You want to stay in your home.

Maybe you need a little help with bathing and meals. Maybe your spouse has dementia and can no longer be left alone. Maybe you’re recovering from an illness and your children can help—but they have jobs and families of their own.

Then you start looking at the cost of hiring someone.

And you think:

How is an ordinary person supposed to afford this?

That’s a very reasonable question.

Long-term help at home can be expensive, and Medicare doesn’t cover most ongoing personal care. Medicaid can provide important assistance, but not everyone qualifies. Long-term care insurance can help some families, but many older adults don’t have it.

That leaves millions of Americans trying to piece together care using Social Security, retirement income, savings, family help, government programs, and whatever community resources they can find.

You don’t need to be wealthy to plan for care at home.

But you do need to understand what you’re paying for, what programs may help, and where you can be strategic.

First, Figure Out What You’re Actually Buying

“Home care” can mean very different things.

Someone who needs two showers a week has a very different financial problem from someone with dementia who requires supervision throughout the day.

Before asking, “Can I afford home care?”, ask:

“How many hours of help do I actually need—and what needs to happen during those hours?”

Make a list.

Perhaps you need help with:

• Bathing
• Dressing
• Meal preparation
• Grocery shopping
• Laundry
• Transportation
• Medication reminders
• Walking safely
• Companionship
• Supervision
• Respite for a family caregiver

Some of those needs may require a paid caregiver.

Others may have less expensive solutions.

That’s an important distinction.

Home Care Gets Expensive Quickly

Paid home care is usually priced by the hour, although agencies may have minimum visit requirements or different rates for nights, weekends, holidays, or higher levels of care.

Rates vary considerably depending on where you live and the type of help required.

Even a seemingly manageable hourly rate becomes substantial when multiplied over weeks and months.

For example, at $35 an hour:

• 10 hours a week is about $1,500 a month
• 20 hours a week is about $3,000 a month
• 40 hours a week is about $6,000 a month

Those are rough examples, not national price quotes, and actual rates can be higher or lower.

But they demonstrate the problem.

Care that costs $35 for one hour can become tens of thousands of dollars when someone needs ongoing assistance.

And around-the-clock care is in an entirely different financial category.

Medicare Usually Isn’t the Answer for Long-Term Personal Care

This is worth understanding before you build a budget around Medicare.

Medicare may cover eligible home health services such as skilled nursing and therapy when you meet its requirements.

But Medicare generally does not pay for ongoing personal or custodial care when that is the only help you need.

So Medicare usually isn’t going to pay for someone to come every morning indefinitely to:

• Help you get dressed
• Make breakfast
• Do the laundry
• Take you shopping
• Keep you company
• Stay with you because you shouldn’t be alone

Those needs are real.

They’re simply outside much of Medicare’s traditional home health benefit.

Don’t Overlook Medicaid

Medicaid is very different from Medicare.

It is a joint federal-state program, and for eligible individuals it can be one of the most important sources of assistance with long-term care.

States offer various home- and community-based services, often referred to as HCBS, that may help eligible people receive care in their homes rather than institutions.

Depending on your state and program, assistance may include services such as:

• Personal care
• Help with activities of daily living
• Respite care
• Adult day services
• Home modifications
• Other community-based supports

But Medicaid rules are complicated.

Eligibility depends on factors that may include:

• Income
• Assets
• Functional needs
• Age or disability
• Marital status
• State-specific requirements

Programs and benefits vary substantially by state.

Don’t assume you make too much money or own too much to qualify without checking.

And don’t give away assets or move money around simply because someone tells you it will help you qualify. Medicaid has complicated financial eligibility and transfer rules. If significant assets are involved, qualified elder-law or benefits advice may be worthwhile before making major financial decisions.

If You’re a Veteran, Ask About VA Benefits

Veterans and their families sometimes overlook benefits that could help with care.

The Department of Veterans Affairs offers several programs that may support eligible veterans who need assistance at home.

Depending on eligibility and circumstances, these can include:

• Homemaker and Home Health Aide services
• Respite care
• Adult day health care
• Veteran-Directed Care in participating locations
• Certain pension benefits, including additional amounts associated with Aid and Attendance for eligible veterans and survivors

These programs have different eligibility requirements.

If you or your spouse served in the military, it’s worth asking the VA or an accredited veterans service representative what may apply to your situation.

Be cautious about businesses charging large fees simply to “unlock” veterans benefits. Free assistance is available from accredited veterans service organizations and other approved representatives.

What About Long-Term Care Insurance?

If you already have long-term care insurance, now is the time to find the policy and understand it.

Don’t assume it only pays for nursing homes.

Many policies may provide benefits for qualifying care at home.

Look for details such as:

• What triggers eligibility for benefits?
• Does the policy cover home care?
• What is the daily or monthly benefit?
• Is there an elimination period before benefits begin?
• Is there a maximum benefit period?
• Does it require licensed or agency-based caregivers?
• Are there inflation protections?
• How are cognitive impairments such as dementia treated?

Policies vary considerably, particularly depending on when they were purchased.

Call the insurer and ask for an explanation of benefits in writing.

For someone who doesn’t already have coverage, purchasing traditional long-term care insurance later in life may be expensive or unavailable depending on health and age. It shouldn’t be treated as a last-minute solution after substantial care needs have already developed.

What About Medicare Advantage?

Some Medicare Advantage plans offer supplemental benefits that Original Medicare doesn’t provide.

Depending on the plan, year, location, and eligibility requirements, these may include limited assistance involving things such as:

• Meals
• Transportation
• Certain in-home supports
• Home safety items

These benefits vary widely and may be limited.

If you have Medicare Advantage, call the number on your insurance card and ask:

“Do I have any supplemental benefits that could help me remain safely at home?”

Ask what is covered, how often, what eligibility requirements apply, and whether you must use particular providers.

Don’t assume your plan provides something simply because you saw it advertised.

Start With the Care You Can’t Replace

If money is limited, one approach is to identify which needs truly require paid help.

Suppose Mom needs:

• A shower
• Groceries
• Laundry
• Transportation to the doctor
• Lunch
• Someone to check on her

Instead of paying a caregiver to do everything, perhaps:

• A paid aide handles bathing and personal care.
• Groceries are delivered.
• A family member does laundry once a week.
• A senior transportation program handles appointments.
• A meal program provides several lunches.
• Family members rotate phone calls and visits.

That doesn’t work for every family.

But it illustrates an important principle:

You may not need to purchase every form of help from the same person.

Use Paid Care Strategically

If you can only afford a limited number of paid hours, use those hours where they matter most.

For example, a caregiver might come in the morning to help with:

• Getting out of bed
• Bathing
• Dressing
• Breakfast
• Setting up the day safely

Or the caregiver might come in the afternoon when a person with dementia tends to become more confused.

Another family may use paid care specifically so a spouse caregiver can:

• Sleep
• Attend medical appointments
• Shop
• Exercise
• See friends
• Simply leave the house without worrying

Sometimes a few well-placed hours can make the overall care arrangement much more sustainable.

Family Help Has a Cost Too

Unpaid family caregiving is often treated as though it costs nothing.

It doesn’t.

A daughter who reduces her work hours may lose income.

A son who leaves the workforce may lose retirement contributions and Social Security earnings.

A spouse providing care around the clock may experience declining physical and mental health.

Families should talk openly about these costs.

Questions worth discussing include:

• Who can realistically provide care?
• How many hours?
• Who lives nearby?
• Who can handle transportation?
• Who can manage finances?
• Can one sibling contribute money while another contributes time?
• What happens if the primary caregiver becomes ill?
• Is the current arrangement sustainable for another year?

Avoid building a long-term plan that depends entirely on one family member continually doing more.

Look for Community Programs

Many communities have programs that can reduce the amount of care families need to purchase privately.

Your local Area Agency on Aging is an excellent place to start.

Depending on your location and eligibility, programs may include:

• Home-delivered meals
• Transportation
• Adult day programs
• Caregiver support
• Respite care
• Benefits counseling
• Personal care programs
• Home modification assistance
• Legal assistance
• Senior centers
• Volunteer programs

Some services are free.

Some are income-based.

Some request a contribution.

Some have waiting lists.

You won’t know what’s available until you ask.

The federal Eldercare Locator can connect you with your local aging network at Eldercare.acl.gov or 1-800-677-1116.

Adult Day Programs Can Fill an Important Gap

Adult day services don’t work for everyone, but they can be an important and sometimes more affordable alternative to paying for one-on-one care for the same number of hours.

Programs vary, but may provide:

• Supervision
• Meals
• Social activities
• Exercise
• Assistance with personal needs
• Health-related services in some programs
• A break for family caregivers

For a person with dementia who cannot safely remain alone during the day, an appropriate adult day program may provide both structure and caregiver respite.

Availability and cost vary by community.

Small Home Changes May Reduce Paid Care Needs

Sometimes the problem isn’t that a person needs another human being all day.

The problem is that the environment no longer fits the person.

An occupational therapist or home safety professional may identify modifications that make daily activities easier or safer.

Examples might include:

• Grab bars
• Better lighting
• Handrails
• Raised toilet equipment when appropriate
• Shower seating
• Removing trip hazards
• Rearranging frequently used items
• Improving access to entrances
• Creating first-floor living space

Technology may also help in appropriate situations:

• Medication reminders
• Automatic pill dispensers
• Emergency response systems
• Door sensors
• Fall-detection devices
• Video communication
• Smart lighting

Technology can’t replace human care when human care is necessary.

But it can sometimes reduce risk or make limited caregiving resources go further.

Be Careful With “Cheap” Care

When money is tight, hiring someone privately for much less than an agency charges can be tempting.

Private hiring isn’t necessarily wrong, but understand what you’re taking on.

Questions include:

• Has the person had a background check?
• Are references verified?
• Who provides backup if the caregiver doesn’t arrive?
• Who handles payroll and employment taxes?
• Is the worker properly insured?
• What happens if the caregiver is injured in your home?
• Who supervises the quality of care?
• What access will this person have to money, credit cards, medications, or personal information?

Older adults who need assistance can be particularly vulnerable to financial exploitation.

Price matters.

So does safety.

Don’t Hand Financial Control to a Caregiver Casually

A caregiver may legitimately need to buy groceries or pick up prescriptions.

That doesn’t mean they should automatically have unrestricted access to:

• Bank accounts
• Credit cards
• Checkbooks
• PIN numbers
• Investment accounts
• Online banking passwords

Create safeguards.

Review statements.

Keep receipts.

Have more than one trusted person involved when possible.

And be especially cautious if someone begins isolating an older person from family, requesting unusual gifts, borrowing money, or encouraging changes to wills, beneficiaries, or financial accounts.

Needing help at home should not mean surrendering control of your finances.

Don’t Wait Until the Money Is Almost Gone

Families sometimes privately pay for care month after month until savings are nearly exhausted and only then begin investigating assistance programs.

Try to look ahead.

If you’re spending $3,000 or $5,000 a month on care, ask:

How long can we realistically continue doing this?

Six months?

Two years?

Ten years?

Then investigate Medicaid, VA benefits, community programs, insurance benefits, and other options before you reach the financial cliff.

Planning earlier gives you more choices.

Build a Care Budget, Not Just a Caregiver Budget

Instead of asking:

“How much does a caregiver cost?”

Create a broader monthly care budget.

Include things such as:

• Paid caregiving
• Meals
• Transportation
• Housekeeping
• Medical equipment
• Home modifications
• Medication expenses
• Adult day services
• Emergency response systems

Then subtract resources that may be available through:

• Medicare
• Medicaid
• Veterans benefits
• Insurance
• Community programs
• Family assistance

You may discover that the solution isn’t one large service.

It’s several smaller ones working together.

You Don’t Have to Solve Five Years Today

Nobody knows exactly what their health will look like five years from now.

Start with the situation you have.

Ask:

What help do I need right now?

Then:

What might I need if my condition gets worse?

And finally:

How long could we afford the current plan?

Those three questions can tell you a great deal.

Staying Home Often Takes a Patchwork

There isn’t a secret government program that pays for unlimited home care for every older American.

There also isn’t a rule saying you must be wealthy to remain at home.

For many families, staying home is accomplished through a combination of:

Medicare for qualifying healthcare.

Medicaid for eligible long-term services and supports.

VA benefits for eligible veterans and families.

Community programs.

Some paid home care.

Family assistance.

Home modifications.

Technology.

And a lot of planning.

It may not be simple.

But understanding the pieces gives you a much better chance of building something that works.

If you’re worried that you won’t be able to afford help at home, don’t begin with:

“We can’t afford this.”

Begin with:

“What help do we actually need, what resources might already be available to us, and which parts do we truly have to pay for ourselves?”

Those are questions ordinary families can start answering.

And sometimes, putting together the right combination of help is what makes staying home possible.

This completes the introductory six-part Getting Help at Home series.

The series includes:

1. I Think I Need Help at Home. Where Do I Start?
2. Home Health vs. Home Care: They Sound the Same, But They’re Not
3. Home Health: What It Is, Who Qualifies and How You Get It
4. Medicare and Help at Home: What It Pays For—and What It Doesn’t
5. Can I Stay in My Home? How to Know When You Need More Help
6. Paying for Help at Home When You’re Not Wealthy

Helpful U.S. resources: Start with the federal Eldercare Locator at Eldercare.acl.gov or 1-800-677-1116 for local aging resources. For Medicare information, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). Veterans can explore long-term care and caregiver resources through VA.gov.

This article is for general educational purposes and is not a substitute for individualized medical, legal, insurance, tax, or financial advice. Medicare, Medicaid, VA, insurance, and community-program rules and benefits can change and vary by state, plan, and individual circumstances.