Guide
Home care for seniors: options, costs and help in the U.S.
Updated October 15, 2026 · Reviewed against official sources
Many Latino families prefer to care for their elders at home. It's a perfectly valid choice and, with the right support, it can work for years. This guide explains your options, what they typically cost and what your obligations are if you hire a caregiver directly.
Two types of help at home that are easy to confuse
Two similar terms mean different things:
- Home health care: nursing care or physical, occupational or speech therapy, ordered by a doctor. A Medicare-certified agency provides it. It comes in visits and lasts for a limited time.
- Non-medical home care (sometimes called personal care or companion care): help with bathing, dressing, using the bathroom, eating and getting around, plus cooking, cleaning or keeping your loved one company. An agency can provide it, or a caregiver your family hires.
Medicare can pay for the first one. The second is almost always paid for by the family, Medicaid or another program.
Home health care with Medicare
Original Medicare covers home health care if these conditions are met:
- The person is homebound: leaving home takes a major effort, or they need help to do it.
- A doctor is caring for them and orders a plan of care.
- They need intermittent or part-time skilled care (nursing or therapy).
- The agency is Medicare-certified.
With Original Medicare, the person usually pays $0 for these services. Durable medical equipment (for example, a wheelchair or a walker) has a 20% coinsurance.
If your loved one gets nursing or therapy, Medicare can also cover visits from a home health aide as part of that plan. But Medicare doesn't pay for 24-hour care, home-delivered meals, or personal care or housekeeping when that's the only help needed. You can look for certified agencies in our home health agencies section, which lists the home health agencies registered with Medicare. If your loved one just left the hospital, also see our guide on hospital discharge.
Agency or private hire
| Agency | Hired directly by the family | |
|---|---|---|
| Who the employer is | The agency | You (the family) |
| Taxes and insurance | The agency pays them | You pay them |
| Background checks and training | The agency, as its state license requires | You arrange them |
| Replacement if the caregiver can't come | Usually yes | No |
| Cost per hour | Higher | Lower, but you add taxes |
There are also registries, or referral agencies, that only introduce you to a caregiver. In that case, you are usually still the employer. Before you sign with any agency, bring our list of questions to ask a home care agency.
How much a caregiver costs
As a reference point, the CareScout 2025 cost survey (median rates that providers charge) shows these rates for a non-medical caregiver from an agency:
| Location | Per hour | Per month (44 hours a week) |
|---|---|---|
| National median | $35 | $6,673 |
| California | $40 | $7,627 |
| Texas | $30 | $5,720 |
| Florida | $32 | $6,101 |
| New York | $35 | $6,673 |
These are statewide medians: in your city, the rate may be higher or lower. An agency's rate is higher than the caregiver's wage because it includes taxes, insurance, supervision, training and replacements. To figure out your own case, with overtime and your state's taxes, use our home care calculator. For examples by city, read how much a caregiver charges per hour.
If you hire directly: your obligations
The IRS considers a caregiver a household employee (not an independent contractor) when you decide what work they do and how they do it. In practice, that's almost always the case. These are the main obligations in 2026 (IRS Publication 926):
- Social Security and Medicare (FICA): if you pay the caregiver $3,000 or more in cash wages in the year, you must pay 7.65% as the employer and withhold another 7.65% from the caregiver's wages.
- Federal unemployment tax (FUTA): applies if you pay $1,000 or more in a quarter. The usual net cost is 0.6% of the first $7,000 (up to $42 per employee per year), although it can be higher in credit reduction states.
- Employer Identification Number (EIN): you can get one for free at IRS.gov.
- Form I-9: verifies that the person can work in the U.S. You keep it; you don't send it in.
- Schedule H and Form W-2: Schedule H goes with your tax return. You give the W-2 to the caregiver and send it to the Social Security Administration.
- State unemployment and workers' compensation: each state has its own rules.
Some people don't count for FICA or FUTA: your spouse, your child under 21 and your parent (with some exceptions explained in Publication 926). Keep in mind that if an adult child cares for their mom and she pays them, that exception doesn't apply, and she may have obligations as an employer.
Minimum wage and overtime
Federal law requires paying at least minimum wage and, in general, overtime to a caregiver who doesn't live in the home. Several states have their own rules for domestic workers. For example, in California a personal attendant earns time and a half after 9 hours a day or 45 hours a week. In New York, it's after 40 hours a week (44 if the caregiver lives in the home). Check with your state's labor agency before you agree on a schedule.
Hiring directly can cost less per hour, but it's best to do it by the book: with your taxes up to date and insurance that covers you if the caregiver gets hurt in your home. If you have questions, talk with a tax professional.
Medicaid programs that pay for home care
Medicaid can pay for home and community-based services, often through waivers (special programs a state offers with federal permission). They can include personal care, adult day care, respite care for the caregiver, meals and home modifications. Because spots are limited, many states have waiting lists. Examples:
- California, IHSS (In-Home Supportive Services): pays a provider, who can be a family member, to help with personal care and household chores for people with Medi-Cal who are 65 or older, blind or disabled. You apply at the county social services office. More details in our guide to Medi-Cal and IHSS.
- Texas, STAR+PLUS: a Medicaid program for people 65 or older and adults with disabilities. It includes personal assistance and day services. You apply at YourTexasBenefits.com or by calling 2-1-1. See our guide to STAR+PLUS.
- New York, CDPAP: lets the person choose and direct their own personal assistant, who can be a family member. Since 2025, the state has used a single fiscal intermediary for the whole program, Public Partnerships LLC (PPL). See our guide to New York Medicaid.
- Florida: the Medicaid long-term care program (SMMC LTC) can include in-home services. See our guide to Florida Medicaid.
- PACE: for people 55 or older who need a nursing home level of care but can live at home with support. See our guide to the PACE program.
- Veterans: the VA has home health aides and the Veteran-Directed Care program, which can pay family members. See our guide to veterans benefits.
If your loved one is undocumented or has a recent immigration status, first read immigration status and benefits.
Other help that lightens the load
- Adult day centers: your loved one spends the day with company and care while you work. The CareScout 2025 national median is $95 a day. Search our adult day centers and read our guide to adult day care for seniors.
- Area Agencies on Aging (AAA): they offer meals, transportation, help at home and support for caregivers, including respite care (a few hours or days of rest for you). Find yours through the Eldercare Locator: 1-800-677-1116, Monday through Friday, 9 a.m. to 8 p.m. Eastern time. Ask for Spanish when you call.
- Taking care of yourself, too: caring for a family member is a huge job. Read about respite care and the signs of caregiver burnout.
How to tell how much help is needed
Before you hire anyone, figure out what your loved one can and can't do on their own. Our Katz and Lawton scales help you sort out their needs (bathing, dressing, taking medicines, managing money); they're a guide, not a diagnosis. If the help needed is already more than several hours a day, or someone is needed at night, compare the cost with a care home in how much senior care costs. If you don't know where to start, our guided search walks you through it step by step.
Frequently asked questions
Does Medicare pay for a caregiver to bathe and dress my mom?
Not if that's the only help she needs. Medicare pays for that kind of help only as part of a home health care plan, when she's also getting nursing or therapy. For daily personal care, look into Medicaid, PACE, the VA or her long-term care insurance.
Can I get paid to care for my dad?
In several states, yes, through Medicaid (for example, IHSS in California or CDPAP in New York) or through VA programs. The rules on which relatives can be paid vary by state and program. See help for family caregivers.
Which is better, an agency or hiring directly?
It depends on your time and how much you want to take on. An agency costs more, but it handles taxes, training and replacements. Hiring directly costs less per hour, but you take on the employer's duties.
Rules vary by state. This guide is for information only and is not legal, tax or medical advice.
Sources
- Medicare.gov, Home health services (accessed October 15, 2026)
- IRS, Publication 926 (2026), Household Employer's Tax Guide (accessed October 15, 2026)
- IRS, Topic 756 (accessed October 15, 2026)
- U.S. Department of Labor, minimum wage by state (accessed October 15, 2026)
- California DIR, Domestic Worker Bill of Rights FAQ (accessed October 15, 2026)
- New York State DOL, Domestic Workers' Bill of Rights (accessed October 15, 2026)
- New York State Department of Health, CDPAP transition (accessed October 15, 2026)
- Texas HHSC, STAR+PLUS (accessed October 15, 2026)
- CareScout, Cost of Care Survey 2025 (accessed October 15, 2026)
- ACL, Find Help (Eldercare Locator) (accessed October 15, 2026)
This is general information, not medical, legal or financial advice. Rules vary by state and by year: confirm with the official agency that applies to you.
Keep reading
Help for family caregivers
What the National Family Caregiver Support Program is, who qualifies, its five services and how to apply. Plus FMLA and Medicaid for family caregivers.
Medi-Cal and IHSS
How Medi-Cal pays for a nursing home and how IHSS pays a caregiver at home, even a family member. The 2026 asset limit, CBAS and how to apply.
STAR+PLUS in Texas
Learn about STAR+PLUS, Texas Medicaid for older adults: who qualifies, what it covers (nursing home, help at home, adult day care), and how to apply.
Medicaid home care waivers
What Medicaid waivers and other Medicaid programs for care at home (HCBS) are, who qualifies, why there are waiting lists and how to apply.
