caregivers, take care of all the paperwork, billing, and taxes, and help with backup options if the caregiver is unavailable.

You can also hire someone directly, like a friend or family member, but taxes and employee benefits can get complicated. 

Home health care can fall into two categories: hourly care or intermittent care.

Several nurses rotate shifts with hourly home health care to provide 24/7 care and monitoring. These skilled in-home caregivers are the best option when your loved one needs palliative care or is recovering from a serious injury or illness.

With intermittent home health care, nurses come for scheduled appointments. Physical therapy, occupational therapy, speech therapy, and more complicated wound care are often delivered this way.  

Here are some synonyms for home health care:

• Private duty nursing
• Shift nursing
• Home-based skilled nursing
• Long-term nursing care
• Visiting nurse services

Yes, as long as the person has the appropriate nursing qualifications and agrees to also perform personal care duties. But nurses often have higher hourly rates than personal in-home caregivers.

Do the math and see if it makes more sense to hire a personal caregiver and an hourly home nurse versus an all-in-one superstar.

In-home care usually requires hourly payment, and the going rate for these services varies from state to state. We share some ballpark figures below.

According to the Bureau of Labor Statistics (BLS), the median pay for Personal Care Aides and Home Health Aides was $14.50 an hour in 2021.¹  However, the Genworth 2021 Cost of Care survey says the national average cost of these services is between $26 and $27 an hour.² 

The difference may boil down to the fact that many Aides gain employment through an agency. While each Aide may receive an hourly wage of about $14.50, agencies charge more than that for their screening and booking services.

Costs also vary considerably from state to state, with in-home services being most affordable in West Virginia ($18.50/hr. median) and most expensive in Minnesota ($35.00/hr. median).

Your out-of-pocket cost also depends on whether the insurance covers your care.

We explored a few caregiver agency websites to pin down an answer. Most want you to call for a quote since the price of care depends on your medical needs and where you live.

That said, the caregiving agency Nurse Next Door gives a ballpark estimate of $50 to $130 per hour for in-home health care.³ 

Since home health care providers are nurses and therapists, let’s take a look at the national average hourly wage for those skilled caregivers:

• Licensed practical/vocational nurse: $23.11/hr.⁴
• Registered nurse: $37.31/hr.⁵
• Occupational therapist: $41.14/hr.⁶
• Physical therapist: $45.97/hr.⁷
• Speech-language pathologist: $38.01/hr.⁸
• Respiratory therapist: $29.73/hr.⁹

Expect your expenses to be higher than these rates due to agency markups.

Yes and no.

Medicare Part A and Part B don’t cover personal in-home care or round-the-clock in-home health care. But these plans do cover intermittent home health care (such as therapy appointments that take place in the home) and part-time hourly nursing.

To be eligible for in-home Medicare coverage, a doctor has to create your loved one’s in-home care plan and certify that they’re homebound—meaning they’re unable to receive this care anywhere else.

Of course, Medicare (and health insurance in general) is full of exceptions, eligibility clauses, and too much red tape. Visit Medicare.gov for more information, or call a Medicare representative to understand your coverage and out-of-pocket expenses.

It’s possible to get paid to be your parent’s caregiver. One option is to get reimbursed by your parent’s long-term care insurance. You can also look into your state’s Adult Foster Care compensation program.

As with so many tax-related questions, it depends. We take a closer look at this topic in another article: Is Home Health Care Tax Deductible?

In-home care isn’t the only way to ensure seniors have a good quality of life. Here’s an overview of some of the other options available.

Welcoming your loved one into your home solves several problems, such as combatting loneliness and reducing some monthly costs, like your loved one’s rent or mortgage payments. It can also ease your own stress since you won’t have to travel to check on your loved one or wonder if they’re really being cared for.

Despite these advantages, hiring a personal caregiver to help with housekeeping, grooming, appointment transportation, and companionship can still be helpful. SafeWise’s health advisor Sally Russell also notes that “people who are a danger to themselves or others (so confused they might turn a stove on, or fall down a flight of stairs) would need someone with them 24/7.”

If your loved one needs constant supervision, don’t hesitate to hire a respite caregiver to give yourself regular breaks.

Learn more:

• 10 Ways to Upgrade Your Home for an Older Family Member
• How Smart Home Tech Can Help Older Adults

Adult day services—also called adult day health care—get your loved one out of the house for supervised activities and socialization. Routine medical care, meals, and transportation are usually provided during their time out as well.

Senior living communities are usually collections of apartments, townhomes, duplexes, or condos designed for people over a certain age. These senior living campuses typically include spas, gyms, restaurants, and more within easy walking distance, along with optional housekeeping and meal services.

The communities promote socialization while easing the burden of some daily living activities. This scenario is ideal if your loved one is mobile but interested in personal care services. Medical care usually isn’t included as a senior living community perk.

If your loved one needs round-the-clock care, they may do better in an assisted living facility or nursing home.

Assisted living facilities combine a senior living community and a nursing home. Instead of full-on condos for each person, there are usually smaller apartments or private rooms for each resident, plus shared common areas to encourage socialization. The facility also provides personal care and health care.

Nursing homes provide the most comprehensive levels of medical care to their residents. In addition to nurses, physical and occupational therapists are often on-site to assist with injury rehabilitation.

Nursing home rooms may be private or shared, and residents can get 24-hour assistance with medical needs. While some personal care is provided—like help with bathing or getting dressed—nursing home staff are unlikely to help with other personal matters, like running errands on behalf of residents.

Learn more:

• What Is the Difference Between an Assisted Living Facility and a Nursing Home?
• How to Ensure Your Loved One is Safe in a Nursing Home

• Ultimate Guide to Aging in Place
• Is It Safe for My Parent to Live Alone?
• Room-by-Room Guide to Senior Home Safety
• How to Prevent Falls
• Senior Safety FAQs

1. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, “Home Health and Personal Care Aides,” September 2022. Accessed October 26, 2022.
2. Genworth, “Cost of Care Survey,” June 2022. Accessed October 26, 2022.
3. Nurse Next Door, “How Much Does Senior In-Home Care Cost?” May 2022. Accessed October 26, 2022.
4. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, “Licensed Practical and Licensed Vocational Nurses,” September 2022. Accessed October 26, 2022.
5. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, “Registered Nurses,” September 2022. Accessed October 26, 2022.
6. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, “Occupational Therapists,” September 2022. Accessed October 26, 2022.
7. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, “Physical Therapists,” September 2022. Accessed October 26, 2022.
8. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, “Speech-Language Pathologists,” September 2022. Accessed October 26, 2022.
9. U.S. Bureau of Labor Statistics, Occupational Outlook Handbook, “Respiratory Therapists,” September 2022. Accessed October 26, 2022.